Peds Midterm Previous Quiz Questions

During a well-child visit, an 11 year old girl states to the nurse that she looks different from her friends who are wearing bras. What is an appropriate response?

"It is normal for there to be differences in the time and rate girls your age develop." Letting the girl know that differences are normal and that development occurs at different times and rates among girls her age is reassuring. Focusing on strengths is positive but talks around the child's concern. Telling her she has a common worry minimizes her complaint and provides no information. Concern about breast development does not equate to peer pressure

The best way for parents to aid a toddler in achieving his development task would be to:

Allow him to make simple decisions Making decisions is primary practice toward achieving independence

A group of 10 year old girls have formed a "girls only" club. It is only open to girls who still like to play with dolls. How should this behavior be interpreted?

Appropriate social development Nine-year old take the values of their peer group seriously. They are interested in being with peers of like minded and activities. Clubs are formed with specific exclusions of peers. Such clubs typically have a secret password and secret meeting places. Membership is generally all girls or all boys. These groups are not based on the immaturity of the children nor do they encourage sexism and bullying

The nurse is preparing to conduct a physical examination of a 3 yr old child. Which assessment will the nurse introduce for the first time to this client?

BP recording BP measurement begins to be a part of the routine assessment at 3 years of age. The preschool E-chart is used for vision screening at this age. Walking gait and standing height measurement will be introduced in future assessments

The parent of a 4 year old child has expressed concern that the child is wetting her bed several times each week. What should the nurse teach the parent?

Bed wetting is not an unexpected behavior at this age Bed wetting is not normally considered a problem unless is persists after the age of 5-7. Limiting fluids after midafternoon may create a risk for dehydration

The nursing student is preparing to explain the appropriate steps for assessing an infant. The instructor determines the student's presentation is successful after illustrating which location as appropriate for obtaining an apical pulse?

Between the sternum and the left nipple When taking an infants apical pulse, the stethoscope is placed between the child's left nipple and sternum. The other location will not assist with localizing over the apex of the heart

The nurse is assessing a 3 year old at a well-child visit and the child appears to be progressing well. Which activity will then nurse ask the child to attempt to appropriately assess the fine motor skills of the preschooler?

Button cloths The 3 year old should be able to button his cloths and use a pencil or crayon. By the age of 4-5, the child should be able to use scissors, tie shoelaces, and print his first name

Parents bring a toddler age 19 months to the clinic for a regular checkup. When palpating the toddlers fontanels, what should the nurse expect to find?

Closed anterior and posterior fontanels By age 18 months, the anterior and posterior fontanels should be closed. The diamond-shaped anterior fontanel normally closes between age 9 and 18 months. The triangular posterior fontanel normally closes between age 2 and 3 months

A preschooler's mother ask the nurse an appropriate time to tell her son that she is pregnant. The nurse's best answer would be:

Probably at the point she begins to look pregnant Preschoolers have many fears and do not adjust well to secrets kept from them. When the mother looks pregnant, therefore, she should tell the preschooler, so he can begin to prepare as well

The school-age child develops the ability to recognize that if a block of clay is in a round ball and then is flattened, the shape changes but not the amount of clay. This child has developed an understanding of:

Conversation The skill of conservation is the ability to recognize that a change in shape dose not necessarily man a change in amount or mass

Which immunization would you plan to administer at a preschool health maintenance visit?

DTaP Preschoolers are typically administered a booster or their fourth dose of DTaP vaccine prior to starting school

When describing the various changes that occur in organ systems during adolescence, what would the nurse include?

Decrease in HR During adolescence, the HR decreases while the systolic BP increases. Brain growth continues, but the size of the brain does not increase significantly. Ossification is more advanced in girls and occurs at an earlier age. Sebaceous glands activity increases during adolescence.

When assessing heart sounds on a high school athlete the nurses hears a "lub d-dub" sound which is associated with inspiration. What should the nurse do next?

Document this find as normal With inspiration and the resulting increase or pressure in the lungs, the pulmonary valves close slightly later than the aortic valve. This causes a variation in heart sounds. This is termed physiologic splitting and is heard as a "lub d-dub" sound. As long as this is associated with inspiration this is a normal finding. If splitting were to be consistently heard this would indicate difficulty with the pulmonary valves closing and suggests pathology. Because this is a normal finding no referrals need to be made

Which nurse best fosters a school-aged child's adaptation to hospitalization? The nurse who:

Explains procedures and shows the child equipment that will be used on them Hospitalized school-aged children adapt best if they nurse explains what is going to happen to them and shows them the equipment that the nurse will be using. Honesty is also imperative for development of trust in the caregiver, so if a procedure is going to be uncomfortable or painful, the nurse needs to tell the child this. Encouraging parental overindulgence or being accepting of regressive or acting-out behaviors is not recommended

Broken fluency is a serious condition, and children who exhibit it should be referred to a speech pathologist for treatment.

False The nurse may need to remind parents that broken fluence is a part of normal development, if accepted as such, will pass

A parent brings her 3 year old child in for a sick visit for the third time this year. The child, who attends a preschool program, continues to develop upper respiratory infections. The parent is frustrated with the situation and ask the nurse for advice. What would be the best recommendation for the nurse to give to the parent in this situation?

Make sure that frequent handwashing is being stressed at the preschool. Even through the number of major illnesses is few in this age group, the number of minor illnesses, such as a common cold and ear infections are high. Children who attend childcare or preschool programs have an increased incidence of GI disturbances (vomiting and diarrhea) and upper respiratory infections form the exposure to other children unless frequent handwashing is stressed at the setting. Withdrawing the child from preschool likely is not a viable option for the parent. Sending the child to preschool with a health snack, although a good recommendation, will not prevent upper respiratory infections. Teaching the child to cover the mouth when sneezing is helpful in preventing transmission of infection to other children but not in preventing the child from becoming infected.

The nurse instructs a mother on actions to prevent sibling rivalry between a preschool-age child and newborn. Which observation indicates that instruction has been effective?

Mother sets aside afternoon time for the preschool-age child while the baby naps To help reduce sibling rivalry, the mother should set aside afternoon time for the preschool-age child while the baby naps. Sleeping when the baby sleep, asking if the preschool-age child likes the baby, and limiting gift s to the preschool-age child until behavior changes will promote sibling rivalry

The nurse is helping the parents and their underweight adolescent collaborate on planning a healthy menu. The nurse should be aware of which nutritional requirements of adolescents?

Teenagers have a need for increased calories, zinc, calcium, and iron for growth Teenagers have a need for increased calories, zinc, calcium, and iron for growth. However, the number of calories needed for adolescence depends on the teen's age and activity level as well as growth patterns. Teenage girls who are active require about 2,200 calories per day. Teenage boys who are active require between 2,500 and 3,000 calories per day. Adolescents require about 1,200 and 1,500 mg of calcium each day

During a well-child check-up, the parents of a 9 year old boy tell the nurse that their son's friends told him that soccer is a stupid game, and now he wants to play baseball. Which comment by the nurse best explains the effects of peer groups?

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

All infants should have their head circumference measured at health-assessment visits. This measurement is made from:

Just above the eyebrows through the prominent part of the occiput Measuring heads consistently from above the eyebrows to the occiput allows measurements at different visits to be compared

The nurse is preparing to assess a school-age child who is experiencing pain in his left femur area. When conducting this assessment, at which point should the nurse assess the painful region?

Last If a child has a sensitive or painful body part, palpate that area last. Otherwise, the child may be unwilling to allow other parts to be touched in fear of additional pain. The painful regions should not be assessed first, after measuring vital signs, or before the abdominal assessment

The parent of a 4 year old is expressing concern that his child is not talking as much- or as well as her other children did at that age. Which question should the nurse prioritize when assessing this preschooler for this concern?

"Has your child had her hearing tested?" Delays or other difficulties in language development may result form hearing impairment or other physical problems. Although reading to a child, having conversations with family members and other people, and praising and encouraging the child's efforts to communicate help the child develop language skills, most importantly a hearing concern would need to be assessed and treated.

During an annual visit of the 6 year old boy, the nurses observes dental caries on two of the child's primary teeth. Which response by the parents suggests more education is needed regarding the importance of primary teeth?

"These are only his baby teeth so we are not worried." Parents need to understand that value of the primary teeth and not see them only as temporary and soon-to-be replaced. Referral to a pediatric dentist are parental supervision of tooth brushing both lead to dental health and may be better appreciated once parents understand the importance of the primary teeth. Fluoride supplementation is not necessary if fluoride is part of the local water supply.

A mother brings her 8 year old daughter into the doctors office because over the past year her tonsils have increased in size to the point that the mother is concerned that her breathing will be obstructed. The girl has no pain, fever or other symptoms. Following this data collection, which instruction is best?

"This may be normal growth of lymphatic tissue for this age." The IgG and IgA each reach adults levels during the school-age period; lymphatic tissue continues to grow in size until about age 9. The resulting abundance of tonsillar and adenoid tissue in schoolchildren is often mistaken for disease as the tonsils seem to fill the entire back of the throat. The fact that there is no other symptoms indicate that this child's enlarged tonsils are simply a result of the normal growth of lymphatic tissue for this age.

A nurse is noting common changes in a group of preschoolers. Which predominant change during this period is a topic of anticipatory guidance

Physical growth slows During the preschool period, physical growth slows considerably, while personality and cognitive growth continues at a rapid rate

A nurse is caring for a 4 year old girl. The mother says that the girl is afraid of cats and dogs and does not like to go to the playground anymore because she wants to avoid the dogs that are often being walked at the park. What should the nurse tell the mother?'

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

The school nurse is conducting a health class with a group of high school students on the topics of sex and sexuality issues. Then nurse determines the session is successful when the students correctly choose which aspect as most important?

"Adolescents need to know how to use condoms correctly to avoid sexually transmitted infections." The priority is to prevent STIs. Adolescents need to understand that STIs can be acquired via oral sex as well as vaginal sex. They also need to understand that using contraceptive pills will not prevent STIs. They need contraceptive information to prevent pregnancy but more importantly they need straightforward information about using condoms to protect them against HIV and other infections. Both male and female adolescents need this information, and girls should be advised to carry their own condoms if they believe there is any possibly to having sexual intercourse.

The mother of an obese 10 year old child ask the nurse what she can do at home to help the child have a more healthy weight. Which is the best response make by the nurse?

"Encourage the child to increase daily physical activity." Obese children should be encouraged to participate in physical activity and decrease fat intake to 35% of total calories, but not to completely eliminate fat. Children should be encouraged to eat a healthy breakfast. Healthy snacks can be included in the diet

A nurse is discussing safety measures with the parents of a toddler. What would the nurse emphasize to address the most frequent type of accident in toddlers?

"Keep all cleaning products and drugs out of the reach of your child." Although all the instructions are important, accidental ingestion (poisoning) are the most frequent accident in toddlers. Therefore, it is imperative to focus on keeping all poisonous substances, drugs, and small objects securely out of the reach of children. Burns, motor vehicle accidents, and falls such as from a tricycle occur frequently in toddlers, However, they occur less frequently than poisoning

The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which statement made by the caregivers best indicates a common aspect of the diet and nutrition of the preschool child?

"My child is so picky and eats the same thing every day for days on end." The preschooler's appetite is erratic; at one sitting the preschooler may devour everything on their plate, and at the next meal he or she may be satisfied with just a few bites. Portions are smaller than adult-sized portions, so they child may need to have meals supplemented with nutritious snacks

A mother calls the pediatrician's off ice upset because her toddler has begun actin gout not that the new baby is home. He wants to have a bottle like the newborn and has begun to have accidents in his pants. Which statement by the nurse would best address this problem?

"Set aside time to spend one-on-one with your older child and make him understand that he is still loved and very special." When parents have a second child, the firstborn is often jealous and feels pushed aside by the new baby. Parents need to make time for the first child and set aside one-on-one time with them, showing them that they are still loved and there is enough time and love for both children. Ignoring the jealous behavior will not help the situation, not will scolding him for his accidents. Regression is a commonly seen with the arrival of a new baby. Offering him formula in a cup does not address the underlying problem of jealousy and feeling neglected

The parents of a 5 year old child calls the doctor's office to seek advice about proper nutrition for her child. Which statement by the mother indicates that further teaching is needed?

"Since she doesn't like vegetables, we no longer serve them to her." Although preschoolers may not like every food offered to them, they need to try them. If the foods are refused, the parent needs to offer them at a later date. A preschooler needs 1.5 to 2.5 cups of vegetables each day, so the nurse could recommend alternative ways of getting the needed amount of vegetables into the child's diet. Suggestions would include offering raw vegetables with dip or baking with vegetables incorporated into the food, such as zucchini bread. All other statements are reflective of successful teaching

A 3.5 year old shouts, "Look out for Boo-ga-loo!" as the nurse enters the exam room. The father explains Boo-ga-loo is his daughters imaginary friend. How should the nurse respond?

"Tell me about Boo-ga-Loo." The imaginary friend serves as a companion and playmate for the preschooler. The child knows this friend is not real, yet is very invested in the imaginary playmate who can be and do anything the child's fantasy life can invent. The nurse should acknowledge this friend, not minimize the friend's importance. "Tell me..."does this. The other responses do not

During a health check-up without his parents present, 17 year old tells the nurse he is gay. Which initial question is best?

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

The nurse is performing a health history on a 6 year old who is having trouble adjusting to school. Which question would most likely elicit valuable information?

"What are your new classmates like?" A careful conversation and interview with the child and/or the caregiver will provide important information about eh child's health. Depending on the intent of the health assessment, many of the questions will be direct, and may will require the caregiver or child to answer simple "yes" or "no." In other than emergency situations, though, asking open-ended questions such as "What are your classmates like?" offers an excellent opportunity to learn more about the child's life

A mother of a 2 year old girl is asking her friends when she should start potty training the child. The mother expresses concern about the high cost of diapers and training pants and would really like to have her trained as soon as possible. Which advice by the friend would be considered the best response?

"When she is uncomfortable in her wed diaper and brings a clean diaper to you, that's a good indication she is ready for potty training." The markers of readiness are subtle, but as a rule, children are ready for toilet training when they begin to be uncomfortable in wet diapers. They demonstrate this by pulling or tugging at soiled diapers, or they may bring a parent a clean diaper after they have soiled so they can be changed. The other answer do not address this. Usually the child needs to walk well independently before training can occur.

An adolescent who is depressed states, "Nothing ever seems t be right in my life." Which would be the most appropriate response by the nurse.

"You are feeling sad right now. It's a hard time." Some degree of depression is present in most adolescents because they are not only losing their parents while they grow apart from them but also their carefree childhood. When using therapeutic communication, it is important for the nurse to accept the client's verbalization as real. Support should be real. Telling the adolescent that things will be better in college provides false reassurance. Telling the adolescent to "look on the bright side of things" or that "being a teen is hard work" offers platitudes and interrupt the client's interactions

A mother of a toddler ask the nurse, "How will I know that my daughter is ready for toilet training?" Which response by the nurse would be most appropriate?

"You'll probably notice that your daughter is uncomfortable in wet diapers." The markers of readiness for toilet training are subtle, but as a rule, children are ready for toilet training when they begin to be uncomfortable in wet diapers. Although the rectal and urethral sphincters are mature by the end of the first year, children are not cognitively and socially ready. In fact, may children do not understand what is being asked of them until they are 2 or even 3 years old

During a well-child visit, the mother of a preschool tells the nurse that her daughter is "daddy's girl." She says, "IT seems like I don't exist." Which response by the nurse would be most appropriate?

"Your daughter is showing normal behavior for her age." The daughter is exhibiting signs of the Electra complex, competing with the same-sex parent for the love and attention of the other parent. This behavior is entirely normal but parents who are not prepared may feel hurt or rejected. Telling the mother that this is a problem, asking the mother about why, and asking the mother if she did something to make the daughter anger are inappropriate responses and focus on the mother's behavior, not the child's

The maximum time-out duration is how many minutes for each year of age?

1 minute The maximum time-out duration should be 1 minute for each year of age, but it may be necessary to start with must shorter time-outs. The other time frames are incorrect

When assessing a 33 month old, the nurse would expect to find how many teeth?

20 Eight new teeth erupt during the second year. All 20 deciduous teeth are generally present by 2.5 or 3 years of age

Where is the point of maximal impulse (PMI) found in a 5 yr old girl

4th intercostal space The area of most intense cardiac pulsation, or point of maximal impulse (PMI), varies with age. In children younger than 7 it occurs at the fourth intercostal space

The nurse is conducting a support group for parents of 9 & 10 year old. The parents express concern about the amount of time their children want to spend with friends outside the home. What should the nurse teach the parents that peer groups provide?

A sense of security as children gain independence 9 year old take their peer groups seriously. They are more interested in how other children dress than what their parents want them to wear. This is the club age where groups are formed and others are excluded from the club. This age group is imitating their peers as they develop their own identify and separate from their parents. Groups are fluid as they change regularly due to many reasons; each member lives on the same street, each member plays on the same ball team, or one member has fewer material things than the others. Security is gained through these clubs because it helps the school-age child develop independence away from the family. Most of the time in the school-age-child peer groups relationships are the same -sex friends. Children do not become self-sufficient through these clubs. They remain dependent on their families for their physical needs.

Parents are proud of their toddler's fast-developing motor skills. What skill they describe should the nurse point out as a safety risk?

Ability to turn knobs Turning knobs opens doors and may allow the child access to the outdoors or unsafe areas within the home. Close to follow will be the ability to unscrew lids, creating poisoning risks. The other abilities promote learning and involve lesser safety hazards

A nurse is explaining cognitive development in children to a client, with the help of Piaget's theory of cognitive development. What would be the best explanation by the nurse about the formal operations level of cognitive development?

After age 12 children can think in the abstract, including complex problem solving. The nurse should explain that there are four levels of cognitive development in Piaget's theory. The sensorimotor level is up to age 2 where children learn about touching, tasting, and feeling. They learn to control body movement. Preoperational level is children from ages 2-7 yrs who investigate and explore the environment and look at things from their own point of view. At the concrete operations level from age 7-11 yrs, children internalize actions and can perform them in the mind. At the formal operations after the age of 12 children can think in the abstract. Complex problem solving is included in this category.

Every time a toddler's mother ask her a question, the response is "No!" regardless of what the mother ask the child. What would the nurse recommend to the mother to help alleviate this behavior?

Allow the child choices when asking questions such as "Do you want to wear the red or blue top?" Negativism is commonly seen in toddlers and is an expression of independence, not defiance. The best way to reduce the number of negative responses is to ask few questions and be sure that any question asked allows the toddler a choice of behavior or response. Berating the child or telling the toddler what to do all the time will only make matters worse

What would be most effective in helping promote initiative and nutritional health for a preschooler?

Allowing the child to spread soft cheese on crackers Allowing a child to do things such as spreading cheese on crackers helps to foster initiative and nutrition. High carbohydrate snacks should be avoided. Cutting an apple into pieces would be a safety issue. Apples are hard and difficult to cut, placing the child at risk for cutting himself. Small servings of food would be more appropriate because preschoolers do not have ravenous appetites. Praising he child for cleaning his place which contains a small serving of food, not large, would be appropriate

When 12 year old Chelsie comes in for her annual check-up, the nurse must take a health history and do a physical exam. What is the most appropriate manner for the nurse to obtain a health history?

Ask Chelsie if she minds if her mother is in the room with her Cultural and spiritual dynamics are important in taking a health history. A child this age likes choices and is concerned about modesty and privacy. For pre-adolescents, lettings children choose whether or not a parent is with them in the exam room and during the history is appropriate. In either event, it is important to speak with the adolescent alone at some point. Asking Chelsie to wait outside does not acknowledge her as a person. Asking Chelsie's mom to leave the room does not give Chelsie a choice in her care. Asking Chelsie to fill the form out herself is not supportive, and does not facilitate an exploration of her history.

When the nurse performs her head-to-toe assessment on a 2 year old child, when would she examine the child's ears?

At the end of the exam in case the child gets upset The nurse should do any type of intrusive examination, such as of the mouth or ears, at the end of the physical exam so as not to distress the child. The other choices all could cause distress to the child before or during the exam

The nurse is assessing the development of a 15 month old girl during a well-child visit. Which would the nurse expect to see?

Stands alone At 15 months, toddlers have mastered standing and walking alone. The child has yet to develop the ability to feed herself with a spoon, point to her nose and mouth, or run to her mother

A nurse is performing a physical examination on a newborn. Which assessment should she include?

Axillary temp, femoral pulse, head circumference When examining newborns take axillary or temporal temp to prevent rupture of rectal mucosa. Be certain to take femoral pulses in newborns to rule out coarctation of the aorta. Include newborn reflexes, head circumference, and an assessment of gestational age as routine parts of the examination. Taking BP is not necessary because this value is unreliable in newborns.

A nurse is presenting a class on discipline for a group of parents of toddlers. What information would be important for the nurse to teach his group? SATA

Consistency in the rules is important so the child understands what is expected Even at this young age, children need boundaries If a child does something wrong, the parents must address the behavior immediately so the child understands what they did wrong Discipline for toddlers must have consistency and correct timing. Parents need to come to a consensus on how to discipline their child and do so consistently and in a unified fashion. Also, the toddler needs to receive negative feedback for negative behavior as soon as the infraction occurs so the child understands what they did wrong. Parents should never label the child as bad, just their behavior. Every child needs boundaries - it is just that every family's boundaries may vary. Discipline begins early in life and toddlers can learn self-control.

An 18 month old has fanning of the toes and dorsiflexion of the big toe seen on physical examination. Based on this finding the nurse should:

Document as a normal finding The infant should be assessed for a Babinski reflex. To achieve this stroke the sole of the foot. Fanning of the toes will occur in infants younger than 3 months of age. A downward reflex of the toes will occur beyond 3 months of age. Some infants will demonstrate a flaring Babinski reflex until 2 years of age. In the absence of other neurologic findings this is a normal response. The nurse would document this normal finding. The child would not need to be referred for further evaluation. The finding does not indicate any particular type shoe the child would require.

Which type of play should the nurse encourage for a preschool age child who is hospitalized?

Dressing in the mother's coat to play house Preschool-aged children have active imaginations and dressing up to play house would be an appropriate play activity for the nurse to encourage. The child's fine motor skills are not developed to play an electronic handheld game. Children of this age are afraid of the dark so turning out the lights to play hide and seek is not appropriate. Planting flower bulbs is an activity that is too long-term for this age range.

The school nurse is meeting with a 10 year old boy who is concerned about his weight. He reports he doesn't eat much candy but loves fruit, pasta, potatoes, and bread. Which suggestion should the nurse prioritize to help maintain a healthy weight?

Encourage activities that will increase the physical activity Encouraging daily physical activity and following the dietary standards (such as Choose MyPlate guidelines) will help the child meet necessary nutritional guidelines. Following popular fad diets or using weight-loss supplements must be avoided because they do not supply adequate nutrients for the growing child. The child is aware of the weight problem, but is would not be beneficial to just ignore it because the child may develop harmful eating habits such as bingeing

The nurse is performing a physical exam on a 3 yr old boy. What method would the nurse use to perform the exam?

Examine the child's head and work down to the child's toes. A preschooler or toddler child should be examined starting from their head and working down all the way to their toes for a thorough exam. In infants, the examination starts with chest, and then proceeds from head to toe

The nurse is evaluating statistics of dental care of preschoolers in the community. Which should the nurse focus on as having the greatest overall impact?

Fluoridated water system in the community When looking to have the largest impact, having a fluoridated water supply within the community would be the focus of the nurse. This would reach every preschooler in the community and can significantly reduce the number of dental caries.

The nurse is presenting information about school-aged children at a community event. Which statement should the nurse prioritize for further teaching and providing more information

Food is so expensive, we always make our children eat everything on their plate Obesity can be an issue in the school-aged child, especially if they are urged to clean their plates even if they have more food than they want or need on their plate. The parents should be encouraged to use smaller plates for the children so they will still appear to have a full plate but smaller portion. Firm guidance and direction is important with the school-aged child. Calcium and phosphorus are important to healthy teeth. Exercise each day is important, especially outdoor exercise.

The parents of a 16 yr old male are worried about recent changes in his behavior, ignoring his schoolwork and sports, and spending almost all of his free time interacting with his girlfriend. Which suggestion should the nurse point out would best address this situation?

He has developed his own identity by now; being able to establish close relationships with girls is important preparation for all of his adult relationships. They should honor his need to be with, or talk to, his girlfriend as long as he has completed his schoolwork for the day. When identify has been established, generally between the ages of 16-18 yrs, adolescents seek intimate relationships, usually with members of the opposite sex. Intimacy, which is mutual sharing of one's deepest feelings with another person, is impossible unless both persons have established a sense of trust and a sense of identify. Intimate relationships are a preparation for long-term relationships, and people who fail to achieve intimacy may develop feelings of isolation and experience chronic difficulty in communicating with others.

The nurse is teaching the student nurse who to perform a physical assessment based on the child's developmental stage. Which statement accurately describes a recommended guideline for setting the tone of the examination for a school-age child?

Include the child in all parts of the examination; speak to the caregiver before and after the examination For a school-age child, the nurse should include the child in all parts of the examination, and speak to the caregiver before and after the examination. For a newborn, the nurse should keep up a running dialogue with the caregiver, explaining each step as it is done. The nurse should speak to the early teen using mature language and appeal to his or her desire to self-care. For an infant, the nurses should address the child by name, and speak to the caregiver and do the most invasive parts last.

A 3 year old wants to do everything independently, including putting on shoes. Every day, no matter how hard he tries, he puts the shows on the wrong feet until finally he is successful. According to Erikson, the nurse identifies successful completion of what development task?

Initiative vs guilt The developmental task of the preschool, according to Erikson, is initiative vs. guilt. The others are not associated with the preschooler

The nurse is meeting with a group of caregivers of adolescents. Which example should the nurse point out is most effective for the caregiver to support the adolescent?

Let them choose their hairstyle, even through it may not look the best for them. The adolescent whose family caregivers make it difficult to conform are adding another stress to an already emotion-laden period. By allowing the adolescent to follow trends and fads in clothing choice, hairstyles, and music, the caregiver decreases the stress for the child. Information about substance abuse is important to share, but the topics would be better discussed with the child. It is important the adolescent spend time with peers.

A nurses realizes safety teaching has been successful when the parents identify which action to help prevent the leading cause of death in preschoolers

Placing the child in an approved car seat The leading cause of death in the preschool group is automobile accidents, followed by poisoning and falls. Placing the child in an approved car seat is a safety precaution to help prevent serious injury and even death. All safety measures help keep children safe. Many infectious diseases are preventable as a result of health promotion and illness prevention techniques

The nurse is presenting an in-service on the types of playing that children may engage in. The nurse determines that the session is successful when the attending nurses correctly choose which example as representing cooperative play

Playing in an organized group with each other During cooperative play, children play in an organized group with each other as in team sports. Solitary independent play means playing apart from other without making an effort to be part of the group or group activity. Associative play occurs when children play together and are engaged in similar activity but without organization, rules, or a leader, and each child does what she or he wishes. Parallel play occurs when the toddler plays alongside other children but not with them

The nurse is supervising a play group of children on the unit. The nurse expect the toddlers will most likely be involved in which activity?

Playing with the plastic vacuum cleaner and pushing it around the room Playtime for the toddler involves imitation of the people around them such as adults, siblings, and other children. Push-pull toys allow them to use their developing gross motor skills. Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar character. The school-age child enjoys group activities and making things, such as drawing, painting, and craft projects. The adolescent enjoys activities they can participate in with their peers

The nurse is assessing the growth of a premature infant. What would be the appropriate action by the nurse to complete this assessment?

Plot the infants weight, height, and length on a growth chart The assessment for growth for a premature infant entails platting his or her weight, length, and height on a growth chart, which is then analyzed. If the infant is below the growth curve, they are not growing appropriately and interventions may be needed. The nurse weighing the diapers is checking the intake and output of the infant, as does asking mom if the infants eats enough. Taking vital signs does not relate to growth

A nurse is testing a client for strabismus and amblyopia using the cover-uncover test. Which is the likely developmental age of the client?

Preschool children The cover-uncover test is reliable for assessing strabismus in children older than 2 years. One can test the corneal light reflex in children older from age 6 months to 24 months, but it is not reliable. If testing is not done until school age, a vision loss may have occurred

A nurse is admitting a 16 yr old male to the floor for an appendectomy. How can the nurse prepare this client for hospitalization? SATA

Provide privacy when client is changing into the hospital gown or going to the bathroom. Interview the adolescent separately form the parent to allow expression of information that he may not be comfortable sharing in front of the parent Encourage him to keep his cell phone nearby to communicate with his friends In order for a adolescent to adapt well to hospitalization, the nurse needs to provide him privacy and allow him control over his surroundings and care when possible. Keeping in contact with peers is very important to an adolescent, as is being discreet in regard to sharing personal information that typically is elicited in admission interview

When childproofing the home for a toddler, the most important thing her parents should consider is to:

Put medicine in a locked cupboard Poisoning is at peak incidence during he toddler period. Special precautions need to be taken against poising at this time

A mother tells the nurse that her toddler does not want to go to bed at night and keeps getting back up when she is put to bed. What recommendations would the nurse make to his mother to foster sleep in the toddler?

Read the child a book in bed and take time to calm the child down before turning out the lights Bedtime rituals are commonly used to prepare children for going to bed. By slowing down, reading a book in bed with the lights down, it calms the child and transitions them to a state of sleepiness, when they can then go to sleep. Parents are never advised to lock the child in the room, threaten them with taking away a favorite toy or stuffed animal, or to allow the child to stall and prolong their bedtime. Patents must be firm but kind when enforcing bedtimes.

The mother of a 7 year old girl tell tells the school nurse that her child is deathly afraid of going to school. What would be the best intervention the nurse could suggest in this situation?

Return the child to school and investigate the cause of the fear. It is important to investigate specific causes of school refusal/school phobia and take appropriate action. The parents should return the child to school, investigate the cause of the fear, support the child, collaborate with teachers, and praise success in school attendance. This is not a situation for punishment, and changing schools would not solve the child's school phobia

The nurse teaches parents of adolescents that teenagers need the support of parents and nurses to facilitate healthy lifestyles. What should be a priority focus of this guidance?

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

The nurse is observing the behavior of a preschool-age child and becomes concerned. Which observation suggests that the child's thinking is inconsistent with normal preschooler growth and development?

Refusing to play with "real" children Many preschoolers have imaginary friends who play with them. Imaginary friends are a normal, creative part of the preschool years and can be invented by children who are surrounded by real playmates as well as by those who have few friends. As long as the child has exposure to real playmates, imaginary friends do not take center stage in the child's life or prevent them from socializing with other children. In these cases, the imaginary friend should not post a problem. Refusing to go to bed without the friend, having the friend eat dinner with the family, and watching television with the friend are all acceptable behaviors by the preschool-age child

Parents who just moved into their "dream home" are concerned because their toddler boy, who had achieved daytime bowel and bladder control, has begun wetting and defecating in his underwear. The nurse explains this is called:

Regression He is returning (regressing) to an earlier, possibly safer stage of development caused by a stressor (moving). Autonomy is a stage of development in Erikson's theory. Egocentrism refers to the toddler's focus on self. Ritualism for toddlers provides sameness, the expected, and security

A 2 year old child is shopping with her mother when she suddenly falls to the ground and begins to scream, "I want it!" over and over regarding a bag of candy. What would the nurse recommend to the mother to deal with this behavior? SATA

Remain calm and ignore the tantrum Do not reward the behavior by giving into the toddler's demands and buying the candy Pick the toddler up and move her to a safe environment but do not give in to her desires Temper tantrums in toddlers are very common as they try to control their environment and the caregiver's environment. They become frustrated at their inability to do so or to verbalize their desires. If a toddler has a temper tantrum, the best thing for the parent to do is ignore them and protect them from harm. Parents cannot reason with a toddler - they lack the ability to understand or the desire to change their behavior. Never give in to their demands; they will only learn that if they scream loud enough, they get their way. However, spanking is not recommended. The child has just lost control and needs time to regain self-control

The nurse is explaining to parents that the preschooler's development task is focused on the development of initiative rather than guilt. What is a priority intervention the nurse might recommend for parents of preschoolers to stimulate initiative?

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

The family has recently moved into the area and is bringing their 18 month old son in to the office for his first visit. The father is in dusty work cloths and explains that they are in the process of restoring the house they recently moved into, which was built in the 1920s and which had been vacant for many years. The nurse urges the father to have a blood test done on the son. Which of the following is the best rational for this intervention?

Risk of lead paint poisoning due to the age of the house The best rationale for the nurse's intervention is the risk for lead paint poisoning due to the age of the house. All children between the ages of 6 months and 6 years who live in communities with buildings built before 1950 should be tested for the presence of too much lead in the body (lead poisoning). Elevated lead levels are caused by eating, chewing, or sucking on objects (such as windowsills, paint chips, or furniture) that are covered with lead-based paint. There is not enough evidence in the scenario to indicate that the child may be at risk for developing tetanus or that he has ingested cleaning products; in any case, the interventions for these would not include a blood test. There is no basis in the scenarios for the suspicion of diabetes in the child.

It is nap time and the caregiver of a 2 year old says to child, "I will help you put all of your stuffed animals in a row next to your bed just like we do every day." This statement is an example of:

Ritualism Ritualism employed by the young child to help develop security involves following routines that make rituals of even simple tasks.

The nurse is determining the toddler's language development. What is an expected finding for the language development in a 2 year old?

Speaks in 2 word sentences using a noun and a verb A 2 year old child should be speaking in simple 2 word sentences using a noun and a verb. Any 2 year old child who does not talk in 2 world, noun-verb simples sentences needs a careful assessment to determine the cause because this is beyond a point of normal development. Counting is not an expectation for a 2 year old child. The child will not be able to speak 20 nouns and 4 pronouns

To obtain an accurate HR in an infant, what would be the most important for the nurse to do?

Take the apical pulse Taking the apical pulse with a pediatric stethoscope and counting the rate for a full minute is the most accurate way to obtain the HR of an infant. The radial pulse should only be taken with older children, as it is difficult to palpate accurately in children younger than 2 years of age because the blood vessels lay close to the skin surface and are easily obliterated.

A nurse is evaluating a 5 year old client in the clinic. Which finding would indicate to the nurse that the client is not meeting Erikson's stages of psychosocial development?

The client ask permission to play During the preschool years, Erikson's psychosocial stage of development are focused on initiative vs guilt. At 5 years old, the client should begin to move past the egocentric focus of the toddler years and to seek reassurance from the parents

A mother observes the office nurse charting her son's height and weight on a growth chart and ask the nurse the purpose of plotting this information for her child. The nurse would reply with which explanation?

The height and weight of each client is plotted on a growth chart at each visit to note how the child is growing and compare the growth to the norm Plotting a child's height and weight are very important to determine if a child is growing normally or is too large or too small for their age. This is determined by plotting these measurements on a standardized growth chart. This data gives the health care provider a good clue as to the child's health status

The nurse is weighting a 20 month old who is in the clinic for a well-child visit. Which action by the nurse would be most appropriate for weighing this child?

The nurse should have the child sit on the scale while keeping a hand close to but not touching the child. The toddler who is able to sit can be weight sitting. Keep a hand within 1 in of the child at all times to be ready to protect the child from injury

The nurse is caring for a 9 year old who belongs to a spite club. The chief characteristic of a 9 year old spite club are:

They have a secret word; they exclude someone 9 year old gangs are typically one sex, exclude someone, and have secrete codes for passwords

The mother of a toddlers the child play next to another child but not with the child. What should the nurse explain to the mother about this type of play behavior?

This is parallel play and is expected All during the toddler period, children play beside children next to them, not with them. This side-by-side play called parallel play is not unfriendly but is a normal developmental sequence that occurs during the toddler period. This is not a peer, adjacent, or premature play. This behavior is not abnormal, does not need to be stopped, and is not seen in school-age children

An adolescent is concerned that although he has pubic hair, he has no facial hair yet. He wishes facial hair would grow to cover acne lesions. The nurse would advise him that facial hair:

Usually follows pubic hair growth In the average adolescent, pubic hair develop at 13-15 yrs, facial hair at 15-16.

When is the best time for the nurse to count a 9 month old respirations?

When he is quiet in his mother's lap The best time to count a child's respirations is when the child is quite and calm. Having the child on his mom's lap will keep him quite and supported. During the other choices or scenarios, the child is active and the count could give an inaccurate assessment