Peds Exam #1

Play serves many purposes. In teaching parents about appropriate activities, the nurse should inform them that play serves which of the following function? (Select all that apply.) a. Intellectual development b. Physical development c. Socialization d. Creativity e. Temperament development

A, C, D A common statement is that play is the work of childhood. Intellectual development is enhanced throughout he manipulation and exploration of objects. Socialization is encouraged by interpersonal activities and learning of social roles. In addition, creativity is developed through the experimentation characteristic of imaginative play. Physical development depends on many factors; play is not one of them. Temperamentrefers to behavioral tendencies that are observable from the time of birth. The actual behaviors, but notthe child's temperament attributes, may be modified through play.DIF: Cognitive Level: Understand REF: p. 49TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

At which age, is a strong preference exhibited for members of the same sex to engage in play activities rather than play with mixed groups? A. 7 B. 6 C. 8 D. 9

ANS. A At age 7, boys prefer to play with boys and girls prefer to play with girls. At age 6, play is considered to be more independent but showing some degree of socialization. Between the ages of 8 and 9, there is more interest in body-girl relationships and beginning to mix group play.

A finding that is consistent with prepubescence is: A. variation in physical appearance between boys and girls. B. age of onset of physical signs is the same for both boys and girls. C. does not occur during the preadolescence period. D. appearance of secondary sex characteristics is the same for both boys and girls.

ANS. A During the period of prepubescence there is a variation in physical appearance between boys and girls. The age of onset of these appearances also varies with girls exhibiting changes earlier than their male counterparts. The changes occur during the preadolescence period. Secondary sex characteristics also present at different times for boys and girls.

Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which should the nurse consider when discussing this issue with the parents? A. Changing self-esteem is difficult after about age 5 years. B. Self-esteem is the objective judgment of one's worthiness. C. Transitory periods of lowered self-esteem are expected developmentally. D. High self-esteem develops when parents show adequate love for the child.

ANS. C Self-esteem changes with development. Transient declines are expected and, with positive encouragement and support, are only temporary. Self-esteem is influenced throughout adolescence. One aspect of self-esteem is a subjective judgment of one's worthiness. Self-esteem is based on several factors, including competence, sense of control, moral worth, and worthiness of love and acceptance.

A school nurse is teaching a group of preadolescent girls about puberty. Which is the mean age of menarche for girls in the United States? a. 11 1/2 years b. 12 3/4 years c. 13 1/2 years d. 14 years

ANS. b The average age of menarche is 12 years 9.5 months in North American girls, with a normal range of 10 1/2 to 15 years. Ages 11 1/2, 13 1/2, and 14 are within the normal range for menarche, but these are not the average ages.

Which is most suggestive that a nurse has a nontherapeutic relationship with a patient and family? a. Staff is concerned about the nurse's actions with the patient and family. b. Staff assignments allow the nurse to care for same patient and family over an extended time. c. Nurse is able to withdraw emotionally when emotional overload occurs but still remains committed. d. Nurse uses teaching skills to instruct patient and family rather than doing everything for them.

ANS: A An clue to a nontherapeutic staff-patient relationship is concern of other staff members. Allowingthe nurse to care for the same patient over time would be therapeutic for the patient and family.Nurses who are able to somewhat withdraw emotionally can protect themselves while providingtherapeutic care. Nurses using teaching skills to instruct patient and family will assist intransitioning the child and family to self-care.DIF: Cognitive Level: Analyze REF: p. 8TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Psychosocial Integrity

Which is the leading cause of death in infants younger than 1 year? a. Congenital anomalies b. Sudden infant death syndrome c. Respiratory distress syndrome d. Bacterial sepsis of the newborn

ANS: A Congenital anomalies account for 20.1% of deaths in infants younger than 1 year. Sudden infantdeath syndrome accounts for 8.2% of deaths in this age group. Respiratory distress syndrome accounts for 3.4% of deaths in this age group. Infections specific to the perinatal period account for 2.7% of deaths in this age group.DIF: Cognitive Level: Remember REF: p. 6TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

17. A nurse is planning a class on accident prevention for parents of toddlers.Which safety topic is the priority for this class? a. Appropriate use of car seat restraints b. Safety crossing the street c. Helmet use when riding a bicycle d. Poison control numbers

ANS: A Motor vehicle accidents (MVAs) continue to be the most common cause of death in childrenolder than 1 year, therefore the priority topic is appropriate use of car seat restraints. Safetycrossing the street and bicycle helmet use are topics that should be included for preschoolparents but are not priorities for parents of toddlers. Information about poison control isimportant for parents of toddlers and would be a safety topic to include but is not the priorityover appropriate use of car seat restraints.DIF: Cognitive Level: Apply REF: p. 3TOP: Integrated Process: Nursing Process: PlanningMSC: Area of Client Needs: Health Promotion and Maintenance

The nurse is providing guidance strategies to a group of parents with toddlers at a community outreach program. Which statement by a parent indicates a correct understanding of the teaching? a. I should expect my 24-month-old child to express some signs of readiness for toilet training. b. I should be firm and structured when disciplining my 18-month-old child. c. I should expect my 12-month-old child to start to develop a fear of darkness and to need a security blanket. d. I should expect my 36-month-old child to understand time and proximity of events.

ANS: A A 24-month-old toddler starts to show readiness for toilet training; it is important for the parent to be aware of this and be ready to start the process. At 18 months of age, a child needs consistent but gentle discipline because the child cannot yet understand firmness and structure with discipline. Development of fears and need for security items usually occurs at the end of the 18- to 24-month stage. A 36-month-old child does not yet understand time and proximity of events, so the parent needs to understand that the toddler cannot hurry up or we will be late.

A nurse is assessing a family's structure. Which describes a family in which a mother, her children, and a stepfather live together? a. Blended b. Nuclear c. Binuclear d. Extended

ANS: A A blended family contains at least one stepparent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling.

Girls experience an increase in weight and fat deposition during puberty. What do nursing considerations related to this include? a. Give reassurance that these changes are normal. b. Suggest dietary measures to control weight gain. c. Encourage a low-fat diet to prevent fat deposition. d. Recommend increased exercise to control weight gain.

ANS: A A certain amount of fat is increased along with lean body mass to fill the characteristic contours of the adolescents gender. A healthy balance must be achieved between expected healthy weight gain and obesity. Suggesting dietary measures or increased exercise to control weight gain would not be recommended unless weight gain was excessive because eating disorders can develop in this group. Some fat deposition is essential for normal hormonal regulation. Menarche is delayed in girls with body fat contents that are too low.

In terms of fine motor development, what should the infant of 7 months be able to do? a. Transfer objects from one hand to the other and bang cubes on a table. b. Use thumb and index finger in crude pincer grasp and release an object at will. c. Hold a crayon between the fingers and make a mark on paper. d. Release cubes into a cup and build a tower of two blocks.

ANS: A By age 7 months, infants can transfer objects from one hand to the other, crossing the midline,and bang objects on a hard surface. The crude pincer grasp is apparent at about age 9 months,and releasing an object at will is seen around 8 months. The child can scribble spontaneously atage 15 months. At age 12 months, the child can release cubes into a cup and build a smalltower.DIF: Cognitive Level: Understand REF: p. 306TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

Which accurately describes the speech of the preschool child? a. Dysfluency in speech patterns is normal. b. Sentence structure and grammatic usage are limited. c. By age 5 years, child can be expected to have a vocabulary of about 1000 words. d. Rate of vocabulary acquisition keeps pace with the degree of comprehension of speech.

ANS: A Dysfluency includes stuttering and stammering, a normal characteristic of languagedevelopment. Children speak in sentences of three or four words at age 3 to 4 years and eightwords by age 5 years. At 5 years, children have a vocabulary of 2100 words. Children often gainvocabulary beyond degree of comprehension.DIF: Cognitive Level: Understand REF: p. 389TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. How should the nurse interpret this action? a. Normal development b. Significant developmental lag c. Slightly delayed development due to prematurity d. Suggestive of a neurologic disorder such as cerebral palsy

ANS: A Holding a rattle but not voluntarily grasping it is indicative of normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. The infant is expected to be able to perform this task by age 3 months. If the child's age is corrected because of being 2 weeks preterm, the child is at the midpoint of the range for this developmental task and the behavior is age appropriate. No evidence of neurologic dysfunction is present.DIF: Cognitive Level: Apply REF: p. 306TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

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

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

Which is probably the single most important influence on growth at all stages of development? a. Nutrition b. Heredity c. Culture d. Environment

ANS: A Nutrition is the single most important influence on growth. Dietary factors regulate growth at all stages ofdevelopment, and their effects are exerted in numerous and complex ways. Adequate nutrition is closelyrelated to good health throughout life. Heredity, culture, and environment contribute to the child's growthand development. However, good nutrition is essential throughout the life span for optimal health.DIF: Cognitive Level: Understand REF: p. 43TOP: Integrated Process: Nursing Process: PlanningMSC: Area of Client Needs: Health Promotion and Maintenance

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

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

When assessing a family, the nurse determines that the parents exert little or no control over their children. What is this style of parenting called? a. Permissive b. Dictatorial c. Democratic d. Authoritarian

ANS: A Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their children's actions. Dictatorial or authoritarian parents attempt to control their children's behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their children's behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect the child's individual nature.

Teasing can be common during the school-age years. The nurse should recognize that which applies to teasing? a. Can have a lasting effect on children b. Is not a significant threat to self-concept c. Is rarely based on anything that is concrete d. Is usually ignored by the child who is being teased

ANS: A Teasing in this age group is common and can have a long-lasting effect. Increasing awareness of differences, especially when accompanied by unkind comments and taunts from others, may make a child feel inferior and undesirable. Physical impairments such as hearing or visual defects, ears that "stick out," or birth marks assume great importance.

Which information could be given to the parents of a 12-month-old child regarding appropriate play activities? a. Give large push-pull toys for kinetic stimulation. b. Place cradle gym across crib to facilitate fine motor skills. c. Provide child with finger paints to enhance fine motor skills. d. Provide stick horse to develop gross motor coordination.

ANS: A The 12-month-old child is able to pull to standing and walk holding on or independently.Appropriate toys for a child this age include large pull toys for kinesthetic stimulation. A cradlegym should not be placed across the crib. Finger paints are appropriate for older children. A 12-month-old child does not have the stability to use a stick horse.DIF: Cognitive Level: Apply REF: p. 314TOP: Integrated Process: Teaching/LearningMSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

How does the onset of the pubertal growth spurt compare in girls and boys? a. In girls, it occurs about 1 year before it appears in boys. b. In girls, it occurs about 3 years before it appears in boys. c. In boys. it occurs about 1 year before it appears in girls. d. It is about the same in both boys and girls.

ANS: A The average age of onset is 9 1/2 years for girls and 10 1/2 years for boys. Although pubertal growth spurts may occur in girls 3 years before it appears in boys on an individual basis, the average difference is 1 year. Usually girls begin their pubertal growth spurt earlier than boys.

An infant gains head control before sitting unassisted. The nurse recognizes that this is which type of development? a. Cephalocaudal b. Proximodistal c. Mass to specific d. Sequential

ANS: A The pattern of development that is head-to-tail, or cephalocaudal, direction is described by an infant'sability to gain head control before sitting unassisted. The head end of the organism develops first and islarge and complex, whereas the lower end is smaller and simpler, and development takes place at a latertime. Proximodistal, or near to far, is another pattern of development. Limb buds develop before fingersand toes. Postnatally, the child has control of the shoulder before achieving mastery of the hands. Mass tospecific is not a specific pattern of development. In all dimensions of growth, a definite, sequential patternis followed.DIF: Cognitive Level: Understand REF: p. 38TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

Which characterizes the development of a 2-year-old child? A. Engages in parallel play B. Fully dresses self with supervision C. Has a vocabulary of at least 500 words D. Has attained one third of his or her adult height

ANS: A Two-year-olds play alongside each other, otherwise known as parallel play. Toddlers need help with dressing because this is a task they are just beginning to learn; learning this extends into the preschool years. A toddler commonly has a vocabulary of 300 words. A toddler has attained one half of his or her adult height.

Which is a useful skill that the nurse should expect a 5-year-old child to be able to master? a. Tie shoelaces b. Use knife to cut meat c. Hammer a nail d. Make change out of a quarter

ANS: A Tying shoelaces is a fine motor task of 5-year-olds. Using a knife to cut meat is a fine motor taskof a 7-year-old. Hammering a nail and making change out of a quarter are fine motor andcognitive tasks of an 8- to 9-year-old.DIF: Cognitive Level: Understand REF: p. 386TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

The school nurse recognizes that students who are targeted for repeated harassment and bullying may exhibit what? (Select all that apply.) a. Skip school b. Attempt suicide c. Bring weapons to school d. Attend extracurricular activities e. Report symptoms of depression

ANS: A, B, C, E Students targeted for repeated teasing and harassment are more likely to skip school, to report symptoms of depression, and to attempt suicide. Equally troubling, teens who are regularly harassed or bullied are also more likely to bring weapons to school to feel safe. Students who are bullied do not want to attend extracurricular activities.

Which toys should a nurse provide to promote imaginative play for a 3-year- old hospitalized child? (Select all that apply.) a. Plastic telephone b. Hand puppets c. Jigsaw puzzle (100 pieces) d. Farm animals and equipment e. Jump rope

ANS: A, B, D To promote imaginative play for a 3-year-old child, the nurse should provide: dress-up clothes,dolls, housekeeping toys, dollhouses, play-store toys, telephones, farm animals and equipment,village sets, trains, trucks, cars, planes, hand puppets, or medical kits. A 100-piece jigsawpuzzle and a jump rope would be appropriate for a young, school-age child but not a 3-year-oldchild.DIF: Cognitive Level: Apply REF: p. 383TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

What guidelines should the nurse use when interviewing adolescents? (Select all that apply.) a. Ensure privacy. b. Use open-ended questions. c. Share your thoughts and assumptions. d. Explain that all interactions will be confidential. e. Begin with less sensitive issues and proceed to more sensitive ones.

ANS: A, B, E Guidelines for interviewing adolescents include ensuring privacy, using open-ended questions, and beginning with less sensitive issues and proceeding to more sensitive ones. The nurse should not share thoughts but maintain objectivity and should avoid assumptions, judgments, and lectures. It may not be possible for all interactions to be confidential. Limits of confidentiality include a legal duty to report physical or sexual abuse and to get others involved if an adolescent is suicidal.

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

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

The nurse is teaching parents of a toddler how to handle temper tantrums. What should the nurse include in the teaching? (Select all that apply.) a. Provide realistic expectations. b. Avoid using rewards for good behavior. c. Ensure consistency among all caregivers in expectations. d. During tantrums, ignore the behavior and continue to be present.

ANS: A, C, D The best approach toward tapering temper tantrums requires consistency and developmentally appropriate expectations and rewards. Ensuring consistency among all caregivers in expectations, prioritizing what rules are important, and developing consequences that are reasonable for the childs level of development help manage the behavior. During tantrums, ignore the behavior, provided the behavior is not injurious to the child, such as violently banging the head on the floor. Continue to be present to provide a feeling of control and security to the child after the tantrum has subsided. Starting at 18 months, time-outs work well for managing temper tantrums, but not at 12 months.

A school-age child has been a victim of bullying. What characteristics does the nurse assess for in this child? (Select all that apply.) a. Anxiety b. Outgoing c. Low self-esteem d. Psychosomatic complaints e. Good academic performance

ANS: A, C, D Victims of bullying are at increased risk for low self-esteem; anxiety; depression; feelings of insecurity and loneliness; poor academic performance; and psychosomatic complaints such as feeling tense, tired, or dizzy.

Which interventions should the nurse implement when caring for a family of a sudden infant death syndrome (SIDS) infant? (Select all that apply.) a.Allow parents to say goodbye to their infant. b.Once parents leave the hospital, no further follow-up is required. c.Arrange for someone to take the parents home from the hospital. d.Avoid requesting an autopsy of the deceased infant. e.Conduct a debriefing session with the parents before they leave the hospital.

ANS: A, C, E An important aspect of compassionate care for parents experiencing a SIDS incident is allowing them to say good-bye to their infant. These are the parents' last moments with their infant, and they should be as quiet, meaningful, peaceful, and undisturbed as possible. Because the parents leave the hospital without their infant, it is helpful to accompany them to the car or arrange for someone else to take them home. A debriefing session may help health care workers who dealt with the family and deceased infant to cope with emotions that are often engendered when a SIDS victim is brought into the acute care facility. An autopsy may clear up possible misconceptions regarding the death. When the parents return home, a competent, qualified professional should visit them after the death as soon as possible.

The nurse is teaching a class on breastfeeding to expectant parents. Select all of the following that are contraindications for breastfeeding. a. Human immunodeficiency virus (HIV) in mother b. Mastitis c. Inverted nipples d. Maternal cancer therapy e. Twin births

ANS: A, D a and d. Both of these conditions place the infant at risk. HIV can be transmitted through breast milk, as can be the metabolites of chemotherapy.b, c, and e. These are not contraindications.

A nurse is planning to use an interpreter during a health history interview of a non-English speaking patient and family. Which nursing care guidelines should the nurse include when using an interpreter? (Select all that apply.) a. Elicit one answer at a time. b. Interrupt the interpreter if the response from the family is lengthy. c. Comments to the interpreter about the family should be made in English. d. Arrange for the family to speak with the same interpreter, if possible. e. Introduce the interpreter to the family.

ANS: A, D, E When using an interpreter, the nurse should pose questions to elicit only one answer at a time,such as: "Do you have pain?" rather than "Do you have any pain, tiredness, or loss of appetite?"Refrain from interrupting family members and the interpreter while they are conversing.Introduce the interpreter to family and allow some time before the interview for them to becomeacquainted. Refrain from interrupting family members and the interpreter while they areconversing. Avoid commenting to the interpreter about family members because they mayunderstand some English.DIF: Cognitive Level: Apply REF: p. 60TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

The parent of a 4-year-old boy tells the nurse that the child believes that monsters and boogeymen are in his bedroom at night. What is the nurse's best suggestion for coping with this problem? a. Let the child sleep with his parents. b. Keep a night-light on in the child's bedroom. c. Help the child understand that these fears are illogical. d. Tell the child frequently that monsters and boogeymen do not exist.

ANS: B A night-light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with parents will not get rid of the fears. A 4-year-old child is in the preconceptual age and cannot understand logical thought.DIF: Cognitive Level: Apply REF: p. 388TOP: Integrated Process: Teaching/LearningMSC: Area of Client Needs: Health Promotion and Maintenance

A male school-age student asks the school nurse, How much with my height increase in a year? The nurse should give which response? a. Your height will increase on average 1 inch a year. b. Your height will increase on average 2 inches a year. c. Your height will increase on average 3 inches a year. d. Your height will increase on average 4 inches a year.

ANS: B Between the ages of 6 and 12 years, children grow an average of 5 cm (2 inches) per year.

The nurse is assessing a 6-month-old healthy infant who weighed 7 pounds at birth. The nurse should expect the infant to now weigh approximately how many pounds? a. 10 b. 15 c. 20 d. 25

ANS: B Birth weight doubles at about age 5 to 6 months. At 6 months, a child who weighed 7 pounds atbirth would weigh approximately 15 pounds; 10 pounds is too little. The infant would have gonefrom the 50th percentile at birth to below the 5th percentile; 20 to 25 pounds is too much. Theinfant would have tripled the birth weight at 6 months.DIF: Cognitive Level: Understand REF: p. 301TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

A school nurse notes that school-age children generally obey the rules at school. The nurse recognizes that the children are displaying which stage of moral development? a. Preconventional b. Conventional c. Postconventional d. Undifferentiated

ANS: B Conventional stage of moral development is described as obeying the rules, doing one's duty, showingrespect for authority, and maintaining the social order. This stage is characteristic of school-age children'sbehavior. The preconventional stage is characteristic of the toddler and preschool age. At this stage, thechild has no concept of the basic moral order that supports being good or bad. The postconventional levelis characteristic of an adolescent and occurs at the formal stage of operation. Undifferentiated describesan infant's understanding of moral development.DIF: Cognitive Level: Analyze REF: p. 46TOP: Integrated Process: Nursing Process: EvaluationMSC: Area of Client Needs: Health Promotion and Maintenance

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

ANS: B During growth spurts, the need for sleep increases. Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contribute to fatigue.

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

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

Parents of a firstborn child are asking whether it is normal for their child to be extremely competitive. The nurse should respond to the parents that studies about the ordinal position of children suggest that firstborn children tend to: a. be praised less often. b. be more achievement oriented .c. be more popular with the peer group. d. identify with peer group more than parents.

ANS: B Firstborn children, like only children, tend to be more achievement oriented. Being praised less often, being more popular with the peer group, and identifying with peer groups more than parents are characteristics of later-born children.

When discussing discipline with the mother of a 4-year-old child, the nurse should include which instruction? a. Children as young as 4 years old rarely need to be punished. b. Parental control should be consistent. c. Withdrawal of love and approval is effective at this age. d. One should expect rules to be followed rigidly and unquestioningly.

ANS: B For effective discipline, parents must be consistent and must follow through with agreed-on actions. Realistic goals should be set for this age group. Parents should structure the environment to prevent unnecessary difficulties. Requests for behavior change should be phrased in a positive manner to provide direction for the child. Withdrawal of love and approval is never appropriate or effective. Discipline strategies should be appropriate to the child's age, temperament, and severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old.

Which statement is most characteristic of the motor skills of a 24-month-old child? A. The toddler walks alone but falls easily. B. The toddler's activities begin to produce purposeful results. C. The toddler is able to grasp small objects but cannot release them at will. D. The toddler's motor skills are fully developed but occur in isolation from the environment.

ANS: B Gross and fine motor mastery occurs with other activities that have a purpose, such as walking to a particular location or putting down one toy and picking up a new toy. By 2 years of age, children are able to walk up and down stairs without falling. Grasping small objects without being able to release them is a task of infancy. Interaction with the environment is essential for mastery of both fine and gross motor skills at this age and beyond.

The nurse is caring for a patient who has chosen to breastfeed her infant. Which statement should the nurse include when teaching the mother about breastfeeding problems that may occur? a. If you experience painful nipples, cleanse your nipples with soap two times per day and keep your nipples covered as much as possible. b. If you experience plugged ducts, continue to breastfeed every 2 to 3 hours and alternate feeding positions. c. If mastitis occurs, discontinue breastfeeding while taking prescribed antibiotics and apply warm compresses. d. If engorgement occurs, use cold compresses before a feeding and wear a well-fitting bra at night.

ANS: B If a woman experiences plugged ducts, the best interventions are to continue breastfeeding every 2 to 3 hours and alternate feeding positions while pointing the infants chin toward the obstructed area. Other interventions include massaging breasts and applying warm compresses before feeding or pumping. If painful nipples occur, the woman should avoid soaps, oils, and lotions and air the nipples as much as possible. If mastitis occurs, the woman should continue breastfeeding to keep the breast well drained. If engorgement occurs, the woman should use a warm compress before feedings and wear a well-fitting bra 24 hours a day.

The nurse is teaching a group of 10- to 12-year-old children about physical development during the school-age years. Which statement made by a participant, indicates the correct understanding of the teaching? a. "My body weight will be almost triple in the next few years." b. "I will grow an average of 2 inches per year from this point on." c. "There are not that many physical differences among school-age children." d. "I will have a gradual increase in fat, which may contribute to a heavier appearance."

ANS: B In middle childhood, growth in height and weight occurs at a slower pace. Between the ages of 6 and 12 years, children grow 2 inches per year. In middle childhood, children's weight will almost double; they gain 3 kg/year. At the end of middle childhood, girls grow taller and gain more weight than boys. Children take on a slimmer look with longer legs in middle childhood.

The nurse is discussing development and play activities with the parent of a 2-month-old. Recommendations should include giving a first rattle at about which age? a. 2 months b. 4 months c. 7 months d. 9 months

ANS: B It is recommended that a brightly colored toy or rattle be given to the child at age 4 months.Grasping has begun as a deliberate act, and the infant grasps, holds, and begins shaking tohear a noise; 2 months is too young. The infant still has primarily reflex grips; 7 to 9 months istoo old for the first rattle. The child should be given toys that provide for further exploration.DIF: Cognitive Level: Apply REF: p. 314TOP: Integrated Process: Teaching/LearningMSC: Area of Client Needs: Health Promotion and Maintenance

Which information should the nurse give a mother regarding the introduction of solid foods during infancy? a. Solid foods should not be introduced until 8 to 10 months, when the extrusion reflex begins to disappear. b. Foods should be introduced one at a time, at intervals of 4 to 7 days. c. Solid foods can be mixed in a bottle to make the transition easier for the infant. d. Fruits and vegetables should be introduced into the diet first.

ANS: B One food item is introduced at intervals of 4 to 7 days to allow the identification of food allergies.Solid foods can be introduced earlier than 8 to 10 months. The extrusion reflex usuallydisappears by age 6 months. Mixing solid foods in a bottle has no effect on the transition to solidfood. Iron-fortified cereal should be the first solid food introduced into the infant's diet.DIF: Cognitive Level: Apply REF: p. 319TOP: Integrated Process: Teaching/LearningMSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is conducting parenting classes for parents of adolescents. Which parenting style should the nurse recommend? a. Laissez-faire b. Authoritative c. Disciplinarian d. Confrontational

ANS: B Parents should be guided toward an authoritative style of parenting in which authority is used to guide the adolescent while allowing developmentally appropriate levels of freedom and providing clear, consistent messages regarding expectations. The authoritative style of parenting has been shown to have both immediate and long-term protective effects toward adolescent risk reduction. The laissez-faire method would not give adolescents enough structure. The disciplinarian and confrontational styles would not allow any autonomy or independence.

What is the best age for solid food to be introduced into the infant's diet? a. 2 to 3 months b. 4 to 6 months c. When birth weight has tripled d. When tooth eruption has started

ANS: B Physiologically and developmentally, the 4- to 6-month-old infant is in a transition period. Theextrusion reflex has disappeared, and swallowing is a more coordinated process. In addition,the gastrointestinal tract has matured sufficiently to handle more complex nutrients and is lesssensitive to potentially allergenic food. Infants of this age will try to help during feeding; 2 to 3months is too young. The extrusion reflex is strong, and the child will push food out with thetongue. Infant birth weight triples at 1 year. Solid foods can be started earlier. Tooth eruptioncan facilitate biting and chewing; most infant foods do not require this ability.DIF: Cognitive Level: Understand REF: p. 319TOP: Integrated Process: Nursing Process: PlanningMSC: Area of Client Needs: Health Promotion and Maintenance

A school nurse observes school-age children playing at recess. Which is descriptive of the play the nurse expects to observe? a. Individuality in play is better tolerated than at earlier ages. b. Knowing the rules of a game gives an important sense of belonging. c. They like to invent games, making up the rules as they go. d. Team play helps children learn the universal importance of competition and winning.

ANS: B Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age, children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play, children learn about competition and the importance of winning, an attribute highly valued in the United States.

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

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

The nurse observes some children in the playroom. Which play situation exhibits the characteristics of parallel play? a. Kimberly and Amanda sharing clay to each make things b. Brian playing with his truck next to Kristina playing with her truck c. Adam playing a board game with Kyle, Steven, and Erich d. Danielle playing with a music box on her mother's lap

ANS: B Playing with trucks next to each other but not together is an example of parallel play. Both children areengaged in similar activities in proximity to each other; however, they are each engaged in their own play.Sharing clay to make things is characteristic of associative play. Friends playing a board game together ischaracteristic of cooperative play. A child playing with something by herself on her mother's lap is anexample of solitary play.DIF: Cognitive Level: Analyze REF: p. 48TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

Which statement best describes the clinical manifestations of the preterm newborn? a. Head is proportionately small in relation to the body. b. Sucking reflex is absent, weak, or ineffectual. c. Thermostability is well established. d. Extremities remain in attitude of flexion.

ANS: B Reflex activity is only partially developed. Sucking is absent, weak, or ineffectual. The preterm newborns head is proportionately larger than the body. Thermoregulation is poorly developed, and the preterm newborn needs a neutral thermal environment to be provided. The preterm newborn may be listless and inactive compared with the overall attitude of flexion and activity of a full-term newborn.

Parents of a twelve-year-old child ask the clinic nurse, "How many hours of sleep should our child get?' The nurse should respond that 12-year-old children need how many hours of sleep at night?a. 8 b. 9 c. 10 d. 11

ANS: B School-age children usually do not require naps, but they do need to sleep approximately 11 hours at age 5 years and 9 hours at age 12 years each night.

A school-age child has begun to sleepwalk. What does the nurse advise the parents to perform? a. Wake the child and help determine what is wrong. b. Leave the child alone unless he or she is in danger of harming him- or herself or others. c. Arrange for psychologic evaluation to identify the cause of stress. d. Keep the child awake later in the evening to ensure sufficient tiredness for a full night of sleep.

ANS: B Sleepwalking is usually self-limiting and requires no treatment. The child usually moves about restlessly and then returns to bed. Usually the actions are repetitive and clumsy. The child should not be awakened unless in danger. If there is a need to awaken the child, it should be done by calling the childs name to gradually bring to a state of alertness. Some children, who are usually well behaved and tend to repress feelings, may sleepwalk because of strong emotions. These children usually respond to relaxation techniques before bedtime. If a child is overly fatigued, sleepwalking can increase.

A nurse is teaching parents about language development for preschool children. Which dysfunctional speech pattern is a normal characteristic the parents might expect? a. Lisp b. Stammering c. Echolalia d. Repetition without meaning

ANS: B Stammering and stuttering are normal dysfluency patterns in preschool-age children. Lisps arenot a normal characteristic of language development. Echolalia and repetition are traits oftoddlers' language.DIF: Cognitive Level: Apply REF: p. 389TOP: Integrated Process: Teaching/LearningMSC: Area of Client Needs: Health Promotion and Maintenance

A healthy, stable, preterm newborn will soon be discharged. The nurse should recommend which position for sleep? a. Prone b. Supine c. Side lying d. Position of comfort

ANS: B The American Academy of Pediatrics recommends that healthy newborns be placed to sleep in a supine position. Other positions are associated with sudden infant death syndrome. The prone position can be used for supervised play.

Which factor most impacts the type of injury a child is susceptible to according to the child's age? a. Physical health of the child b. Developmental level of the child c. Educational level of the child d. Number of responsible adults in the home

ANS: B The child's developmental stage determines the type of injury that is likely to occur. The child's physical health may facilitate the child's recovery from an injury but does not impact the type of injury. Educational level is related to developmental level, but it is not as important as the child's developmental level in determining the type of injury. The number of responsible adults in the home may affect the number of unintentional injuries, but the type of injury is related to the child's developmental stage.DIF: Cognitive Level: Understand REF: p. 3TOP: Integrated Process: Nursing Process: PlanningMSC: Area of Client Needs: Health Promotion and Maintenance

What should the nurse consider when discussing language development with parents of toddlers? a. Sentences by toddlers include adverbs and adjectives. b. The toddler expresses himself or herself with verbs or combination words. c. The toddler uses simple sentences. d. Pronouns are used frequently by the toddler

ANS: B The first parts of speech used are nouns, sometimes verbs (e.g., "go"), and combination words (e.g., "bye-bye"). Responses are usually structurally incomplete during the toddler period. The preschool childbegins to use adjectives and adverbs to qualify nouns followed by adverbs to qualify nouns and verbs.Pronouns are not added until the later preschool years. By the time children enter school, they are able touse simple, structurally complete sentences that average five to seven words.DIF: Cognitive Level: Apply REF: p. 46TOP: Integrated Process: Teaching/LearningMSC: Area of Client Needs: Health Promotion and Maintenance

Parents of an 8-year-old child ask the nurse how many inches their child should grow each year. The nurse bases the answer on the knowledge that after age 7 years, school-age children usually grow what number of inches per year? a. 1 b. 2 c. 3 d. 4

ANS: B The growth velocity after age 7 years is approximately 5 cm (2 inches) per year. One inch is too small anamount. Three and 4 inches are greater than the average yearly growth after age 7 years.DIF: Cognitive Level: Apply REF: p. 41TOP: Integrated Process: Nursing Process: ImplementationMSC: Area of Client Needs: Health Promotion and Maintenance

Parents are asking the clinic nurse about an appropriate toy for their toddler. Which response by the nurse is appropriate? a. "Your child would enjoy playing a board game." b. "A toy your child can push or pull would help develop muscles." c. "An action figure toy would be a good choice." d. "A 25-piece puzzle would help your child develop recognition of shapes."

ANS: B Toys should be appropriate for the child's age. A toddler would benefit from a toy he or she could push orpull. The child is too young for a board game, action figure, or 25-piece puzzle.DIF: Cognitive Level: Apply REF: p. 50TOP: Integrated Process: Teaching/LearningMSC: Area of Client Needs: Health Promotion and Maintenance

Parents express concern that their pubertal daughter is taller than the boys in her class.The nurse should respond with which statement regarding how the onset of pubertal growth spurt compares in girls and boys? a. It occurs earlier in boys. b. It occurs earlier in girls. c. It is about the same in both boys and girls. d. In both boys and girls, the pubertal growth spurt depends on growth in infancy.

ANS: B Usually, the pubertal growth spurt begins earlier in girls. It typically occurs between the ages of 10 and 14years for girls and 11 and 16 years for boys. The average earliest age at onset is 1 year earlier for girls.There does not appear to be a relation to growth during infancy.DIF: Cognitive Level: Apply REF: p. 41TOP: Integrated Process: Nursing Process: ImplementationMSC: Area of Client Needs: Health Promotion and Maintenance

Which statement is correct about toilet training? a. Bladder training is usually accomplished before bowel training. b. Wanting to please the parent helps motivate the child to use the toilet. c. Watching older siblings use the toilet confuses the child. d. Children must be forced to sit on the toilet when first learning.

ANS: B Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please parent by holding on rather than pleasing self by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

The nurse observes that a new mother avoids making eye contact with her newborn. The nurse should do which of the following? a. Examine newborn's eyes for ability to focus. b. Assess for other attachment behaviors. c. Recognize this as a common reaction in new mothers. d. Ask mother why she won't look at infant.

ANS: B b. Attachment behaviors are thought to indicate the formation of emotional bonds between the newborn and the mother. The mother's failure to make eye contact with her newborn may indicate difficulties with the formation of emotional bonds. The nurse should perform a more thorough assessment.a. Newborns do not have binocularity and cannot focus.c. This is an uncommon reaction in new mothers.d. This is a confrontational question that would put the mother in a defensive position.

A nursing intervention to promote parent-infant attachment would be which of the following? a. Delaying parent-child interactions until the second period of reactivity b. Explaining individual differences among infants to the parents c. Alleviating stress for parents by decreasing their participation in the infant's care d. Encouraging parents to hold child frequently unless he or she is fussy

ANS: B b. Nurses can positively influence the attachment of parent and child by recognizing and explaining individual differences to the parents. The nurse should emphasize the normalcy of these variations and demonstrate the uniqueness of each child.a. The nurse should facilitate parent-child interaction during the first period of reactivity.c. Decreasing the parents' participation in care will interfere with parent-infant attachment.d. The parents should be encouraged to hold the child when he or she is fussy and learn how best to soothe their child.

The American Academy of Pediatrics recommends that the best form of infant nutrition is: a. exclusive breastfeeding until age 2 months. b. exclusive breastfeeding until at least age 1 year. c. commercially prepared infant formula for 1 year. d. commercially prepared infant formula until age 4 to 6 months.

ANS: B b. The American Academy of Pediatrics has reaffirmed its position that an infant be breast-fed exclusively for the first year of life. This group also supports programs that enable women to return to work and continue breastfeeding.a. This is too short a period.c and d. The recommendation is for breastfeeding, not commercial formula. If the mother has stopped breastfeeding, then commercial formula, rather than whole milk, should be used until age 1 year.

The nurse is assessing a 3-day-old, breast-fed newborn who weighed 7 pounds, 8 ounces at birth. The infant's mother is now concerned that the infant weighs 6 pounds, 15 ounces. The most appropriate nursing intervention is which of the following? a. Recommend supplemental feedings of formula. b. Explain that this weight loss is within normal limits. c. Assess child further to determine cause of excessive weight loss. d. Encourage mother to express breast milk for bottle feeding the infant.

ANS: B b. The neonate normally loses about 10% of the birth weight by age 3 or 4 days. The birth weight is usually regained by the tenth day of life.a, c, and d. Because this is an expected occurrence, no further action is needed. The mother should be taught about normal infant feeding and growing patterns.

A parent asks the nurse, When will I know my child is ready for toilet training? The nurse should include what in the response? (Select all that apply.) a. The child should be able to stay dry for 1 hour. b. The child should be able to sit, walk, and squat. c. The child should have regular bowel movements. d. The child should express a willingness to please.

ANS: B, C, D Signs of toilet training readiness include physical and psychological readiness. The ability to sit, walk, and squat and having regular bowel movements are physical readiness signs. Expressing a willingness to please is a sign of psychological readiness. The child should be able to stay dry for 2 hours, not 1.

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

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

A nurse is conducting a teaching session on the use of time-out as a discipline measure to parents of toddlers. Which are correct strategies the nurse should include in the teaching session? (Select all that apply.) a. Time-out as a discipline measure cannot be used when in a public place. b. A rule for the length of time-out is 1 minute per year. c. When the child misbehaves, one warning should be given. d. The area for time-out can be in the family room where the child can see the television. e. When the child is quiet for the specified time, he or she can leave the room.

ANS: B, C, E A rule for the length of time-out is 1 minute per year of age; use a kitchen timer with an audible bell to record the time rather than a watch. When the child misbehaves, one warning should be given. When the child is quiet for the duration of the time, he or she can then leave the room. Time-out can be used in public places and the parents should be consistent on the use of time-out. Implement time-out in a public place by selecting a suitable area or explain to children that time-out will be spent immediately on returning home. The time-out should not be spent in an area from which the child can view the television. Select an area for time-out that is safe, convenient, and unstimulating but where the child can be monitored, such as the bathroom, hallway, or laundry room.

Which behaviors by the nurse indicate a therapeutic relationship with children and families? (Select all that apply.) a. Spending off-duty time with children and families b. Asking questions if families are not participating in the care c. Clarifying information for families d. Buying toys for a hospitalized child e. Learning about the family's religious preferences

ANS: B, C, E Asking questions if families are not participating in the care, clarifying information for families,and learning about the family's religious preferences are positive actions and foster therapeuticrelationships with children and families. Spending off-duty time with children and families andbuying toys for a hospitalized child are negative actions and indicate overinvolvement withchildren and families, which is nontherapeutic.DIF: Cognitive Level: Understand REF: p. 8TOP: Integrated Process: Nursing Process: EvaluationMSC: Area of Client Needs: Psychosocial Integrity

A nurse is conducting education classes for parents of infants. The nurse plans to discuss sudden infant death syndrome (SIDS). Which risk factors should the nurse include as increasing an infant's risk of a sudden infant death syndrome incident? (Select all that apply.) a.Breastfeeding b.Low Apgar scores c.Male sex d.Birth weight in the 50th or higher percentile e.Recent viral illness

ANS: B, C, E Certain groups of infants are at increased risk for SIDS: low birth weight, low Apgar scores, recent viral illness, and male sex. Breastfed infants and infants of average or above average weight are not at higher risk for SIDS.

Characteristics of bullies include what? (Select all that apply.) a. Female b. Depressed c. Good peer relationships d. Poor academic performance e. Exposed to domestic violence

ANS: B, D, E Children who are bullies are likely to be male, depressed, have poor academic performance, be exposed to domestic violence, have poor peer relationships, and have poor communication with their parents.

A nurse is teaching a parent about introduction of solid foods into an infant's diet. Which should the nurse include in the teaching session? (Select all that apply.) a. Solid food introduction can be started at 2 months of age. b. Rice cereal is introduced first. c. Begin the introduction of solid foods by mixing with formula in the bottle. d. Introduce egg white in small quantities (1 tsp) toward the end of the first year.e. Introduce one food at a time, usually at intervals of 4 to 7 days.

ANS: B, D, E Rice cereal, because of its low allergenic potential, is the first solid food introduced to an infantat 4 to 6 months of age. Introduce one food at a time, usually at intervals of 4 to 7 days, toidentify food allergies. Introduce egg white in small quantities (1 tsp) toward the end of the firstyear to detect an allergy. Solid food introduction should be started at 4 to 6 months of age.Never introduce foods by mixing them with the formula in a bottle.DIF: Cognitive Level: Apply REF: p. 319TOP: Integrated Process: Teaching/LearningMSC: Area of Client Needs: Health Promotion and Maintenance

Which leading cause of death topic should the nurse emphasize to a group of African-American boys ranging in age from 15 to 19 years? a. Suicide b. Cancer c. Firearm homicide d. Occupational injuries

ANS: C Firearm homicide is the second overall cause of death in this age group and the leading cause of death in African-American males. Suicide is the third-leading cause of death in thispopulation. Cancer, although a major health problem, is the fourth-leading cause of death in this age group. Occupational injuries do not contribute to a significant death rate for this age group.DIF: Cognitive Level: Understand REF: p. 7TOP: Integrated Process: Nursing Process: PlanningMSC: Area of Client Needs: Health Promotion and Maintenance

9. A nurse on a pediatric unit is practicing family-centered care. Which is most descriptive of the care the nurse is delivering? a. Taking over total care of the child to reduce stress on the family b. Encouraging family dependence on health care systems c. Recognizing that the family is the constant in a child's life d. Excluding families from the decision-making process

ANS: C The three key components of family-centered care are respect, collaboration, and support.Family-centered care recognizes the family as the constant in the child's life. Taking over total care does not include the family in the process and may increase stress instead of reducing stress. The family should be enabled and empowered to work with the health care system. The family is expected to be part of the decision-making process.DIF: Cognitive Level: Remember REF: p. 7TOP: Integrated Process: Nursing Process: ImplementationMSC: Area of Client Needs: Health Promotion and Maintenance

Which play is most typical of the preschool period? a. Solitary b. Parallel c. Associative d. Team

ANS: C Associative play is group play in similar or identical activities but without rigid organization orrules. Solitary play is that of infants. Parallel play is that of toddlers. School-age children play inteams.DIF: Cognitive Level: Understand REF: p. 383TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

A female school-age child asks the school nurse, How many pounds should I expect to gain in a year? The nurse should give which response? a. You will gain about 2.4 to 4.6 lb per year b. You will gain about 3.4 to 5.6 lb per year. c. You will gain about 4.4 to 6.6 lb per year. d. You will gain about 5.5 to 7.6 lb per year.

ANS: C Between the ages of 6 and 12 years, children will almost double in weight, increasing 2 to 3 kg (4.4 to 6.6 lb) per year.

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

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

Developmentally, what should most children at age 12 months be able to do? a. Use a spoon adeptly b. Relinquish the bottle voluntarily c. Eat the same food as the rest of the family d. Reject all solid food in preference to the bottle

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

The school nurse recognizes that pubertal delay in boys is considered if no enlargement of the testes or scrotal changes have occurred by what age? a. 11 1/2 to 12 years b. 12 1/2 to 13 years c. 13 1/2 to 14 years d. 14 1/2 to 15 years

ANS: C Concerns about pubertal delay should be considered for boys who exhibit no enlargement of the testes or scrotal changes by ages 13 1/2 to 14 years or if genital growth is not complete 4 years after the testicles begin to enlarge.

An infant has been pronounced dead from sudden infant death syndrome (SIDS) in the emergency department. Which is an appropriate question to ask the parents? a."Did you hear the infant cry out?" b."Why didn't you check on the infant earlier?" c."What time did you find the infant?" d."Was the head buried in a blanket?"

ANS: C During a SIDS incident, if the infant is not pronounced dead at the scene, he or she may be transported to the emergency department to be pronounced dead by a physician. While they are in the emergency department, the parents are asked only factual questions, such as when they found the infant, how he or she looked, and whom they called for help. The nurse avoids any remarks that may suggest responsibility, such as "Why didn't you go in earlier?" "Didn't you hear the infant cry out?" "Was the head buried in a blanket?"

In which type of play are children engaged in similar or identical activity, without organization, division of labor, or mutual goal? a. Solitary b. Parallel c. Associative d. Cooperative

ANS: C In associative play, no group goal is present. Each child acts according to his or her own wishes.Although the children may be involved in similar activities, no organization, division of labor, leadershipassignment, or mutual goal exists. Solitary play describes children playing alone with toys different fromthose used by other children in the same area. Parallel play describes children playing independently butbeing among other children. Cooperative play is organized. Children play in a group with other childrenwho play in activities for a common goal.DIF: Cognitive Level: Understand REF: p. 48TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

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

ANS: C In most girls, the initial indication of puberty is the appearance of breast buds, an event known as thelarche. The usual sequence of secondary sexual characteristic development in girls is breast changes, a rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation (menarche), and abrupt deceleration of linear growth.

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

ANS: C Information about the attainment of developmental milestones is important to obtain. It providesdata about the child's growth and development that should be included in the past history.Developmental milestones provide important information about the child's physical, social, andneurologic health and should be included in the history for a 3-year-old child. If pertinent,attainment of milestones by siblings would be included in the family history. The review ofsystems does not include the developmental milestones.DIF: Cognitive Level: Understand REF: p. 65TOP: Integrated Process: Communication and DocumentationMSC: Area of Client Needs: Health Promotion and Maintenance

Which is the most frequent source of acute childhood lead poisoning? a. Folk remedies b. Unglazed pottery c. Lead-based paint d. Cigarette butts and ashes

ANS: C Lead-based paint in houses built before 1978 is the most frequent source of lead poisoning. Some folk remedies and unglazed pottery may contain lead, but they are not the most frequent source. Cigarette butts and ashes do not contain lead.

By what age does birth length usually double? a. 1 year b. 2 years c. 4 years d. 6 years

ANS: C Linear growth or height occurs almost entirely as a result of skeletal growth and is considered a stablemeasurement of general growth. On average, most children have doubled their birth length at age 4 years.One and 2 years are too young for doubling of length. Most children will have achieved the doubling byage 4 years.DIF: Cognitive Level: Remember REF: p. 41TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

By which age should the nurse expect an infant to be able to pull to a standing position? a. 6 months b. 8 months c. 11 to 12 months d. 14 to 15 months

ANS: C Most infants can pull themselves to a standing position at age 9 months. Infants who are notable to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months, infants have just obtained coordination of armsand legs. By age 8 months, infants can bear full weight on their legs. Any infant who cannot pullto a standing position by age 1 year should be referred for further evaluation.DIF_ Cognitive Level_ Understand REF_ p. 306TOP_ Integrated Process_ Nursing Process_ AssessmentMSC_ Area of Client Needs_ Health Promotion and Maintenance

Which is the leading cause of death from unintentional injuries for females ranging in age from 1 to 14? a. Mechanical suffocation b. Drowning c. Motor vehicle-related fatalities d. Fire- and burn-related fatalities

ANS: C Motor vehicle-related fatalities are the leading cause of death for females ranging in age from 1 to 14, either as passengers or as pedestrians. Mechanical suffocation is fourth or fifth, depending on the age. Drowning is the second- or third-leading cause of death, depending on the age. Fire- and burn-related fatalities are the second-leading cause of death.DIF: Cognitive Level: Remember REF: p. 3TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

Why are imaginary playmates beneficial to the preschool child? a. Take the place of social interaction sb. Take the place of pets and other toys c. Become friends in times of loneliness d. Accomplish what the child has already successfully accomplished

ANS: C One purpose of an imaginary friend is to be a friend in time of loneliness. Imaginary friends donot take the place of social interaction, but may encourage conversation. Imaginary friends donot take the place of pets or toys. Imaginary friends accomplish what the child is still attempting.DIF: Cognitive Level: Understand REF: p. 384TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

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

ANS: C Puberty signals the beginning of the development of secondary sex characteristics. This begins earlier in girls than in boys. Usually a 2-year difference occurs in the age of onset. Girls and boys do not usually begin puberty at the same age. Girls generally begin puberty 2 years earlier than boys.

A nurse is assigned to four children of different ages. In which age group should the nurse understand that body integrity is a concern? a. Toddler b. Preschooler c. School-age child d. Adolescent

ANS: C School-age children have a heightened concern about body integrity. They place importanceand value on their bodies and are oversensitive to anything that constitutes a threat orsuggestion of injury. Body integrity is not as important a concern to toddlers, preschoolers, oradolescents.DIF: Cognitive Level: Understand REF: p. 61TOP: Integrated Process: Nursing Process: PlanningMSC: Area of Client Needs: Health Promotion and Maintenance

What statement best describes the relationship school-age children have with their families? a. Ready to reject parental controls b. Desire to spend equal time with family and peers c. Need and want restrictions placed on their behavior by the family d. Peer group replaces the family as the primary influence in setting standards of behavior and rules

ANS: C School-age children need and want restrictions placed on their behavior, and they are not prepared to cope with all the problems of their expanding environment. Although increased independence is the goal of middle childhood, they feel more secure knowing that an authority figure can implement controls and restriction. In the middle school years, children prefer peer group activities to family activities and want to spend more time in the company of peers. Family values usually take precedence over peer value systems.

At what age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 10 months

ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age4 months, an infant can sit with support. At age 6 months, the infant will maintain a sittingposition if propped. By 10 months, the infant can maneuver from a prone to a sitting position.DIF: Cognitive Level: Understand REF: p. 306TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

In boys, what is the initial indication of puberty? a. Voice changes b. Growth of pubic hair c. Testicular enlargement d. Increased size of penis

ANS: C Testicular enlargement is the first change that signals puberty in boys; it usually occurs between the ages of 9 1/2 and 14 years during Tanner stage 2. Voice change occurs between Tanner stages 3 and 4. Fine pubic hair may occur at the base of the penis; darker hair occurs during Tanner stage 3. The penis enlarges during Tanner stage 3.

The school nurse is teaching female school-age children about the average age of puberty. What is the average age of puberty for girls? a. 10 years b. 11 years c. 12 years d. 13 years

ANS: C The average age of puberty is 12 years in girls.

The school nurse is teaching male school-age children about the average age of puberty. What is the average age of puberty for boys? a. 12 years b. 13 years c. 14 years d. 15 years

ANS: C The average age of puberty is 14 years in boys. Boys experience little sexual maturation during preadolescence.

A nurse is collecting subjective and objective information about target populations to diagnose problems based on community needs. This describes which step in the community nursing process? a. Planning b. Diagnosis c. Assessment d. Establishing objectives

ANS: C The nursing process stages are similar, whether the client is one child or a population ofchildren. The assessment phase of the nursing process focuses on collecting subjective andobjective data. Planning is the development of community-centered goals and objectives.Diagnosis is the identification of problems specific to the community.DIF: Cognitive Level: Understand REF: p. 11TOP: Integrated Process: Communication and DocumentationMSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care

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

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

Which is the major cause of death for children older than 1 year? a. Cancer b. Heart disease c. Unintentional injuries d. Congenital anomalies

ANS: C Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. Congenital anomalies are the leading cause of death in those younger than 1year. Cancer ranks either second or fourth, depending on the age group, and heart disease ranks fifth in the majority of the age groups.DIF: Cognitive Level: Remember REF: p. 7TOP: Integrated Process: Nursing Process: PlanningMSC: Area of Client Needs: Health Promotion and Maintenance

Successful breastfeeding is most dependent on which of the following? a. Mother's socioeconomic level b. Size of mother's breasts c. Mother's desire to breastfeed d. Birth weight of infant

ANS: C c. The factors that contribute to successful breastfeeding are the mother's desire to breastfeed, satisfaction with breastfeeding, and available support systems.a. This may affect the mother's need to return to work and available support systems, but with support, the mother can be successful.b. This does not affect the success of breastfeeding.d. Very low-birth-weight infants may be unable to breastfeed. The mother can express milk, and it can be used for the child.

Stroking the neonate's cheek along the side of the mouth causes the infant to turn the head toward that side and begin to suck. This is which of the following reflexes? a. Perez b. Sucking c. Rooting d. Extrusion

ANS: C c. This is a description of the rooting reflex, which usually disappears by age 3 to 4 months but may persist for up to 12 months.a. The Perez reflex involves stroking the infant's back when prone; the child flexes extremities, elevating head and pelvis. It disappears at age 4 to 6 months.b. The infant begins strong sucking movements in response to circumoral stimulation. The reflex persists throughout infancy, even without stimulation.d. Infants force their tongues outward, when the tongue is touched or depressed. This reflex usually disappears by age 4 months.

A nurse is planning a teaching session for parents of preschool children.Which statement explains why the nurse should include information about morbidity and mortality? a. Life span statistics are included in the data. b. It explains effectiveness of treatment. c. Cost-effective treatment is detailed for the general population. d. High-risk age groups for certain disorders or hazards are identified.

ANS: D Analysis of morbidity and mortality data provides the parents with information about which groups of individuals are at risk for which health problems. Life span statistics is a part of the mortality data. Treatment modalities and cost are not included in morbidity and mortality data.DIF: Cognitive Level: Apply REF: p. 11TOP: Integrated Process: Nursing Process: PlanningMSC: Area of Client Needs: Health Promotion and Maintenance

What is an important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS)? a.Explain how SIDS could have been predicted and prevented. b.Interview parents in depth concerning the circumstances surrounding the child's death. c.Discourage parents from making a last visit with the infant. d.Make a follow-up home visit to parents as soon as possible after the child's death.

ANS: D A competent, qualified professional should visit the family at home as soon as possible after the death and provide the family with printed information about SIDS. An explanation of how SIDS could have been predicted and prevented is inappropriate. SIDS cannot be prevented or predicted. Discussions about the cause will only increase parental guilt. The parents should be asked only factual questions to determine the cause of death. Parents should be allowed and encouraged to make a last visit with their child.

The school nurse recognizes that adolescents should get how many hours of sleep each night? a. 6 hours b. 7 hours c. 8 hours d. 9 hours

ANS: D Adolescents should generally get around 9 hours of sleep each night.

Which is the term for a family in which the paternal grandmother, the parents, and two minor children live together? a. Blended b. Nuclear c. Binuclear d. Extended

ANS: D An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one stepparent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

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

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

By which age should the nurse expect that most children could obey prepositional phrases such as "under," "on top of," "beside," and "behind"? a. 18 months b. 24 months c. 3 years d. 4 years

ANS: D At 4 years, children can understand directional phrases. Children at 18 months, 24 months, and3 years are too young.DIF: Cognitive Level: Understand REF: p. 385TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

A 13-year-old girl asks the nurse how much taller she will get. She has been growing about 2 inches per year but grew 4 inches this past year. Menarche recently occurred. The nurse should base her response on which statement? a. Growth cannot be predicted. b. Pubertal growth spurt lasts about 1 year c. Mature height is achieved when menarche occurs. d. Approximately 95% of mature height is achieved when menarche occurs.

ANS: D At the time of the beginning of menstruation or the skeletal age of 13 years, most girls have grown toabout 95% of their adult height. They may have some additional growth (5%) until the epiphyseal platesare closed. Although growth cannot be definitively predicted, on average, 95% of adult height has beenreached with the onset of menstruation. Pubertal growth spurt lasts about 1 year does not address thegirl's question. Young women usually will grow approximately 5% more after the onset of menstruation.DIF: Cognitive Level: Apply REF: p. 41TOP: Integrated Process: Teaching/LearningMSC: Area of Client Needs: Health Promotion and Maintenance

Which characteristic best describes the language of a 3-year-old child? a. Asks meanings of words b. Follows directional commands c. Describes an object according to its composition d. Talks incessantly regardless of whether anyone is listening

ANS: D Because of the dramatic vocabulary increase at this age, 3-year-olds are known to talkincessantly regardless of whether anyone is listening. A 4- to 5-year-old asks lots of questionsand can follow simple directional commands. A 6-year-old can describe an object according toits composition.DIF: Cognitive Level: Understand REF: p. 385TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

Parents tell the nurse that their 1-year-old son often sleeps with them. They seem unconcerned about this. The nurse's response should be based on which statement? a. Children should not sleep with their parents. b. Separation from parents should be completed by this age. c. Daytime attention should be increased. d. This is a common and accepted practice, especially in some cultural groups.

ANS: D Co-sleeping, or sharing the family bed, in which the parents allow the children to sleep with them, is a common and accepted practice in many cultures. Parents should evaluate the options available and avoid conditions that place the infant at risk. Population-based studies are currently under way; no evidence at this time supports or condemns the practice for safety reasons. Co-sleeping is a cultural practice. One year is the age at which children are just beginning to individuate. Increased daytime activity may help decrease sleep problems in general, but co-sleeping is a culturally determined phenomenon.DIF: Cognitive Level: Understand REF: p. 321TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

The nurse suspects that a child has ingested some type of poison. Which clinical manifestation would be most suggestive that the poison was a corrosive product? a. Tinnitus b. Disorientation c. Stupor, lethargy, coma d. Edema of lips, tongue, pharynx

ANS: D Edema of lips, tongue, and pharynx indicates a corrosive ingestion. Tinnitus is indicative of aspirin ingestion. Corrosives do not act on the central nervous system (CNS).

The most common cause of death in the adolescent age group involves: a. drownings. b. firearms. c. drug overdoses. d. motor vehicles.

ANS: D Forty percent of all adolescent deaths in the United States are the result of motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but are not the most common cause of death.

The school nurse recognizes that pubertal delay in girls is considered if breast development has not occurred by which age? a. 10 years b. 11 years c. 12 years d. 13 years

ANS: D Girls may be considered to have pubertal delay if breast development has not occurred by age 13 years or if menarche has not occurred within 2 to 2 1/2 years of the onset of breast development.

An infant who weighs 7 pounds at birth would be expected to weigh how many pounds at age 1 year? a. 14 b. 16 c. 18 d. 21

ANS: D In general, birth weight triples by the end of the first year of life. For an infant who was 7 pounds at birth,21 pounds would be the anticipated weight at the first birthday; 14, 16, or 18 pounds is below what wouldbe expected for an infant with a birth weight of 7 pounds.DIF: Cognitive Level: Understand REF: p. 41TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is observing children playing in the playroom. What describes parallel play? a. A child playing a video game b. Two children playing a card game c. Two children watching a movie on a television d. A child playing with blocks next to a child playing with trucks

ANS: D Parallel play is when a toddler plays alongside, not with, other children. A child playing with blocks next to a child playing with trucks is descriptive of parallel play. The child playing a video game is descriptive of solitary play. Two children playing cards is descriptive of cooperative play. Two children watching a television is descriptive of associative play.

The mother of a preterm newborn asks the nurse when she can start breastfeeding. The nurse should explain that breastfeeding can be initiated when her newborn: a. achieves a weight of at least 3 pounds. b. indicates an interest in breastfeeding. c. does not require supplemental oxygen. d. has adequate sucking and swallowing reflexes.

ANS: D Research supports that human milk is the best source of nutrition for term and preterm newborns. Preterm newborns should be breastfed as soon as they have adequate sucking and swallowing reflexes and no other complications such as respiratory complications or concurrent illnesses. Weight is not an issue. Interest in breastfeeding can be evaluated by having nonnutritive sucking at the breast during skin-to-skin kangaroo care so the mother and child may become accustomed to each other. Supplemental oxygen can be provided during breastfeeding by using a nasal cannula.

A nurse is planning play activities for school-age children. Which type of a play activity should the nurse plan? a. Solitary b. Parallel c. Associative d. Cooperative

ANS: D School-age children engage in cooperative play where it is organized and interactive. Playing a game is agood example of cooperative play. Solitary play is appropriate for infants, parallel play is an activityappropriate for toddlers, and associative play is an activity appropriate for preschool-age children.DIF: Cognitive Level: Apply REF: p. 48TOP: Integrated Process: Nursing Process: PlanningMSC: Area of Client Needs: Health Promotion and Maintenance

Which following function of play is a major component of play at all ages? a. Creativity b. Socialization c. Intellectual development d. Sensorimotor activity

ANS: D Sensorimotor activity is a major component of play at all ages. Active play is essential for muscledevelopment and allows the release of surplus energy. Through sensorimotor play, children explore theirphysical world by using tactile, auditory, visual, and kinesthetic stimulation. Creativity, socialization, andintellectual development are each functions of play that are major components at different ages.DIF: Cognitive Level: Understand REF: p. 49TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance: Developmental Stages and Transitions

The parents of a 5-year-old child ask the nurse, How many hours of sleep a night does our child need? The nurse should give which response? a. A 5-year-old child requires 8 hours of sleep. b. A 5-year-old child requires 9.5 hours of sleep. c. A 5-year-old child requires 10 hours of sleep. d. A 5-year-old child requires 11.5 hours of sleep.

ANS: D Sleep requirements decrease during school-age years; 5-year-old children generally require 11.5 hours of sleep.

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

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

A 14-year-old male mentions that he now has to use deodorant but never had to before. The nurse's response should be based on knowledge that which occurs during puberty? a. Eccrine sweat glands in the axillae become fully functional during puberty. b. Sebaceous glands become extremely active during puberty. c. New deposits of fatty tissue insulate the body and cause increased sweat production. d. Apocrine sweat glands reach secretory capacity during puberty.

ANS: D The apocrine sweat glands, nonfunctional in children, reach secretory capacity during puberty. They secrete a thick substance as a result of emotional stimulation that, when acted on by surface bacteria, becomes highly odoriferous. They are limited in distribution and grow in conjunction with hair follicles, in the axilla, genital, anal, and other areas. Eccrine sweat glands are present almost everywhere on the skin and become fully functional and respond to emotional and thermal stimulation. Sebaceous glands become extremely active at this time, especially those on the genitalia and the "flush" areas of the body such as face, neck, shoulders, upper back, and chest. This increased activity is important in the development of acne. New deposits of fatty tissue is not the etiology of apocrine sweat gland activity.

The nurse is teaching parents about toilet training. What should the nurse include in the teaching session? a. Bladder training is accomplished before bowel training. b. The mastery of skills required for toilet training is present at 18 months. c. By 12 months, the child is able to retain urine for up to 2 hours or longer. d. The physiologic ability to control the sphincters occurs between 18 and 24 months.

ANS: D The physiologic ability to control the sphincters occurs somewhere between ages 18 and 24 months. Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The mastery of skills required for training are not present before 24 months of age. By 14 to 18 months of age, the child is able to retain urine for up to 2 hours or longer.

A nurse observes a toddler playing with sand and water. How should the nurse document this type of play? a. Skill b. Dramatic c. Social-affective d. Sense-pleasure

ANS: D The toddler playing with sand and water is engaging in sense-pleasure play. This is characterized bynonsocial situations in which the child is stimulated by objects in the environment. Infants engage in skillplay when they persistently demonstrate and exercise newly acquired abilities. Dramatic play is thepredominant form of play in the preschool period. Children pretend and fantasize. Social-affective play isone of the first types of play in which infants engage. The infant responds to interactions with people.DIF: Cognitive Level: Apply REF: p. 47TOP: Integrated Process: Communication and DocumentationMSC: Area of Client Needs: Health Promotion and Maintenance

The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. What knowledge should the nurse's response should be based? a. Unacceptable because of the risk of sudden infant death syndrome (SIDS) b. Unacceptable because it does not encourage achievement of developmental milestones c. Acceptable to encourage fine motor development d. Acceptable to encourage head control and turning over

ANS: D These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleepon their backs and then be placed on their abdomens when awake to enhance development ofmilestones such as head control. The face-down position while awake and on the back for sleepare acceptable because they reduce risk of SIDS and allow achievement of developmentalmilestones. These position changes encourage gross motor, not fine motor, development.DIF: Cognitive Level: Analyze REF: p. 306TOP: Integrated Process: Teaching/LearningMSC: Area of Client Needs: Health Promotion and Maintenance

The father of a 12-year-old child tells the nurse that he is concerned about his son getting "fat." His son is at the 50th percentile for height and the 75th percentile for weight on the growth chart. The most appropriate nursing action is to: a. reassure the father that his child is not fat. b. reassure the father that his child is just growing. c. suggest a low-calorie, low-fat diet. d. explain that this is typical of the growth pattern of boys at this age.

ANS: D This is a characteristic pattern of growth in preadolescent boys, where the growth in height has slowed in preparation for the pubertal growth spurt, but weight is still gained. The nurse should review this with both the father and the child and develop a plan to maintain physical exercise and a balanced diet. It is false reassurance to tell the father that his son is not fat. His weight is high for his height. The child needs to maintain his physical activity. The father is concerned, so an explanation is required. A nutritional diet with physical activity should be sufficient to maintain his balance.

In terms of fine motor development, which should the 3-year-old child be expected to do? a. Lace shoes and tie shoelaces with a bow. b. Use scissors to cut pictures, and print a few numbers. c. Draw a person with seven parts and correctly identify the parts. d. Draw a circle and name what has been drawn.

ANS: D Three-year-olds are able to accomplish this fine motor skill. Being able to lace shoes and tie shoelaces with a bow, use scissors to cut pictures, and print a few numbers, or draw a person with seven parts and correctly identify the parts are fine motor skills of 4- or 5-year-olds.DIF: Cognitive Level: Understand REF: p. 380TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

Which should the nurse expect of a healthy 3-year-old child? a. Jump rope b. Ride a two-wheel bicycle c. Skip on alternate feet d. Balance on one foot for a few seconds

ANS: D Three-year-olds are able to accomplish this gross motor skill. Jumping rope, riding a two-wheelbicycle, and skipping on alternate feet are gross motor skills of 5-year-olds.DIF: Cognitive Level: Understand REF: p. 391TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Health Promotion and Maintenance

Which is most characteristic of the physical punishment of children, such as spanking? a. Psychological impact is usually minimal. b. Children rarely become accustomed to spanking. c. Children's development of reasoning increases. d. Misbehavior is likely to occur when parents are not present.

ANS: D Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake, but rather out of fear of punishment. Spanking can cause severe physical and psychological injury and interfere with effective parent-child interaction. Children do become accustomed to spanking, requiring more severe corporal punishment each time. The use of corporal punishment may interfere with the child's development of moral reasoning.

Place in order the expected sequence of fine motor developmental milestones for an infant beginning with the first milestone achieved and ending with the last milestoneachieved. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d, e). a. Voluntary palmar grasp b. Reflex palmar grasp c. Puts objects into a container d. Neat pincer grasp e. Builds a tower of two blocks, but fails

ANS:b, a, d, c, e Grasping occurs during the first 2 to 3 months as a reflex and gradually becomes voluntary. By5 months, infants are able to voluntarily grasp objects. Gradually, the palmar grasp (using thewhole hand) is replaced by a pincer grasp (using the thumb and index finger). By 8 to 10months of age, infants use a crude pincer grasp, and by 11 months, they have progressed to aneat pincer grasp. By 11 months, they put objects into containers and like to remove them. Byage 1 year, infants try to build towers of two blocks but fail.DIF: Cognitive Level: Analyze REF: p. 307TOP: Integrated Process: Nursing Process: EvaluationMSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is assisting a group of parents of adolescents to develop skills that will improve communication within the family. The nurse hears one parent state, "My son knows he better do what I say." Which of the following parenting styles is the parent exhibiting? A. authoritarian b. permissive c. authoritative d. passive

Ans: A This parent is exhibiting an authoritarian parenting style. The parent controls the adolescent's behaviors and attitudes through unquestioned rules and expectations.

The nurse's BEST approach for effective communication with a preschool age child is through: A. speech. B. play. C. drawing. D. actions.

B (Preschoolers' most effective means of communication is through play. Play allows preschoolers to understand, adjust to, and work out life's experiences through their imagination and ability to invent and imitate. Speech is not effective, because preschoolers assume that everyone thinks as they do and that a brief explanation of their thinking makes them understood by others, which is often not true. Also, preschoolers often do not understand the meaning of words and often take statements literally. Drawing is still being developed as a fine motor skill; therefore, it is not the most effective means of communication. Actions are not an appropriate means of communication for a preschooler.)

A 4-year-old child is seen playing with his father while waiting in the clinic area for a well checkup visit. The nurse observing the interaction notes that this behavior as being an example of?a.)Imaginative play b.) Mutual play c.) Dramatic play d.) Avoidance play

B.) Mutual play

When should the nurse expect breastfeeding-associated jaundice to first appear in a normal infant? A: 2-12 hours B: 12-24 hours C: 2-4 days D: after the fifth day

C: 2-4 days

The nurse would expect that most children would be using sentences of six to eight words by age: A. 18 months. B. 24 months. C. 3 years. D. 5 years.

D (Children ages 4 to 5 years use sentences of four or five words. An 18-month-old child has a vocabulary of approximately 10 words. A 24-month-old child uses two- or three-word phrases. A 3-year-old child uses sentences of three or four complete words.)

Place in order the sequence of cephalocaudal development that the nurse expects to find in the infant. Begin with the first development expected, sequencing to the final. Provide answers separated by commas (e.g., a, b, c, d). a. Crawl b. Sit unsupported c. Lift head when prone d. Gain complete head control e. Walk

NS:c, d, b, a, e Cephalocaudal development is head-to-tail. Infants achieve structural control of the head before they havecontrol of their trunks and extremities, they lift their head while prone, obtain complete head control, situnsupported, crawl, and walk sequentially.DIF: Cognitive Level: Apply REF: p. 38TOP: Integrated Process: Nursing Process: ImplementationMSC: Area of Client Needs: Health Promotion and Maintenance

What is the most common cause of death and disability in children in the United States? a) Injuries b) Violence c) Drowning d) Mental health problems

a.) Injuries. Rationale: Injuries account for the most common cause of death and disability to children in the United States. Violence, drowning, and mental health problems are not the most common causes of death and disability in children in the United States.

A nurse is performing a developmental screening on an 18 month old. Which of the following skills should the toddler be able to perform?(Select all that apply) A. Build a tower with 6 blocks B. Throw a ball overhand C. Walk up and down stairs D. Draw circles E. Use a spoon without rotation

answer: B, E Tower w/ 6 blocks = 2 yearWalk up & down stairs = 2 yrDraw circles = 2.5 yr

A nurse understands that moral values are important in any decision making. What does the moral value autonomy refer to? a.) The obligation to prevent or minimize harm b.) The patient's right to be self-governing c.) The concept of fairness d.) The obligation to promote the patient's well-being

b.) The patient's right to be self-governing. Rationale: Autonomy refers to the patient's right to be self-governing and make decisions about his or her own healthcare. The obligation to prevent or minimize harm is called nonmaleficence. The concept of fairness is called justice. The obligation to promote the patient's well-being is called beneficence.

After recording the weight of a newborn child, the nurse concludes that it is a low-birth-weight (LBW) baby. What is the weight of the baby? a.) More than 4.5 kg b.) More than 3.5 kg c.) Less than 2.5 kg d.) Less than 5.0 kg

c.) Less than 2.5 kg Rationale: LBW is a major cause of neonatal death. LBW is defined as a birth weight of a live born infant less than 2.5 kg (5.5 pounds). Birth weights of more than 4.5 kg, more than 3.5 kg, and less than 5.0 kg are normal.

A nurse is delivering a lecture to a group of parents on child health and diseases. What is the most common cause of death in children older than 1 year? a.) Obesity b.) Type 2 diabetes c.) Motor vehicle accidents d.) Heart disease

c.) Motor Vehicle Accidents Rationale: Motor vehicle accidents are the most common cause of death in children over 1 year of age. Obesity is the most common nutritional problem in children and can lead to type 2 diabetes. Incidents related to death due to heart diseases, such as coronary heart disease, in children are not that common.

When teaching safety and injury prevention, the nurse explains that children are at risk for different injuries based on their developmental stage. Which group of children is at the greatest risk of street accidents? a.) Small infants b.) Crawling infants c.) Mobile toddler d.) Preschooler

d.) Preschooler Rationale: The type of injury mostly depends on the developmental stage of the child and the activities related to that developmental age. Preschoolers may become too absorbed in their play activities to be aware of environmental hazards such as street traffic and water. Small infants do not move much, but when they try to move or roll, they can fall from unprotected surfaces. Crawling infants tend to put objects in their mouth and are thus at high risk of aspiration and poisoning. Mobile toddlers are at high risk of falls, burns, and collision with objects due to their newfound capability to run and climb.

A nurse explains to a young patient's parent that, in children, the frequency of certain diseases decreases with age. Which condition should the nurse state as an example to prove her point? a.) Headaches b.) Acne c.) Type 1 diabetes mellitus d.) Tonsillitis

d.) Tonsillitis Rationale: The types of illnesses that children contract are dependent on age. The incidence of upper respiratory tract infections like tonsillitis decreases with age. Headaches and acne increase in frequency with age. Type 1 or juvenile diabetes is not associated with a specific age.