PEDS Lifespan

The school nurse is planning an educational program centered on abstinence for adolescents. Which of the following methods does the nurse recognize as the most effective way to present this program? 1. Use peer-led programs that emphasize the consequences of unprotected sexual contact. 2. Teach students methods to resist peer pressure. 3. Offer students the opportunity to care for a simulator infant for 1 week. 4. Offer statistics, pamphlets, and films discussing the consequences of unprotected sexual contact.

ANS: 1 Adolescents are most concerned with what their peers think and feel. They are most receptive to information that comes from another adolescent.

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

ANS: 1 Preschoolers understand time in rela- tion to events.

A 9-year-old boy has been hospitalized following a bicycle injury. What should the nurse recommend to the child's parents to prevent future injury? 1. Their son should wear safety equipment while riding bicycles. 2. Their son should read educational material on bicycle safety. 3. Their son should watch a video on bicycle safety. 4. Their son should ride his bike in the presence of adults.

ANS: 1 Safety equipment is essential for bicycling, skateboarding, and participating in contact sports. Most injuries occur during the school-age years, when children are more active and participate in contact sports.

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

ANS: 1 The brains of young teens are not completely developed, which often leads to poor judgment and low impulse control.

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

ANS: 1 The child is taking the initiative to ask questions, as all toddlers do, and the nurse should always answer those questions as appropriately and accu- rately as possible.

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

ANS: 1 The child should be walking indepen- dently by 15 to 18 months. Because this toddler is 18 months and not walk- ing, a referral should be made for a developmental consult.

A 4-year-old has been hospitalized with FTT. The child has orders for daily weights, strict input and output, and calorie counts as a means of measuring her nutritional status. Which action by the nurse would be a concern? 1. The nurse weighs the child every morning before the child eats breakfast. 2. The nurse weighs the child with no clothing except for undergarments. 3. The nurse sits with the child when the child eats her meals. 4. The nurse weighs the child using the same scale every morning.

ANS: 1 The child should be weighed every day before she eats. Her weight will not be an accurate reflection if she is fed prior to being weighed.

The nurse is performing a physical assessment on a 6-month-old baby. Which finding should the nurse understand as abnormal for this child? 1. The child's posterior fontanel is open. 2. The child's anterior fontanel is open. 3. The child has the beginning signs of tooth eruption. 4. The child is able to track and follow objects.

ANS: 1 The posterior fontanel should close between 6 and 8 weeks of age.

The nurse is caring for a 12-month-old girl. The child's mother asks if the unit has any toys that her daughter can play with. The nurse goes to the toy area in search of a toy for the child. Which toy is the best choice for this child? 1. A doll. 2. A musical rattle. 3. A board book. 4. Colorful beads.

ANS: 2 A musical rattle is the perfect toy for this child. Infants have short attention spans and enjoy auditory and visual stimulation.

The nurse is caring for a 6-month-old in the ER. The physician orders the nurse to give the child a dose of Rocephin IM. The 1.5-mL dose arrives from the pharmacy. The nurse must do which of the following? 1. Administer the injection in the deltoid muscle. 2. Split the dose into two injections. 3. Administer the injection in the dorsogluteal muscle. 4. Administer the dose as a single injection to the vastus lateralis muscle.

ANS: 2 A nurse should not deliver more than 1 mL per IM injection to a child of 6 months.

A 16-year-old girl is having a discussion with her nurse about her recent diagnosis of lupus. The nurse understands how to best answer the young woman's questions about her prognosis because she understands that cognitively: 1. Adolescents are preoccupied with thoughts of the here and now. 2. Adolescents are able to understand and imagine possibilities for the future. 3. Adolescents are capable of thinking only in concrete terms. 4. Adolescents are overly concerned with past events and relationships.

ANS: 2 Adolescents are becoming abstract thinkers and are able to imagine possibilities for the future.

An 18-year-old boy comes to the ER complaining of a rash and itching in the groin area. He is concerned that he has contracted a sexually transmitted disease and worries that his parents will find out. The nurse's best response is: 1. "We will need to contact your parents to let t 2. "We will not contact your parents regarding this visit." 3. "Who would you like us to contact about your visit here today?" 4. "We cannot promise that the hospital will not contact your parents."

ANS: 2 An adolescent has every right to pri- vacy as long as the situation is not life-threatening.

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

ANS: 2 Children 3 years old are literal thinkers. The child's parents told her that Grandpa was in heaven. She sees his body, so she thinks they are all in heaven.

A 5-year-old boy has always been one of the shortest children in class since pre- school. His mother tells the school nurse that her husband is 6' and she is 5'7". She is concerned about her son's height. Based on her knowledge of a child's physical growth during the school-age years, what should the nurse tell the child's mother? 1. She should expect him to grow about 3 inches every year from ages 6 to 9 years. 2. She should expect him to grow about 2 inches every year from ages 6 to 9 years. 3. She should have him seen by an endocrinologist for growth hormone injections. 4. Be sure to have her son's growth reevaluated when he is 7 years old.

ANS: 2 During the school-age years, a child grows approximately 2 inches per year.

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

ANS: 2 Falls are one of the most common in- juries, and it may make the parent feel better to know that this is common among all toddlers.

A 17-year-old male is being seen in the ER. In order to obtain the adolescent's health information, his nurse should: 1. Interview the adolescent using direct questions. 2. Gather information during a casual conversation. 3. Interview the adolescent only in the presence of his parents. 4. Gather information only from the parents.

ANS: 2 Frequently adolescents will share more information when it is gathered during a casual conversation.

A male infant is visiting the pediatrician for his 6-month well-child checkup. His mother tells the nurse she wants to advance the infant's diet. Which statement by the infant's mother leads the nurse to believe that she needs further education about the nutritional needs of a 6-month-old? 1. "I will continue to breastfeed my son and will give him rice cereal three times a day." 2. "I will start my son on fruits and gradually introduce vegetables." 3. "I will start my son on carrots and will introduce one new vegetable every few days." 4. "I will not give my son any more than 8 ounces of baby juice per day."

ANS: 2 Infants should be started on vegetables prior to fruits. The sweetness of the fruits may inhibit them from taking vegetables.

A 2-year-old boy has been admitted to the hospital for anemia. His mother asks the nurse what foods to include in his diet to improve his nutritional status. Which of the following should the nurse recommend? 1. Increase the child's intake of whole cow's milk to 32 ounces a day. 2. Increase the child's intake of meats, eggs, and green vegetables. 3. Increase the child's intake of fruits, whole grains, and rice. 4. Increase the number of snacks the child eats during the day.

ANS: 2 Meat, eggs, and green vegetables are excellent sources of iron.

An 11-month-old girl has a diagnosis of iron-deficiency anemia. The child's mother tells the nurse that her daughter is currently taking iron and a multivitamin. Which statement made by the mother should be of concern to the nurse? 1. "I give my daughter her iron and multivitamin at the same time each morning." 2. "I give my daughter her iron and her multivitamin in her morning 6-oz bottle." 3. "I give my daughter her iron and multivitamin in a nipple before I feed her the morning bottle." 4. "I give my daughter her iron and multivitamin in oral syringes toward the back of her cheek."

ANS: 2 Medications should never be mixed in a large amount of food or formula because the parent cannot be sure that the child will take the entire feeding. Formula decreases the absorption of iron.

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

ANS: 2 Newborns can lose up to 10% of their birth weight without concern but should regain their birth weight by 2 weeks of age.

A 16-year-old male is hospitalized for cystic fibrosis. He will be an inpatient for 2 weeks while he receives IV antibiotics. As the nurse caring for this patient, what action can you take that will most enhance his psychosocial development? 1. Fax the teen's teacher, and have her send in his homework. 2. Encourage the teen's friends to visit him in the hospital. 3. Encourage the teen's grandparents to visit frequently. 4. Tell the teen he is free to use his phone to call friends.

ANS: 2 Teens are most concerned about being like their peers. Having the teen's friends visit will help him feel he is still part of the school and social environment.

A 5-year-old is at the pediatrician's office for his well-child checkup. The nurse will be administering three immunizations to the child. The nurse should expect which reaction from the child when she gives his immunizations? 1. The child will likely remain silent and still. 2. The child will likely cry and tell the nurse that it hurts. 3. The child will likely try to stall the nurse. 4. The child will likely remain still while telling the nurse that she is hurting him.

ANS: 2 The common response of a 5-year-old is to cry and protest during an immunization.

A 2-day-old girl is being discharged from the hospital. Her mother asks the nurse when she will receive her first hepatitis B immunization. Which is the nurse's best response? 1. "Babies receive the hepatitis B vaccine only if their mother is hepatitis B-positive." 2. "She will receive her first dose of the hepatitis B vaccine prior to discharge today." 3. "She will receive her first hepatitis B vaccine when she is 1 year of age." 4. "She will receive her first hepatitis B vaccine at 6 months of age."

ANS: 2 The first dose of hepatitis B vaccine is recommended between birth and 2 months. Most hospitals give the vaccine prior to discharge home.

A mother requests that her child receive the varicella vaccine at her 9-month well-child checkup. The nurse tells the mother that: 1. Children who are vaccinated will likely develop a mild case of the disease from the vaccine. 2. The nurse cannot give the vaccine. 3. The nurse will administer the vaccine after the physician examines the child. 4. The child will need a booster vaccination at 18 months of age.

ANS: 2 The nurse should not give the vaccine. The varicella vaccine is not usually administered prior to 1 year of age.

The nurse caring for an 8-year-old boy is trying to encourage developmental growth. What activity can the nurse provide for the child to encourage his sense of industry? 1. Allow the child to choose what time to take his medication. 2. Provide the child with the homework his teacher has sent in. 3. Allow the child to assist with his bath. 4. Allow the child to help with his dressing change.

ANS: 2 The school-age child is focused on aca- demic performance; therefore the child can achieve a sense of industry by com- pleting his homework and staying on track with his classmates.

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

ANS: 2 This is common behavior. Girls of 9 and 10 generally prefer to have friends who are of the same gender.

Which of the following are stressors common to hospitalized toddlers? Select all that apply. 1. Social isolation. 2. Interrupted routine. 3. Sleep disturbances. 4. Self-concept disturbances. 5. Fear of being hurt.

ANS: 2,3,5 2. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. 3. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. 5. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. The stressors of social iso- lation and self-concept disturbances are stressors of the hospitalized teen.

The nurse caring for a 4-year-old female in the ER is about to start a peripheral IV. The nurse's best method for explaining the procedure to the child is to: 1. Show the child a pamphlet with pictures showing the IV placement procedure. 2. Have the 5-year-old patient next door tell the 4-year-old about her experience with her IV placement. 3. Show the child the IV placement equipment, and demonstrate the procedure on a doll. 4. Tell the child that if she remains still, the procedure will be over quickly.

ANS: 3 A 4-year-old child understands things in very concrete and simple terms. Therefore, medical play is an excellent method for helping her understand the procedure.

An 8-year-old is NPO while he awaits surgery for central line placement later in the afternoon. The nurse is trying to engage the child in some form of activity to distract him from thinking about his upcoming surgery. Which is the best method of distraction for a child of this age in this situation? 1. Encourage the child to use the telephone to call friends. 2. Encourage the child to watch television. 3. Encourage the child to play a board game. 4. Encourage the child to read the central line pamphlet he was given.

ANS: 3 A board game is the optimal choice be- cause school-age children enjoy being engaged in an activity with others that will require some skill and challenge.

A 3-year-old was admitted to the hospital with croup. His nurse just obtained vital signs. The child's heart rate is 90, his respiratory rate is 44, his blood pressure is 100/52, and his temperature is 98.8°F (37.1° C). The parents ask the nurse if his vital signs are appropriate for a child his age. The nurse's best response to the parents is: 1. "Your son's blood pressure is elevated, but the other vital signs are within normal limits." 2. "Your son's temperature is elevated, but the other vital signs are within normal limits." 3. "Your son's respiratory rate is elevated, but the other vital signs are within normal limits." 4. "Your son's heart rate is elevated, but the ogther vital signs are within normal limits."

ANS: 3 A normal respiratory rate for a child from 3 to 6 years is 20 to 30 breaths per minute.

A 3-year-old female is hospitalized for a femur fracture. As her nurse, what nursing action would help foster the child's sense of autonomy? 1. Allow the child to choose what time to take her oral antibiotics. 2. Allow the child to have a doll for medical play. 3. Allow the child to administer her own dose of Keflex (cephalexin) via oral syringe. 4. Allow the child to watch age-appropriate videos.

ANS: 3 Allowing toddlers to participate in actions of which they are capable is an excellent way to enhance their autonomy.

A 16-year-old boy has a diagnosis of new onset diabetes. The child is meeting with the nurse educator regarding changes that will need to be made in his diet. What would most influence a teenager's food choices? 1. Parents and their dietary choices. 2. Cultural background. 3. Peers and their dietary choices. 4. Television and other forms of media influence.

ANS: 3 As a teen, the child is most influenced by his peers. Teens long to be like others around them.

The parents of a 7-month-old girl are attending a class on child safety. Following the class, what should the child's parents understand as one of the most common causes of injury and death for a 7-month-old child? 1. Poisoning. 2. Child abuse. 3. Aspiration. 4. Dog bites.

ANS: 3 Aspiration is a common cause of injury and death among children of this age. These children often find small objects lying on the floor and place them in their mouths. Older siblings are often responsible for leaving small objects around.

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

ANS: 3 Children should double their birth weight by 4 to 6 months of age.

A 12-month-old boy weighed 8 lb 2 oz at birth. Understanding developmental mile- stones, what should the nurse caring for the child calculate his current weight as? 1. Approximately 16 lb 4 oz. 2. Approximately 20 lb 5 oz. 3. Approximately 24 lb 6 oz. 4. Approximately 32 lb 8 oz.

ANS: 3 Children should triple their birth weight by 12 months of age.

The mother has brought her 16-year-old daughter to the ER because she is concerned her daughter is anorexic. During the child's initial physical assessment, the nurse notes the daughter has signs and symptoms of nutritional deficit. Which assessment item led the nurse to this initial conclusion? 1. The child has a protein level within normal limits. 2. The child's blood pressure is 110/66. 3. The child's hair and nails are brittle and dry. 4. The child's teeth appear to be eroded.

ANS: 3 Dry and brittle hair and nails are common among people who have a nutritional deficit.

A 13-year-old boy is visiting the pediatrician's office for his well-child checkup. The child tells the nurse that he is worried because his breasts are growing and they hurt. He tells the nurse he is afraid to take his shirt off in front of the other boys during gym class. What should the nurse tell him? 1. "The pediatrician will draw some blood to find out why your breasts are growing." 2. "It is just a slight hormonal imbalance that can be easily corrected with medication." 3." This is a normal condition of puberty that will resolve within a year or two." 4. "This is a rare finding that occurs in about 5% of boys during puberty."

ANS: 3 Gynecomastia and breast tenderness are common for about a third of boys during middle puberty. Gynecomastia usually resolves in 2 years.

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

ANS: 3 Having parents hold their child while in the hospital is an excellent means of building the trust relationship. Infants are most secure when they are being held, patted, and spoken to.

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

ANS: 3 It is very important to try to maintain a child's home routine both when par- ents are present and when they have to leave the hospital. This will increase the child's sense of security and de- crease anxiety.

The nurse is caring for a 7-year-old female on the school-age unit. Her mother is con- cerned that she may have some developmental delays. Which of the following statements would indicate to the nurse that the child is not developmentally on track for her age: 1. The child is able to follow a four-to-five-step command. 2. The child started wetting the bed on this admission to the hospital. 3. The child has an imaginary friend named Kelly. 4. The child enjoys playing board games with her sister.

ANS: 3 Most school-age children do not have imaginary friends. This is much more common for children of 3 and 4 years of age.

A 7-year-old female is being admitted to the hospital for a diagnosis of acute lympho- cytic leukemia. The nurse wants to gather information from the child regarding her feelings about her diagnosis. Which nursing action is most appropriate to gain infor- mation about how the child is feeling? 1. The nurse should actively attempt to make friends with the child before asking her about her feelings. 2. The nurse should ask the child's parents what feelings she has expressed in regard to her diagnosis. 3. The nurse should provide the child with some paper to draw a picture of how she is feeling. 4. The nurse should ask the child direct questions about how she is feeling.

ANS: 3 Often children will include much more detail of their feelings in drawings. They will often express things in pictures they are unable to verbalize.

The nurse is instructing a new breastfeeding mother in the need to provide her pre- mature infant with an adequate source of iron in her diet. Which one of the following statements reflects a need for further education of the new mother? 1. "I will use only breast milk or an iron-fortified formula as a source of milk for my baby until she is at least 12 months old." 2. "My baby will need to have iron supplements introduced when she is 4 months old." 3. "I will need to add iron supplements to my baby's diet when she is 9 months old." 4. "When my baby begins to eat solid foods, I should introduce iron-fortified cereals to her diet."

ANS: 3 Premature infants have iron stores from the mother that last approxi- mately 2 months, so it is important to introduce an iron supplement by 2 months. Full-term infants have iron stores that last approximately 4 to 6 months.

A 4-year-old is visiting the pediatrician's office for his well-child checkup. The nurse needs to take his blood pressure. Which action by the nurse is a developmentally appropriate method for eliciting the child's cooperation? 1. Have the child's parents help put on the blood pressure cuff. 2. Tell the child that if he sits still, the blood pressure machine will go quickly. 3. Ask the child if he feels a squeezing of his arm. 4. Tell the child that blood pressures do not hurt.

ANS: 3 Preschool children enjoy games, and it is a good way to elicit their assistance and cooperation during a procedure.

An 8-year-old girl is at the pediatrician's office for a well-child checkup. Her mother tells the nurse that she has been having some difficulty getting her daughter to com- plete her chores. The child's mother asks the nurse for techniques for gaining the child's cooperation with chores. Which of the following should the nurse suggest the mother do? 1. Use "grounding" as a technique. 2. Use "time-out" as a technique. 3. Use a reward system as a technique. 4. Use spanking as a technique.

ANS: 3 School-age children usually respond very well to a reward system and often enjoy the rewards so much that they will continue chores without continual reminders.

The mother of a 15-year-old boy is frustrated because he spends much of his weekend time sleeping. She informs the nurse, "My son sleeps longer now than he did when he was in kindergarten." What is the nurse's best response to the child's mother's frustration? 1. "Your son may be trying to catch up on the sleep he misses during the week while he is studying." 2. "Developmental theorists believe that teens require more sleep as they begin to integrate new roles into their lives." 3. "Teens require more sleep due to the rapid physical growth that is occurring during adolescence." 4. "Teens require more sleep due to the increase in their social obligations."

ANS: 3 Teens require more sleep due to the rapid physical growth that occurs during adolescence.

A 5-year-old boy is being screened for developmental delays using the Denver Developmental Screening Test. The child's mother is explaining to the nurse her understanding of the screening test. The nurse realizes that the child's mother needs further education about the test when she states which of the following? 1. "It screens my son's gross motor skills." 2. "It screens my son's fine motor skills." 3. "It screens my son's intelligence level." 4. "It screens my son's language development."

ANS: 3 The Denver Developmental Test does not test a child's level of intelligence.

A 2-day-old girl is being discharged home. The nurse is working on discharge teach- ing with her parents. They are asking the nurse about how to use the infant car seat and where it should be placed in their vehicle. Which of the following should the nurse do? 1. Give the parents a pamphlet explaining how to install the car seat. 2. Accompany the parents to the car, and show them how to install the car seat. 3. Contact the hospital's car-seat safety officer, and ask the officer to accompany the parents to the car for car-seat installation. 4. Show the parents a video on car-seat installation and safety, and ask if they are comfortable with the information.

ANS: 3 The car-seat safety officer is the best choice, as that individual would have the needed information and certification to help the family.

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

ANS: 3 The nurse should tell the child's mother that this is a normal finding in teenage girls as they enter puberty.

The mother of a child 2 years 6 months has arranged a play date with the neighbor and her 3-year-old daughter. During the play date the two mothers should expect that the children will do which of the following? 1. The children will share and trade their toys while playing. 2. The children will play with one another with little or no conflict. 3. The children will play alongside one another but not actively with one another. 4. The children will play with one or two items, ignoring most of the other toys.

ANS: 3 Toddlers engage in parallel play. They often play alongside another child but they rarely engage in activities with the other child.

An 8-week-old male has just had surgery for pyloric stenosis. His nurse is assessing his level of pain. The child's mother asks the nurse what vital sign changes she should expect to see in a child who is experiencing pain. The nurse's best response is: 1. "We expect to see a child's heart rate decrease and respiratory rate increase." 2. "We expect to see a child's heart rate and blood pressure decrease." 3. "We expect to see a child's heart rate and blood pressure increase." 4. "We expect to see a child's heart rate increase and blood pressure decrease."

ANS: 3 When a child is experiencing pain, the normal physiological response is for the heart rate, respiratory rate, and blood pressure to increase.

An 8-day old female was admitted to the hospital with vomiting and dehydration. The nurse has just obtained vital signs. The child's heart rate is 185, her respiratory rate is 44, her blood pressure is 85/52, and her temperature is 99°F (37.2° C). The child's parents ask the nurse if her vital signs are within normal limits. What is the nurse's best response to the parents? 1. "Your daughter's blood pressure is elevated, but the other vital signs are within normal limits." 2. "Your daughter's temperature is elevated, but the other vital signs are within normal limits." 3. "Your daughter's respiratory rate is elevated, but the other vital signs are within normal limits." 4. "Your daughter's heart rate is elevated, but the other vital signs are within normal limits."

ANS: 4 A normal heart rate for a child from birth to 1 month is 90 to 160.

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

ANS: 4 Developmental theorists like Erickson and Freud believe that toilet training is the essential event that must be mas- tered by the toddler.

The parents of a 2-year-old boy are concerned about his behavior. Since the child's admission to the hospital 2 days ago he has been crying much more than usual and is inconsolable much of the time. The nurse's best response to the child's parents is: 1. The child is in the detachment phase of separation anxiety, which is normal for children during hospitalization. 2. The child is in the despair stage of separation anxiety, which is normal for children during hospitalization. 3. The child is in the bargaining stage of separation anxiety, which is normal for children during hospitalization. 4. The child is in the protest stage of separation anxiety, which is normal for children during hospitalization.

ANS: 4 During the protest stage of separation anxiety, children are often inconsolable, and they often cry more than they do when they are at home. These children also frequently ask to go home.

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

ANS: 4 Infants are most secure when in prox- imity to the parent. The parent's lap is an excellent place to assess the child.

A 5-year-old girl has been brought to the ER for suspected child abuse. What approach should the nurse use to gather information from the child? 1. The nurse should promise the child that her parents will not know what she tells the nurse. 2. The nurse should promise the child that she will not have to see the suspected abuser again. 3. The nurse should use correct anatomical terms to discuss body parts. 4. The nurse should tell the child that the abuse is not her fault and that she is a good person.

ANS: 4 Many young children believe abuse or illness is their fault, and they should be reminded they are not to blame. Many children of this age believe they have acquired a disease or have been abused because they are bad people.

The school nurse is preparing a discussion on nutrition with the fourth-grade class. Based on the childrens' developmental level, what information should she include in her presentation? 1. A review of the number of calories that a fourth-grade child should consume in a day. 2. A review of a list of high-calorie foods that all fourth-graders should avoid. 3. A review of how to read food labels so children know which foods are good for them. 4. A review of nutritious foods with basic scientific information about how they affect the body organs and systems.

ANS: 4 Reviewing nutritious choices keeps the lesson on a positive note, and school- age children are very interested in how food affects their bodies. They are ca- pable of understanding basic medical terminology.

An 11-year-old male is being evaluated in the ER for an inguinal hernia. Which statement accurately describes how the nurse should approach him for his physical assessment? 1. The nurse should ask the child's parents to remain in the room during the physical exam. 2. The nurse should auscultate the child's heart, lungs, and abdomen first. 3. The nurse should explain to the child that the physical exam will not hurt. 4. The nurse should explain to the child what the nurse will be doing in basic understandable terms.

ANS: 4 School-age children are capable of understanding basic functions of the body and should be taught about their diagnosis in simple, basic terms.

A 17-year-old male has had some recent behavioral changes. His mother calls the nurse at the pediatrician's office and tells her that her son has been coming home from school every day, closing his door, and refraining from interaction with his parents. The child's mother does not know what she should do about her son's unsociable behavior. The nurse's best response to the child's mother is: 1. "You should go speak with your son and ask him directly what is wrong with him." 2. "You should set limits with your son and tell him that this is unacceptable behavior." 3. "Your son's behavior is abnormal, and he is going to need a psychiatric referral." 4. "Your son's behavior is normal. You should listen to him without being judgmental."

ANS: 4 The child's behavior is typical of a teen's response to developmental and psychosocial changes of adolescence.

A 2-year-old girl has just become a big sister. Her mother has been a stay-at-home mother. Based on the developmental level of a 2-year-old, which comment should the child's mother expect from her toddler about her new baby brother? 1. "Mommy, when my baby brother takes a nap, will you play with me?" 2. "Mommy, can I play with my baby brother?" 3. "Mommy, he is so cute. I love him." 4. "Mommy, it is time to put him away so we can play."

ANS: 4 This is a typical statement that would be made by a toddler. Toddlers are very egocentric and do not consider the needs of the other child.

What describes a child who is abused by the parent(s)? a. Unintentionally contributes to the abusing situation b. Belongs to a low socioeconomic population c. Is healthier than the nonabused siblings d. Abuses siblings in the same way as child is abused by the parent(s)

ANS: A A child's temperament, position in the family, additional physical needs, activity level, or degree of sensitivity to parental needs unintentionally contributes to the abusing situation. Socioeconomic status is an environmental characteristic. This child is less likely to be abused than one who is premature, disabled, or very young. The abused child does not in turn abuse his or her siblings.

Preschoolers' fears can best be dealt with by: a. Actively involving them in finding practical methods to deal with the frightening experience. b. Forcing them to confront the frightening object or experience in the presence of their parents. c. Using logical persuasion to explain away their fears and help them recognize how unrealistic the fears are. d. Ridiculing their fears so they understand that there is no need to be afraid.

ANS: A Actively involving the child in finding practical methods to deal with the frightening experience is the best way to deal with fears. Forcing a child to confront fears may make the child more afraid. Preconceptual thought prevents logical understanding. Ridiculing

Which aspect of cognition develops during adolescence? a. Capability to use a future time perspective b. Ability to place things in a sensible and logical order c. Ability to see things from the point of view of another d. Progress from making judgments based on what they see to making judgments based on what they reason

ANS: A Adolescents are no longer restricted to the real and actual. They also are concerned with the possible; they think beyond the present. During concrete operations (between ages 7 and 11 years) children exhibit the ability to place things in a sensible and logical order, the ability to see things from another's point of view, and the ability to make judgments based on what they reason rather than just what they see.

An appropriate play activity for a 7-month-old infant to encourage visual stimulation is: a. Playing peek-a-boo. b. Playing pat-a-cake. c. Imitating animal sounds. d. Showing how to clap hands.

ANS: A Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation. Playing pat-a-cake and showing how to clap hands will help with kinetic stimulations. Imitating animal sounds will help with auditory stimulation.

The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as: a. A normal finding. b. A questionable finding—infant should be rechecked in 1 month. c. An abnormal finding—indicates need for immediate referral to practitioner. d. An abnormal finding—indicates need for developmental assessment.

ANS: A Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required.

The nurse is interviewing the father of 10-month-old Megan. She is playing on the floor when she notices an electrical outlet and reaches up to touch it. Her father says "No" firmly and removes her from near the outlet. The nurse should use this opportunity to teach the father that Megan: a. Is old enough to understand the word "No." b. Is too young to understand the word "No." c. Should already know that electrical outlets are dangerous. d. Will learn safety issues better if she is spanked.

ANS: A By age 10 months children are able to associate meaning with words. The father is using both verbal and physical cues to alert the child to dangerous situations. The child should be old enough to understand the word "No." The 10-month-old is too young to understand the purpose of an electric outlet. The father is using both verbal and physical cues to teach safety measures. Physical discipline should be avoided.

In terms of fine motor development, the infant of 7 months should be able to: a. Transfer objects from one hand to the other. b. Use thumb and index finger in crude pincer grasp. c. Hold crayon and make a mark on paper. d. Release cubes into a cup.

ANS: A By age 7 months infants can transfer objects from one hand to the other, crossing the midline. The crude pincer grasp is apparent at about age 9 months. The child can scribble spontaneously at age 15 months. At age 12 months the child can release cubes into a cup.

Samantha, age 5 years, tells the nurse that she "needs a Band-Aid" where she had an injection. The best nursing action is to: a. Apply a Band-Aid. b. Ask her why she wants a Band-Aid. c. Explain why a Band-Aid is not needed. d. Show her that the bleeding has already stopped.

ANS: A Children at this age group still fear that their insides may leak out at the injection site. Provide the Band-Aid. No explanation should be required.

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

ANS: A Children at this age may view illness or injury as a punishment for a real or imagined mystique. The belief in divine punishment is common at this age.

Which statement is true about smoking in adolescence? a. Smoking is related to other high-risk behaviors. b. Smoking is more common among athletes. c. Smoking is less common when the adolescent's parent(s) smokes. d. Smoking among adolescents is becoming more prevalent.

ANS: A Cigarettes are considered a gateway drug. Teenagers who smoke are 11.4 times more likely to use an illicit drug. Teens who refrain from smoking often have a desire to succeed in athletics. If a parent smokes, it is more likely that the teen will smoke. Cigarette smoking has declined among all groups since the 1990s.

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

ANS: A Cognitive thinking culminates with capacity for abstract thinking. This stage, the period of formal operations, is Piaget's fourth and last stage. The concrete operations stage usually develops between ages 7 and 11 years. Conventional and postconventional thought refer to Kohlberg's stages of moral development.

Four-year-old Brian appears to be upset by hospitalization. An appropriate intervention is to: a. Let him know that it is all right to cry. b. Give him time to gain control of himself. c. Show him how other children are cooperating. d. Tell him what a big boy he is to be so quiet.

ANS: A Crying is an appropriate behavior for the upset preschooler. The nurse provides support through physical presence. Giving the child time to gain control is appropriate, but the child must know that crying is acceptable. The preschooler does not engage in competitive behaviors.

The most fatal type of burn in the toddler age group is: a. Flame burn from playing with matches. b. Scald burn from high-temperature tap water. c. Hot object burn from cigarettes or irons. d. Electric burn from electrical outlets.

ANS: A Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age group. Scald burns from water, hot object burns from cigarettes or irons, and electric burns from outlets are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use.

Matthew, age 18 months, has just been admitted with croup. His parent is tearful and tells the nurse, "This is all my fault. I should have taken him to the doctor sooner so he wouldn't have to be here." What is appropriate in the care plan for this parent who is experiencing guilt? a. Clarify the misconception about the illness. b. Explain to the parent that the illness is not serious. c. Encourage the parent to maintain a sense of control. d. Assess further why the parent has excessive guilt feelings.

ANS: A Guilt is a common response of parents when a child is hospitalized. They may blame themselves for the child's illness or for not recognizing it soon enough. The nurse should clarify the nature of the problem and reassure parents that the child is being cared for. Croup is a potentially very serious illness. The nurse should not minimize the parents' feelings. Encouraging the parent to maintain a sense of control would be difficult for the parents while their child is seriously ill. No further assessment is indicated at this time—guilt is a common response for parents.

Which statement is correct about childhood obesity? a. Heredity is an important factor in the development of obesity. b. Childhood obesity in the United States is decreasing. c. Childhood obesity is the result of inactivity. d. Childhood obesity can be attributed to an underlying disease in most cases.

ANS: A Heredity is an important fact that contributes to obesity. Identical twins reared apart tend to resemble their biologic parents to a greater extent than their adoptive parents. It is difficult to distinguish between hereditary and environmental factors. The rate of childhood obesity has increased so dramatically that it has now reached epidemic proportions. Inactivity is an important contributing factor; however, obesity is the result of a combination of a number of other factors. Fewer than 5% of all cases of obesity can be linked to underlying disease.

When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as: a. Punishment. b. Threat to child's self-image. c. An opportunity for regression. d. Loss of companionship with friends.

ANS: A If a toddler is not prepared for hospitalization, a typical preschooler fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds. Threat to child's self-image and loss of companionship with friends are reactions typical of school-age children. Regression is a response characteristic of toddlers when threatened with loss of control.

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

ANS: A In adolescence nutritional needs are closely related to the increase in body mass. The peak requirements occur in the years of maximal growth. The caloric and protein requirements are higher than at almost any other time of life. This describes the expected eating pattern for young adolescents as long as weight and height are appropriate; obesity is not a concern.

Sara, age 4 months, was born at 35 weeks' gestation. She seems to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was term. The nurse should explain that: a. Infants' temperaments are part of their unique characteristics. b. Infants become less difficult if they are not kept on scheduled feedings and structured routines. c. Sara's behavior is suggestive of failure to bond completely with her parents. d. Sara's difficult temperament is the result of painful experiences in the neonatal period.

ANS: A Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant's unique temperament. Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. Sara's temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to Sara's temperament.

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

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

In terms of cognitive development the 5-year-old child would be expected to: a. Use magical thinking. b. Think abstractly. c. Understand conservation of matter. d. Be unable to comprehend another person's perspective.

ANS: A Magical thinking is believing that thoughts can cause events. Abstract thought does not develop until school-age years. The concept of conservation is the cognitive task of school-age children ages 5 to 7 years. Five-year-olds cannot understand another's perspective.

Parents tell the nurse that their toddler daughter eats little at mealtime, only sits at the table with the family briefly, and wants snacks "all the time." The nurse should recommend that the parents: a. Give her planned, frequent, and nutritious snacks. b. Offer rewards for eating at mealtimes. c. Avoid snacks so she is hungry at mealtimes. d. Explain to her in a firm manner what is expected of her.

ANS: A Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirement associated with the slower growth rate. Parents should assist the child to develop healthy eating habits. The toddler is often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat nonnutritious foods in response.

Which statement characterizes moral development in older school-age children? 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 and 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. Both the situation and the morality of the rule itself influence reactions.

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? a. Roll from abdomen to back. b. Roll from back to abdomen. c. Sit erect without support. d. Move from prone to sitting position.

ANS: A Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position.

An adolescent girl tells the nurse that she is very suicidal. The nurse asks her if she has a specific plan. Asking this should be considered: a. An appropriate part of the assessment. b. Not a critical part of the assessment. c. Suggesting that the adolescent needs a plan. d. Encouraging the adolescent to devise a plan.

ANS: A Routine health assessments of adolescents should include questions that assess the presence of suicidal ideation or intent. Questions such as, "Have you ever developed a plan to hurt yourself or kill yourself" should be part of that assessment. Threats of suicide should always be taken seriously and evaluated. Suggesting that the adolescent needs a plan and encouraging them to devise this plan are inappropriate statements by the nurse.

Natasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What will help her most in her adjustment to the hospital? a. Explain hospital schedules such as mealtimes. b. Use terms such as "honey" and "dear" to show a caring attitude. c. Explain when parents can visit and why siblings cannot come to see her. d. Orient her parents, because she is young, to her room and hospital facility.

ANS: A School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for experiences that are unavoidable. The nurse should refer to the child by the preferred name. Telling the child about all of the limitations of visiting does not help her adjust to the hospital. At the age of 8 years the child and parent should be oriented to the environment.

A common characteristic of those who sexually abuse children is that they: a. Pressure the victim into secrecy. b. Are usually unemployed and unmarried. c. Are unknown to victims and victims' families. d. Have many victims that are each abused only once.

ANS: A Sex offenders may pressure the victim into secrecy, regarding the activity as a "secret between us" that other people may take away if they find out. Abusers are often employed upstanding members of the community. Most sexual abuse is committed by men and persons who are well known to the child. Abuse is often repeated with the same child over time. The relationship may start insidiously without the child realizing that sexual activity is part of the offer.

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

ANS: A Signs of stress include stomach pains or headache, sleep problems, bed-wetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. This child is exhibiting signs of stress.

What information could be given to the parents of a 12-month-old child regarding appropriate play activities for this age? 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 a stand and walk holding on or independently. Appropriate toys for this age child include large pull toys for kinesthetic stimulation. A cradle gym 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.

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

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

By what age does the posterior fontanel usually close? a. 6 to 8 weeks c. 4 to 6 months b. 10 to 12 weeks d. 8 to 10 months

ANS: A The bones surrounding the posterior fontanel fuse and close by age 6 to 8 weeks. Ten weeks or longer is too late.

The best play activity for a 6-month-old infant to provide tactile stimulation is to: a. Allow to splash in bath. b. Give various colored blocks. c. Play music box, tapes, or CDs. d. Use infant swing or stroller.

ANS: A The feel of the water while the infant is splashing provides tactile stimulation. Various colored blocks provide visual stimulation for a 4- to 6-month-old. Music box, tapes, and CDs provide auditory stimulation. Swings and strollers provide kinesthetic stimulation.

The nurse notices that a 10-month-old infant being seen in the clinic is wearing expensive, inflexible, high-top shoes. The nurse should explain that: a. Soft and flexible shoes are generally better. b. High-top shoes are necessary for support. c. Inflexible shoes are necessary to prevent in-toeing and out-toeing. d. This type of shoe will encourage the infant to walk sooner.

ANS: A The main purpose of the shoe is protection. Soft, well-constructed, athletic-type shoes are best for infants and children. High-top shoes are not necessary for support but may be helpful keeping the child's foot in the shoe. Inflexible shoes can delay walking, aggravate in-toeing and out-toeing, and impede development of the supportive foot muscles.

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

ANS: A The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications only a locked cabinet is safe. Toddlers can climb by using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize as dangerous all of the different forms of medications that may be available in the home. This is not feasible. Many parents require medications for chronic illnesses. They must be taught safe storage for their home and when they visit other homes.

What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Separation anxiety b. Loss of control c. Fear of bodily injury d. Fear of pain

ANS: A The major stress for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age group.

A 14-year-old boy and his parents are concerned about bilateral breast enlargement. The nurse's discussion of this should be based on knowing that: a. This is usually benign and temporary. b. This is usually caused by Klinefelter syndrome. c. Administration of estrogen effectively reduces gynecomastia. d. Administration of testosterone effectively reduces gynecomastia.

ANS: A The male breast responds to hormone changes. Some degree of bilateral or unilateral breast enlargement occurs frequently in boys during puberty. This is not a manifestation of Klinefelter syndrome. Administration of estrogen and testosterone will have no effect on the reduction of breast tissue and may aggravate the condition.

A mother calls the school nurse saying that her daughter has developed a school phobia. She has been out of school 3 days. The nurse's recommendations should include: a. Immediately returning the child to school. b. Explaining to the child that this is the last day she can stay home. c. Determining the cause of the phobia before returning child to school. d. Seeking professional counseling before forcing child to return to school.

ANS: A The primary goal is to return the child to school. Parents must be convinced gently but firmly that immediate return is essential and that it is their responsibility to insist on school attendance. Telling the child that this is the last day she can stay home will increase the fear of the child. She must play a role in preparing for her return to school. Beginning with half days might be beneficial. The child may not be able to identify the cause for the phobia. Treatment will depend on the cause if known. Relaxation techniques are commonly used. Professional counseling is usually not necessary to resolve this condition.

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. The nurse should interpret this as: a. Normal development. b. Significant developmental lag. c. Slightly delayed development caused by prematurity. d. Suggestive of a neurologic disorder such as cerebral palsy.

ANS: A This indicates normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. No evidence of neurologic dysfunction is present.

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, "Wait a minute," and, "I'm not ready." The nurse should recognize that: a. This is normal behavior for a school-age child. b. This behavior is usually not seen past the preschool years. c. The child thinks the nurse is punishing her. d. The child has successfully manipulated the nurse in the past.

ANS: A This school-age child is attempting to maintain control. The nurse should provide the girl with structured choices about when the IV will be inserted. This can be characteristic behavior when an individual needs to maintain some control over a situation. The child is trying to have some control in the hospital experience.

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

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

Turner's syndrome is suspected in an adolescent girl with short stature. This is caused by: a. Absence of one of the X chromosomes. b. Presence of an incomplete Y chromosome. c. Precocious puberty in an otherwise healthy child. d. Excess production of both androgens and estrogens.

ANS: A Turner's syndrome is caused by an absence of one of the X chromosomes. Most girls who have this disorder have one X chromosome missing from all cells. A Y chromosome is not part of the genetic makeup of girls. Puberty is delayed and amenorrhea is a clinical manifestation in girls with Turner's syndrome. These girls often need hormone therapy to increase their levels of these hormones.

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

ANS: A Tying shoelaces is a fine motor task typical of 5-year-olds. Using a knife to cut meat is a fine motor task of a 7-year-old. Hammering a nail and making change from a quarter are fine motor tasks of an 8- to 9-year-old.

The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Data collection should include the: a. Mode of administration. b. Actual content of the drug. c. Function the drug plays in the adolescent's life. d. Adolescent's level of interest in rehabilitation.

ANS: A When the drug is questionable or unknown, every effort must be made to determine the type, amount of drug taken, the mode and time of administration, and factors relating to the onset of presenting symptoms. Because the actual content of most street drugs is highly questionable, this information would be difficult to obtain. It is helpful to know the pattern of use but not essential during this emergency. This is an inappropriate time for an evaluation about the level of interest in rehabilitation.

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? Choose all that apply. a. Roll from abdomen to back b. Put feet in mouth when supine c. Roll from back to abdomen d. Sit erect without support e. Move from prone to sitting position f. Adjust posture to reach an object

ANS: A, B Rolling from abdomen to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant.

Strict isolation is required for a child who is hospitalized with (choose all that apply): a. Mumps. b. Chickenpox. c. Exanthema subitum (roseola). d. Erythema infectiosum (fifth disease). e. Parvovirus B19.

ANS: A, B, C, D Childhood communicable diseases requiring strict transmission-based precautions (contact, airborne, droplet) include: diphtheria, chickenpox, measles, mumps, tuberculosis, adenovirus, hemophilus B, mumps, pertussis, plague, streptococcal pharyngitis or scarlet fever. Strict isolation is not required for parvovirus B19.

Pacifiers can be extremely dangerous because of the frequency of use and the intensity of the infant's suck. In teaching parents about appropriate pacifier selection, the nurse should explain that a pacifier should have which characteristics? Choose all that apply. a. Easily grasped handle b. One-piece construction c. Ribbon or string to secure to clothing d. Soft, pliable material e. Sturdy, flexible material

ANS: A, B, E A good pacifier should be easily grasped by the infant. One-piece construction is necessary to avoid having the nipple and guard separate. The material should be sturdy and flexible. An attached ribbon or string and soft, pliable material are not characteristics of a good pacifier.

A 9-year-old child has just been diagnosed with recurrent abdominal pain (RAP). What should the nurse include in preparing the family for discharge? Choose all that apply. a. "Your child should be on a high-fiber diet." b. "You may give your child a stimulant laxative once a week." c. "You should help your child with bowel training to establish regular bowel habits." d. "Your child may place ice packs on the abdomen when pain occurs."

ANS: A, C A high-fiber diet with possible addition of bulk laxatives is beneficial in children with RAP. Bowel training is recommended to assist the child in establishing regular bowel habits. Giving a child a stimulant laxative once a week and placing ice packs on the abdomen for pain would not be included in discharge teaching for this patient and family.

Research has shown that the most successful smoking cessation programs among teens include (choose all that apply): a. Peer-led education and support. b. Information on the long-term effects of smoking. c. Programs including the media. d. School-based programs. e. Information on the immediate effects of smoking.

ANS: A, C, D, E Two areas of antismoking campaigns that have shown success are those that are peer-led and use media in education related to smoking prevention. School-based programs have also shown success and can be strengthened by expansion into the community and youth groups. Teens respond much better to education that focuses on the immediate effects of smoking. For the most part, smoking prevention programs that focus on the negative long-term effects of smoking have been ineffective.

Ryan has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and Ryan's condition is beginning to stabilize. When speaking with the parents, the nurses should expect which stressors to be evident? Choose all that apply. a. Unfamiliar environment b. Usual day-night routine c. Strange smells d. Provision of privacy e. Inadequate knowledge of condition and routine

ANS: A, C, E Intensive care units, especially when the family is unprepared for the admission, are a strange and unfamiliar place. There are many pieces of unfamiliar equipment, and the sights and sounds are much different from a general hospital unit. Also, with the child's condition being more precarious, it may be difficult to keep the parents updated and knowledgeable about what is happening. Lights are usually on around the clock, seriously disrupting the diurnal rhythm. There is usually little privacy available for families in intensive care units.

The nurse is caring for a hospitalized 4-year-old boy, Ryan. His parents tell the nurse that they will be back to visit at 6 PM. When Ryan asks the nurse when his parents are coming, the nurse's best response is: a. "They will be here soon." b. "They will come after dinner." c. "Let me show you on the clock when 6 PM is." d. "I will tell you every time I see you how much longer it will be."

ANS: B A 4-year-old understands time in relation to events such as meals. Children perceive "soon" as a very short time. The nurse may lose the child's trust if his parents do not return in the time he perceives as "soon." Children cannot read or use a clock for practical purposes until age 7 years. This answer assumes that the child understands the concept of hours and minutes, which is not developed until age 5 or 6 years.

The parent of a 4-year-old son tells the nurse that the child believes "monsters and boogeyman" are in his bedroom at night. The nurse's best suggestion for coping with this problem is to: a. Insist that the child sleep with his parents until the fearful phase passes. b. Suggest involving the child to find a practical solution such as a night light. c. Help the child understand that these fears are illogical. d. Tell the child frequently that monsters and boogeyman 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 is in the preconceptual age and cannot understand logical thought.

An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler is to: a. Provide for privacy. b. Encourage parents to room in. c. Explain procedures and routines. d. Encourage contact with children the same age.

ANS: B A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room in as much as possible. Maintaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents. Contact with same-aged children would not substitute for having the parents present.

Acyclovir (Zovirax) is given to children with chickenpox to: a. Minimize scarring b. Decrease the number of lesions. c. Prevent aplastic anemia. d. Prevent spread of the disease.

ANS: B Acyclovir decreases the number of lesions; shortens duration of fever; and decreases itching, lethargy, and anorexia; however, it does not prevent scarring. Preventing aplastic anemia is not a function of acyclovir. Only quarantine of the infected child can prevent the spread of disease.

Kimberly's parents have been using a rearward-facing convertible car seat since she was born. Most car seats can be safely switched to the forward-facing position when the child weighs: a. 10 pounds c. 30 pounds b. 20 pounds d. 40 pounds

ANS: B Although the transition point for switching to the forward-facing position is defined by the manufacturer, it is generally at 9 kg or 20 pounds. Ten pounds is too small to be safe. The relatively large head of this size child should be in the rear-facing position. It is usually safe to put children who weigh more than 20 pounds in forward-facing convertible safety seats.

At what age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month c. 3 months b. 2 months d. 4 months

ANS: B At age 2 months the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. The 3-month-old can recognize familiar faces. At age 4 months the infant can enjoy social interactions.

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

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

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: a. 10 pounds c. 20 pounds b. 15 pounds d. 25 pounds

ANS: B Birth weight doubles at about age 5 to 6 months. At 6 months a child who weighed 7 pounds at birth would weigh approximately 15 pounds. Ten pounds is too little. The infant would have gone from the 50th percentile at birth to below the 5th percentile. Twenty pounds or more is too much. The infant would have tripled the birth weight at 6 months.

In terms of language and cognitive development, a 4-year-old child would be expected to: a. Think in abstract terms. b. Follow simple commands. c. Understand conservation of matter. d. Comprehend another person's perspective.

ANS: B Children ages 3 to 4 years can give and follow simple commands. Children cannot think abstractly at age 4 years. Conservation of matter is a developmental task of the school-age child. A 4-year-old child cannot comprehend another's perspective.

The psychologic effects of being obese during adolescence include: a. Sexual promiscuity. b. Poor body image. c. Memory has no effect on eating behavior. d. Accurate body image but self-deprecating attitude.

ANS: B Common emotional consequences of obesity include poor body image, low self-esteem, social isolation, and feelings of depression and isolation. Sexual promiscuity is an unlikely effect of obesity. The obese adolescent often substitutes food for affection. Eating behaviors are closely related to memory. Memory and appetite are closely linked and can be modified over time with treatment. Obese adolescents most often have a very poor self-image.

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 is increased. Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contribute to fatigue.

Which statement best describes fear in school-age children? a. They are increasingly fearful for body safety. b. Most of the new fears that trouble them are related to school and family. c. They should be encouraged to hide their fears to prevent ridicule by peers. d. Those who have numerous fears need continuous protective behavior by parents to eliminate these fears.

ANS: B During the school-age years children experience a wide variety of fears, but new fears related predominantly to school and family bother children during this time. During the middle-school years children become less fearful of body safety than they were as preschoolers. Parents and other persons involved with children should discuss their fear with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding the fears does not end them and may lead to phobias.

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

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

What is descriptive of the preschooler's understanding of time? a. Has no understanding of time b. Associates time with events c. Can tell time on a clock d. Uses terms like "yesterday" appropriately

ANS: B In a preschooler's understanding time has a relation with events such as, "We'll go outside after lunch." Preschoolers develop an abstract sense of time at age 3 years. Children can tell time on a clock at age 7 years. Children do not fully understand use of time-oriented words until age 6 years.

Which statement accurately describes physical development during the school-age years? a. The child's weight almost triples. b. A child grows an average of 2 inches per year. c. Few physical differences are apparent among children at the end of middle childhood. d. Fat gradually increases, which contributes to the child's heavier appearance.

ANS: B In middle childhood growth in height and weight occur at a slower pace. Between the ages of 6 to 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.

In which communicable disease are Koplik spots present? a. Rubella b. Measles (rubeola) c. Chickenpox (varicella) d. Exanthema subitum (roseola)

ANS: B Koplik spots are small, irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before systemic rash. Koplik spots are not present with rubella, varicella, or roseola.

When 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 is in a transition period. The extrusion 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 less sensitive to potentially allergenic food. Infants of this age will try to help during feeding. Two to three months is too young. The extrusion reflex is strong, and the child will push food out with the tongue. No research base indicates that the addition of solid food to a bottle has any benefit. Infant birth weight doubles at 1 year. Solid foods can be started earlier. Tooth eruption can facilitate biting and chewing; most infant foods do not require this ability.

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

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

What is descriptive of the play of school-age children? 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.

A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was "bad." The nurse's best interpretation of this comment is that it is: a. A sign of stress. b. Common at this age. c. Suggestive of maladaptation. d. Suggestive of excessive discipline at home.

ANS: B Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think that they are directly responsible for events, making them feel guilt for things outside of their control. Children of this age show stress by regressing developmentally or acting out. Maladaptation is unlikely. This comment does not imply excessive discipline at home.

A 3-month-old infant dies shortly after arrival to the emergency department. The infant has subdural and retinal hemorrhages but no external signs of trauma. The nurse should suspect: a. Unintentional injury. b. Shaken-baby syndrome. c. Sudden infant death syndrome (SIDS). d. Congenital neurologic problem.

ANS: B Shaken-baby syndrome causes internal bleeding but may have no external signs. Violent shaking of the brain results in shearing forces that tears blood vessels and neurons. The baby will then present with subdural hematoma and retinal hemorrhage. This is not the characteristic injury pattern of a baby who has received an unintentional injury. With SIDS the baby usually presents to the emergency department with no signs of life. These findings are inconsistent with a congenital neurologic problem.

Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, "We are sick of Mom always sitting with you in the hospital and playing with you. It isn't fair that you get everything and we have to stay with the neighbors." The nurse's best assessment of this situation is that: a. The siblings are immature and probably spoiled. b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling. c. The family has ineffective coping mechanisms to deal with chronic illness. d. The siblings need to better understand their sister's illness and needs.

ANS: B Siblings experience loneliness, fear, worry, anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. These are not uncommon responses by normal siblings. There is no evidence that the family has maladaptive coping.

A normal characteristic of the language development of a preschool-age child is: a. Lisp b. Stammering c. Echolalia d. Repetition without meaning

ANS: B Stammering and stuttering are normal dysfluency in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers' language.

An appropriate recommendation in preventing tooth decay in young children is to: a. Substitute raisins for candy. b. Serve sweets after a meal. c. Use honey or molasses instead of refined sugar. d. Serve sweets between meals.

ANS: B Sweets should be consumed with meals so the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth. Raisins, honey, and molasses are highly cariogenic and should be avoided.

The mean age of menarche in the United States is: a. 11.5 years c. 13.5 years b. 12.75 years d. 14 years

ANS: B The average age of menarche is 12 years and 9.5 months in North American girls, with a normal range of 10.5 to 15 years.

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

ANS: B The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. Although motor vehicle collisions do cause injuries to bicyclists, most injuries result from falls. The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission. Children should not ride double.

The clinic is lending a federally approved car seat to an infant's family. The nurse should explain that the safest place to put the car seat is: a. Front facing in back seat. b. Rear facing in back seat. c. Front facing in front seat with airbag on passenger side. d. Rear facing in front seat if an air bag is on the passenger side.

ANS: B The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck. Infants should face the rear from birth to 20 pounds and as close to 1 year of age as possible. The middle of the back seat provides the safest position. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat

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

ANS: B Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. Intimacy is the developmental stage for early adulthood. Initiative is the developmental stage for early childhood. Independence is not one of Erikson's developmental stages.

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 the 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.

When teaching injury prevention during the school-age years, the nurse should include: a. Teach the need to fear strangers. b. Teach basic rules of water safety. c. Avoid letting children cook in microwave ovens. d. Caution children against engaging in competitive sports.

ANS: B Water safety instruction is an important source of injury prevention at this age. The child should be taught to swim, select safe and supervised places to swim, swim with a companion, check sufficient water depth for diving, and use an approved flotation device. Teach stranger safety, not fearing strangers. This includes not going with strangers, not having personalized clothing in public places, having children tell parents if anyone makes them uncomfortable, and teaching children to say "no" in uncomfortable situations. Teach children safe cooking methods. Caution against engaging in hazardous sports such as those involving trampolines.

When is a child with chickenpox considered to be no longer contagious? a. When fever is absent b. When lesions are crusted c. 24 hours after lesions erupt d. 8 days after onset of illness

ANS: B When the lesions are crusted, the chickenpox is no longer contagious. This may be a week after onset of disease. The child is still contagious once the fever has subsided, after the lesions erupt, and may or may not be contagious any time after 6 days as long as all lesions are crusted over.

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

ANS: B, C Usually by age 30 months, the primary dentition of 20 teeth is completed, and the child has sphincter control in preparation for bowel and bladder control. A doubling of birth weight, opening of the anterior fontanel, doubling of length, and handedness orientation are not characteristic of the physical development of a 30-month-old child.

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

ANS: C Associative play is group play in similar or identical activities but without rigid organization or rules. Solitary play is that of infants. Parallel play is that of toddlers. School-age children play in teams.

Most infants begin to fear strangers at age: a. 2 months c. 6 months b. 4 months d. 12 months

ANS: C Between ages 6 and 8 months fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and nonfamiliar people. At age 2 months infants are just beginning to respond differentially to the mother. At age 4 months the infant is beginning the process of separation individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the child does not fear strangers at this age.

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

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

What describes moral development in younger school-age children? a. The standards of behavior now come from within themselves. b. They do not yet experience a sense of guilt when they misbehave. c. They know the rules and behaviors expected of them but do not understand the reasons behind them. d. They no longer interpret accidents and misfortunes as punishment for misdeeds.

ANS: C Children who are ages 6 and 7 years know the rules and behaviors expected of them but do not understand the reasons for them. Young children do not believe that standards of behavior come from within themselves but that rules are established and set down by others. Younger school-age children learn standards for acceptable behavior, act according to these standards, and feel guilty when they violate them. Misfortunes and accidents are viewed as punishment for bad acts.

What behavior indicates that an infant has developed object permanence? a. Recognizes familiar face such as mother b. Recognizes familiar object such as bottle c. Actively searches for a hidden object d. Secures objects by pulling on a string

ANS: C During the first 6 months of life infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows that an object exists even when it is not visible. Between ages 8 and 12 weeks infants begin to respond differentially to the mother. They cry, smile, vocalize, and show distinct preference for the mother. This preference is one of the stages that influence the attachment process, but it is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence. The ability to understand cause and effect is part of secondary schema development.

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

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

During the preschool period the emphasis of injury prevention should be placed on: a. Constant vigilance and protection. b. Punishment for unsafe behaviors. c. Education for safety and potential hazards. d. Limitation of physical activities.

ANS: C Education for safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Constant vigilance and protection is not practical at this age since preschoolers are becoming more independent. Punishment may make children scared of trying new things. Limitation of physical activities is not appropriate.

Vitamin A supplementation may be recommended for the young child who has: a. Mumps. c. Measles (rubeola). b. Rubella. d. Erythema infectiosum.

ANS: C Evidence shows that vitamin A decreases morbidity and mortality associated with measles. Vitamin A will not lessen the effects of mumps, rubella or fifth disease.

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should recommend that the infant be given: a. Skim milk. b. Whole cow's milk. c. Commercial iron-fortified formula. d. Commercial formula without iron.

ANS: C For children younger than 1 year the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, iron-fortified commercial formula should be used. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia.

Which statement best describes the infant's physical development? a. Anterior fontanel closes by age 6 to 10 months. b. Binocularity is well established by age 8 months. c. Birth weight doubles by age 5 months and triples by age 1 year. d. Maternal iron stores persist during the first 12 months of life.

ANS: C Growth is very rapid during the first year of life. The birth weight has approximately doubled by age 5 to 6 months and triples by age 1 year. The anterior fontanel closes at age 12 to 18 months. Binocularity is not established until age 15 months. Maternal iron stores are usually depleted by age 6 months.

The school nurse tells adolescents in the clinic that confidentiality and privacy will be maintained unless a life-threatening situation arises. This practice is: a. Not appropriate in a school setting. b. Never appropriate because adolescents are minors. c. Important in establishing trusting relationships. d. Suggestive that the nurse is meeting his or her own needs.

ANS: C Health professionals who work with adolescents should consider the adolescents' increasing independence and responsibility while maintaining privacy and ensuring confidentiality. However, circumstances may occur in which they are not able to maintain confidentiality such as self-destructive behavior or maltreatment by others. Confidentiality and privacy are necessary to facilitate trust with this age group. The nurse must be aware of the limits placed on confidentiality by local jurisdiction.

The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven and will be able to heat the baby's formula faster. The nurse should recommend to: a. Never heat a bottle in a microwave oven. b. Heat only 10 ounces or more. c. Always leave bottle top uncovered to allow heat to escape. d. Shake bottle vigorously for at least 30 seconds after heating.

ANS: C If a microwave is being used, the bottle should be left uncovered. This will allow heat to escape. Bottles can be heated safely in microwave ovens if safe guidelines are followed. No more than 4 ounces should be heated at any one time. The bottle should be inverted 10 times; vigorous shaking is not necessary.

According to Piaget, the 6-month-old infant would be in what stage of the sensorimotor phase? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata

ANS: C Infants are usually in the secondary circular reaction stage from age 4 months to 8 months. This stage is characterized by a continuation of the primary circular reaction for the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. The use of reflexes is primarily during the first month of life. Primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from age 1 month to 4 months. The fourth sensorimotor stage is coordination of secondary schemata. This is a transitional stage in which increasing motor skills enable greater exploration of the environment.

he nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident. Which statement by the adolescent would be expected about separation anxiety? a. "I wish my parents could spend the night with me while I am in the hospital." b. "I think I would like for my siblings to visit me but not my friends." c. "I hope my friends don't forget about visiting me." d. "I will be embarrassed if my friends come to the hospital to visit."

ANS: C Loss of peer-group contact may pose a severe emotional threat to an adolescent because of loss of group status; friends visiting are an important aspect of hospitalization for an adolescent and would be very reassuring. Adolescents may welcome the opportunity to be away from their parents. The separation from siblings may produce reactions from difficulty coping to a welcome relief.

By what age should the nurse expect that an infant will be able to pull to a standing position?

ANS: C Most infants can pull themselves to a standing position at age 9 months. Infants who are not able to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months the infant has just obtained coordination of arms and legs. By age 8 months infants can bear full weight on their legs. Any infant who cannot pull to a standing position by age 1 year should be referred for further evaluation.

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

ANS: C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. A boys-only club does not have a direct correlation with later gang activity.

Imaginary playmates are beneficial to the preschool child because they: a. Take the place of social interactions. b. 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 do not take the place of social interaction but may encourage conversation. Imaginary friends do not take the place of pets or toys. They accomplish what the child is still attempting, not what has already been accomplished.

An important consideration when the nurse is discussing enuresis with the parents of a young child is that: a. Enuresis is more common in girls than in boys. b. Enuresis is neither inherited nor does it have a familial tendency. c. Organic causes that may be related to enuresis should be considered first. d. Psychogenic factors that cause enuresis persist into adulthood.

ANS: C Organic causes that may be related to enuresis should be ruled out before psychogenic factors are considered. Enuresis is more common in boys and has a strong familial tendency. Nocturnal bed-wetting usually ceases long before adulthood.

Kimberly, age 3 years, is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." The nurse's reply should be based on an understanding that: a. New toys make hospitalization easier. b. New toys are usually better than older ones for children of this age. c. At this age children often need the comfort and reassurance of familiar toys from home. d. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

ANS: C Parents should bring favorite items from home to be with the child. Young children associate inanimate objects with significant people; they gain comfort and reassurance from these items. New toys will not serve the purpose of familiar toys and objects from home. The parents may experience some guilt as a response to the hospitalization, but there is no evidence that it is maladaptive.

A characteristic of children with depression is: a. Increased range of affective response. b. Preoccupation with need to perform well in school. c. Change in appetite, resulting in weight loss or gain. d. Tendency to prefer play instead of schoolwork.

ANS: C Physiologic characteristics of children with depression include change in appetite resulting in weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping pattern, insomnia or hypersomnia, and constipation. This child displays a predominantly sad facial expression with absence or diminished range of affective response. The child has lower grades in school, with lack of interest in doing homework or achieving in school. Solitary play, disinterest in play, or a tendency to be alone are more characteristic.

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

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

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

ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months the infant can maneuver from a prone to a sitting position.

Latasha is a breastfed infant being seen in the clinic for her 6-month checkup. Her mother tells the nurse that she recently began to suck her thumb. The best nursing intervention is to: a. Recommend that the mother substitute a pacifier for her thumb. b. Assess Latasha for other signs of sensory deprivation. c. Reassure the mother that this is very normal at this age. d. Suggest that the mother breastfeed Latasha more often to satisfy sucking needs.

ANS: C Sucking is an infant's chief pleasure, and she may not be satisfied by bottle-feeding or breastfeeding alone. During infancy and early childhood there is no need to restrict nonnutritive sucking. Dental damage does not appear to occur unless the use of the pacifier or finger persists after age 4 to 6 years. The nurse should explore with the mother her feelings about pacifier vs. thumb. This is a normal behavior to meet nonnutritive sucking needs. No data support that Latasha has sensory deprivation.

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. The most appropriate recommendation is to: a. Punish the child. b. Leave the child alone until the tantrum is over. c. Ignore the behavior, provided that it is not injurious. 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 during this age group as the child becomes more independent and increasingly complex tasks overwhelm him or her. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The presence of the parent is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

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

ANS: C The peer group serves as a strong support to teenagers, providing them with a sense of belonging and strength and power. During adolescence the parent/child relationship changes from one of protection-dependency to one of mutual affection and quality. Parents continue to play an important role in the personal and health-related decisions. The peer group forms the transitional world between dependence and autonomy.

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

ANS: C This is a good parent-child interaction. The 18-month-old is capable of building a tower of 3 or 4 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. At this age children imitate others around them.

In terms of fine motor development, what could the 3-year-old child be expected to do? a. Tie shoelaces. b. Use scissors or a pencil very well. c. Draw a person with seven to nine parts. d. Copy (draw) a circle.

ANS: D 3-year-olds are able to accomplish the fine motor skill of drawing a circle. Tying shoelaces, using scissors or a pencil very well, and drawing a person with multiple parts are fine motor skills of 5-year-old children.

What would 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 3-year-olds are able to accomplish the gross motor skill of balancing on one foot. Jumping rope, riding a two-wheel bike, and skipping on alternative feet are gross motor skills of 5-year-old children

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

ANS: D 36% 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 do not cause the majority of deaths.

The nurse is guiding parents in selecting a day care facility for their child. When making the selection, it is especially important to consider: a. Structured learning environment. b. Socioeconomic status of children. c. Cultural similarities of children. d. Teachers knowledgeable about development.

ANS: D A teacher knowledgeable about development will structure activities for learning. A structured learning environment is not necessary at this age. Socioeconomic status is not the most important factor in selecting a preschool. Preschool is about expanding experiences with others; cultural similarities are not necessary.

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

ANS: D At 4 years, children can understand directional phrases. 18 to 24 months and 3 years is too young.

Which characteristic best describes the language of a 3-year-old child? a. Asks meanings of words b. Follows directional commands c. Can describe 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 talk incessantly, regardless of whether anyone is listening. A 4- to 5-year-old asks lots of questions and can follow simple directional commands. A 6-year-old can describe an object according to its composition.

The nurse is assisting the family of a child with a history of encopresis. What should be included in the nurse's discussion with this family? a. Instruct the parents to sit the child on the toilet at twice-daily routine intervals. b. Instruct the parents that the child will probably need to have daily enemas. c. Suggest the use of stimulant cathartics weekly. d. Reassure the family that most problems are resolved successfully, with some relapses during periods of stress.

ANS: D Children may be unaware of a prior sensation and unable to control the urge once it begins. They may be so accustomed to bowel accidents that they are unable to smell or feel it. Family counseling is directed toward reassurance that most problems resolve successfully, although relapses during periods of stress are possible. Constipation is the most common cause of encopresis. This should be corrected, and, if the condition persists, behavioral therapy may be necessary. Relief of fecal impaction does not require daily enemas. Dietary changes are necessary and would be more beneficial that cathartics.

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 knowing that: 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 abandons the practice for safety reasons. This is a cultural practice. This 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.

By what age should concerns about pubertal delay be considered in boys? a. 12 to 12.5 years c. 13 to 13.5 years b. 12.5 to 13 years d. 13.5 to 14 years

ANS: D Concerns about pubertal delay in boys should be considered for boys who exhibit no enlargement of the testes or scrotal changes from 13.5 to 14 years. Ages younger than 13.5 years are too young for initial concern.

An adolescent girl asks the school nurse for advice because she has dysmenorrhea. She says that a friend recommended that she try an over-the-counter nonsteroidal antiinflammatory drug (NSAID). The nurse's response should be based on knowing that: a. Aspirin is the drug of choice for the treatment of dysmenorrhea. b. Over-the-counter NSAIDs are rarely strong enough to provide adequate pain relief. c. NSAIDs are effective because of their analgesic effect. d. NSAIDs are effective because they inhibit prostaglandins, leading to reduction in uterine activity.

ANS: D First-line therapy for adolescents with dysmenorrhea is NSAIDs. This group of drugs blocks the formation of prostaglandins. NSAIDs are the drug of choice for this condition. Aspirin may increase bleeding. In most cases NSAIDs are sufficient to treat the symptoms of dysmenorrhea. They should be started at the first sign of bleeding and taken for 2 to 3 days. NSAIDs are effective because of their antiinflammatory effects.

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

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

The parents of a 12-month-old child ask the nurse if the child can eat hot dogs. The nurse's reply should be based on knowing that: a. The child is too young to digest hot dogs. b. The child is too young to eat hot dogs safely. c. Hot dogs must be sliced into sections to prevent aspiration. d. Hot dogs must be cut into small, irregular pieces to prevent aspiration.

ANS: D Hot dogs are of a consistency, diameter, and round shape that may cause complete obstruction of the child's airway. If given to young children, the hot dog should be cut into small irregular pieces rather than served whole or in slices. The child's digestive system is mature enough to digest hot dogs. To eat the hot dog safely, the child should be sitting down, and the hot dog should be appropriately cut into irregularly shaped pieces.

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

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

What describes the cognitive abilities of school-age children? a. Have developed the ability to reason abstractly b. Become capable of scientific reasoning and formal logic c. Progress from making judgments based on what they reason to making judgments based on what they see d. Have the ability to classify, group and sort, and hold a concept in their minds while making decisions based on that concept

ANS: D In Piaget's stage of concrete operations children have the ability to group and sort and make conceptual decisions. Children cannot reason abstractly until late adolescence. Scientific reasoning and formal logic is a skill of adolescents. Making judgments on what the child sees versus what they reason is not a developmental skill.

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

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

What is descriptive of bulimia during adolescence? a. Strong sense of control over eating behavior b. Feelings of elation after the binge-purge cycle c. Profound lack of awareness that the eating pattern is abnormal d. Weight that can be normal, slightly above normal, or below normal

ANS: D Individuals with bulimia are of normal or more commonly slightly above normal weight. Those who also restrict their intake can become severely underweight. Behavior related to this eating disorder is secretive, frenzied, and out of control. These cycles are followed by self-deprecating thoughts and a depressed mood. These young women are keenly aware that this eating pattern is abnormal.

What is characteristic of dishonest behavior in children ages 8 to 10 years? a. Cheating during games is now more common. b. Lying results from the inability to distinguish between fact and fantasy. c. They may steal because their sense of property rights is limited. d. They may lie to meet expectations set by others that they have been unable to attain.

ANS: D Older school-age children may lie to meet expectations set by others to which they have been unable to measure up. Cheating usually becomes less frequent as the child matures. In this age group children are able to distinguish between fact and fantasy. Young children may lack a sense of property rights; older children may steal to supplement an inadequate allowance, or it may be an indication of serious problems.

The role of the peer group in the life of school-age children is that it: a. Gives them an opportunity to learn dominance and hostility. b. Allows them to remain dependent on their parents for a longer time. c. Decreases their need to learn appropriate sex roles. d. Provides them with security as they gain independence from their parents.

ANS: D Peer-group identification is an important factor in gaining independence from parents. Through peer relationships children learn ways to deal with dominance and hostility. They also learn how to relate to people in positions of leadership and authority and explore ideas and the physical environment. Peer-group identification helps in gaining independence rather than remaining dependent. A child's concept of appropriate sex roles is influenced by relationships with peers.

A mother tells the nurse that she doesn't want her infant immunized because of the discomfort associated with injections. The nurse should explain that: a. This cannot be prevented. b. Infants do not feel pain as adults do. c. This is not a good reason for refusing immunizations. d. A topical anesthetic, eutectic mixture of local anesthetic (EMLA), can be applied before injections are given.

ANS: D Several topical anesthetic agents can be used to minimize the discomfort associated with immunization injections. These include EMLA and vapor coolant sprays. Pain associated with many procedures can be prevented and minimized by using the principles of atraumatic care. With preparation the injection site can be properly anesthetized to decrease the amount of pain felt by the infant. Infants have the neural pathways to sense pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process.

A 17-month-old child would be expected to be in what stage according to Piaget? a. Trust b. Preoperations c. Secondary circular reaction d. Tertiary circular reaction

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

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

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

Steve, 14 years old, mentions that he now has to use deodorant but never had to before. The nurse's response should be based on knowledge that: 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 areas, and others. 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 genitals 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 insulate the body and cause increased sweat production is not the etiology of apocrine sweat gland activity.

The parents of a newborn say that their toddler "hates the baby . . . he suggested that we put him in the trash can so the trash truck could take him away." The nurse's best reply is: a. "Let's see if we can figure out why he hates the new baby." b. "That's a strong statement to come from such a small boy." c. "Let's refer him to counseling to work this hatred out. It's not a normal response." d. "That is a normal response to the birth of a sibling. Let's look at ways to deal with this."

ANS: D The arrival of a new infant represents a crisis for even the best-prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. The nurse should work with parents on ways to involve the toddler in the newborn's care and help focus attention on the toddler. The toddler does not hate the infant. This is an expected response to the changes in routines and attention that affect the toddler. This is a normal response. The toddler can be provided with a doll to care for to tend to its needs when the parent is performing similar care for the newborn

A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is: a. A sign that the child is spoiled. b. A way to exert unhealthy control. c. Regression, common at this age. d. Ritualism, common at this age.

ANS: D The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain sameness and reliability. It provides a sense of comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. This does not indicate a child who has unreasonable expectations, but rather normal development. Toddlers use ritualistic behaviors to maintain necessary structure in their lives. This is not regression, which is a retreat from a present pattern of functioning.

The nurse is discussing with a parent group the importance of fluoride for healthy teeth. The nurse should recommend that the parents: a. Use fluoridated mouth rinses in children older than 1 year. b. Have children brush teeth with fluoridated toothpaste unless fluoride content of water supply is adequate. c. Give fluoride supplements to breastfed infants beginning at age 1 month. d. Determine whether water supply is fluoridated.

ANS: D The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount. It is difficult to teach this age group to spit out the mouthwash. Swallowing fluoridated mouthwashes can contribute to fluorosis. Fluoridated toothpaste is still indicated, but very small amounts are used. Fluoride supplementation is not recommended until after age 6 months.

Anorexia nervosa may best be described as: a. Occurring most frequently in adolescent males. b. Occurring most frequently in adolescents from lower socioeconomic groups. c. Resulting from a posterior pituitary disorder. d. Resulting in severe weight loss in the absence of obvious physical causes.

ANS: D The etiology of anorexia remains unclear, but a distinct psychologic component is present. The diagnosis is based primarily on psychologic and behavioral criteria. Anorexia nervosa is observed more commonly in adolescent girls and young women. It does not occur most frequently in adolescents from a lower socioeconomic group. In reality, these are often families of means who have high parental expectations for achievement. Anorexia is a psychiatric disorder.

The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infant's stool. The nurse bases her explanation on knowing that: a. Child should not be given fibrous foods until digestive tract matures at age 4 years. b. Child should not be given any solid foods until this digestive problem is resolved. c. This is abnormal and requires further investigation. d. This is normal because of the immaturity of digestive processes at this age.

ANS: D The immaturity of the digestive tract is evident in the appearance of the stools. Solid foods are passed incompletely broken down in the feces. An excess quantity of fiber predisposes the child to large, bulky stools. This is a normal part of the maturational process, and no further investigation is necessary.

A parent asks the nurse about negativism in toddlers. The most appropriate recommendation is to: a. Punish the child. b. Provide more attention. c. Ask child not always to say "no." d. Reduce the opportunities for a "no" answer.

ANS: D The nurse should suggest to the parent that questions should be phrased with realistic choices rather than yes or no answers. This provides a sense of control for the toddler and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young to be asked to not always say "no."

An adolescent boy tells the nurse that he has recently had homosexual feelings. The nurse's response should be based on knowledge that: a. This indicates that the adolescent is homosexual. b. This indicates that the adolescent will become homosexual as an adult. c. The adolescent should be referred for psychotherapy. d. The adolescent should be encouraged to share his feelings and experiences.

ANS: D These adolescents are at increased risk for health-damaging behaviors, not because of the sexual behavior itself, but because of society's reaction to the behavior. The nurse's first priority is to give the young man permission to discuss his feelings about this topic, knowing that the nurse will maintain confidentially, appreciate his feelings, and remain sensitive to his need to talk it. In recent studies among self-identified gay, lesbian, and bisexual adolescents, many of the adolescents report changing their self-labels one or more times during their adolescence.

The father of 12-year-old Ryan tells the nurse that he is concerned about his son getting "fat." Ryan's body mass index for age is at the 60th percentile. The most appropriate nursing action is to: a. Reassure the father that Ryan is not "fat." b. Reassure the father that Ryan is just a growing child. 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, in which the growth in height has slowed in preparation for the pubertal growth spurt but weight is still gained. This should be reviewed with both the father and Ryan, and a plan should be developed to maintain physical exercise and a balanced diet. Saying that Ryan is not "fat" is false reassurance. His weight is high for his height. Ryan needs to maintain his physical activity. The father is concerned; an explanation is required. A nutritional diet with physical activity should be sufficient to maintain his balance.

The nurse is doing a prehospitalization orientation for Diana, age 7, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that she will not be able to talk because of an endotracheal tube but that she will be able to talk when it is removed. This explanation is: a. Unnecessary. b. The surgeon's responsibility. c. Too stressful for a young child. d. An appropriate part of the child's preparation.

ANS: D This is a necessary part of preoperative preparation that will help reduce the anxiety associated with surgery. If the child wakes and is not prepared for the inability to speak, she will be even more anxious. It is a joint responsibility of nursing, medical staff, and child life personnel. This is a necessary component of preparation that will help reduce the anxiety associated with surgery.

Austin, age 6 months, has six teeth. The nurse should recognize that this is: a. Normal tooth eruption. b. Delayed tooth eruption. c. Unusual and dangerous. d. Earlier-than-normal tooth eruption.

ANS: D This is earlier than expected. Most infants at age 6 months have two teeth. The average number of teeth in 6-month-old infants is two. Six teeth at 6 months is not delayed; it is early tooth eruption. Although unusual, it is not dangerous.

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

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

What may be given to high risk children after exposure to chickenpox to prevent varicella? a. Acyclovir b. Vitamin A c. Diphenhydramine hydrochloride d. Varicella zoster immune globulin (VZIG)

ANS: D VZIG is given to high risk children to help prevent the development of chickenpox. Immune globulin intravenous may also be recommended. Acyclovir is given to immunocompromised children to reduce the severity of symptoms. Vitamin A reduces morbidity and mortality associated with the measles. The antihistamine diphenhydramine is administered to reduce the itching associated with chickenpox.

The weight loss of anorexia nervosa is often triggered by: a. Sexual abuse. b. School failure. c. Independence from family. d. Traumatic interpersonal conflict.

ANS: D Weight loss may be triggered by a typical adolescent crisis such as the onset of menstruation or a traumatic interpersonal incident; situations of severe family stress such as parental separation or divorce; or circumstances in which the young person lacks personal control such as being teased, changing schools, or entering college. There may in fact be a history of sexual abuse; however, this is not the trigger. These girls are often overachievers who are successful in school, not failures in school. The adolescent is most often enmeshed with his or her family.

Because of their striving for independence and productivity, which age group of children is particularly vulnerable to events that may lessen their feeling of control and power? a. Infants b. Toddlers c. Preschoolers d. School-age children

ANS: D When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurps individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that lessen their control and power. Infants, toddlers, and preschoolers, although affected by loss of power, are not as significantly affected as are school-age children.

The school nurse has been asked to begin teaching sex education in the 5th grade. The nurse should recognize that: a. Children in 5th grade are too young for sex education. b. Children should be discouraged from asking too many questions. c. Correct terminology should be reserved for children who are older. d. Sex can be presented as a normal part of growth and development.

ANS: D When sex information is presented to school-age children, sex should be treated as a normal part of growth and development. Fifth graders are usually 10 to 11 years old. This age is not too young to speak about physiologic changes in their bodies. They should be encouraged to ask questions. Preadolescents need precise and concrete information.

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

ANS:3 The FLACC scale utilizes behavioral and physical responses of the child to measure the child's level of pain. The scale utilizes facial expression, leg position, activity, intensity of cry, and level of consolability.

The mother of 11-year-old fraternal twins tells the nurse at their well-child checkup that she is concerned because her daughter has gained more weight and height than her twin brother. The mother is concerned that there is something wrong with her son. The nurse's best response is: 1. "I understand your concern. I will talk with the physician, and we can draw some lab work." 2. "I understand your concern. Has your son been ill lately?" 3. "It is normal for girls to grow a little taller and gain more weight than boys at this age." 4. "It is normal for you to be concerned, but I am sure your son will catch up with your daughter eventually."

ANS:3 This is the appropriate response. The nurse understands that it is normal for girls to grow taller and gain more weight than boys near the end of mid- dle childhood.

The parent of 2-week-old Sarah asks the nurse if Sarah needs fluoride supplements because she is exclusively breastfed. The nurse's best response is: a. "She needs to begin taking them now." b. "They are not needed if you drink fluoridated water." c. "She may need to begin taking them at age 6 months." d. "She can have infant cereal mixed with fluoridated water instead of supplements."

Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 6 months if the child is not drinking adequate amounts of fluoridated water. The recommendation is to begin supplementation at 6 months. The amount of water that is ingested and the amount of fluoride in the water are considered when supplementation is being considered.