Peds prep u lvl 1-5 EX 1

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The infant measures 21.5 in (54.6 cm) at birth. If the infant is following a normal pattern of growth, what would be an expected height for the infant at the age of 6 months? A)29 in (74 cm) B)27.5 in (70 cm) C)30.5 in (77.5 cm) D)32 in (81 cm)

ANSWER Explanation: Infants gain about 0.5 to 1 in (1.25 to 2.5 cm) in length for each of the first 6 months of life. Therefore, a 21.5-in (54.6-cm) infant adding 6 in (15 cm) of growth would be 27.5 in (70 cm). Infants grow the fastest during the first 6 months of life and slow down the second 6 months. By 12 months of age, the infant's length has increased by 50%, making this infant 32 in (81 cm) at 1 year old.

The infant weighs 7 lb 4 oz (3,300 g) at birth. If the infant is following a normal pattern of growth, what would be the expected weight for this child at the age of 12 months? A)28 lb 4 oz (12.8 kg) B)25 lb (11.3 kg) C)14 lb 8 oz (6.6 kg) D)21 lb 12 oz (9.9 kg)

ANSWER The average weight of a newborn is 7.5 lb (3400 g). The infant gains about 30 g each day. By 1 year of age, the infant has tripled the birth weight and has grown 10 to 12 in (25 to 30 cm). 7.25 lb × 3 = 21.75 lb or 21 lb 12 oz (9.9 kg)

The nurse is assessing a 2-year-old boy during a well-child visit. The nurse correctly identifies the child's current stage of Erikson's growth and development as: A)autonomy versus shame and doubt B)industry versus inferiority C)trust versus mistrust D) initiative versus guilt

ANSWER A A toddler can understand language and is able to follow commands far sooner than he or she can actually use the words. By 2 years of age, a toddler typically speaks in two-word (noun and verb) sentences. Two-year-old toddlers have a vocabulary of about 40 to 50 words, and they start to use descriptive words (hungry, hot). The words "ma-ma" and da-da" occur much earlier than the toddler stage. The toddler is about 36 months of age before using pronouns or plurals in sentences. Children are unable to count to 20 until they are 5 to 6 years old.

A nurse is reviewing the health records of several 4-month-old infants who were seen in the pediatric office today. Which infant behavior will require referral for further evaluation of growth and development? A)unable to support head B)cannot sit without assistance C)rolls from prone to supine position D)reaches for nearby objects

ANSWER A An infant at 4 months of age who cannot support his or her head should be referred for evaluation. A 4-month-old infant should be able to reach for objects of interest and should be able to roll from a prone to a supine position. A 4-month-old infant is not able to sit alone without support.

A 12-month-old seen at a walk-in clinic weighed 8 pounds 4 ounces (3750 g) at birth. Weight now is 20 pounds 8 ounces (9300 g). The nurse determines: A) the child weighs less than expected for age. B)the child weighs more than expected for age. C)the child weighs the expected amount for age. D)the weight assessment is blatantly inaccurate.

ANSWER A Birth weight should triple by 12 months. The child should weigh near 24 pounds 12 ounces (11250 g). The child is underweight for age.

The nurse is promoting language and cognitive development to the parents of a 3-year-old boy. Which guidance about reading with their child will be most helpful? A)Ask the child questions as you read. B)Keep story time a reward for being good. C)Read a different book if he knows the story. D)Have the child sit still during the story.

ANSWER A Engage the child by asking him questions as he listens. This gives him a chance to contribute to the story. The child does not have to sit still. He may want to move around or even act out part of the story. Story time should happen regularly and not be just a reward. Even if the child can tell the story, he may wish to hear it read again because he enjoys the repetition and familiarity.

The nurse is assessing the language development of a 3-year-old girl. Which finding would suggest a problem? A) speaks in 2- to 3-word sentences B) tells the nurse she saw Na-Na today C) makes simple conversation D) tells the nurse her name

ANSWER A If the child is still speaking telegraphically in only 2- to 3-word sentences, it suggests there is a language development problem. If the child makes simple conversation, tells about something that happened in the past, or tells the nurse her name she is meeting developmental milestones for language.

The nurse is supervising a play group of children on the unit. The nurse expects the toddlers will most likely be involved in which activity? A) Playing with the plastic vacuum cleaner and pushing it around the room B) Pretending to be mommies and daddies in the play house C) Watching a movie with other children their age D) Painting pictures in the art corner of the room

ANSWER A 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 characters. The school-age child enjoys group activities and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities they can participate in with their peers.

When performing neurological reflexes on the infant, which primitive reflex will be present longest? A)Babinski B)Moro C)step D)rooting

ANSWER A Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. Except for the Babinski, which disappears around 1 year of age, these primitive reflexes diminish over the first few months of life, giving way to protective reflexes.

The parents of an overweight 2-year-old boy admit that their child is a bit "chubby," but argue that he is a picky eater who will eat only junk food. Which response by the nurse is best to facilitate a healthier diet? A)"Give him more healthy choices with less junk food available." B)"Calorie requirements for toddlers are less than infants." C)"Serve only healthy foods. He'll eat when he's hungry." D)"You may have to serve a new food 10 or more times."

ANSWER A Suggesting that the parents transition the child to a healthier diet by serving him more healthy choices along with smaller portions of junk food will reassure them that they are not starving their child. The parents would have less success with an abrupt change to healthy foods. Explaining calorie requirements and the timeline for acceptance of a new food does not offer a practical reason for making a change in diet.

The nurse is educating the mother of a newborn about feeding practices. The nurse correctly advises the mother that: A)the newborn's stomach can hold between 0.5 oz and 1 oz. B)demand scheduled feeding is associated with increased difficulty getting the baby to sleep through the night. C)most newborns need to eat about 4 times per day. D)the best feeding schedule offers food every 4 to 6 hours.

ANSWER A The capacity of the normal newborn's stomach is between 0.5 oz and 1 oz. The recommended feeding plan is to use a demand schedule. Newborns may eat as often as 1.5 to 3 hours. Demand scheduled feedings are not associated with problems sleeping at night.

A pediatric nurse is providing care to several children. The nurse is reviewing the assessment findings for each of the children. Which finding requires the nurse to intervene? A)9-month-old infant who can pull self up to a standing position B)14-month-old toddler who walks with a parent's assistance C)3-year-old preschool-aged child who goes up stairs on hands and knees D)24-month-old toddler who engages in parallel play

ANSWER C At 3 years of age, a child should be able to climb the stairs one step up at a time or using alternating feet. If the child can only go up on hands and knees, further evaluation is needed. At 9 months of age, an infant can pull oneself up to a standing position and sometimes is able to cruise around furniture or even walk. Toddlers begin to walk between 9 and 18 months of age. Toddler at 24 months of age engage in parallel play rather than cooperative play.

In teaching caregivers of preschool children, the nurse would reinforce that which activity would be most important for this age group? A)The preschool child should cover mouth when coughing or sneezing. B)The preschool child should be properly restrained when riding in a vehicle. C)The preschool child should be screened for amblyopia. D)The preschool child should brush and floss teeth after snacks and meals.

ANSWER B A major cause of accidents in the preschool child occurs when the child is not properly restrained in a motor vehicle. Safety is the highest priority.

A nurse is preparing a presentation for a health fair discussing various aspects of preschoolers. Which example should the nurse use to best illustrate dramatic play? A)Watching television or videos B)Acting out a troubling or stressful situation C)Playing apart from others without being part of a group D)Playing a video game with several other children

ANSWER B Dramatic play allows a child to act out a troubling or stressful situation. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. During cooperative play, children play in an organized group with each other as in team sports or video games. Onlooker play occurs when there is observation without participation, such as watching television or videos.

The parents of a 4-year-old girl tell the nurse that their daughter is having frequent nightmares. Which statement indicates that the girl is having night terrors instead of nightmares? A) "She comes and wakes us up after she awakens." B) "She screams and thrashes when we try to touch her." C) "She is scared after she wakes up." D) "She has a hard time going back to sleep."

ANSWER B During a night terror, a child is typically unaware of the parent's presence and may scream and thrash more if restrained. During a nightmare, a child is responsive to the parent's soothing and reassurances. The other statements are indicative of a nightmare.

The parents of a 4-year-old girl tell the nurse that their daughter is having frequent nightmares. Which statement indicates that the girl is having night terrors instead of nightmares? A)"She has a hard time going back to sleep." B)"She screams and thrashes when we try to touch her." C)"She is scared after she wakes up." D)"She comes and wakes us up after she awakens."

The infant weighs 6 lb 8 oz (2,950 g) at birth. If the infant is following a normal pattern of growth, what would be an expected weight for this child at the age of 12 months? A)15 lb 4 oz (6920 g) B)19 lb 8 oz (8825 g) C)13 lb (5900 g) D)10 lb 8 oz (4760 g)

ANSWER B The average newborn weighs 7.5 lb (3400 g). The average newborn loses 10% of birth weight over the first week of life but regains it in about 10 to 14 days. Most infants double their birth weight by 4 to 6 months of age and triple their birth weight by the time they are 1 year old. If the newborn weighed 6 lb 8 oz (2,950 g) at birth and tripled that weight at 12 months, the infant should weigh 19 lb 8 oz (6.5 lb × 3 = 19.5 lb) or 8825 g.

The nurse is providing client education to the parent about bathing the infant. What would be important to instruct the parent? A)Soap lubricates and oils an infant's skin B)Bath time provides an opportunity for play C)Never use soap on an infant's hair D)Infants need a daily bath

ANSWER B The work of children is play. Play provides a natural way for the infant to learn. In early infancy infants prefer their parents rather than toys. Parents can talk and sing to infants during feeding, bathing, and changing diapers. Infants do not need a daily bath as long as the diaper area is washed with diaper changes. Soap is actually drying to an infant's skin. Washing the hair with soap can help remove excess oil.

The nurse is assessing a 2-year-old toddler. Which observation(s) will alert the nurse that the child may be experiencing a developmental delay? Select all that apply. A) The toddler is unable to stack more than four blocks on top of another. B) The toddler will not pick up a toy or touch the nose when directed by the nurse. C) The toddler's vocabulary consists of the words "ball," "dadda," "mum," "drink," and "up." D) The toddler pushes and pulls the play vacuum cleaner in the toy room. E) The toddler claps the hands in response to the nurse clapping hands.

ANSWER B-C The 2-year-old toddler should be speaking in two-word sentences, and should be able to follow simple commands. Imitating the clapping of hands and pushing and pulling objects is expected of a 2-year-old toddler. The child should not be able to stack more than four blocks until the age of 3, so this observation would not be a concern at this age.

The caregiver of a 6-year-old expresses concern that the child cannot yet print her first and last name. The caregiver is wondering if this is normal. Which response by the nurse would be most appropriate? A)"Some children this age cannot hold a pencil or crayon well enough to write legibly." B)"It is not unusual for children of this age to be writing their first name in cursive." C)"By the age of 6, most children can print some letters and maybe their first name." D)"Usually by the age of 6, most children can write numbers up to nine, but no letters."

ANSWER C By 3 years of age, a child should be able to hold a pencil in the writing position. By age 4, the child can draw circles and squares and a body with four parts. At age 5, the child can print letters, copy a triangle and a picture of a person with six parts and cut with scissors. The 6-year-old child can print letters or numbers and may be able to print his or her own name. Children do not write in cursive until school age.

The father of a 6-week-old infant voices concerns about his son's stooling. He further shares that his son grunts and cries when having a bowel movement. What response by the nurse is most appropriate? A)"Grunting is normal with infant stool formation." B)"Is he in pain?" C)"What does his stool look like?" D)"We will need to collect a stool specimen for analysis."

ANSWER C Grunting, crying and straining during bowel movements by infants and newborns is normal. This is due to the immaturity of the gastrointestinal system. The most important thing to do initially is to determine the appearance of the stool. The grunts and cries are not of concern unless the stool is dry and hard, so asking about the characteristics is the initial response. Simply indicating this is normal without having additional information is not the appropriate response. There is no need for a stool specimen based upon the information provided.

The clinic nurse is collecting vital signs on a 4-year-old client being seen for a yearly well check-up. Which measurements should the nurse collect? A) height, weight, abdominal girth, and head circumference B) height, weight, and head circumference C) height and weight D) height, weight, and abdominal girth

ANSWER C Height and weight are the standard measurements at every yearly visit. The nurse should understand that head circumference is not routinely measured past 2 years of age and abdominal girth is only collected in infants.

A mother expresses surprise to the nurse that her daughter has begun masturbating. The most important initial nursing response is that: A) toilet teaching places much focus on the genitals. B) girls as well as boys will masturbate. C) this is a normal and expected activity best treated matter-of-factly. D) there may be undue stress in your child's life.

ANSWER C Masturbation is a normal event to be done in private. Calling attention to the behavior may increase the frequency. Both girls and boys masturbate, and toilet teaching calls attention to the genital area. These two statements are accurate information but not the best first response. Excessive or public masturbation points to stress.

Which milestone would the nurse expect an infant to accomplish by 8 months of age? A)Creeping on all fours B)Being able to sit from a standing position C)Sitting without support D)Pulling self to a standing position

ANSWER C Physical development of infants occurs in a cephalocaudal fashion. That means they must learn to control and lift their heads first. This is followed by the ability to turn over. Once this occurs the remainder of development occurs quickly. Most infants are able to sit unsupported by 8 months. They are able to creep at 9 months and pull to a standing position by 10 months. At 12 months the infant is able to sit from a standing position and is learning to walk.

The mother of a 4-year-old boy reports her son has voiced curiosity about her breasts. She asks the nurse what she should do. Which information is best for the nurse to give the parent? A)Advise the parent that sexual curiosity is unusual at this age. B)Encourage the parent to provide a detailed discussion about human sexuality with the child. C)Encourage the parent to determine what the child's specific questions are and answer them briefly. D)Advise the parent to explain to the child that he is too young to discuss such things.

ANSWER C Sexual curiosity is normal in the preschool-aged child. The parents should be encouraged to provide brief, honest answers to the child. The parents must also determine the type of curiosity the child has. Explanations should be within the level of understanding of the child.

A nurse is educating a client being discharged with her newborn baby. What is the highest priority item that must be included in the teaching plan? A)Keep all pots and pans in lower cabinets. B)Give warm bottles of formula to the baby. C)Restrain the baby in a car seat. D)Lock all cabinets that contain cleaning supplies.

ANSWER C The client should restrain the baby in a car seat when driving. Infants are especially vulnerable to injuries resulting from falls from changing tables or being unrestrained in automobiles. Locking the cabinets and giving warm bottles of formula to the baby are secondary teachings.

The nurse is caring for a 4-year-old girl following an appendectomy. The girl becomes fearful and starts to cry as soon as the nurse walks into the room. When the nurse asks about the crying, the girl says, "Nurses who wear shirts with flowers give shots." The nurse understands that this statement is an example of: A)beginning empathy. B)animism. C)transduction. D)magical thinking.

ANSWER C The nurse identifies transduction. Because the 4-year-old recently received an injection from a nurse in a flowered uniform, the girl believes that all nurses who wear flowered uniforms give shots. Transduction is reasoning by viewing one situation as the basis for another situation even though the two may or may not be causally linked. Magical thinking involves believing that one's thoughts are all-powerful. Animism is attributing life-like characteristics to inanimate objects. Empathy is the understanding of others' feelings.

The nurse is conducting a health screening for a 3-year-old boy as required by his new preschool. Which statement by the parents warrants further discussion and intervention? A) "The school has a loose environment, which is a good match for his temperament." B) "The school requires processed foods and high sugar foods be avoided." C) "The school is quite structured and advocates corporal punishment." D) "There is a very low student-teacher ratio, and they do a lot of hands-on projects."

ANSWER C The nurse needs to emphasize that there are number of reasons that a parent should not choose a preschool that utilizes corporal punishment. It may negatively affect a child's self-esteem as well as ability to achieve in school. It may also lead to disruptive and violent behavior in the classroom and should be discouraged. The other statements would not warrant further discussion or intervention.

The nurse finds the diet of a 30-month-old girl to be low in calcium. What suggestion can significantly increase this toddler's calcium intake? A) Use unsweetened applesauce as a dessert. B) Offer chocolate milk to increase milk intake. C) Give her slices of cheddar cheese as a snack. D) Include dark greens and spinach in her meals.

ANSWER C Two and one-half ounces of cheddar cheese provides the toddler's daily requirement of 500 mg of calcium. Chocolate milk provides calcium but the sugar it contains should not be a regular part of a toddler diet. Applesauce provides fiber, not calcium. Spinach and dark greens do contain calcium, but that calcium has limited bioavailability.

A 9-month-old has been brought to the clinic for a well-child visit. The mother reports her son was born 6 weeks prematurely. During the data collection, the child's mother reports her son seems to be a few months "behind" what she recalls from her older children. What is the best response by the nurse? A)"We will need to check this out since any delays related to prematurity should be resolved by the time a child is 6 months old." B)"You should talk with the doctor about getting your son tested." C)"Delays are normal when a child is premature." D)"All children mature and develop at different rates so it is unwise to compare them in this way."

ANSWER C When infants are born prematurely delays may be noted. When assessing the growth and development of a premature infant, use the infant's adjusted age to determine expected outcomes. To determine adjusted age, subtract the number of weeks that the infant was premature from the infant's chronological age. Plot growth parameters and assess developmental milestones based on adjusted age. Delays will not necessarily be resolved by the age of 6 months. While the mother should talk with the physician about concerns, this is not the best initial response by the nurse.

The nurse comes into an infant's room on the pediatric floor. The nurse wants to try to feed the infant for the first time since her surgery. How does the nurse know what state the infant is in by what the mother says, and that it's fine to try and feed the infant? A)"She is so quiet today; that is not like her." B)"She has been crying every time someone picks her up." C)"She is still sleeping; I guess she is worn out." D)"She has been a chatterbox and smiles just like her brother."

ANSWER D The best time to feed an infant is when the child is in the active alert state. This infant is talking and smiling, which shows she is calm and actively awake. In the active alert state the infant has normal respirations, limited movement, and eyes that are bright and shiny and attentive. The other choices put the infant in a crying state, quiet alert or deep sleep, or drowsing. These stages are not optimal for interacting with the child.

The nurse is examining a 3-year-old girl during a regular visit. Which finding would disclose a developmental delay in this child? A) The child follows directions when made one at a time. B) The child imitates the nurse in use of a stethoscope. C) The child copies a circle on a piece of paper. D) The child demonstrates separation anxiety.

ANSWER D The child should be past the stage of separation anxiety by age 3 years. Imitating actions, copying a circle on paper, and responding to single requests are developmentally appropriate.

The nurse is providing anticipatory guidance to the parents of an 18-month-old child. Which recommendation should be the most helpful to the parents? Describe proper behavior when the child misbehaves. When needed, place the child in time out for 1½ minutes. Slap the hand using one or two fingers if the child hits another. Ignore bad behavior until the child is older.

Answer A Stopping the child when misbehaving and describing proper behavior sets limits and models good behavior. This will be the most helpful advice to the parents. At 18 months, the child is too young to use time out or extinction (ignoring the child's behavior) as discipline. Slapping the child's hand, even done carefully with two fingers, is corporal punishment, which has been found to have negative effects on child development.

The parents of a 30-month-old toddler have brought the toddler into the emergency department because of a seizure. During the health history, the nurse learns that the toddler was frustrated and angry immediately preceding the seizure. The nurse suspects the toddler had a breath-holding spell. Which parental report suggests breath-holding? A tantrum preceded the event. The event took place during a nap. The toddler became unconscious. The toddler was lethargic afterward.

Answer A Temper tantrums are the natural result of frustrations that toddlers experience. They continue to occur until the toddler is old enough to verbalize feelings. The fact that there was a precipitating event of frustration and anger points to the likelihood that this is a cyanotic breath-holding spell. Breath-holding spells never occur during sleep, nor do they feature postictal confusion. Unconsciousness is not definitive because it is common to both seizures and breath-holding spells.

Which activity will the nurse encourage new parents to complete in order to assist their infant in accomplishing Erikson's developmental task for the first year of life? A)Respond promptly when the infant cries. B)Appropriately enunciate words when speaking to the infant. C) Read age-appropriate books to the infant daily. D)Praise the infant when a new milestone is reached.

Answer A The developmental task of the infant year, according to Erikson, is to gain a sense of trust. This can be accomplished by promptly meeting the infant's needs during the first year of life. If the infant does not learn to trust, mistrust will develop. Praising will help meet the future developmental tasks of the child. Reading books and appropriately enunciating words will aid in the infant's language development.

An infant is breastfed. When assessing the stools, which findings would be typical? A)Less constipation than bottle-fed infants B) Harder stools than those of bottle-fed infants C)A strong odor D)Fewer stools than bottle-fed infants

Answer A The first stool of the infant is meconium. It is the result of digestion of amniotic fluid and it is black-green color and sticky. Following that, in 1 to 2 days the infant's stools change to a yellowish-tan color. The stools of breastfed infants tend to be yellow-tan. They are looser in texture and appear "seedy." The stool of a bottle-fed baby has the consistency of peanut butter. The stools of breastfed babies generally have no odor since all milk is digested. Some babies will have a bowel movement with every feeding but it is small. Bottle-fed babies have less stools each day but they are larger and more likely to have an associated odor.

A 5-month-old infant being assessed was born at 32 weeks. The nurse doing the well-child check-up should compare the baby to what norms? Athe development of a 3-month-old bthe development of a 10-week-old Cthe growth of a 2-month-old Dthe growth of a 5-month-old

Answer A The infant was born 8 weeks early. Two months are subtracted from the present age of 5 months. Both growth and development should be assessed using 3-month norms.

The nurse is assessing the sleeping practices of the parents of a 4-month-old girl who wakes repeatedly during the night. Which parent comment might reveal a cause for the night waking? The child has a regular, scheduled bedtime. They sing to her before she goes to sleep. If she is safe, they lie her down and leave. They put her to bed when she falls asleep.

answer D If the parents are keeping the child up until she falls asleep, they are not creating a bedtime routine for her. Infants need a transition to sleep at this age. If the parents are singing to her before she goes to bed, if she has a regular, scheduled bedtime, and if they check on her safety when she wakes at night, then lie her down and leave, they are using good sleep practices.

The nurse identifies transduction. Because the 4-year-old recently received an injection from a nurse in a flowered uniform, the girl believes that all nurses who wear flowered uniforms give shots. Transduction is reasoning by viewing one situation as the basis for another situation even though the two may or may not be causally linked. Magical thinking involves believing that one's thoughts are all-powerful. Animism is attributing life-like characteristics to inanimate objects. Empathy is the understanding of others' feelings.

*TIPS - PLUS *

CH 26

CHAPTER 28

CHAPTER 29

CHAPTER 32

Chapter 25 newborn/infant

A nurse realizes the importance of nutritional assessment during the health history. When doing so, the nurse must assess the quality as well as quantity of food eaten. The best way to assess food intake is to do a: 3-day recall. 24-hour recall. 1-week recall. 12-hour recall.

Food intake is best obtained by asking a parent to describe a typical day (24-hour recall), listing what the child ate for each meal and between meals as well.

The nurse is assisting a 15-year-old who has been diagnosed with anemia in making menu selections. Which selections for the upcoming day's meals indicate an understanding of what foods are high in iron? Select all that apply. kiwi fruit brown rice liver peanut butter sandwich kale

Foods high in iron include liver and other meat products such as beef, chicken, and fish. Peanut butter, nuts, seeds, and leafy green vegetables are also sources of iron.

The nurse is preparing a presentation for a local health fair depicting the differences in maturity between preadolescents. Which differing factor should the nurse prioritize in the presentation? Boys grow at a slower, steadier rate than do girls. Girls grow at a slower, steadier rate than do boys. Boys grow at a rapid, sporadic rate. Boys and girls grow at the same rate.

Preadolescent boys grow generally at a slower, steadier rate than do girls. Girls grow more rapidly during preadolescence and then their growth rate slows dramatically after menarche.

The nurse is doing an assessment of a 10-year-old girl. She whispers the girl's name from behind the girl. Which cranial nerve is the nurse assessing for? V IV III VIII

Testing a child's hearing by observing a response to a whisper without a visual clue assesses cranial nerve VIII, the acoustic nerve. Nerve V is the trigeminal, nerve IV is the trochlear, and nerve III is the oculomotor, none of which are involved in hearing.

A mother of a toddler asks the nurse, "How will I know that my daughter is ready for toilet training?" Which response by the nurse would be most appropriate? "Your daughter can understand holding urine and stool by about 1 year of age." "Don't worry, your daughter will probably give you very definite signals." "Most children are ready for toilet training by the time they are 18 months old." "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, many children do not understand what is being asked of them until they are 2 or even 3 years old.

A nurse is preparing to examine the ear of a 2-year-old child. The nurse would pull the pinna in which direction? down and back up and back forward up

The nurse should pull the pinna of the ear down and back for a child younger than age 3 years to help straighten the ear canal. For a child older than age 3 years, the pinna is pulled up and back.

A nurse is preparing to examine the ear of a 2-year-old child. The nurse would pull the pinna in which direction? up down and back up and back forward

The nurse should pull the pinna of the ear down and back for a child younger than age 3 years to help straighten the ear canal. For a child older than age 3 years, the pinna is pulled up and back.

When auscultating bowel sounds, which of the following frequencies would the nurse identify as normal? One to two per minute Thirty to 40 per minute Sixty per minute Five to 10 per minute

ANSWER D The usual frequency of bowel sounds is 5 to 10 per minute.

The father of a 15-year-old daughter is concerned she is not getting adequate nutrition to play high school basketball. Her games are on Friday nights. Which suggestion should the nurse point out will best suit the needs of this adolescent? Pasta with a small amount of meat sauce and two slices of bread for dinner on Wednesday and Thursday evenings and again at 2 p.m. on Friday. Three daily meals that include choices from each of the food groups with an additional serving of fruit and several extra glasses of water on Friday. Boiled eggs with bacon or ham and a glass of orange juice for breakfast on Thursday and Friday mornings along with some sliced turkey and a salad at noon on Friday. Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates.

A meal that is low in fat and high in complex carbohydrates, eaten 3 to 4 hours before an event, is appropriate for the teen athlete. Carbohydrate-loading, which some practice during the week before an athletic event, increases the muscle glycogen level to 2 to 3 times normal and may hinder heart function. The other suggested menus would not provide the additional muscle glycogen needed for optimal functioning.

The nurse is talking with parents of a depressed 16-year-old boy. Which question is of the most importance? Is there a gun in your home? How is his personal hygiene? Have his sleeping and eating habits changed? Does he exercise?

answer a He may be at risk for suicide. Firearm-related suicides have been responsible for a large number of the suicide deaths in 15- to 19-year-olds nationwide. All the other questions assess for depression and do not protect against suicide.

The parents of a 16-year-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 is not developmentally mature enough to have an intimate relationship with one girl; they should encourage him to spend time with groups of friends rather than time alone with his girlfriend. 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. He has chosen a girl who is overly dependent on him. They should talk to him about making sure he meets his own needs, including doing the schoolwork he enjoys, in any relationship. He is not developmentally mature enough to make healthy choices about the ways in which he spends his time, so it would be helpful if they would make a schedule for him that includes about a half-hour per day to talk with his girlfriend.

answer b When identity has been established, generally between the ages of 16 and 18 years, 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 identity. 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 assessing the abdomen of a 3-year-old. Which finding should be reported immediately? active bowel sounds rounded abdomen visible peristaltic waves tympany over the abdomen

Visible peristaltic waves are abnormal and require further evaluation. The other findings are considered normal for the child's age.

The mother of a 9-year-old female voices concern to the nurse about her daughter developing breasts "at such a young age." How should the nurse respond? "I am sure you are concerned but children develop at different rates." "I understand your concern, but girls typically enter puberty around the age of 9 or 10." "Do the females in your family typically develop at an early age?" "This is rather young to be developing breasts. I will be sure to let the doctor know."

Voicing empathy regarding the mother's concern conveys support, and letting her know that this is normal growth and development helps ease her concerns. The other responses don't address her concerns or show genuine empathy.

The nurse is taking a respiratory history of a newly admitted child. While documenting the symptoms the child has, what other item is important to document when taking a history on an altered respiratory status? The child's hospital history The child's weight The triggers in the environment The child's diet

When assessing a respiratory history, it is very important for the nurse to find out what in the environment worsens the child's symptoms. These are called "triggers." The other choices would be part of a general health history.

The nurse is obtaining the health history for a 9-year-old child who has been brought to the ambulatory care clinic with reports of a backache. Which initial action by the nurse is most appropriate? Ask the child when the pain started. Palpate the child's back while asking the severity of discomfort being experienced. Ask the child to demonstrate movements involving the back. Ask the child's parent about when the parent was first made aware of the discomfort.

When beginning the interview, it is best for the nurse to ask the child about the health concern. If additional information is needed, the nurse can subsequently consult the parent. Palpating the back and asking the child to demonstrate movements takes place during the examination portion of the appointment and not the health history portion.

The nurse is obtaining the health history for a 9-year-old child who has been brought to the ambulatory care clinic with reports of a backache. Which initial action by the nurse is most appropriate? Ask the child's parent about when the parent was first made aware of the discomfort. Ask the child when the pain started. Palpate the child's back while asking the severity of discomfort being experienced. Ask the child to demonstrate movements involving the back.

A nurse is packing a bag with all of the equipment she will need to perform a complete physical assessment at a client's home. What will the nurse need? Select all that apply. Syringe Ophthalmoscope Stethoscope IV bag Tongue depressor Thermometer

When performing a complete physical assessment, the nurse will need the following equipment: a thermometer, a stethoscope, a tongue depressor, an ophthalmoscope, an otoscope, a sphygmomanometer, a tape measure, a tuning fork, a reflex (percussion) hammer, examination gloves, and perhaps a client drape or gown. A syringe or IV bag would not be needed.

During the physical examination, the nurse notes a positive Kernig and Brudzinski sign. The nurse interprets these findings to suggest which condition? visual impairment meningeal irritation auditory problems organic heart murmur

A positive Kernig and Brudzinski sign are indicative a meningeal irritation and are not associated with auditory or visual problems or heart murmurs.

What activity would best foster the developmental task of an adolescent who uses a wheelchair to ambulate? Talking to another adolescent who has a similar situation Allowing the adolescent to decide when to bathe Having a teacher bring school work to the adolescent Watching television on the set in the adolescent's room

A sense of identity is developed by "trying on" roles and discussing values and goals with others. A sense of trust develops when an adolescent is able to find out whom (and what ideas) to have faith in. The adolescent period is also a time where past stages of development are revisited. The sense of autonomy is where the adolescent seeks ways to express individuality. The stage of initiative is where the adolescent develops vision of what he or she might become. Talking with another adolescent who also uses a wheelchair to ambulate will help the adolescent see possibilities and reassurances. Making decisions or having assistance from someone else does not allow the adolescent to "try out" roles.

A nurse is caring for a hospitalized 7-year-old child whose family members have been unable to visit for 2 days. The nurse is preparing a diversional activity for the child. Which activity would best be suited for a child in this age group? A card game such as solitaire A board game such as monopoly An activity focusing on learning fractions A paint-by-numbers activity creating a picture

ANSWER Between the ages of 6 and 8 years, children begin to enjoy participating in real-life activities, such as helping with gardening, housework, and other chores. They love making things, such as drawings, paintings, and craft projects. The child would need additional instruction to learn fractions, which may not be considered fun. A card game such as solitaire and a board game of monopoly may be too hard for the 7-year-old. In addition, the game of monopoly would require additional players.

The mother of a 6-year-old is asking the nurse how to handle the child's lying and fabricated stories when confronted with questionable actions. Which response would be most appropriate by the nurse? "Your child could be in serious trouble in school if he continues to tell lies." "The child should have privileges taken away for several days each time he tells a lie." "Is there any possibility he is telling the truth and you just don't know it is the truth?" "Children this age sometimes can't distinguish between fantasy and reality."

ANSWER Children in the age group 6 to 7 years often engage in magical thinking. They may still believe in the tooth fairy, Santa Claus, monsters under the bed, and other imaginary characters. These keen imaginations may also conjure up fears—especially at night—about remote, fanciful, or imaginary events. If a child of this age has trouble distinguishing fantasy from reality, it may incline them to lie to escape punishment or to boost self-confidence. The other choices do not consider this child's stage of development or give the mother the most appropriate information for the situation.

The parents of a 10-year-old tell the clinic nurse that they are concerned because they noticed that their child has gained about 10 pounds over the past 2 years. What is the best response by the nurse? "Your child doesn't seem to be overweight, so it isn't a concern." "We see most children of this age in our clinic gaining similar amounts." "Normal growth and development for this age results in an average weight gain of 7 pounds per year." "I understand why you are concerned. Is your child sedentary quite a bit? Encouraging activity may limit weight gain."

ANSWER Children of school-age grow an average of 2.5 inches (6 to 7 centimeters) per year and gain an average of 7 pounds per year; therefore, the 10 pounds over 2 years is normal and it is important for the parents to know this, regardless if they are not overweight. Simply comparing them to other children seen in the clinic doesn't mean it is a normal expectation. While activity is important, the nurse must first address the parent's concern.

The school nurse has completed an educational program for parents at a local elementary school. Which statement by a parent would indicate the need for further education? "My son should wear his helmet whenever he rides his bicycle. " "I will teach my 8-year-old to watch for cars backing up in parking lots." "It's okay for my 10-year-old to sit in the front seat of the car since he doesn't need a booster seat anymore." "I need to get childproof locks fixed on the back doors of my car."

ANSWER Children under 12 should ride in the back seat of the car, even if they do not need a booster seat. Wearing helmets when riding, watching for cars backing up in parking lots, and using childproof locks on back doors in cars are all correct statements.

The school nurse receives a report that a child is having difficulty with grades and always appears hungry. When the nurse is assessing this child, what information would be most important to ascertain? recent illnesses amount of sleep relationship with parents amount of food consumed daily

ANSWER Children who live with a parent with alcohol use disorder are at greater risk for having emotional problems than others because of the frequent disruption in their lives. Two symptoms children may exhibit are poor nutrition and decreasing grades in school because the parent's behavior is so erratic that no regular schedule of meal times or bed times exists. The child may experience helplessness to change the situation. Recent illnesses, the amount of sleep the child receives, and the amount of food consumed daily are also important factors, but in order to improve those the nurse would first need to understand the dynamics of the family and any problems with the parents.

A parent calls the health care provider about the 7-year-old child's dental hygiene. The child has had three cavities. The parent does not know what to do and asks the nurse for guidance. How should the nurse respond? "Did you teach your child how to brush the teeth?" "What type of toothbrush does your child use?" "Are you able to supervise your child's brushing?" "Is there fluoride toothpaste available for use?"

ANSWER Dental caries is the leading chronic disease in the United States. Children need help with toothbrushing until they are between 7 and 10 years of age. The parent should monitor the toothbrushing to make sure it is thorough, observe for any abnormal tooth alignment, and schedule cleanings every 6 months. Children tend to concentrate on the front teeth, because they can see them easily and "forget" the teeth in the back. Parental oversight is needed to be sure those teeth are brushed carefully.

An 8-year-old boy who says he wants to be a doctor when he grows up pleads with the nurse to let him put on his own band-aid after receiving an injection. The nurse agrees and watches as the boy very carefully lines the band-aid up with the mark left by the injection and applies it to his skin. Then he asks, "Did I do it right?" and waits eagerly for the nurse's feedback. The nurse recognizes in this situation the boy's attempt to master the primary developmental step of school age. What is that step? Industry Perfectionism Accommodation Conservation

ANSWER During the early school years, children attempt to master their new developmental step: learning a sense of industry or accomplishment. Accommodation is the ability to adapt thought processes to fit what is perceived, such as understanding there can be more than one reason for other people's actions. Conservation is the ability to appreciate that a change in shape does not necessarily mean a change in size. Perfectionism is the desire to do something perfectly. The boy's desire to apply the band-aid "the right way" is a hallmark of the development of industry. The other answers are not as pertinent.

The nurse is teaching a group of school-age children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching? "There are not many physical differences among school age boys." "I will appear heavier due to an increase in fat production." "I will grow an average of 2.5 in (6.5 cm) per year." "I will have improved gross motor skills."

ANSWER During the school-age years, the child will grow an average of 2.5 in (6.5 cm). As puberty approaches, there will be significant differences in development between boys and girls. As development occurs, weight does increase, but it is not directly related to fat production. This is an area where much education needs to occur with young girls because "dieting" can be detrimental to the child's health and increased size is tied to the child's body image and self-esteem. By 10 years of age, brain growth is complete, and fine motor coordination is refined.

A nurse is caring for a hospitalized 10-year-old child. What would be an appropriate activity for this child to meet the developmental tasks of this age group? Participating in a craft project Playing with a jack-in-the-box Playing with blocks Writing letters to friends

ANSWER During this stage, the child is interested in how things are made and run. The child learns to manipulate concrete objects. The child likes engaging in meaningful projects and seeing them through to completion. Playing jack-in-the-box and blocks are for much younger children. If anything, the child would be texting back and forth with friends, not writing a letter.

The nurse is assessing the pain level of a child newly admitted to the pediatric orthopedic unit with a fractured femur. The client denies pain, but the nurse suspects the child is having leg pain based on what observations? The child has not smiled during the entire conversation and assessment. The child is lying on one side and drawing his knees up to the abdomen. The child guards the leg when the nurse reaches to touch it. The child's oxygen saturation level is at the low end of normal. The child has an elevated pulse and respiratory rate.

ANSWER Guarding the injured extremity, elevation of vital signs, low oxygen saturation level and lack of emotion are common signs of pain. Typically, children with abdominal pain will lie on one side and draw their knees up to the abdomen.

The nurse is discussing home safety with the parents of a 10-year-old client. Which statement by the client's parents most concerns the nurse? "Our child is home alone for an hour each day." "Our child swims alone before we get home from work." "Our child refuses to eat any green vegetables." "We do our best to keep no-cook snacks in the home."

ANSWER Latchkey children need to learn to be independent but safe. The nurse would be most concerned about the child swimming while no one else is at the home. If the child becomes endangered while swimming, there is no one there to assist. It is common for children at this age to be home alone between arriving home from school and when the parents arrive home from work. This is not an issue, as long as the child knows and follows safety rules. There are other ways the child can gain nutrition beyond green vegetables. No-cook snacks should be kept in the home as this ensures the child does not use the oven or stove to prepare a meal when hungry. This statement requires follow-up, but is not more concerning than swimming alone.

A mother states that her 6-year-old has starting biting nails and regressing to baby talk since beginning school. What instructions are best for the nurse to give the mother regarding this behavior? Make time each day to spend with the child individually. Apply a nail biting product to the nails to deter biting. Get a description of the classroom behavior from the teacher. Remind the child to stop each time the behavior is witnessed.

ANSWER Many first graders are capable of mature action at school but appear less mature when they return home. They may bite their fingernails, suck their thumb, or talk baby talk. Scolding, nagging, threatening, or punishing does not stop the problem and can actually make them worse. Methods such as bad-flavored nail polish or restraining the child's hands make the problems worse. These behaviors stop when the underlying stress is discovered and alleviated. Parents should be urged to spend time with the child after school or in the evening so the child continues to feel secure in the family and does not feel pushed out by being sent to school.

An 8-year-old male child is being seen for a well-child visit. His weight at his visit last year was 50 lb (22.7 kg) and his height was 47 in (119 cm). If he is developing normally, which finding will the nurse expect to note this year? Weight 62 lb (28.1 kg) Height 49.5 in (124 cm) The child's weight is seven times his birth weight. The child has all of his adult teeth present.

ANSWER Normal physical growth for school-age children is a gain in height of 2.5 inches (6.25 cm) each year. Thus, a height of 49.5 in (124 cm) would be expected growth. The growth in weight is not within normal parameters as this is a 12 lb (5.4 kg) weight gain. A 7-year-old child, not 8-year-old child, should weigh seven times his birth weight. Adult teeth do not normally come in until age 10 to 12.

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. What understanding has this child developed? conservation decentration classification reversibility

ANSWER Piaget described concrete operational thought occurring in the child ages 7 to 10 years. During this time the child develops various skills to see objects and the world. The skill of conservation is the ability to recognize that a change in shape does not necessarily mean a change in amount or mass. Using reversibility, the child can understand that processes can be reversed or canceled out by other things. Decentration is developed when the child can pay attention to multiple attributes of an object or situation instead of only one. In classification, the child is able to put objects together by shared qualities or characteristics.

An 8-year-old boy's foster mother is concerned about three recent cavities found in his permanent teeth and reports the child eats a nutritional diet, doesn't eat junk food, and the town water supply is fluoridated. Which suggestion should the nurse prioritize to this mother in regard to the child's dental health? Encourage the child to abstain from eating sugary snacks at school. Accept that the child is genetically predisposed to having more cavities than most children. Ensure that the child brushes his teeth after each meal and snacks. Have the child's teeth professionally cleaned every 3 months.

ANSWER Proper dental hygiene includes a routine inspection and conscientious brushing after meals. A well-balanced diet with plenty of calcium and phosphorus and minimal sugar is important to healthy teeth. Foods containing sugar should be eaten only at mealtimes and should be followed immediately by proper brushing. The school-aged child should visit the dentist at least twice a year for a cleaning and application of fluoride.

A school-aged child develops school phobia. When counseling her mother, the nurse would advise her that the accepted action is to: keep her child home until this fear passes. make her child attend school every day. allow her child to decide daily if she wants to go to school or not. ask the teacher to decide if the child should come to school or not each day.

ANSWER School refusal or phobia may result from both a parent not wanting a child to attend school and a child not wanting to leave a parent. Th nurse's role is to help them work together while keeping the child in school to resolve the issue.

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? poor peer relationships encouragement for bullying and sexism appropriate social development immaturity for this age group

ANSWER Ten-year-olds take the values of their peer group seriously. They are interested in being with peers of like mind and activities. Clubs are formed with specific exclusions of peers. Such clubs typically have a secret password and secret meeting place. 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 parents of an 8-year-old boy report their son is being bullied and teased by a group of boys in the neighborhood. Which response by the nurse is best? "Perhaps teaching your son self-defense courses will help him to have a greater sense of control and safety." "Bullying can have lifelong effects on the self-esteem of a child." "Fortunately the scars of being picked on will fade as your son grows up." "Your son is at high risk for bullying other children as a result of this situation."

ANSWER The child can be permanently scarred by negative experiences such a bullying. Activities such as self-defense and sports can promote a sense of accomplishment but don't relate directly to the problem of bullying. There is no indication the child in the scenario will become a bully.

A 10-year-old child tells the school nurse that she is embarrassed that she is afraid of the dark. Which is the best response by the nurse? "I was afraid of the dark at your age. You will grow out of that fear soon." "It is normal for a 10-year-old to be afraid of the dark so there is no need to be embarrassed. Would you like to talk about it?" "Are you afraid that something is going to happen to you or that something or someone may be outside that you can't see?" "That is so horrible that you are afraid of the dark. Can you sleep at night at all?"

ANSWER The school-age child needs reassurance that his or her fears are normal for this developmental age. Parents, teachers, and other caretakers should discuss the fears and answer questions posed by the child. However, the adult should not embellish the fear in any way. In addition, telling the child that she will "grow out of it" is not reassuring to the child.

The nursing instructor is leading a discussion on school-aged children. The instructor determines the session is successful when the students correctly choose which factor as being a priority for the school-aged child? Needs 10 to 12 hours of sleep per night Should brush their teeth at bedtime Have a routine physical exam every 6 months Be screened for scoliosis once a year

ANSWER The school-aged child needs 10 to 12 hours of sleep per night. They need to brush their teeth after every meal and at bedtime. A routine physical exam once a year is all that is necessary. Children are screened around the age of 10 or 11 for scoliosis.

Which behavior(s) involving a 11-year-old child warrants further education to the family? Select all that apply. The child is allowed to sit in the front seat of the car. The child wears a lap belt when riding in the car. The child uses a backpack to carry books when riding their bike to and from school. The child rides in the third row of the car seats. The child utilizes a lap and shoulder belt when riding in the car.

ANSWER When riding in the car children under the age of 12 should ride in the back seat and not the front seat. Safety belts consisting of a lap and shoulder harness should be employed. Front baskets on a bike should be used to carry heavy objects. Using a backpack can cause balance issues leading to a fall and should be avoided.

What foods could a parent provide that would be the most beneficial to support healthy dentition for a school-aged child? Fish, spinach salad and a glass of milk Hamburger and a cherry Coke Chicken sandwich with pretzels and apple juice Bagels and cream cheese with sherbet

ANSWER A well-balanced diet rich in calcium and phosphorus fosters healthy teeth. Minimal sugar, a diet of whole grain breads, and fish and cheeses are all good sources of calcium and/or phosphorus. Sugary soda drinks and juices, pretzels and bagels, beef and sherbet do not provide substantial amounts of calcium or phosphorus.

During a routine wellness examination, the nurse is trying to determine how well a 5-year-old boy communicates and comprehends instructions. What is the best specific trigger question to determine the preschooler's linguistic and cognitive progress? "Does your son speak in complete sentences all the time?" "How well does your son communicate or follow instructions?" "Is your son's speech clear enough that anyone can understand it?" "Would you say your son has a vocabulary of about 900 words?"

ANSWER Asking how well the boy communicates and follows instructions is the best trigger question because it is open-ended. Asking if the child uses complete sentences or speaks clearly will elicit a yes or no answer about only those specific areas of development. The parents would have no way of judging the size of their child's vocabulary.

The nurse is talking with the parents of an 8-year-old child who has been cheating at school. Which comment by the nurse would be appropriate as a first step? "Punishment should be subtle to allow the child to confess to cheating and lessen the behavior." "If cheating is noted at this age, referral to a family counselor is highly recommended." "Perhaps the academic environment is too easy for your child, causing the cheating." "Be sure the adults in the child's life, including you, as parents, demonstrate positive behavior."

ANSWER Because they are role models for their children, parents must first realize the importance of their own behaviors. If the academic environment is too difficult, not too easy, the child may be cheating to keep up with the increased rigor. Punishment should be geared toward discussion and helping the child understand the seriousness of cheating, and not be a subtle approach. After a discussion with the child, a review of the child's academic situation (is the work too hard? Is tutoring needed?) and positive role-modeling is assured, then referral to a counselor would be indicated but not as the first step in the resolution.

The parents of a 10-year-old tell the clinic nurse that they are concerned because they noticed that their child has gained about 10 pounds over the past 2 years. What is the best response by the nurse? "Normal growth and development for this age results in an average weight gain of 7 pounds per year." "We see most children of this age in our clinic gaining similar amounts." "Your child doesn't seem to be overweight, so it isn't a concern." "I understand why you are concerned. Is your child sedentary quite a bit? Encouraging activity may limit weight gain."

A nurse is assisting in a parent education class on accident prevention. Which statement by a parent indicates that further education is needed? "I will teach my daughter her full name and phone number." "My son can let his friend ride as a passenger on his bicycle as long as they both wear helmets." "We will be sure that our daughter wears a life jacket the next time we go boating at the lake." "I will teach my son not to arrange a meeting with someone he met on the Internet."

ANSWER Children should be taught ways to stay safe and prevent accidents. All children should wear bicycle helmets; however, unless the bicycle has a sidecar, the bike riding is safe for only one rider. The parents are correct that their children should learn their names and addresses, should not set up a meeting with a person they met on the Internet without parental supervision, and should wear a life jacket when boating.

A hospitalized 7-year-old is recovering from a head injury. Occupational therapy has been ordered to assist the child in regaining eye/hand coordination. If the child cannot master this skill, what feelings may arise? A sense of mistrust A sense of doubt A feeling of inferiority A sense of shame

ANSWER Children who are unsuccessful in completing activities during the school-age phase, whether from physical, social, or cognitive disadvantages, develop a feeling of inferiority.

The nurse is caring for a 6-year-old child. During the course of a routine wellness examination, the parent proudly reports that the child eats whatever the parent puts on the plate. The nurse wants to emphasize the importance of allowing the child to make some choices regarding the types of foods eaten. How should the nurse communicate this to the parent? "Now is the time to let your child choose some of the meals." "You must let your child make some choices for oneself." "You need to make sure your child has input regarding the food eaten." "I want you to give your child choices about the food eaten."

ANSWER Diet preferences are established in the preschool years and continue to develop as the child ages. The diet is influenced by family, peers, and media. Because of these influences and the child striving for independence, it is important to involve the child in helping select the food choices and guiding the child to healthy food choices. With parents, as well as children, it is more effective and less a matter of personal opinion to say "now is the time" rather than "you need," "I want you to," or "you must" do something. The nurse can emphasize the importance of the child participating in meal selection while encouraging the child's independence in a gentle manner.

The parents of an 8-year-old girl with a slow-to-warm temperament are concerned about their daughter's reaction when she visits the dentist for the first time after having a cavity filled at the last visit. How should the nurse respond? "Remind your daughter of the importance of proper oral hygiene." "Tell your daughter that it is just like going to see the pediatrician." "Remind her in simple terms what will happen in the dentist's office." "Wait to tell her about the visit until just before the appointment."

ANSWER Due to the girl's temperament, it is best if the parents talk to the dentist before the first visit to find out exactly what the dentist will be doing and then describe to the child in simple terms what will occur. Reminding the child about the importance of proper oral hygiene is unhelpful. Telling the child that the dental checkup is just like going to see the pediatrician is untrue. It is inappropriate to advise the parents to not prepare the girl in advance.

The nurse is addressing a caregiver's concerns regarding adequate sleep for an 11-year-old child who gets up at 6:30 a.m. each morning. The nurse should point out which time as the most appropriate bedtime for this child? 7:30 p.m. 8:00 p.m. 9:00 p.m. 10:00 p.m.

ANSWER Exercise and sufficient rest are important for school-age children. The school-aged child needs 10 to 12 hours of sleep per night. The 6-year-old needs 12 hours of sleep whereas an 11-year-old child needs closer to 10 hours of sleep per night, which would mean going to bed at 8:30 to 9:00 p.m. The older adolescent could go to bed slightly later and get adequate sleep.

The nurse is teaching a group of school-aged children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching? "There are not many physical differences between school-aged boys and girls." "Menarche is usually the first sign of puberty in school-aged girls." "Boys normally grow an average of 5 in (12.5 cm) each year." "Girls typically experience a rapid growth spurt before boys."

ANSWER Girls typically experience a rapid growth spurt before boys, and are usually taller by about 2 in (5 cm) or more than preadolescent boys. During the school-age years, the child will grow approximately 1 to 2.5 in (2.5 to 6.25 cm) per year. As puberty approaches, there will be significant differences in development between boys and girls. The first sign of puberty for girls is breast changes, not menarche.

The school nurse is reviewing the chart of a 12-year-old student who has had excessive absences due respiratory infections. What is the best action by the nurse? Discuss with the child's teacher to determine if the number of absences has affected academic performance. Speak with the parents about the unusual increased number of respiratory infections. Ask the child if he really has had respiratory infections during these absences. Continue to monitor the child's absences.

ANSWER In the school-age child, the respiratory system continues to mature with the development of the lungs and alveoli, resulting in fewer respiratory infections. Because the child is absent excessively for respiratory infections the nurse should speak with the parents to aid in determining if there is an underlying cause, or suggest the child visit the pediatrician to discuss the issue.

The nurse is conducting a routine well-child evaluation for a family with five children. The parent seems frazzled, and the two oldest children are engrossed in their hand-held video games. The other three children—all preschoolers—are gathered around a portable DVD player watching a movie while they wait for their appointment. The nurse suspects that the children spend a great deal of time in front of electronic screens and that the nurse's values greatly differ from this family's. How should the nurse approach the issue of television exposure during this evaluation? "Children who watch a great deal of television are more likely to become obese." "Would you like a pamphlet telling how TV watching affects children's health?" "It appears as if your children are watching too much TV. What do you think?" "One to two hours of television or video games a day should be the limit for children."

ANSWER It can be difficult to initiate a conversation when the nurse perceives that his or her values are different from those of the client. The nurse should approach the subject in a factual and nonjudgmental way. This gives the parent the opportunity to invite further discussion on the subject. Telling the parent that the children appear to be watching too much TV could cause the parent to become defensive. The other responses are true, but the nurse will likely have more success if the nurse lets the parent initiate further discussion.

On physical examination, the nurse discovers that a 6-year-old child's palatine tonsils are somewhat enlarged in the back of the throat. What would be the nurse's best action? Record this as a normal finding in an early school-age child. Suggest the health care provider examine the child for breathing difficulty. Take the child's temperature; this must be tonsillitis. Give the child something for pain.

ANSWER Lymphoid tissue reaches maximum growth in early school-aged children. The tonsils may decrease in size somewhat from the preschool years but they remain larger than those of adolescents. The tonsils and adenoids may appear larger than normal even in the absence of infection. The nurse would be correct to document this as a normal finding. The child would not need pain medication nor an examination for respiratory problems if this a normal finding.

The nurse is conducting a support group for parents of 9- and 10-year-olds. 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? time to remain dependent on their parents an opportunity for children to become self sufficient a sense of security as children gain independence time to establish relationships with the opposite sex

ANSWER Nine-year-olds take their peer group seriously. They are more interested in how other children dress than what their parents want them to wear. This is the age where groups are formed and others are excluded from the club. This age group is imitating their peers as they develop their own identity 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, etc. 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 group relationships are with same-sex friends. Children do not become self-sufficient through these clubs. They remain dependent on their families for their physical needs.

The nurse is teaching parents of an 11-year-old child how to deal with the issue of peer pressure regarding the use of tobacco and alcohol. Which suggestion by the nurse provides the best course of action for the parents? Avoid smoking in the house or in front of the child. Encourage the child to avoid having friends who smoke or drink. Discuss tobacco and alcohol use and effects with the child. Keep any alcohol products in the home in a locked cabinet.

ANSWER Parents are major influences on school-age children and should discuss the dangers of tobacco and alcohol use with the child. Not smoking in the house and hiding alcohol send mixed messages to the child. Open and honest discussion is the best approach rather than discouraging the child from making friends with kids that use tobacco or alcohol.

While observing a group of 9-year-old children at school, the nurse is concerned that one of the children is not cognitively developing according to Piaget's stage of concrete-operational thought processes. With which activity is the nurse concerned? does not understand the phrase "slow as molasses" when used by the teacher arrives to class late from recess and apologizes to the teacher believed that not turning in homework on time was acceptable, but has since decided it is not acceptable enjoys math instruction and decides to join the math club

ANSWER Piaget's stage of cognitive development for the 7- to 11-year-old is the period of concrete-operational thoughts. In developing concrete operations, the child is able to assimilate and coordinate information about his or her world from different dimensions. Abstract thinking, such as understanding the meaning of the phrase "slow as molasses," is expected at this stage of cognitive development.

While observing a group of 9-year-old children at school, the nurse is concerned that one of the children is not cognitively developing according to Piaget's stage of concrete-operational thought processes. With which activity is the nurse concerned? enjoys math instruction and decides to join the math club believed that not turning in homework on time was acceptable, but has since decided it is not acceptable does not understand the phrase "slow as molasses" when used by the teacher arrives to class late from recess and apologizes to the teacher

The nurse is admitting a 10-year-old for surgery. What action should the nurse prioritize when caring for this child? Offer to help with bathing. Answer questions regarding pain. Encourage family caregivers to stay with the child. Avoid prolonged discussions about the child's anxiety.

ANSWER School-age children need privacy more than younger children do and may not want to have physical contact with adults; this wish should be respected. These attitudes should be recognized and handled in a way that ensures as much privacy as possible. Children's questions, including those about pain, should be answered truthfully. An opportunity to verbalize anxieties will help a child deal with them. Family caregivers may feel guilty about the child's need for hospitalization and, as a result, may overindulge the child. The child may regress in response to this, but this regression should not be encouraged.

What activities would a nurse recommend to the families of school-aged children to promote attainment of Erikson's developmental stage of industry vs. inferiority? Select all that apply. Participating on the school soccer team Praising the child for their academic efforts Voicing parental doubts when the child begins a new activity, such as playing a musical instrument to avoid embarrassment Allowing the child to assist her teacher in straightening up the classroom Commiserating with the child when he or she does not get selected for the school choir

ANSWER School-age children need support in order to achieve attainment of the developmental stage of industry vs. inferiority; parents can play a large role in the child accomplishing this. Encouraging participation in group sports, allowing children to assist their teacher and praising their academic efforts, even though they may not have made the best grade, are all ways to help the child accomplish this task. Expressing doubts about the child's abilities or defending them when they are not successful in accomplishing a skill only increases the chance the child will develop a sense of inferiority.

An 11-year-old child is preparing to see the dentist to have his teeth cleaned. Which finding would considered most appropriate for this age? The child has 4 primary teeth and 24 permanent teeth. The child has 32 permanent teeth. The child has 28 permanent teeth. The child has 2 primary teeth and 26 permanent teeth.

ANSWER School-aged children have lost their 20 primary teeth. These have been replaced by 28 permanent teeth. They do not have their third molars.

The parents of a 7-year-old girl report concerns about her seemingly low self-esteem. The parents question how self-esteem is developed in a young girl. Which response by the nurse is best? "The peers of a child at this age are the greatest influence on self-esteem." "Several interrelated factors are to blame for low self-esteem." "Your daughter's self-esteem is influenced by feedback from people they view as authorities at this age." "A child's self-esteem is greatly inborn and environmental influences guide it."

ANSWER Self-esteem is developed early in childhood. The feedback a child receives from those perceived in authority such as parents and educators impacts the child's sense of self-worth. As the child ages, the influence of peers and their treatment of the child begin to have an increasing influence on self-esteem.

A parent brings a 6-year-old to the clinic and informs the nurse that the child is tired all the time, even though the child sleeps 7 to 8 hours each night. What is the best response by the nurse? "We should ask the health care provider to run some tests; with that much sleep, the child should not be tired." "Your child should be getting at least 9 hours of sleep per night." "Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school." "Your child should be getting 8 to 9 hours of sleep per night."

ANSWER Sleep needs for children change according to their ages. A 6- to 8-year-old child needs 12 hours of sleep per night. The 8- to 10-year-old child needs 10 to 12 hours of sleep per night. The 10- to 12-year-old child needs between 9 and 10 hours of sleep per night. Many younger children need a nap or to be provided with quiet time after school to recharge after a busy day in the classroom. Increasing the child's sleeping hours should be attempted before asking for medical intervention.

The parent of an 8-year-old child requests information from the nurse on proper nutrition for his child. Which is the best statement by the nurse? "An 8-year-old who is moderately active needs between 1,200 and 1,400 calories a day." "An 8-year-old needs 800 to 1,000 mg of calcium daily. "In looking at daily caloric intake for an 8-year-old, 35% to 45% should come from carbohydrates." "Approximately 30% to 40% of your child's daily calories should come from protein."

ANSWER The 4- to 8-year-old child needs 800 to 1,000 mg of calcium. Boys and girls 4 to 8 years old who are moderately active will need about 1,400 to 1,600 calories a day. Of these calories, 45% to 65% should come from carbohydrates, 10% to 30% from protein, and 25% to 35% from fat

The nurse has taken a health history and performed a physical exam for a 12-year-old boy. Which finding is the most likely? The child's body fat has decreased since last year. The child has different diet preferences than his parents. The child has a leaner body mass than a girl at this age. The child described a somewhat reduced appetite.

ANSWER The nurse would have found that the child still has a leaner body mass than girls at this age. Both boys and girls increase body fat at this age. Food preferences will be highly influenced by those of her parents. Although caloric intake may diminish, appetite will increase.

The nurse is educating the parents of a 10-year-old girl in ways to help their child avoid tobacco. Which suggestion should be part of the nurse's advice? "Keep your cigarettes where she can't get to them." "As parents, you need to be good role models." "Always go outside when you have a cigarette." "Tell her only losers smoke and chew tobacco."

ANSWER The nurse would recommend that the parents be good role models and quit smoking. Locking up or hiding your cigarettes and going outside to smoke is not as effective as having a tobacco-free environment in the home.

The nurse is talking with a school-aged child about her interests. In which interest do most school-aged children place the most focus? school family church pets

ANSWER The school-age child typically values school attendance and school activities. During school-age, the focus expands from family to teachers, peers, and other outside influences.

Which gross motor skill would the 4-year-old child have most recently attained? A)The child can hop on one foot. B)The child can cut his/her food. C)The child can tie his/her shoelaces. D)The child can button his/her clothes.

ANSWER A Gross and fine motor skills continue to develop rapidly in the preschool-aged child. Gross motor skills have to do with the development of large muscles. Balance improves around the age of 4, thus the child can hop on one foot and stand on one foot for 5 seconds. A 3-year-old child does not have the ability to accomplish these tasks. A 5-year-old child can button his/her own clothes, tie shoes, and cut his/her food.

The nurse is obtaining a health history on a toddler and asks the parents about their health history, the health history of their other children, and of their parents' health history. The parents ask the nurse why this information is necessary. What is the best response by the nurse? "The information can alert us to any disease process that might run in families." "This is part of the health form that we are required to complete during an admission." "I understand your confusion about why these things matter, but it's part of my job." "The health history helps us get to know our clients and their families better."

ANSWER A Obtaining a three-generation health history can help in determining the risk of potential disease processes that have familial tendencies, such as diabetes, heart disease, etc. While the family health history is part of the standard assessment that must be completed, this response does not address the parent's question.

A nurse is preparing an educational seminar about the moral and spiritual development of preschoolers. When describing this topic, which information would the nurse include? A)Tendency to do good out of self-interest B)Enjoyment of religious rituals based on the understanding of an outside force C)Ease in transferring rules to new situations D) Determination of right and wrong based on the reason for rules

ANSWER A Preschoolers tend to do good out of self-interest rather than from the development of a conscience. They determine right and wrong based on rules, not the reason or rationale for the rules. They have difficulty with rules that they know apply to a new situation. Preschoolers enjoy religious holidays and rituals based on the fact that these offer them reassurance and security.

A father and his 4-year-old son are waiting in an exam room when the nurse enters and greets them. Which activity that the nurse observes the boy doing would best demonstrate the primary developmental task of the preschool-age child, according to Erikson? A)opening drawers in the room, pulling out supplies, and examining them B)roughhousing with his father C)singing a song he learned at preschool D)reading a book

ANSWER A The developmental task for the preschool-age child is to achieve a sense of initiative versus guilt (Erikson, 1993). Children with a well-developed sense of initiative like to explore as they have discovered that learning new things is fun. Opening the drawers, pulling out supplies, and examining them is the best example of initiation and exploration among these answers. Roughhousing and singing a song learned in preschool are examples of typical play for preschool children. Reading a book at age 4 would be developmentally precocious but would not necessarily be the best example of initiative.

The nurse is assessing deep tendon reflexes on a child admitted for severe dehydration. The assessment reveals hyperactive reflexes. How should the nurse document this finding? 4+ 3+ 2+ 1+

ANSWER A Deep tendon reflexes are graded by the strength of the response using the standard scale from 0 to 4+: 0, no response; 1+, diminished or sluggish; 2+, average; 3+, brisker than average; 4+, very brisk, may involve clonus.

The nurse is providing an in-service for parents of preschoolers regarding nutrition. Which comments by the parents demonstrate successful learning following the in-service? Select all that apply. A)"I generally give my child choices about foods within each food category, ensuring all food groups are represented." B) "My 4-year-old should be ingesting at least 700 mg of calcium through food daily to promote good bone health." C) "The only way I can get my child to consume sources of vitamin C is through fruit juices. I guess it's better than not at all." D) "We very rarely feed our child fast food and when we do we try to keep it as healthy as possible with no soda." E) "My 4-year-old is above normal in weight but I'm sure it's just baby fat and will be lost with age."

ANSWER A-B-D Worldwide, over 22 million children younger than 5 years old are obese. In the past 30 years, the number of US children and adolescents who are overweight has doubled, which increases chances for obesity to continue into childhood and increases the risk for obesity-related diseases. The 3- to 5-year-old requires 700 to 1000 mg calcium. Allowing preschoolers controlled choices of foods fosters good eating habits as the child grows. Fruit juice should be limited to 4 to 6 ounces per day, as excess consumption can lead to excess weight gain and dental caries due to the sugar content. Nutrient-poor, high-calorie foods such as sweets and typical fast foods should be offered only in limited amounts.

The parent of 3 1/2-year-old preschooler tells the nurse that the child argues quite a bit and says that the child is always right. The nurse interprets this information as indicating: A)guilt. B)centering. C)conservation. D)initiative.

ANSWER B At age 3 years, cognitive development is still preoperational. Although children during this period do enter a second phase called intuitional thought, they lack insight to view themselves as others see them or put themselves in another's place. This is called centering. Because preschoolers cannot make this kind of mental substitution, they feel they are always right and causes them to argue. Conservation is reflected in the child's ability to distinguish that two items of equal size are the same despite a change in form. Initiative is the developmental task of preschoolers and is reflected in the child attempting to learn as much as possible about the world around them by trying new activities or having new experiences. Guilt occurs if children are punished or criticized for attempts at initiative.

The nurse is assessing a 3-year-old child. Which assessment finding would the nurse identify as abnormal? A) unscrews a bolt on a toy B) falls when bending over to touch toes C) pedals tricycle without assistance D) builds a tower of 10 cubes

ANSWER B Bending over easily without falling is a normal expected gross motor skill in a 3-year-old. Building a tower of nine or ten cubes, pedaling a tricycle without assistance, and unscrewing lids, bolts, or nuts are also expected gross and fine motor skills for this age.

The nurse is watching a 4-year-old child play with another preschool child. The children are playing a game with rules. The nurse notes that the child is demonstrating what type of play? A)parallel play B)cooperative play C)associative play D)dramatic play

ANSWER B Cooperative play is when children play in a group with each other, and play by rules. Examples are board games or sports. Associative play involves allowing the child to work through feelings about procedures and separation; parallel play involves children playing side to side with each engaging in his/her own activities; dramatic play involves living out of the drama of human life.

While at school, the client is called to the school nurse's office. The school nurse is performing secondary prevention interventions. Which would the nurse most likely be performing? asking the client about what he or she usually eats each day assessing vision asking the client if he or she likes school checking temperature

ANSWER B Hearing and vision screenings are examples of secondary prevention in health assessments. These are usually state-or federally-mandated screenings to prevent risk factors of specific diseases.

The nurse is preparing to assess the respiratory rate of a crying 15-month-old boy. To get the most accurate assessment, what approach should the nurse take? Count abdominal movements. Count after the child stops crying and is comfortable. Count the respiratory rate for 30 seconds. Place a stethoscope to count respirations.

ANSWER B Respirations should be assessed when the child is resting or sitting quietly because respiratory rate changes significantly when children cry, eat, or become more active. They also breathe more rapidly when anxious or frightened. Counting respirations for a full minute assures accuracy. Infants' respirations are primarily diaphragmatic; therefore, counting abdominal movements promotes accuracy. Placing a stethoscope to count respirations tends to be seen as invasive by a toddler and will result in movement away or an increase in respirations.

A nurse realizes safety teaching has been successful when the parents identify which action to help prevent the leading cause of death in preschoolers? A) Washing hands after using the bathroom B)Placing the child in an approved car seat C)Putting latches on lower cabinets D)Using gates at the top of the stairs

ANSWER B The leading cause of death in the preschool group is automobile accidents, followed by poisonings 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. Putting latches on the lower cabinets and using a baby gate at the top of the stairs are important to prevent poisonings and to prevent falls which could cause head injuries and fractures. Many infectious diseases are preventable as a result of health promotion and illness prevention techniques.

At a physical examination, a nurse asks the father of a 4-year-old how the boy is developing socially. The father sighs deeply and explains that his son has become increasingly argumentative when playing with his regular group of three friends. The nurse recognizes that this phenomenon is most likely due to: playing in an even-number group of children (four). preschoolers having a harder time sharing than toddlers. testing and identification of group role. regression.

ANSWER C Although 4-year-olds continue to enjoy play groups, they may become involved in arguments more than they did at age 3, especially as they become more certain of their role in the group. This development, like so many others, may make parents worry a child is regressing. However, it is really forward movement, involving some testing and identification of their group role. Because 3-year-olds are capable of sharing, they play with other children their age much more agreeably than do toddlers, which makes the preschool period become a sensitive and critical time for socialization. The elementary rule that an odd number of children will have difficulty playing well together generally pertains to children at this age: two or four will play, but three or five will quarrel.

During a well-child checkup, the mother of a 5-year-old girl reports her daughter seems much smaller than her 2 older children did at this same age. A review of the medical record reveals that the child is 44 inches tall and weighs 42 pounds. What information should be included in the response by the nurse? A)"Your daughter is within normal limits for her weight but she is slightly shorter in stature than other children her age." B)"The weight of your daughter at this time is with normal limits for her age but she is moderately taller than other children her age." C)"Your daughter is slightly taller than other children her age but her weight is normal." D)"Your daughter is within the acceptable range for her height but she is significantly smaller in weight for her age."

ANSWER C The average weight of a child who if 5 years is 41 pounds. The average height is 43 inches. This child is within normal limits for both height and weight.

An 18-month-old infant is brought to the emergency room and the nurse notes a strong camphor-like smell. What should the nurse do first? Administer activated charcoal. Initiate a nasogastric tube. Determine the type of ingestion. Call poison control.

ANSWER C Utilizing the sense of smell during a health assessment helps the nurse to focus on finding a source for the odor and the potential cause of the odor. When the smell of camphor is present the nurse should evaluate for the ingestion of mothballs. Urine that smells like maple syrup is a symptom of a protein metabolic condition. A sweet smell is associated with a pseudomonas infection. A putrid smell can be associated with fat in the stool from inadequate absorption. Prior to initiating any treatment it is important to find what the child has ingested if at all possible. The poison control center can provide antidotes and treatment protocols for all types of ingestion. The nasogastric tube and/or activated charcoal may or not be needed depending on the type of ingestion that has occurred.

A parent tells the nurse about being frustrated because the preschool-aged child screams every time the parent attempts to buckle the child's seat belt. What advice should the nurse give this parent? A)Warn the child of punishment for not buckling up and then follow through. B)Arrange for a babysitter to avoid taking the child in the car. C)Tell the child that you will give a treat for buckling up. D)Do not start the car until seat belts are in place.

ANSWER D Accident prevention is important for preschool-aged children. It can best be taught by role modeling. Not starting the car until everyone is buckled up is an example. Bribing and threatening are not appropriate, nor is keeping the child home at all times. All children up to 4 years whose height meets car seat requirements should be in an approved car seat with harness and top tether. After reaching the height requirements the child can transition to a booster seat with lap and shoulder belts.

A nurse is interviewing a parent regarding the 2-year-old child's recent illness. The nurse would like the parent to elaborate about any symptoms of the illness noticed. Which would be the most effective question for the nurse to ask the parent in this situation? "Has your child exhibited a fever and vomiting?" "Your child hasn't exhibited a fever, has she?" "Has your child exhibited any symptoms?" "What symptoms has your child exhibited?"

ANSWER D An open-ended question, such as, "What symptoms has your child exhibited?" allows a parent to elaborate, which is what the nurse desires in this case. A closed-ended question, such as, "Has your child exhibited any symptoms?" does not allow the parent to elaborate, and thus would be inappropriate in this case. Compound questions, such as, "Has your child exhibited a fever and vomiting?" should be avoided because the information they elicit is often inaccurate and must be clarified. Likewise, leading questions, such as, "Your child hasn't exhibited a fever, has she?" should be avoided.

A father tells the nurse that his son has been asking questions about his genitals. The father states that he is unsure how to answer the questions of a 4-year-old. How should the nurse respond? A)"That is a difficult subject to address. I'm not sure what is the best way to answer that question." B)"I would suggest getting books with pictures to help explain the differences between male and female genitalia." C)"You should answer his questions by whatever feels most comfortable to you." D)"It's best to answer his questions using accurate anatomical names and keep your answers simple."

ANSWER D It is suggested to keep answers brief and use correct anatomical names of body parts. Offering this advice to the father will help guide him in how to address questions. It is not necessary to go into the detail of using books with pictures for children of this age.

During a well-child visit, the caregiver expresses concern that the 3-year-old child often stutters when speaking. Which response should the nurse prioritize to best assist this family? A)"Difficulties with speaking generally indicate that the adults in the child's life are not reading to the child enough." B)"Stuttering is usually indicative of a hearing loss." C)"Stuttering is common in young children because they are not physically capable of forming all the sounds." D)"Children of this age may stutter while they search for just the right word."

ANSWER D Between ages 3 and 5, language development is generally rapid. Most 3-year-old children can construct simple sentences, but their speech has many hesitations and repetitions as they search for the right word or try to make the right sound. Stuttering can develop during this period but usually disappears within 3 to 6 months. Physical capability, hearing loss, or lack of being read to are not reasons stuttering occurs.

Parents bring a toddler age 19 months to the clinic for a regular checkup. When palpating the toddler's fontanels (fontanelles), what should the nurse expect to find? Open anterior and posterior fontanels (fontanelles) Closed anterior fontanel (fontanelle) and open posterior fontanel (fontanelle) Open anterior fontanel (fontanelle) and closed posterior fontanel (fontanelle) Closed anterior and posterior fontanels (fontanelles)

ANSWER D By age 18 months, the anterior and posterior fontanels (fontanelles) should be closed. The diamond-shaped anterior fontanel (fontanelle) normally closes between ages 9 and 18 months. The triangular posterior fontanel (fontanelle) normally closes between ages 2 and 3 months.

A 5-year-old girl is pretending to be a crocodile during a physical examination. Her mother just smiles and rolls her eyes at the nurse. What would be the best response for the nurse to give the child? A)"Oh no! I have a crocodile in my room. Please don't bite me!" B)"My dear, you are a girl, not a crocodile. Now sit still so that I can examine you." C)"What happened to my client? Did you eat her?" D)"What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile."

ANSWER D Parents sometimes strengthen a fantasy role without realizing it. A preschooler might be pretending she is a crocodile. If the nurse plays along, the child may be frightened she has actually become a crocodile. A better response is to support the imitation—this is age-appropriate behavior and a good way of exploring roles—by saying, "What a nice crocodile you're pretending to be." This both supports the fantasy and reassures the child she is still herself.

The nurse is conducting a well-child exam of a 4-year-old boy. Which statement would alert the nurse that the child is at risk for iron deficiency? A)"He does not like spinach, but he does like chicken and beef." B)"He enjoys eggs and fortified cereal for breakfast." C)"He eats a well-balanced diet." d)"He loves milk and drinks it every time he is thirsty."

ANSWER D This is likely to result in a very high intake of milk. Excess milk drinking may lead to iron deficiency since the calcium in milk blocks iron absorption. The nurse needs to emphasize this fact and suggest an appropriate daily milk intake. The other statements all include iron-rich foods and would not point to a risk for iron deficiency.

The nurse is teaching healthy eating habits to the parents of a 7-month-old girl. Which recommendation is the most valuable advice? A)Let the child eat only the foods she prefers. B)Actively urge the child to eat new foods. C)Provide small portions that must be eaten. D)Serve new foods several times.

ANSWER D When introducing a new food to an infant, it may take multiple attempts before the child will accept it. Parents must demonstrate patience. Letting the child eat only the foods she prefers, forcing her to eat foods she does not want, or actively urging the child to eat new foods can negatively affect eating patterns.

A school nurse has completed an educational program for parents of preschool children. Which statement by a participant indicates a need for further education? A) "My 5-year-old son still needs me to dress and undress him." B)"I'm glad to know that it's okay that my 5-year-old is learning to skate." C)"I need to work with my 4-year-old; she should be able to cut paper with scissors on her own." D) "My 3-year-old is doing fine, he can hop on one foot already."

ASWER A Dressing and undressing without assistance is an expected motor skill in a 5-year-old. Four-year-olds should be able to use scissors without assistance. Hopping on one foot is an expected motor skill for a 4-year-old. Learning to skate and swim are normal motor skills for 5-year-olds.

A chronically ill adolescent is readmitted to the hospital with an infected wound requiring long-term dressing changes. What is the best way the nurse can encourage independence for this client? Teach the parents to perform dressing changes at home. Allow the adolescent to choose the time for the dressing change. Have the adolescent go to the teen room every day. Have the school provide homework.

Achieving a sense of identity may be difficult for adolescents who have a chronic illness. Some of the nursing actions which encourage identity in the chronically ill adolescent include the following: respecting food preferences; allowing the adolescent to choose the time for the dressing changes; teaching the name, actions, and possible side effects of medication; and respecting modesty. The school can provide homework so the adolescent does not get further behind in school work, and the teen can go to the teen room each day. These provide a good emotional outlet, but they do not promote independence. Teaching the parents to do the dressing changes makes the adolescent dependent on the parents. If the dressings are at a location the adolescent can reach and dexterity is not limited, then the adolescent should be allowed self-care.

A 15-year-old adolescent is seen at a health care facility for facial acne. When counseling the teen, the nurse would teach that the basic cause of acne is: vitamin deficiency from an inadequate diet. lack of showering adequately after gym class. activation of androgen hormones. thyroid-gland secretions increasing with adolescence.

Acne occurs in adolescence as the result of hormone influence. With increased androgen production the sebaceous glands become more active. With increased testosterone production (in both boys and girls) increased sebum is produced. These increased hormone productions lead to the development of acne. Showering will certainly lead to cleaner skin and the removal of oils but the lack of showering does not cause acne. Diet and thyroid hormones do not play a role in the development of acne.

The parents are concerned their 14-year-old child is always eating. The child weighs 54 kg and is 65 inches (165 cm) tall. What is the best explanation the nurse can give the parents? "The calories help his body increase muscle mass." "His calorie intake predisposes him to future obesity." "He needs the calories because he participates in sports." "He is substituting food for unfilled needs."

Adolescents grow rapidly and mature dramatically during the period from ages 13 to 20 years. An adolescent needs an increased number of calories to support the rapid body growth that occurs. Foods must come from a variety of sources to supply the necessary amounts of carbohydrates, vitamins, protein, and minerals. Boys typically gain about 15 to 55 pounds (7 to 25 kg) during their teenage years. The calorie intake will not predispose him to future obesity unless it is continuously excessive. The majority of adolescents eat as part of their development, not as an emotional need.

The adolescent comes to the clinic seeking information about sexuality concerns. The clinic nurse assures the adolescent that confidentiality and privacy will be maintained unless a life-threatening situation occurs. Maintaining confidentiality demonstrates which nursing goal? Select all that apply. compliance with existing laws inappropriate response because adolescents are minors concern from parents who pay the office visit bill an environment where adolescents can be truthful development of a trusting relationship

Adolescents may seek a health care appointment for an unrelated health concern as a reason to discuss a sexual health question with a health care professional. Reassurance should be given to the adolescent that all questions and concerns will be addressed and will be kept confidential. This is the basis for the nurse-client relationship. All questions and concerns do not involve treatment and therefore do not involve parental consent. Parents may voice concerns because they are responsible for the insurance and billing. The nurse should act as a client advocate and work with the parents to develop a mutual understanding of the situation.

According to Erikson, the adolescent develops their own sense of being an independent person with individual thoughts and goals. This stage is referred to as: industry vs. inferiority. autonomy vs. doubt and shame. identity vs. role confusion. intimacy vs. isolation.

Adolescents must develop their own personal identity—a sense of being independent people with unique ideals and goals. This is the period Erikson calls identity versus role confusion. Erikson believes during this time the adolescent goes back through all previous developmental periods to achieve this identity. The stage of autonomy versus shame and doubt occurs between 18 months and 3 years. Industry versus inferiority occurs between 5 to 12 years. Intimacy versus isolation occurs in adulthood between the ages of 19 to 40 years.

A high school athlete comes to the emergency department with hypertension, aggressiveness, and psychosis. What question would be important for the nurse to ask the client? "Do you take human growth hormone?" "Do you take anabolic steroids?" "Do you take cocaine?" "Do you take amphetamines?"

Anabolic steroids are used by adolescents who play sports. They are used to enhance the adolescent's athletic ability. They produce euphoria and lessened fatigue. Unfortunately, steroid use can also lead to early closure of the epiphyseal plate, acne, elevated triglyceride levels, hypertension, aggressiveness, and possibly psychosis. Human growth hormone is also used to enhance athletic performance. The side effects of it are joint pain and swelling and the development of diabetes. Amphetamines provide a sense of well-being, alertness, and self-esteem. They can produce paranoia and extreme restlessness. Cocaine produces increased pulse and respirations, increased temperature, and blood pressure and decreased appetite.

A 5-year-old child weighs 17.7 kg. How many kilocalories per day (kcal/day) will the nurse instruct the parent are necessary to maintain the child's weight? Record your answering using a whole number.

Answer The typical 5-year-old child requires approximately 85 kcal/kg of body weight per day. 17.7 kg × 85 kcal/kg/day = 1,504.5 kcal/day Rounded to the whole number = 1,505 kcal/day.

The nurse is presenting nutritional information at a community health fair. Which suggestion should the nurse prioritize when illustrating proper nutrition for preschoolers? A)Snacks throughout the day help the child meet nutritional requirements B)Should drink at least 4 cups of milk each day C)Need extra calcium for proper muscle growth D) Need three big meals a day due to rapid growth

Answer A The preschool period is not a time of rapid growth, so children do not need large quantities of food. Protein needs are high to provide for muscle growth. Portions are smaller than adult-sized portions, so the child may need to have meals supplemented with nutritious snacks. The preschool child needs 2 to 3 cups of milk each day.

A nurse is developing a teaching plan for parents of preschoolers about how to address the issue of strangers and safety. Which would the nurse expect to include in the teaching? Select all that apply. A)Wait until children are old enough to tell them how to call for help in an emergency. B)Urge children never to talk to or accept a ride from a stranger. C)Urge your children to report others who are bullying. D)Teach your children to say "no" to anyone whose touching makes them feel uncomfortable. E) Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable.

Answer B-C-D-E The preschool years are not too early to educate children about the potential threat of harm from strangers or how to address bullying from others. Appropriate measures include urging children never to talk to or accept a ride from a stranger; teaching them how to call for help in an emergency; encouraging them to tell parents if someone asks them to keep a secret about something that makes them uncomfortable; urging children to report any bullying behavior; and teaching them to say "no" to anyone whose touching makes them feel uncomfortable.

The nurse is preparing a safety presentation for a health fair for families. Which instruction should the nurse prioritize when illustrating car safety and the family? A) "Reward the child with candy or some other treat each time the child keeps the seat belt on." B)"Explain that wearing a seat belt is a law and the police officer will give a ticket if the seat belt is not buckled." C) "Set a good example. Wear your own seat belt every time you drive." D)"Stop the car any time the preschooler unbuckles the restraints."

Answer C A preschooler wants to please, and if the caregiver consistently wears the seatbelt, that will become the standard for riding in the car. All states have laws that define safety seat and restraint requirements for children. Adults must teach and reinforce these rules. One primary responsibility of adults is always to wear seat belts themselves and to make certain that the child always is in a safety seat or has a seat belt on when in a motor vehicle. A child can also be calmly taught that the vehicle "won't go" unless everyone in it is properly restrained. The child should be taught respect of rules and laws, but making threats or giving rewards is not appropriate.

The nurse has completed an educational program on normal growth and development in children. Which statement by a participant would indicate a need for further education? A) "It is okay for my four-year-old to still play in his sandbox." B)"I will add some crayons, chalk and finger paints to my three-year-old's birthday gifts." C)"My four-year-old will be getting a tricycle for her birthday. I'm glad it's a good gift for her." D)"I am so glad I can get rid of all of those bath toys because they take up so much room."

Answer D Bath toys that squeak, float and squirt are appropriate toys for preschoolers. Creative toys like crayons, chalk and finger paints; gross motor toys like tricycles, big wheels and swing sets; and a sandbox with shovels and other toys for building are also appropriate toys for preschoolers.

The nurse obtains a rectal temperature for an 11-month-old infant. Which action will the nurse perform? Insert thermometer 1.5 inch (3.75 cm). Continue advancing the probe if resistance is felt. Apply water-soluble lubricant to the probe. Explain the procedure to the child.

Applying a lubricant to the thermometer probe will help prevent pain or damage to the rectum. The correct distance to insert a rectal thermometer is no more than 1 in (2.5 cm). Inserting the probe too far can damage or perforate the rectal mucosa. An 11-month-old infant is too young to understand explanation of procedures. If resistance is felt, the nurse should not continue advancing the thermometer probe.

6The nurse is preparing to see a 14-month-old child and needs to establish the chief purpose of the visit. Which approach with the parents would be best? "Is your child feeling sick?" "Has your child been exposed to infectious agents?" "What is your chief complaint?" "What can I help you with today?"

Asking "What can I help you with?" is very welcoming and allows for a variety of responses that may include functional problems, developmental concerns, or disease. Asking about the chief complaint may not be clear to all parents. Asking if the child feels sick will most likely elicit a yes or no answer and no other helpful details. Asking whether the child has been exposed to infectious agents is unclear and would not open a dialogue.

The parents of an 8 year-old state, "I am happy that our child is healthy," when the nurse says that the child falls into the 95th percentile for BMI. How should the nurse respond? "I will let the physician know that your child is in the 95th percentile for BMI." "Being in the 95th percentile for BMI is not a good thing. Your child is on the verge of obesity. It would be a good idea to consider this with meal planning." "The 95th percentile is not an indication of health." "For a child a BMI between the 85th and 95th percentile alerts us to the risk for being overweight. Let's talk about your child's diet and activity level."

BMI between the 85th and 95th percentiles for children between the ages of 2 and 20 indicates risk for overweight. BMI greater than the 95th percentile indicates the child is overweight. Informing of the parents of these findings and discussing diet and activity effectively address the issue in a therapeutic way.

The nurse is assessing a newborn child. The mother asks why the feet are blue. What is the best response by the nurse? "Blueness in the feet of a newborn is called pallor. This is a normal finding in babies up to several days old." "A blue tint to skin means that there is a lack of oxygen. I will need to notify the physician of this immediately." "When a foot or hand is blue, it's called peripheral cyanosis. Peripheral cyanosis is not normal in newborns." "Blueness of hands and feet is a common finding in newborns. It is a result of their circulatory system switching from being in the womb to life outside the mom's body."

Blueness of the hands and feet, known as acrocyanosis, is normal in babies up to several days of age and results from an immature circulatory system completing the switch from fetal to extrauterine life. Although blueness in hands and feet may indicate a lack of oxygen and may be called peripheral cyanosis, acrocyanosis is a normal finding in a newborn. Pallor is defined as paleness, not blueness of skin.

At a physical examination, a nurse asks the father of a 4-year-old how the boy is developing socially. The father sighs deeply and explains that his son has become increasingly argumentative when playing with his regular group of three friends. The nurse recognizes that this phenomenon is most likely due to: A) playing in an even-number group of children (four). B) regression. C) testing and identification of group role. D) preschoolers having a harder time sharing than toddlers.

C) Although 4-year-olds continue to enjoy play groups, they may become involved in arguments more than they did at age 3, especially as they become more certain of their role in the group. This development, like so many others, may make parents worry a child is regressing. However, it is really forward movement, involving some testing and identification of their group role. Because 3-year-olds are capable of sharing, they play with other children their age much more agreeably than do toddlers, which makes the preschool period become a sensitive and critical time for socialization. The elementary rule that an odd number of children will have difficulty playing well together generally pertains to children at this age: two or four will play, but three or five will quarrel.

The nurse is meeting with a group of adolescent athletes to discuss their nutritional needs. The nurse should encourage the adolescents to include which foods in the diet to increase iron intake? Select all that apply. grapes milk shakes cheese sticks peanuts hard-boiled eggs dried fruits

Dried fruits, peanuts, and eggs (especially the egg yolk) are high in iron. Milk shakes, grapes, and cheese sticks are low or have little iron

The nurse is teaching a group of novice nurses how to assess bowel sounds. Which statement will the nurse include in the education? "Bowel sounds should be present within the first few days of life." "You should auscultate all four quadrants for a full minute each." "Bowel sounds will be audible by the naked ear unless distention is present." "Hypoactive bowel sounds are expected in a client with diarrhea."

During assessment, the nurse should auscultate each quadrant for a full minute when assessing bowel sounds. Therefore, the nurse would include this statement in the teaching. The other statements are inaccurate. Hyperactive bowel sounds are often heard in clients with diarrhea. Bowel sounds should be present within a few hours of life. Bowel sounds are not generally audible with the naked ear.

A 15-year-old client's parent comments on the fact that the adolescent seems to always choose the opposite of what everyone else wants and that mood swings are a common occurrence. What statement shows the nurse that the client's parent understands these changes? "I know that my adolescent is doing this because of all the hormones." "This is common for this age group and it will get better with time." "This is my adolescent's temperament, and we will have to learn how to deal with it." "My adolescent will never find anyone to live with if the adolescent acts like this."

During middle adolescence, the adolescent spends more time ignoring adult authority and becomes more reliant on peer relationships. Adolescents might choose a stance directly opposite that of their parents and use peer support to back their ideas. Mood swings are a common occurrence during the adolescent period. They tend to smooth out and the adolescent will become more introspective. By late adolescence emotions become more consistent. Making statements such as "my adolescent will never find anyone to live with" or "we will have to learn to live with [my adolescent's temperament]" does not demonstrate the parent has a good idea of what is happening during the adolescent period.

A 15-year-old client's parent comments on the fact that the adolescent seems to always choose the opposite of what everyone else wants and that mood swings are a common occurrence. What statement shows the nurse that the client's parent understands these changes? "My adolescent will never find anyone to live with if the adolescent acts like this." "This is my adolescent's temperament, and we will have to learn how to deal with it." "I know that my adolescent is doing this because of all the hormones." "This is common for this age group and it will get better with time."

The parents of a 16-year-old are fearful that their child may be using illegal drugs. They report to the nurse that they have noticed recently that their child seems much more focused when doing homework or chores, is losing weight, displays a high level of energy, and becomes agitated easily. The nurse is aware that the teen is displaying symptoms of which type of drug use? inhalant methamphetamine CNS depressant opiate

Euphoria, increased energy and alertness, agitation, weight loss, insomnia, tachycardia, and hypertension are symptoms of methamphetamine use. Stimulants have similar effects as alcohol but the high only lasts a few minutes and includes slurred speech, lack of coordination, euphoria, and dizziness. Opiates produce feelings of relaxation and euphoria. CNS depressants cause euphoria followed by depression or hostility, impaired judgment, decreased inhibitions, slurred speech, and incoordination.

The nurse is measuring the head circumference of a 1-year-old infant during a well-child visit. The parent asks the nurse why this assessment is being performed. Which response will the nurse provide to the parent? "Head circumference is typically assessed until age 2 or 3 to help determine if growth is appropriate." "Head circumference is measured because smaller head size is related to decreased intelligence." "The head circumference measurement will not be needed after this 1-year old check-up."

Head circumference is typically assessed until age 2 or 3 years to help determine if growth is appropriate. This measurement is plotted on a growth chart to ensure head size is proportional to height/weight growth and to monitor for abnormalities, such as microcephaly or macrocephaly. The nurse will palpate to determine if skull suture lines have fused. The size of the infant's skull is not directly related to intelligence.

The nurse is obtaining health information from the parents of a 3-year-old. Which information is of most concern to the nurse? "I am very fortunate to be a stay-at-home mom." "Our children love our new dog. He was a rescue pet so we just finished all of his veterinary visits. "My mother lives in those new condominiums in town and babysits for me when I need her to." "We are renovating an old farmhouse built in the early 1900s."

Homes or apartments built prior to 1978 may contain lead-based paint, and children who live there are at an increased risk for the development of lead poisoning. This paint may be exposed during a renovation so there should be further discussion on this topic. Being a "stay-at-home mom," babysitting by grandparents in a new condo, and a well-cared-for pet are not concerns that need to be investigated further.

The nurse is performing an examination of the eyes of a 7-year-old child. Which finding would indicate that the third cranial nerve is intact? pupil dilation in response to light light of an otoscope reflecting evenly off both pupils eyelid blinks in response to touching the cornea with a wisp of cotton pupil constriction in response to light

If the pupil constricts (reduces in size) in response to the light, it is confirmation the third cranial nerve is intact; it should not dilate. The eyelid blinking in response to touching the cornea with a wisp of cotton is a test of the blink reflex, but should not be performed in children, as it can be painful and frightening to them. During a Hirschberg test, the light of an otoscope should reflect evenly off both pupils if they are in equal alignment.

The nurse is educating a 17-year-old adolescent after a new diagnosis of diabetes. What does the nurse understand about teaching an adolescent? The adolescent will likely have the greatest influence on one's own decisions. The parents will need to be instructed separately from the adolescent. The adolescent will respond best to teaching about how to avoid future complications. The siblings of the adolescent will need to be taught healthy cooking classes related to diabetes.

In late adolescence, the client likely has the greatest influence on his or her own decision making. While offering teaching to the parents and healthy cooking classes to the siblings are options, the adolescent will most benefit from being the one to make choices about care. Focusing on more recent concerns rather than the idea of future complications with the adolescent will gain more credibility.

A 17-year-old female is meeting with the nurse for an annual well-visit and is asking the nurse questions about how to know when one is in love. The nurse should point out which factor to help decide if both individuals have reached a mutual agreement and are ready for an intimate relationship? a)A willingness to take initiative B)An understanding of socialization and of isolation C)A sense of trust and identity D)An ability to be autonomous

In order to be intimate or to share one's deepest feelings with another person, it is impossible unless both persons have established a sense of trust and a sense of identity. Being autonomous or taking initiative are not aspects that lead toward intimate relationships. Socialization and isolation are not relevant to the establishment of intimate relationships.

The nurse is reviewing vital signs taken by the unlicensed assistive personnel on a group of toddlers. Which warrants follow up by the nurse? Heart rate 120 beats/min, respiratory rate 30 breaths/min Heart rate 60 beats/min, respiratory rate 40 breaths/min Heart rate 100 beats/min, respiratory rate 27 breaths/min Heart rate 105 beats/min, respiratory rate 25 breaths/min

In the toddler the heart rate may range from 70 to 140 beats/min, with most toddlers between 98 and 120. The respiratory rate may range from 20 to 37 breaths/min. Of the toddlers listed, the toddler with a heart rate of 60 beats/min and a respiratory rate of 40 breaths/min will require follow up by the nurse. The other toddlers' vital signs are within normal limits.

A female client tells the nurse about noticing an increase in weight and fat deposits during the past year. The nurse reviews the client's chart and recognizes that the client is most likely going through puberty. Which nursing action is most appropriate at this time? Share what foods can be eaten on a low-fat diet to prevent fat deposits. Encourage increased exercise to control weight gain. Provide reassurance that these are normal changes. Review dietary measures to assist in controlling weight gain.

Increased fat deposits and weight and height changes are normal as girls begin hormonal changes of puberty. During adolescence, girls are very sensitive about their appearance and experience a constant need for reassurance. Puberty is a period when children are very self-conscious about their overall appearance. Reassurance needs to be provided that increased fat deposits and weight and height changes are normal. Dietary management is indicated if a true weight problem is present, but healthy eating should be encouraged rather than dieting. Adolescents should be encouraged to participate in appropriate exercise programs. Dieting issues such as anorexia and bulimia can threaten the health of adolescents.

The nursing instructor is monitoring the nursing students as they role-play conducting assessments on children and their caregivers. The instructor determines the session is successful after witnessing the students collect the necessary subjective data during which portion of the assessment process? Weighing and measuring the child Reinforcing teaching with the child's caregivers Taking the child's vital signs Interviewing the child's caregiver

Information spoken by the child or family is called subjective data. Interviewing the family caregiver and child allows you to collect information that can be used to develop a plan of care for the child. Collecting objective data would include weighing and measuring the child and taking the child's vital signs. Reinforcing teaching would involve client education to ensure the caregivers are aware of the treatments and/or further care.

During the assessment of a 15-year-old female, the nurse notes a new body piercing in the navel. Which statements by the nurse would be appropriate in regard to this new piercing? Select all that apply. "I really like your belly ring. Where did you get it?" "A navel piercing is a lot better than a tattoo. At least the piercing doesn't have to be permanent if you don't want it to be." "You are very young to have a navel piercing. Do your parents know you have this?" "Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing." "I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection."

Informing the client about infection risks and prevention are appropriate responses by the nurse when noticing a new body piercing. Judgmental responses and personal responses are not appropriate from the nurse.

Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in middle-to-late adolescence? nocturnal emissions lengthening of the penis reddening of the scrotum pubic hair growth

Involuntary ejaculation during the night can be disturbing to the adolescent male who has little or no understanding of what is happening in the body. Lengthening of the penis begins to occur in early adolescence as does reddening of the scrotum and emergence of pubic hair.

What anticipatory guidance can the nurse provide the girl who has noted the development of breast buds? Menarche should follow in about 2 years. Adult height will be reached at the time of menarche. The growth spurt will begin immediately with menarche. Breast development will be complete with 12 months.

Menarche usually follows within 2 years of the first signs of breast development. Peak height velocity (PVH) in girls occurs 6 to 12 months following menarche. It does not follow immediately. Breast development progresses through several stages and will not be complete until late puberty. Adult height is not reached at the time of menarche but about 6 to 12 months following menarche.

The parent of a Black adolescent voices concern to the nurse because the daughter, "has gotten her period before all of her friends." How should the nurse respond? "On average Black girls start their period earlier than other ethnicities." "I will be sure to let the health care provider know this. We do not want to miss something that may be wrong." "How old are most of her friends? Maybe that is the issue instead of it being a sign of something abnormal." "Some girls just get their period earlier than others."

Menarche, the first menstrual period, usually begins between the ages of 9 and 15 years (average 12.8 years), but on average Black adolescents reach menarche earlier than adolescents of other ethnicitic backgrounds. This response addresses the parent's concern. The other responses do not address the parent's concern or may lead the parent to think this is an abnormal occurrence.

In working with the toddler, which statement would be most appropriate to say to the toddler to decrease the behavior known as negativism? "It is time for lunch. I am going to put your bib on." "Are you getting hungry and ready for lunch?" "Do you want help getting into your chair so we can have lunch?" "You love having the same food every day. Do you want apples again with lunch?"

Negativism is very typical of the toddler years. It is best to avoid questions with a yes or no answer because the answer will always be no. Limiting the number of questions asked of the toddler and making a statement, rather than asking a question or giving a choice, is helpful in decreasing the number of negative responses from the child. Instead of asking questions like "Do you want help getting in your chair?" make the statement "Get in your chair." The toddler years are also ones where the child becomes a picky eater or "grazes" instead of eating a full meal so the toddler may not actually know if he or she is hungry.

The nurse is obtaining a health history on a toddler and asks the parents about their health history, the health history of their other children, and of their parents' health history. The parents ask the nurse why this information is necessary. What is the best response by the nurse? "I understand your confusion about why these things matter, but it's part of my job." "The health history helps us get to know our clients and their families better." "The information can alert us to any disease process that might run in families." "This is part of the health form that we are required to complete during an admission."

Obtaining a three-generation health history can help in determining the risk of potential disease processes that have familial tendencies, such as diabetes, heart disease, etc. While the family health history is part of the standard assessment that must be completed, this response does not address the parent's question.

The nurse is talking to a 13-year-old boy about choosing friends. Which function do peer groups provide that can have a negative result? following role models developing stability sharing problems negotiating differences

Peers serve as role models for social behaviors, so their impact on an adolescent can be negative if the group is using drugs, or the group leader is in trouble. Sharing problems with peers helps the adolescent work through conflicts with parents. The desire to be part of the group teaches the child to negotiate differences and develop loyalties and stability.

Which behavior by an 18-year-old is consistent with successful progression through the stages of Piaget's theory of development? is able to be part of a large group of peers while maintaining a sense of self has a strong sense of understanding of internal identity uses critical thought processes to handle a problem reflects a strong moral code

Piaget's developmental theories focus on the cognitive maturation of the child. The ability to critically think is a sign of successful cognitive maturation. A sense of internal identity is consistent with Erikson's theories of development. Kohlberg's theories development focus on morals and values.

The nurse prepares to examine a 4-year-old boy. How would the nurse proceed? Examine the child's extremities first and then the chest. Examine different sections of the body at various times. Examine the child's chest and then go to the head and down. Examine the child's head and work down to the child's toes.

Preschoolers or young children should be examined starting from their head and working down all the way to their toes for a thorough exam. In infants and young children, the examination starts with the chest and then proceeds from head to toes.

A 14-year-old boy has come to his primary care physician's office for a routine well-child visit with his parent. Which statement by the parent should the nurse prioritize for further investigation after noting the father has a history of alcohol use disorder? "I think I know how my son feels about drinking. He has had substance use disorder education in school." "Sometimes my son asks me questions about his father's low tolerance for alcohol." "Our next door neighbor is older than my son, and he drinks when they hang out together." "I wish there was a blood test for alcohol use disorder. I know my son is at risk."

Some diseases and conditions are seen across families, and this is important in prevention as well as detection for the child. The caregiver can usually provide information regarding family health history. The nurse should use this information to do preventive teaching with the child and family. Early adolescence is a time when experimental use of substances, especially alcohol and tobacco, might be seen. It would be important to assess the use of substances and follow up regarding the behaviors of the adolescent.

The mother of a 13-year-old boy confides to the pediatric nurse practitioner that her son has recently had a nocturnal seminal emission. The mother is concerned, and the nurse explains "wet dreams" and the other male traits of puberty to the mother. Which response indicates a need for further discussion? "My son's spontaneous erections and nocturnal emissions are very normal." "My son is not doing anything to cause the nocturnal emissions; they occur spontaneously." "My son is developing normally and the traits of puberty vary from child to child." "My son must be sexually active or having overly sexual thoughts to have a nocturnal emission."

Spontaneous erections and nocturnal seminal emissions do not mean that the child is sexually active or having overactive sexual thoughts. Parents need to be instructed that these occurrences are spontaneous and that the child is not doing anything to cause them.

The nurse is examining an infant who is 4 days old. The nurse puts the infant in a semi-upright position and lets the head fall back (with immediate support). What infant reflex is the nurse testing? Moro Babinski palmar grasp root

The Moro reflex is stimulated when the infant is semi-upright and the head falls backward. When this happens, the infant responds with symmetrical abduction and extension of the arms, flexion of the thumb, and flexion of the upper limbs. This response should not persist after 4 months of age. The Babinski sign is tested through stimulating the foot/toes. The palmar reflex is tested through the hand/fingers. The root reflex is tested through touch on the corner of the mouth.

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 though it may not look the best for them. Our house rules are stricter than their friends but everyone follows the same rules in our home. Discourage spending too much time with school friends since we know they can be a negative influence. Leave pamphlets about topics such as drugs and alcohol in their room so they can read 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 choices, hairstyles, and music, the caregiver decreases the stress for the child. Information about drugs and alcohol is important to share, but these topics would be better discussed with the child. It is important the adolescent spend time with peers.

A teacher refers a student to the school nurse because the student is frequently falling asleep during class. After talking with the student, the nurse is most concerned by which statement by the student? "I just can't seem to stay awake during that class because it's boring." "I get 7 hours of sleep every night so I don't know why I am so tired." "I guess I need to be more careful about my curfew on school nights." "My mom keeps telling me to turn off my television when I go to bed."

The average number of hours of sleep that teens require per night is 8.5 to 9.5 due to rapid growth that occurs during these years. Following a curfew and limiting distractions at bedtime can help provide the student with adequate hours of sleep each night.

A 16-year-old girl has arrived for her sports physical with a new piercing in her navel. Which response by the nurse is best? "Be sure to clean the navel several times a day." "I hope for your sake the needle was clean." "This is a risk for hepatitis, tetanus, and AIDS." "This is a wound and can become infected."

The best response is to describe the proper care using frequent cleansing with antibacterial soap. It is too late for warnings about the dangers of piercing such as skin- or blood-borne infections, or disease from unclean needles.

The nurse is collecting data on a 9-year-old child being admitted to the pediatric unit. What is the most appropriate way to gather information from the child's caregiver? Have the child read the questions to the caregiver and then write down the answers on the form. Have the caregiver sit in a quiet room and fill out a questionnaire. Ask the caregiver questions and document the answers. Ask the caregiver if he or she can read or if someone is needed to read the questions on the admission form to him or her.

The family caregiver provides most of the information needed in caring for the child. Rather than simply asking the caregiver to fill out a form, it may be helpful to ask the questions and write down the answers. This provides a personal interaction between the nurse and the caregiver. If the caregiver cannot read, the nurse would help with the completion of the form by asking questions and documenting the answers. Children should not be used as interpreters or complete a form. If the child is under the age of 18 it would not be a legal document, and with a child's language skills and comprehension much-needed information could be not obtained.

A 17-year-old adolescent chats excitedly with the nurse about plans for college and a career. The adolescent states having checked out every college in the region and determined which one is the best fit and would give the adolescent the best career options. The nurse recognizes which developmental aspect in this client? Sensorimotor Identification of identity Formal operational thought Socialization

The final stage of cognitive development, the stage of formal operational thought, begins at age 12 or 13 years and grows in depth over the adolescent years, though it may not be complete until about age 25. This step involves the ability to think in abstract terms and use the scientific method (deductive reasoning) to arrive at conclusions. With the ability to use scientific reasoning, adolescents can plan their future. They can create a hypothesis (What if I go to college? What if I do not?) and think through the probable consequences (In the long run, I will earn more money; I could begin earning money immediately). This scenario does not pertain to socialization, role identification, or sensorimotor development.

The nurse is meeting with a group of caregivers of adolescents and discussing sex and sexuality, including how to discuss these issues with their children. Which comment should the nurse prioritize with this group of caregivers? Teenagers spend so much time with their peers, and that is usually how they find out about sex. Being honest and straightforward with teenagers will encourage them to ask about subjects like sexuality. Most schools have excellent programs to teach adolescents about sex and sexuality. Internet resources, movies, and television have the most accurate and current information for your adolescent to learn about sexuality issues.

The most important aspect of discussions about sexuality with adolescents is giving honest, straightforward answers in an atmosphere of caring concern. Children whose need for information is not met through family, school, or community programs will get the information—often inaccurately—from peers, movies, television, or other media.

An 18-year-old adolescent reveals the presence of nipple ring and is looking to get a tattoo in the next few months. What is the most important thing that the nurse can teach the adolescent at this time? Complications are more likely when you tattoo yourself. Review the safety rules for those who do the tattooing. Tattooing carries risks such as infection, disease, and nerve damage. It is not recommended to get the tattoo from your friend in his garage.

The nurse needs to emphasize that tattoos and body piercing can be painful, and carry risks of complications such as infection, blood-borne diseases, keloids and granulomas, allergic reactions, excessive bleeding, nerve damage, or damage to the piercing site. Complications are more likely if a person tattoos oneself or has the tattoo done by a friend. The nurse needs to encourage the adolescent to seek the expertise of a trained technician, doctor, or nurse to have the piercing, tattooing, or branding done. There are developed safety rules for those who do piercing and tattoos.

An 18-year-old adolescent reveals the presence of nipple ring and is looking to get a tattoo in the next few months. What is the most important thing that the nurse can teach the adolescent at this time? Review the safety rules for those who do the tattooing. It is not recommended to get the tattoo from your friend in his garage. Tattooing carries risks such as infection, disease, and nerve damage. Complications are more likely when you tattoo yourself.

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? Children from ages 2 to 7 years investigate and explore the environment and look at things from their own point of view. From ages 7 to 11 years, children internalize actions and can perform them in the mind. Up to age 2, children learn by touching, tasting, and feeling. They learn to control body movement. 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 by touching, tasting, and feeling. They learn to control body movement. Preoperational level takes place in children ages 2 to 7 years who investigate and explore the environment and look at things from their own point of view. At the concrete operations level, from ages 7 to 11 years, children internalize actions and can perform them in the mind. At the formal operations, after age 12, children can think in the abstract. Complex problem solving is included in this category.

A 16-year-old adolescent is talking with the nurse at a local health clinic about skin care. Which comments by the teen does the nurse determine require additional conversation? Select all that apply. "I only tan before going on spring break to get a base tan so I won't burn." "My mom had melanoma so she always makes me wear a sunscreen with an SPF of 30." "My favorite time of day to be outside is the middle of the day, around noon." "Our coach makes us wear sun-protective clothes when we practice outside on the weekends." "The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older."

The nurse should further discuss comments that demonstrate incorrect information about sun exposure. Any exposure to tanning beds should be avoided to prevent skin cancer risks. Other risks for skin cancer include being in the sun between the times of 10:00 am and 4:00 pm, and sun exposure and burns during childhood and adolescence. A minimum SPF of 15 should be used, so SPF 30 is good practice, as is wearing sun-protective clothing when outside during the day.

An adolescent with a new piercing comes to the health center at the school. The client reports feeling hot. Which action will the nurse complete first? Inquire about the piercing technique used. Assess the client for signs of infection. Determine when the client started feeling hot. Ask the client if any other piercings are present.

The nurse will first assess the client for signs of infection. The client reports feeling hot, which could indicate a fever. The nurse would assess the client's temperature and for other signs and symptoms of infection, such as redness, swelling, warmness, drainage, discomfort. The nurse would ask when the client started feeling hot and about the technique used for the piercing to gain additional history and insight. However, these questions are not priority over assessing the client. Determining if the client has any additional piercings is not necessary, as this will not provide information about the client's current situation.

While assessing a 17-year-old client, the nurse notes the following: blood pressure 152/96 mm Hg, pulse 124 beats/minute, respirations 20 breaths/minute, temperature 98.8°F (37.1°C), dilated pupils, euphoric state, and pressured speech. Which intervention would the nurse anticipate the health care provider to prescribe first? Low-sodium diet Magnetic resonance imaging (MRI) Hydrochlorothiazide daily Urine drug screen

The nurse would anticipate the primary health care provider would first prescribe a urine drug screen as the client is exhibiting findings of drug use. Drugs such as cocaine and crack can cause hypertension, tachycardia, dilated pupils, euphoria, pressured speech, weight loss, insomnia, agitation, and increased motor activity. Further prescriptions will be based on the results of the drug screen. At this time, a MRI, low-sodium diet, or thiazide diuretic (hydrochlorothiazide) are not indicated.

The caregiver of a 3-year-old boy presents at the receptionist desk and reports that the child is nauseated. In interviewing the child's caregiver, which question should the nurse prioritize when starting the assessment? "Why did you decide to bring your son to the clinic today?" "How often does your son complain of being nauseated?" "Does anyone else in the family have the same symptoms?" "Has your son had anything to eat that he might be allergic to?"

To provide the best care for the child, it is important to get the most complete explanation of what brought the child to the health care setting. The nurse may not have heard the entire conversation and asking an open-ended question will allow the caregiver to provide the nurse with all the information necessary to provide the best care. The other questions could be asked depending on the answers given by the caregiver.

The nurse is counseling an overweight, sedentary 15-year-old girl. The nurse is assisting her to make appropriate menu choices. Which statement indicates the adolescent understands how to make appropriate dietary selections? "I avoid all fat intake." "I need to eat plenty of fruit each day." "Because of my age, my dairy intake is unlimited." "To lose weight my protein intake should be limited to 2 to 4 servings per day."

The sedentary teen needs to consume approximately 1,600 calories each day. A balanced diet includes plenty of fresh fruit and a small amount of fat. To avoid all fat could place the child's health at risk. Protein intake is important for the development of tissue. The teen will need about 5 ounces of protein daily.

Due to casts on both arms, the nurse must measure an 11-year-old client's blood pressure in the thigh. After placing the blood pressure cuff on the thigh, which action by the nurse demonstrates understanding of the procedure? The nurse places the stethoscope over the femoral artery. The nurse places the stethoscope over the dorsalis pedis artery. The nurse places the stethoscope over the posterior tibial artery. The nurse places the stethoscope over the popliteal artery.

The stethoscope should be placed on the artery nearest, but below, the blood pressure cuff.

The nurse is conducting a physical examination of a 5-year-old girl. The nurse asks the girl to stand still with her eyes closed and arms down by her side. The girl immediately begins to lean. What does this tell the nurse? The child has poor coordination and poor balance. The child warrants further testing for an inner ear infection. The child has a negative Romberg test; no further testing is necessary. The child warrants further testing for cerebellar dysfunction.

This indicates a positive Romberg test which warrants further testing for possible cerebellar dysfunction.

The nurse is conducting a physical assessment on a 2-year-old. What steps are important for the nurse to incorporate in this examination? Select all that apply. Have parents remove the clothing. Measure the blood pressure. Allow the toddler to sit in parent's lap for ear examination. Allow play with the equipment being used. Stand on the scale for height and weight.

When performing an assessment on a toddler or preschooler the nurse may ask the parents to remove the clothing or allow the toddler or preschooler to do this independently. Children this age may be very afraid of examining equipment. To alleviate their fears, allow them to sit on their parent's lap for most of the exam, and let them handle items such as stethoscopes, otoscopes, and blood pressure cuffs before the examination. Include blood pressure measurements as part of the examination at age 3 years. Children up to school-age often need to be restrained for ear and throat examinations because they grow fearful about procedures performed on a part of the body they cannot see. Children older than 2 years of age are weighed on standing scales, in street clothes (no shoes).

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 Above the clavicle on the left side Above the sternum, slightly to the right Below the ribs about one half of an inch

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

The nurse is caring for an infant who was injured in a severe automobile accident. The child experienced several fractures and is in significant pain. The child's mother questions if this will impact her child later in life. What information should be provided by the nurse? Although the pain is severe at this time a child under the age of 2 will not be able to recall the event. Experiences with pain even in infancy can influence an individual's response to pain later. Pain that is short in duration in infancy will not influence the child later. There are no studies that consider the impact of pain in infancy on the child later in life.

answer Repeated exposure to painful procedures and events can have long-term consequences. Memories of pain may be stored in the child's nervous system, influencing later reactions to painful stimuli.

The nurse plans to apply a cream with lidocaine and prilocaine to decrease the pain of an injection. What would be the best technique? Do not cover it after application to prevent it from discoloring. Apply it at least 1 hour before the procedure. Apply it immediately prior to the painful procedure. Wipe it off at least 15 minutes before the procedure.

answer A topical anesthetic cream containing lidocaine and prilocaine must be applied at least 1 hour prior to a superficial procedure (injections, IV starts) to be effective. It needs to be applied at least 2 to 3 hours prior to a deep procedure such as a bone marrow aspiration. The drug should be applied in a thick layer over the area. It is not rubbed into the skin. It should be covered after application with a transparent dressing. This allows for maximum absorption and to prevent the child from tasting it (which could anesthetize the gag reflex). The drug is wiped when the skin is prepped for the procedure. Lidocaine and prilocaine cream is effective in reducing pain from procedures such an IM injection up to 24 hours after the injection.

An adolescent's parent states not knowing what to do with the adolescent. The parent reports the teenager is taking two or three showers a day when not that long ago the parent could barely get the teen to take a shower at all. What should the nurse's reply be to the parent? "Reinforce the family rules but also allow the adolescent to develop one's own routine." "Remind the adolescent about needing to be on a schedule so as to not disrupt the family." "Do not encourage multiple baths; it can be very drying to the skin." "Reevaluate the adolescent's ability to perform hygiene care since showering is so frequent."

answer Adolescents find that frequent baths and deodorants are important due to the apocrine sweat gland secretion activity. The increases in sex hormones and steroids cause the skin to be oily. This leads to more showers or baths daily. This is a time when the adolescent is defining what type of personal hygiene products are preferred. Hygiene and personal care can become a source of family arguments as the young person develops a style of personal care. Parents need to be mindful of the adolescent yet maintain family rules and boundaries regarding aspects of personal care. It is important for teenagers to feel that they have some ability to develop their own personal care standards and daily patterns.

A nurse is caring for a hospitalized 7-year-old child whose family members have been unable to visit for 2 days. The nurse is preparing a diversional activity for the child. Which activity would best be suited for a child in this age group? A paint-by-numbers activity creating a picture An activity focusing on learning fractions A card game such as solitaire A board game such as monopoly

answer Between the ages of 6 and 8 years, children begin to enjoy participating in real-life activities, such as helping with gardening, housework, and other chores. They love making things, such as drawings, paintings, and craft projects. The child would need additional instruction to learn fractions, which may not be considered fun. A card game such as solitaire and a board game of monopoly may be too hard for the 7-year-old. In addition, the game of monopoly would require additional players.

A nurse is assessing the pain level of an infant. Which finding is not a typical physiologic indicator of pain? palmar sweating decreased oxygen saturation plantar sweating decreased heart rate

answer Decreased heart rate is not a physiologic response to pain. Instead, infants demonstrate an increased heart rate, usually averaging approximately 10 beats per minute with possible bradycardia in preterm newborns. Decreased oxygen saturation and palmar and plantar sweating are common physiologic responses to pain in the infant.

A child is in treatment for cancer and has been experiencing pain. The nurse is talking with the parents about assisting with pain management using distraction. Which statement(s) indicates an understanding of the information provided? Select all that apply. "The underlying principle of distraction is focusing on stimuli other than the pain being experienced." "Distraction has been researched to not be very effective with pain management." "Using media such as TV or movies can be a distraction technique." "Distraction is helpful because it helps to lessen the pain." "Some people may find singing or counting a good form of distraction."

answer Distraction involves having the child focus on another stimulus, thereby attempting to shield him or her from pain. Distraction does not lessen the pain but it refocuses attention away from it. The techniques for distraction vary and what will work is individualized. Techniques may include watching TV or movies. Some may find singing, talking or reading helpful.

Which nursing intervention demonstrates proper use of cutaneous stimulation to relieve pain in pediatric clients? Use of a heat pack after abdominal surgery for a 2-week-old infant with necrotizing enterocolitis. Gently massaging a preterm infant's leg for 2 minutes prior to obtaining a blood sample from a heel stick. Use of a cold pack for the treatment of cellulitis on an extremity. Use of a cold pack for 20 minutes to achieve a muscle temperature of 104°F (40°C).

answer Gentle massage of the leg for 2 minutes prior to heel stick may decrease pain response in preterm infants. Massage and pressure relax the muscles and decrease the tension. It also increases blood flow to the area. Use of heat or cold therapy is contraindicated in infants, who are more prone to thermal injuries. Ice packs should not be used for longer than 15 minutes at a time. Heat is most effective in relieving pain from inflammation and spasm.

A young child is in the emergency department with swelling and pain in the right ankle. The client states that while playing soccer, she somehow twisted her ankle and could not walk off the field. The health care provider tells the client that it is a sprain. Which type of pain is this client experiencing? Somatic Visceral Cutaneous Chronic

answer Pain is classified in two categories. Acute pain has a rapid onset, usually as a result of tissue injury and it resolves with the injury healing. The other type of pain is chronic. This type does not end when the injury heals and affects a client's activities of daily living. One type of acute pain is somatic pain. Somatic pain originates from deep body structures, such as muscles or blood vessels. The pain of a sprained ankle is somatic pain. Visceral pain is pain occurring in the organs. Cutaneous pain affects the skin.

The nurse is caring for a 3-year-old child who has an intravenous line. When medications are delivered through the line the child experiences burning. What action by the nurse will be most helpful? Explain to the child that this does hurt but will make him or her better. Sit with the child and use distractions such as toys during the infusion. Apply a local anesthetic to the area prior to infusing the medication. Administer the medications when the child is sleeping.

answer Some medications cause discomfort and burning when they are administered intravenously. Sitting with the child and providing distraction such as with toys will help distract the child during the infusion. Topical anesthetic agents may be used prior to the initiation of the intravenous device. It is not used once the IV line has been started. Telling a 3-year-old child that the medications will make him or her better is not going to be an age-appropriate means to deal with the discomforts of the medication administration. It is not realistic that the medication can be scheduled for administration when the child is sleeping.

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

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

A nurse is caring for a 4-year-old child who is exhibiting extreme anxiety and behavioral upset prior to receiving stitches for a deep chin laceration. Which nursing intervention is a priority? Ensuring the lighting is adequate for the procedure but not so bright to cause discomfort. Ensuring that emergency equipment is readily available. Serving as an advocate for the family to ensure appropriate pharmacologic agents are chosen. Conducting a baseline physical assessment.

answer When a child is manifesting extreme anxiety and behavioral upset, the priority nursing intervention is to serve as an advocate for the family and ensure that the appropriate pharmacologic agents are chosen to alleviate the child's distress. Ensuring emergency equipment is readily available and lighting is adequate for the procedure is also part of the nursing function, but secondary interventions. Conducting a baseline physical assessment is important but would likely be difficult if the child was crying inconsolably or was extremely anxious.

A nurse is caring for a 4-year-old child. The parents indicate that their child often reports that objects in the house are his friends. The parents are concerned because the child says that the grandfather clock in the hallway smiles and sings to him. Which response by the nurse is best? A)"Attributing lifelike qualities to inanimate objects is quite normal at this age." B)"Has your child suffered any type of physical trauma lately?" C)"Your child is demonstrating animism, which is common." D) "Is there any family history of mental health disorders?"

ANSWER A The nurse should explain to the parents that attributing lifelike qualities to inanimate objects is quite normal for a 4-year-old child. Telling the parents that the child is demonstrating animism is correct information, but it would be better for the nurse to explain what animism is and then remind the parents that it is developmentally appropriate for their child. Asking whether the parents think the child had a recent trauma or whether there is a family history of mental disorders is inappropriate and does not teach.

The nurse is assessing a 4-year-old child. The child tells the nurse about her friend, Nancy, who lives in her room at home. The mother tells the nurse that Nancy is not a real person. The nurse would use which term when documenting this assessment finding? A)imaginary friend B) preoperational thought C)magical thinking D)animism

ANSWER A The preschool-age often has an imaginary friend. This friend serves as a creative way for the preschooler to sample different activities and behaviors and practice conversational skills. Preoperational thought is a self-centered understanding of the world. Magical thinking is when a preschooler believes that his or her thoughts are all-powerful. Animism is when a preschooler attributes lifelike qualities to inanimate objects.

The nurse is assessing a toddler's fine motor skills. Which finding by the nurse could be a safety concern? A)Ability to turn door knobs B)Able to use a spoon to self-feed C)Ability to hold a crayon to write D)Put shapes into matching openings

ANSWER A 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 growth and development and involve lesser safety hazards.

The nurse is completing a developmental assessment on a 6-month-old infant. Which findings indicate the need for additional follow-up? Select all that apply. A)The infant does not pay attention to noises behind him. B)The infant seems disinterested in the surrounding environment. C)The infant is unable string together 2 word sentences. D)The infant babbles. E)The infant has frequent episodes of crossed eyes.

ANSWER A-B-E Warning signs that may indicate problems with sensory development include the following: young infant does not respond to loud noises; child does not focus on a near object; infant does not start to make sounds or babble by 4 months of age; infant does not turn to locate sound at age 4 months; infant crosses eyes most of the time at age 6 months. Language development at this stage of development does not include stringing together 2-word sentences.

The nurse is completing an infant history on a 5-month-old and documents the following symptoms. Which will the nurse attribute to teething? Select all that apply. A)Refusing to eat B)Irritability and awakening from sleep C)Drooling and biting D)Increased sucking on hands E)Fever and diarrhea

ANSWER A-BC-D Infants at age 5 months are in the process of cutting their first teeth, typically the upper or lower central incisors. Symptoms associated with the mouth and feeding are common. Fever and diarrhea are considered signs of illness, not teething.

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

ANSWER A-C-E Separation anxiety occurs initially in infancy and then reoccurs again during the toddler stage. Separation anxiety for the toddler is normal. As the toddler begins to develop an understanding of object constancy, separation anxiety will ease. The toddler, while missing the parent, will begin to recognize that the parent will return. Establishing a routine for saying goodbye is helpful for the toddler. There is no indication that the care providers are problematic.

The nurse is providing anticipatory guidance to the parent of a 2-month-old infant in relation to growth and development. Which statement from the parent demonstrates proper understanding? A)"I can expect my infant to become clingy around strangers within the next month." B)"I can expect my infant to be able to raise the head up when on the stomach within the next month." C)"I can expect my infant to laugh out loud within the next month." D)"I can expect my infant to be able to hold a rattle within the next month."

ANSWER B It is expected that a 3-month-old infant can raise the head to 45 degrees while laying on the stomach. Becoming clingy around strangers occurs in the infant around 6 to 8 months of age. The infant can begin to hold a rattle around 5 months of age. At 4 to 5 months, the infant will typically begin to laugh out loud.

A nurse is talking to and making facial expressions at a 9-month-old baby girl during a routine office visit. What is the most advanced milestone of language development that the nurse should expect to see in this child? A) the infant coos, babbles, and gurgles B)The infant says "da-da" when looking at her father C)The infant imitates her father's cough D)The infant squeals with pleasure

ANSWER B By 9 months, an infant usually speaks a first word: "da-da" or "ba-ba." The other answers refer to earlier milestones in language development. In response to a nodding, smiling face, or a friendly tone of voice, a 3-month-old infant will squeal with pleasure or laugh out loud. By 4 months, infants are very "talkative," cooing, babbling, and gurgling when spoken to. At 6 months, infants learn the art of imitating. They may imitate a parent's cough, for example, or say "Oh!" as a way of attracting attention.

The nurse is identifying outcomes for a family with a preschool-age who has broken fluency. Which initial outcome would be the most appropriate? The parents will correct the child each time there is a break in fluency. The parents will not call attention to the child's broken fluency. The mother will encourage the child to repeat words after her. Other children will help the child by finishing words and sentences.

ANSWER B Calling attention to broken fluency can make the situation worse. The child should not be encouraged to speak or practice words if he or she does not want to. The parents should stop any other siblings who desire to finish the child's words or sentences. The child should not be punished or corrected for broken fluency because this is a normal part of speech development.

The nurse is talking to the parent of a 19-month-old toddler about setting limits and supervising activities. In which situation will the nurse recommend letting the toddler do as he or she pleases? A) playing on the picnic table B) exploring one's body C) deciding one's bedtime schedule D) choosing one's own foods

ANSWER B Children learn about gender differences during the toddler years. They observe differences between male and female body parts if they are exposed to seeing it. They question their parents about the differences. It is normal for toddlers to explore their genitals as they develop their own sense of self. The parent should allow this and not punish the child. Choosing food and deciding bedtimes need to be done by an adult. Likewise, safety dictates that the picnic table is not a safe play area.

During the toddler years, the child attempts to become autonomous. Which statement by a 3-year-old toddler's caregiver indicates that the toddler is developing autonomy? A) "Every night my toddler follows the same routine at bedtime." B) "My toddler uses the potty chair and is dry all day long." C) "My toddler has temper tantrums when we go to the store." D) "When my toddler falls down, they always wants me to pick them up."

ANSWER B During the toddler years, the toddler separates from his or her parents, recognizes one's own individuality and exerts autonomy. Being toilet trained is an example of the toddler developing autonomy or independence. Having temper tantrums is a normal response of the toddler as it is a way the toddler expresses frustration of being tired or not being able to accomplish a task. Having the parent pick up the child after the child falls is a security and emotional need. All children need this, so it is not indicative of toddlerhood or autonomy. Having the same routine for bedtime each night provides security but it does not demonstrate autonomy.

Which would be a nutritional goal for a preschool client? A) Reduce messiness and spills. B) Introduce new food gradually and include variety. C) Let the child eat only what the child wants. D) Eat everything on the plate.

ANSWER B Mealtimes can become a power struggle between caregivers and the young child. Reassure caregivers that young children go through periods during which they are very particular about food. Therefore, new foods should be gradually introduced and include variety. Foods that look like or smell like other foods they enjoy are the most likely to be eaten. Eating everything on the plate can lead to obesity; the child needs a variety of the 5 food groups; and messiness and spills allow the child to use fine and gross motor skills and practice their use of utensils and cups.

The home health nurse is visiting a 2-year-old client's home. Which finding will cause the nurse to intervene? A) The toddler in not allowed in the kitchen while food is being prepared. B) The family's medications are located in a kitchen drawer. C) All of the windows in the home are locked. D) The toddler goes to the bathroom alone to urinate.

ANSWER B Poisoning is at peak incidence during the toddler period. Special precautions need to be taken against poisoning at this time. This includes keeping all medications in a high, locked cabinet. It is appropriate for all windows to be locked to prevent a toddler from exiting the home out a window. The toddler may go to the bathroom alone once toilet training is well established. Not allowing the toddler in the kitchen during meal preparation will prevent accidental burns from hot foods and surfaces.

The nurse has brought a group of preschoolers to the playroom to play. Which activity would the nurse predict the children to become involved in? A)Watching a movie with other children their age B)Pretending to be mommies and daddies in the playhouse C) Painting pictures in the art corner of the room D)Playing a board game

ANSWER B Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-aged child enjoys group activities, such as board games, and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities he or she can participate in with their peers.

What suggestions regarding the evaluation of a childcare center would the nurse share with a preschooler's mother? A) Research local newspapers to see if there are any complaints against the center. B) Specific program goals to be accomplished should be available. C) A ratio of 10 children to 1 teacher is adequate. D) The longer the center has been in operation, the better it is.

ANSWER B Preschool is used for toddlers to foster social skills and to acclimate them to the group environment. When a parent is searching for a preschool, he or she should check the school's accreditation, the teacher's qualifications, and seek the recommendations of other parents. Parents should visit the school to see the teacher interact with the children, the focus of the activities, and hygiene practices. Parents should look at the school's daily schedule and the types of activities offered. Are the activities structured or loose? Preschoolers need planned activities. They are very ready to learn, but the activities should be planned to focus on their short attention

A 3-year-old child is hospitalized. The parents are concerned because the child is now refusing to use the potty and is wetting the bed even though the child has achieved toilet training. Which response by the nurse is most appropriate? A)"Do not worry. This is a normal response to being in the hospital." B)"Your child is experiencing regression as a result of stress." C)"Why do you believe your child is refusing to use the potty?" D)"Once discharged, your child will quickly learn to use the toilet again."

ANSWER B Regression is a change from present behaviors to past developmental levels of behavior. This is a normal response among children during times of intense stress, such as a hospitalization or the birth of a new sibling. The nurse should not tell the parents not to worry. The child will not have to learn to use the toilet again. The behavior is already learned. Asking why is not a therapeutic form of communication and may cause the parents to become unnecessarily defensive.

The nurse is assessing an infant at the 6-month well-baby check-up. The nurse notes that at birth the baby weighed 8 lb (3600 g) and was 20 in (50.8 cm) in length. Which finding is consistent with the normal infant growth and development? A)weight of 14 lb (6400 g) and length of 24 in (61.0 cm) B)weight of 16 lb (7300 g) and length of 26 in (66.0 cm) C)weight of 18 lb (8200 g) and length of 28 in (71.1 cm) D)weight of 20 lb (9100 g) and length of 30 in (76.2 cm)

ANSWER B The average newborn weighs 7.5 lb (3400 kg) at birth. Most infants double their birth weight at 4 to 5 months and will triple by the time they are 1 year old. If this infant was 8 lb (3600 kg) at birth, then it is most likely now 16 lb (7300 g). The average newborn is 20 in (50 cm) long at birth. They grow more quickly in length over the first 6 months, than during the second 6 months. By 12 months of age, the infant's length has increase by 50%. At 1 year, this infant will most likely be 30 in (76.2 cm) in length; however, since most of the growth occurs in the first 6 months, it is possible for the infant to grow an additional 6 in (15 cm) during that time.

The mother of a 1-month-old infant voices concern about her baby's respirations. She states they are rapid and irregular. Which information should the nurse provide? A)The normal respiratory rate for an infant at this age is between 20 and 30 breaths per minute. B)The respirations of a 1-month-old infant are normally irregular and periodically pause. C)The irregularity of the infant's respirations are concerning; I will notify the physician. D)An infant at this age should have regular respirations.

ANSWER B The normal respiratory rate for a 1-month-old infant is 30 to 60 breaths per minute. By 1 year of age the rate will be 20 to 30 breaths per minute. The respiratory patterns of the 1-month-old infant are irregular. There may normally be periodic pauses in the rhythm.

The nurse is caring for an 18-month-old child who has had surgery. The medical record indicates the child weighs 23 pounds (10.45 kg). When monitoring his urinary output the nurse is aware that normal hourly output should be what value? A) 5 ml/hr B) 10 ml/hr C) 20 ml/hr D) 15 ml/hr

ANSWER B The normal urinary output for a toddler is approximately 1 ml/kg/hr. This child weighs 23 pounds. This is 10.45 kg. This is approximately 10 ml/hr.

A nurse is caring for a 4-year-old child who will be undergoing a procedure to remove a mass from the abdomen. In order to help the child remain calm in preparation for getting an IV catheter placed, what intervention might the nurse implement? A) Take the child to the playroom for coloring. B) Allow the child to play with a procedure doll. C)Distract the child with games and candy. D) Don't discuss the procedure in front of the child.

ANSWER B The nurse can allow the child to play with a procedure doll that will simulate the procedure for the child.

The parents of a toddler ask the nurse about disciplining their 2-year-old toddler. What suggestions will the nurse provide? Select all that apply. A) "Avoid using physical punishment unless your toddler's behavior is really out of line." B) "Try using time-out, assigning 1 minute per year of your toddler's age." C) "If you allow an unwanted behavior one time at this age, it is difficult to reverse later." d) "You need to wait until the toddler is old enough to understand the rules." E) "It is better to praise correct behavior than to punish wrong behavior."

ANSWER B-C-E Parents should begin to instill some sense of discipline early in life because part of it involves safety limits. Two general rules to follow include the need to be consistent and the use of praise for correct behavior rather than punishment for wrong behavior so that the child can learn the rules. Parents should implement consistent discipline early. Once an unwanted behavior is allowed, it is difficult to reverse as the child grows older. Time-out is an effective technique to help children learn that actions have consequences. One minute per year of the child's age is the common standard. Physical punishment is not recommended. Having a consistent caregiver is important for reducing separation anxiety.

Parents and their nearly 3-year-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay? A) Half of speech understood by outsider B) Asks "why" often C) Uses two-word sentences or phrases D) Talks about a past event

ANSWER C A child nearly 3 years of age should speak in three- to four-word sentences. The other findings indicate normal expressive language for the age.

When assessing a toddler's language development, what is the standard against which you measure language in a 2-year-old toddler? A)The toddler should say two words plus "ma-ma" and "da-da." B)The toddler should be able to count out loud to 20. C)The toddler should speak in two-word sentences ("Me go"). D)The toddler should say 20 nouns and 4 pronouns.

ANSWER C A toddler can understand language and is able to follow commands far sooner than he or she can actually use the words. By 2 years of age, a toddler typically speaks in two-word (noun and verb) sentences. Two-year-old toddlers have a vocabulary of about 40 to 50 words, and they start to use descriptive words (hungry, hot). The words "ma-ma" and da-da" occur much earlier than the toddler stage. The toddler is about 36 months of age before using pronouns or plurals in sentences. Children are unable to count to 20 until they are 5 to 6 years old.

While observing a 13-month-old and her parents in the playroom of the hospital unit, the nurse notes that the toddler is using her index finger to point towards a toy. What should the nurse say to the parents? A)"Has your daughter started turning book pages on her own yet." b)"I notice your daughter is using her index finger to point. This is something we should tell the doctor." C)"Your daughter is demonstrating fine motor skills appropriate to her age by pointing with her index finger." D)"How long has your daughter used her index finger to point to objects?"

ANSWER C At 12 to 15 months of age the toddler should be feeding herself finger foods and using her index finger to point to objects. Turning the pages of books would not be expected until the age of 18 months.

Nursing students are reviewing information about the cognitive development of preschoolers. The students demonstrate understanding of the information when they identify that a 3-year-old is in what stage as identified by Piaget? A) Primary circular reaction B) Coordination of secondary schema C) Tertiary circular reaction D) Preoperational thought

ANSWER D A 3-year-old is in the preoperational stage according to Piaget. Primary circular reaction is seen in infants of 3 months. Coordination of secondary schema is seen in infants at age 10 months. Tertiary circular reaction is seen in toddlers between 12 and 15 months.

A mother of a 9-month-old 18-pound (8.2 kg) infant asks the nurse about choosing the best car seat. What should the nurse recommend? A)a forward-facing 5-point harness restraint B)a forward-facing convertible booster C)a rear-facing booster seat D)a rear-facing 5-point harness restraint

ANSWER D An infant until 2 years of age should be in a rear-facing car seat. The 5-point harness seat is made for children up to 40 pounds (18 kilograms) and the booster seat for children from 40 to 80 pounds (18 to 36 kilograms).

A mother is concerned because her 14-month-old son, who had a big appetite when breastfeeding a few months ago, seems uninterested in eating solid food. She still breastfeeds him daily but is thinking of weaning him soon. How should the nurse respond to this mother? A) "It is not normal for toddlers to lose their appetites; spoon feed him yourself to make sure he gets proper nutrition." B) "It is not normal for toddlers to lose their appetites; have him tested for a gastrointestinal condition." C) "It is normal for toddlers to lose their appetites; try weaning him all at once so that he will be more interested in the solid food." D) "It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate."

ANSWER D Because growth slows abruptly after the first year of life, a toddler's appetite is usually less than an infant's. Children who ate hungrily 2 months earlier now sit and play with their food. It is important to educate parents while the child is still an infant that this decline in food intake will occur so they will not be concerned when it happens. Because the actual amount of food eaten daily varies from one child to another, teach parents to place a small amount of food on a plate and allow their child to eat it and ask for more rather than serve a large portion the child cannot finish. One tablespoonful of each food served is a good start. The nurse should recommend that the mother wean her son gradually to avoid confrontation, not all at once. Most toddlers insist on feeding themselves and generally will resist eating if a parent insists on feeding them.

A mother is concerned because her 14-month-old son, who had a big appetite when breastfeeding a few months ago, seems uninterested in eating solid food. She still breastfeeds him daily but is thinking of weaning him soon. How should the nurse respond to this mother? A)"It is not normal for toddlers to lose their appetites; spoon feed him yourself to make sure he gets proper nutrition." B)"It is not normal for toddlers to lose their appetites; have him tested for a gastrointestinal condition." C)"It is normal for toddlers to lose their appetites; try weaning him all at once so that he will be more interested in the solid food." D)"It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate."

While the nurse is taking a blood pressure on a 4-year-old, the child states that the blood-pressure cuff is too tight and angrily says, "That hurt, you big poo-poo head." What is the most appropriate response by the nurse? A) Scold the child for the insult while apologizing for hurting her, and loosen the cuff. B) Explain that the cuff will only hurt for minute and ask the child's caregiver to please tell the child not to speak to you that way. C) Ask the child's caregiver to please hold the child on their lap until she calms down. D) Calmly explain that you don't mean to hurt her, loosen the cuff, and tell her that is isn't nice to call you names.

ANSWER D Four- and 5-year-olds delight in using "naughty" words or swearing. Bathroom words become favorites and taunts, such as "you're a big doo-doo," bring heady excitement to them. Caregivers may become concerned by this turn of events, but the child simply may be trying out words to test their impact. By using a calm, matter-of-fact response when a preschooler uses naughty or swear words, some of the power of using that type of language will be defused. The child learns that this is not language to use in the company of others.

The nurse is reviewing the diet of an 8-month-old infant with the mother who reveals she has been using evaporated milk to make the formula. Which additional ingredient should the nurse ensure she is including in the formula? A)Vitamin D B)Calcium C)Vitamin E D)Iron

ANSWER D Infants who are fed home-prepared formulas (based on evaporated milk) need supplemental vitamin C and iron. Evaporated milk has adequate amounts of vitamin D, which is unaffected by heat used in the preparation of formula. Calcium and vitamin E would not be a concern in this infant's formula.

The mother of a 4-year-old child is concerned that she caught him masturbating in the bath tub. Which is the most appropriate response by the nurse? A) "If you catch your child masturbating, you should immediately make them stop." B) "Masturbation is not a normal behavior for a child of that age." C) "You will need to speak with the doctor about that behavior since I cannot address sexual issues in a child." D) "Masturbation is a normal part of preschool development."

ANSWER D Masturbation is a healthy and natural part of normal preschool development if it occurs in moderation. If the parent overreacts to this behavior, then it may occur more frequently. The nurse can and should educate the mother on normal growth and development, including sexual issues.

The mother of a 3-year-old tells the nurse that she is concerned that her child is not developing motor skills quickly enough. She states that, "My son can't skip and cannot stand on one foot for any length of time while playing." How should the nurse respond? A)"I wouldn't be too concerned since he seems fine during my assessment." B)"I am sure he will become more proficient in these activities soon." C)"Maybe practicing these activities with him would help him improve these motor skills." D)"Your child is not expected to be able to perform those activities at 3 years of age."

ANSWER D Skipping and standing on one foot for up to 10 seconds are motor skills that are expected from a 5-year-old, not a 3-year-old; therefore, the best response is letting the mother know that her child is not behind in motor development.

The nurse is teaching the parents of a 2-year-old child how to handle the child's temper tantrums. The nurse determines that the teaching was successful if the parents make which statement? A)"We will offer our child a treat to stop having the tantrum." B)"We will place our child in time-out for 5 minutes after the tantrum." C)"We will attempt to reason with our child to limit tantrums." D)"We will ignore our child while having the tantrum."

ANSWER D The best response is to tell a child simply that the parent disapproves of the tantrum and then ignore it. Bribery, such as saying that the child can have a treat if the behavior stops, is rarely effective because by accepting the child's wishes, the parent is encouraging the child to have more tantrums because he or she was successful. Placing the child in time-out does not deal with the actual tantrum. When a child is placed in time-out, the appropriate length is 1 minute per year of age (2 minutes for this child). Tantrums are a result of the child not being able to appropriately express his or her needs, desires, or frustrations. It is not appropriate to attempt to reason with a upset 2-year-old child.

The father of a 2-year-old girl tells the nurse that he and his wife would like to begin toilet training their daughter soon. He asks when the right time is to begin this process. What should the nurse say in response? A)"The best time to start toilet training is as soon as the child Begins walking." B)"She's well past the age to begin toilet training; most children are ready by age 1, when they have developed the needed nervous system control." C)"It is best to wait a little longer, until she is 3; only then will she be socially developed enough to understand what you are asking her to do." D)"When she starts tugging on a wet or dirty diaper, she is letting you know she's ready."

ANSWER D 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. Because physiologic development is cephalocaudal, the rectal and urethral sphincters are not mature enough for control in most children until at least the end of the first year, when tracts of the spinal cord are myelinated to the anal level. A good way for a parent to know a child's development has reached this point is to wait until the child can walk well independently. Toilet training need not start this early, however, because cognitively and socially, many children do not understand what is being asked of them until they are 2 or even 3 years old.

The nurse is conducting a health screening for a 3-year-old boy as required by his new preschool. Which statement by the parents warrants further discussion and intervention? A) "There is a very low student-teacher ratio, and they do a lot of hands-on projects." B) "The school requires processed foods and high sugar foods be avoided." C) "The school has a loose environment, which is a good match for his temperament." D) "The school is quite structured and advocates corporal punishment."

ANSWER D The nurse needs to emphasize that there are number of reasons that a parent should not choose a preschool that utilizes corporal punishment. It may negatively affect a child's self-esteem as well as ability to achieve in school. It may also lead to disruptive and violent behavior in the classroom and should be discouraged. The other statements would not warrant further discussion or intervention.

The nurse is conducting a well-child assessment of a 4-year-old. Which assessment finding warrants further investigation? A) presence of 20 deciduous teeth B) absence of dental caries C) presence of 19 deciduous teeth D) presence of 10 deciduous teeth

ANSWER D The presence of only 10 deciduous teeth would warrant further investigation. The preschooler should have 20 deciduous teeth present. The absence of dental caries or presence of 19 teeth does not warrant further investigation.

The caregivers of a 2-year-old are concerned the child is not learning how to share and play well with other children. While acknowledging their concern and devotion, the nurse should point out which activity would be best for this child's developmental level? A) Mowing the lawn with a toy lawnmower B) Looking at large print magazines c) Sharing finger paints and painting with the caregiver D) Throwing a baseball-sized ball

Answer A Toddlers enjoy talking on a play telephone. They like pots, pans, and toys such as brooms, dishes, and lawnmowers that help them imitate the adults in their environment and promote socialization. Toys that involve the toddler's new gross motor skills, such as push-pull toys, rocking horses, large blocks, and balls are popular. Fine motor skills are developed by use of thick crayons, modeling clay, finger paints, wooden puzzles with large pieces, toys with pieces that fit into shaped holes, and cloth books. The toddler will not be interested in sharing toys until the later stage of toddlerhood; adults should not make an issue of sharing at this early stage.

A mother is discussing her 10-month-old boy with the nurse. Which comment indicates a need for teaching? A "He loves being in his walker and 'zips' around the house." B"He gets a few sips of apple juice each day from a regular cup, not a sippy cup." C"I wipe my son's teeth every day with a fresh washcloth." D"We have safety gates at the top and bottom of our stairs."

Answer A Walkers are safety hazards and not recommended by the American Academy of Pediatrics. They cause falls plus promote the ability to reach items on surfaces otherwise inaccessible. The other comments are age appropriate and acceptable practice.

The nurse is teaching the parents of a 2-year-old child how to handle the child's temper tantrums. The nurse determines that the teaching was successful if the parents make which statement? A) "We will offer our child a treat to stop having the tantrum." B) "We will ignore our child while having the tantrum." C) "We will attempt to reason with our child to limit tantrums." D) "We will place our child in time-out for 5 minutes after the tantrum."

Answer B

The nurse is assessing the sleeping practices of the parents of a 4-month-old girl who wakes repeatedly during the night. Which parent comment might reveal a cause for the night waking? AThey sing to her before she goes to sleep. BThey put her to bed when she falls asleep. CIf she is safe, they lie her down and leave. DThe child has a regular, scheduled bedtime.

Answer B If the parents are keeping the child up until she falls asleep, they are not creating a bedtime routine for her. Infants need a transition to sleep at this age. If the parents are singing to her before she goes to bed, if she has a regular, scheduled bedtime, and if they check on her safety when she wakes at night, then lie her down and leave, they are using good sleep practices.

A staff nurse is talking about Piaget's theory with a nursing student. Infants are in the sensorimotor stage of cognitive development during which object permanence is mastered. An example of an infant displaying this ability is: A)smiling at herself in the mirror. B)looking for a toy in her crib at the last place she saw it. C) pushing a spoon from her high chair tray to the floor. D)shaking a rattle to enjoy the sound

Answer B Looking for the toy where it was last seen indicates object permanence. The infant knows the object still exists even though she cannot see it. All the rest of the infant's behaviors show use of her senses and motor activity but do not illustrate object permanence.

The nurse is assessing a 1-year-old at the well-child annual visit and notes the child is meeting the growth parameters. After noting the birth weight was 8 pounds (3.6 kg) and length was 20 inches (50.8 cm) long, which measurements reflecting height/weight would the nurse expect to document for this visit? A16 lb (7.2 kg) and 26 inches (65 cm) B20 lb (9.1 kg) and 28 inches (70 cm) C24 pounds (10.8 kg) and 30 inches (75 cm) D28 pounds (12.7 kg) and 32 inches (80 cm)

Answer C By 1 year of age, the infant should have tripled his or her birth weight and grown 10 to 12 inches (25 to 30 cm). If this infant was 8 pounds (3.6 kg) at birth, at 1 year, this child should weigh 24 pounds (8 x 3 = 24) and grown to 30 to 32 inches (20 + 10 to 12 = 30 to 32 inches). Most of the growing occurs during the first 6 months with the infant's birth weight doubling and height increasing about 6 inches (15 cm). Growth slows slightly during the second 6 months but is still rapid.

The nurse is preparing a presentation for a health fair which will illustrate various ways to help introduce siblings to a new member of the family. Which suggestion should the nurse prioritize to help older siblings, especially toddlers, understand the change in the family dynamics? A) Plan time for the secondary caregiver to focus on the toddler while the primary caregiver focuses on the infant. B) Plan time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant. C) Have a grandparent or another special adult in the child's life take the toddler on an errand or a special visit. D) Move the toddler to a new bedroom with a "grown-up-bed."

Answer C The secondary caregiver can occasionally take over the care of the new baby while the mother or other primary caregiver devotes herself to the toddler. The primary caregiver might also plan special times with the toddler when the new infant is sleeping and the caregiver has no interruptions. This approach helps the toddler feel special. Moving the older child to a larger bed lets the toddler take pride in being "grown up" now, but it should be done some time before the new baby appears. While acknowledging that time with another adult can be a special time, the main concern is for the toddler to understand they are not being replaced by the newest member of the family.

Stacy is going to visit her son in the intensive care unit. She has been pumping breast milk and storing it in the fridge. Stacy is making her son's bottle for his feeding and goes to warm the breast milk. What option should the nurse give the mom to prepare the bottle? A) "Just use the microwave in our kitchen." B)"It is okay if the frozen milk is in the bottle." C)"Just take the bottle from the fridge and use it." D) "You can use the hot water tap to get warm water to warm the bottle."

Answer D

The nurse is educating the mother of a 6-month-old boy about the symptoms for teething. Which symptom would the nurse identify? A)frequent loose stools B)running a mild fever or vomiting C)choosing soft foods over hard foods D)increased biting and sucking

Answer D

A 13-month-old child is brought to the clinic for a well-child visit. The child's parent expresses concern that the child has not started to walk yet. What is the best action should the nurse take? A) Refer the child to a developmental specialist for evaluation. B) Explain that the child could start walking any day. C) Ask the parent if the child has been ill recently. D) Explain that children can take their first steps as late as 18 months of age.

Answer D Infants can begin walking as early as 8 to 9 months and as late as 18 months of age. Telling the parent that the child will start walking any day is true but not guaranteed. Asking if the child has been ill recently is an appropriate question during a well-child visit but does not address the parent's concerns. Since the child is on track developmentally, there is no indication to refer the child to a developmental specialist.

During the first visit to the pediatrician's practice the nurse is performing an admission interview and assessment of a 4-week-old infant. The mother states, "I am sure my baby girl knows my smell because she is much more settled in my arms rather than my mother's arms when she is upset." What is an appropriate response by the nurse? A) "I'm not sure a 4-week-old infant can tell their mother from another woman's smell." B)"Maybe she just knows your voice better than your mother's." C)"Babies really can't tell the difference between people at that age." D)"You may be right, since infants can sense their mother's smell as early as 7 days old."

Answer D The sense of smell develops rapidly: the 7-day-old infant can differentiate the smell of his or her mother's breast milk from that of another woman and will preferentially turn toward the mother's smell.

The mother of an infant is confused after being told by her dentist not to let her baby go to bed with a bottle of milk. She does not agree with that suggestion. Which response should the nurse prioritize when addressing this situation with the mother? A "Giving a bottle of milk when the infant goes to bed can lead to obesity." B"Bottles given at bedtime can cause erosion of the enamel on the teeth." C"Giving your baby a pacifier at bedtime will satisfy the need to suck." D "You could occasionally give your baby a bottle of water at bedtime."

Answer D The sugar from formula or sweetened juice coats the infant's teeth for long periods and causes erosion of the enamel on the deciduous teeth. While giving water in a bottle at bedtime is acceptable and a pacifier will satisfy the sucking need, the most appropriate response is to warn of possible enamel erosion. Giving a bottle at bedtime is not a factor that leads to obesity.

The home health nurse is visiting a 2-year-old client's home. Which finding will cause the nurse to intervene? a) ll of the windows in the home are locked. B)The family's medications are located in a kitchen drawer. c)The toddler in not allowed in the kitchen while food is being prepared. d)The toddler goes to the bathroom alone to urinate.

Answer b

The nurse is caring for an 18-month-old child. The nurse is aware that the child is which stage according to Erikson? A) Industry versus inferiority B)Autonomy versus shame and doubt C)Trust versus mistrust D) Initiative versus guilt

Answer b

The nurse is teaching parents how to avoid a power struggle with their 2-year-old girl. Which comment indicates that more teaching is needed? a)"Childproofing our home will make it less necessary to say 'No!'" b) "We will make sure she shares her toys with cousins her age." c)"We will give her a choice whenever possible." d) "Both of us, as parents, will agree on and consistently enforce the limits we set."

Answer b

The parents of a toddler ask the nurse, "We are so frustrated. It seems like our child has temper tantrums all the time. What can we do?" Which response by the nurse is appropriate? "When your child gets like this, it is best to give into what the child wants." "Stay calm and nearby then once it is over, try to distract your child." "It is important to show the child who is in control." "Try reasoning with your child when the tantrum starts."

Answer b Temper tantrums, aggressive displays of temper during which the child reacts with rebellion to the wishes of the family caregiver, spring from the many frustrations that are natural results of a child's urge to be independent. Add to this a child's reluctance to leave the scene for necessary rest, and frequently the frustrations become too great. The child is out of control and needs help regaining control. A trusted person who remains calm and patient needs to be nearby until the child gains self-control. In addition, the adult must maintain self-control to reassure the child and provide security. Showing the child who is in control would only further add to the child's frustrations. Trying to reason with the child, scolding the child, or punishing the child during a tantrum is useless. After the tantrum is over, the parent may divert attention with a toy or some other interesting distraction, which can help the child relax. However, the parent should not yield the point or give in to the child's whim.

A stay-at-home father wants to purchase commercial toddler meals because his 16-month-old girl recently choked on table food. Which food items will the nurse suggest not be given to this child? Select all that apply. Fruits such as peaches, pears, and kiwi Round foods such as hot dogs, whole grapes, and cherry tomatoes Sticky foods like peanut butter alone, gummy candies, and marshmallows Vegetables such as corn, green beans, and peas Hard foods such as nuts, raw carrots, and popcorn

Answer b-c- e To offer soft round foods safely, cut hot dogs in uneven pieces and cut grapes and cherry tomatoes into quarters. This prevents food impacting in an airway. Avoid the hard and sticky foods due to aspiration and airway occlusion risks. The cooked vegetables listed are safe as are the soft fruits.

What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition? A)"I give my daughter juice at breakfast and when she is thirsty during the day." B)"New foods are offered along with ones she likes." C)"She drinks three 6-ounce cups of whole milk each day." D)"When she doesn't eat well at meals we give her nutritious snacks."

answer A High juice intake can contribute to either obesity or appetite suppression. None is needed, but if juice is given limit the amount to 4 to 6 ounces daily. Water should be the choice for thirst. The other statements support good toddler nutrition. Whole milk is needed through age 2 years. Two cups daily is adequate. Nutritious snacks support quality intake when quantity is poor. New foods offered with old ones provide sameness along with the new.

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