PEDS test 1

what are causes of infant mortality

#1: Low Birth Weight -congenital malformations -preterm births -SID (Sudden Infant Death Syndrome)

at 9-10 months what are two big cognitive developments infants have?

#1: object permanence, where they realize that objects that leave the visual field still exists so peek a boo doesn't work #2: they have stranger anxiety and realize family from strangers

adolescent - what is their age - it begins and ends when - how is their growth

- 13-18 - begins with the onset of puberty and ends with cessation of body growth at 18-21 years old - they have a rapid physical, cognitive and social maturation and grow with long life friendships

preschooler - age - how are they ?

- 3-5 - we are prepping them for school and being separated from their parents for a longer period of time - has an increased attention span and memory

school age children - age - how is their growth

- 6-12 - slow and steady growth of BMI, weight and height - dental hygiene is important because permanent teeth start to move in

what do we have to education adolescents on?

- 8 hours of sleep - on sex activity, abstinence and contraception - if have acne encourage treatment to improve self image

what are side effects of drugs used to treat ADHD

- ABD pain - headache - appetite loss - sleep issue - growth suppression

what are risk factors for infant mortality

- African American - male because they lack a chromosome - too short or long of a gestation - mom too young or old - lack of prenatal care

what are stimulants- methyphenidase that are used to treat ADHD

- Ritalin - Focalin

what are they questionares we have the parents fill out about their child that they suspect has ADHD

- Vanderbilt - Conner - CBQ

what are the pharmacologic interventions for mild to moderate pain in children

- acetaminophen - Motrin

what are stimulants- amphetamines what are used to treat ADHD

- adderal - vivance

what are nursing interventions with pain in children

- anticipate and intervene - use pain scales - administer proper medications - keep safe places to decrease anxiety and stress of children

how do we examine a school age child

- ask them questions and allow them to answer - head to toe assessment - provide modesty

how is preschooler play

- associative play with no common Goal - cooperative play with a common goal - imaginative and dramatic play

how do we prep the child for a procedure?

- be concrete and honest - explain the procedure first to the parent and then have them help explain it to the child - establish trust

how do we communicate with an adolescent

- be honest and straightforward - be aware of privacy needs - allow time for patient to speak with out the parent in the room

what are s/s of inattention

- cant pay attention - difficult to sustain attention to something - cant follow instruction - problem with organization - forgetfulness

what are the domains the cognitive impairment looks at

- communication - home living - community use - leisure - health - self care - social skills - academics - work - self direction

what are s/s of aspergers

- conversation revolve around them - robotic - poor social interaction - obsession with topics - socially immature and peculiar

what are the characteristics of preschoolers with initiative vs guilt

- creative - imaginative - curious - more cooperative

what are indications of acute pain in children?

- dilated pupils - increase Bp, HR, RR - sweating - decreased urine outputted - N/V - guarding with movement - increased metabolic caloric consumption - hypoglycemia - weight loss - increase loss of fluids - delayed wound healing

what are characteristics of the toddlers autonomy vs shame and doubt

- egocentric - demanding - temper tantrums - negativity - want to lead

how is the sensory development of the school age child

- eyes are developed by age 6 so they need screening - growth spurt can cause myopia - there is maturation of Eustachian tubes so less risk of ear infections - reading skills and language increase

how do we act after a procedure with a child?

- focus on + aspects of the child - praise child for doing good - provide opportunity for therapeutic play

what are associated comorbities with autism ?

- food allergies - skin allergies - asthma - eczema - respiratory allergies WE think because autism is a neuroimunology disorder that attacks the immune system

why do we use PCA for children with severe pain

- for age aprpproapte kids that know how to work it and help avoid constant injections

how do we effectively communicate with children

- get on their eye level - approach gently and quietly - always be truthful - give choices when appropriate and include play when appropriate

how do we examine a preschooler

- have a parent near - let them help and praise them

at each child visit what do we measure

- height - weight - head circumference - BMI

what are the school age needs during their hospital stay

- help them understand the healing process and keep them involved - they need distractions because they get bored

what do you gather in your pain assessment

- history of what worked, how they display pain, the experience with medications - biophysical assessment of vitals and O2 sat - subjective info from child - rating scale and clinical judgement

what are long term complications from pain for children?

- impaired inflammation and immune response - poor motor performance - poor adaptability - cognitive defects - learning disorder - temperament changes - mistrust in environment and anxiety

how is the preschoolers motor development

- increase coordination, muscle strength, running, biking, cutting, drawing and begin buttoning clothes

how are adolescents relationship with their peers

- increase role on each other because they provide a sense of belonging and feeling power - peers form a transitional world between dependance and autonomy - can be usual advocates in health promotion and support

with children who have special needs, when it is anticipated that the family will have stress?

- initial diagnosis - when S/S increase - when child moves to a new setting - during parent absence - end of life - reaching ultimate attainment

what are common concurrent difficulties in childhood with ADHD

- injury - academic underachievement - relationship issues

what does the toddler period consist of with their temper tantrums

- intense period of exploration with temper tantrums due to feeling like they aren't being understood, may be tired, hungry, sick and has poor communication skills

how is toilet training?

- it has to be when the child is ready and willing to please parents - starts out when they are curios about sibling and adults habits and want to do it on their own

school age development of industry vs inferiority, what is it?

- it is the readiness to work and want to have accomplishments - they want to do a task and compete it - they gradually move away from parents and home which was their primary support and enter a world of school, peers and same sex relationships - PEER APPROVAL IS HUGE

how is the physical growth of toddlers

- it slows with a decrease in caloric demand - they now have voluntary control of their elimination but dont have readiness to potty train - HOW THEY LOOK: pot belly from baby fat, bowed legs and flat feet

how do we examine an infant

- keep on parents lap - distraction is key

what children do we use conscious sedation with

- lacerations - fractures - bone marrow - aspiration - burns - dental care

what are signs of developmental delay in an infant?

- lack of eye muscle movement control by 4-6 months - lack of eye contact - lack of social smile by 8-12 weeks - delay in motor development

how is the toddlers cognitive development (sensorimotor)

- learn by trial. and error and mimicry of others - they need to explore their environment

how is the preschoolers moral development (PRECONVENTIONAL)

- learn right from wrong and punishment and consequences - need to be consistent with discipline

how do we examine a toddler

- let them play with the instruments - make the most invasive tests last (ears and throat)

what are common concurrent difficulties in adolescence with ADHD

- low self esteem - substance abuse - MVA

how do we act during a procedure with a child?

- maintain a running dialogue - reinforce whats being done and how it will feel - tell them how much Time is left

what is the etiology of autism

- more common in boy s - linked in siblings

what medications do we use for conscious sedation

- morphine - fentanyl - diazepam - Phenobarbital - propotol

what are pharmacological interventions for moderate to severe pain in children

- morphinne - PCA - epidural analgesia - transdermal analgesia - conscious sedation

what is the diagnostic criteria for a cognitive impairment

- must demonstrate functional impairment in atleast 2/10 adaptive skill areas OR - must have deficits in 1 or more adaptive domains

what are the toddler needs during their hospital stay

- need rituals and routines like they had at home - due to being in autonomy we should give them choices when appropriate like color of bandaid and what medication they wanna take first

what are S/S of autism

- no pretend play or magical thinking - unaware when others speak to them - repeat actions - echolia - loses skills that were already acquired - avoid eye contact - need everything in place - sensitive to noice

describe toddlers play

- parallel play with no common goal - they like to imitate and have tactile play

what are non pharm treatments of ADHD

- parent training - adhd training - IPE - peer group therapy

what are S/S of pervasive developmental disorder ?

- peculiar things in child that dont match others - language and social skill regression and delay

what are s/s of hyperactive

- restless - always on the go - interrupt often - cant remain seated - fidget - excessive talking

how is adolescence moral development: post conventional

- sense of justice is developed through peers and family - they respect law and order - know right from wrong - understand obligations

what are S/S of Neuro concerns in children

- short attention span - clumsy - mirror movements of extremities - hyperkinesis - language disturbance - uneven perceptual development

how is the physical growth of the preschooler

- slow and steady growth with minimal height and weight change - lose baby fat - all teeth in by 3 years

what are the 2 domains that need to have impairment to diagnose autism?

- social interaction AND - restrictive repetitive patterns of behavior, interests and activities

the toddler years are also known as what? what is the age?

- the terrible twos - 12-36 months

what is the health promotion for toddlers

- they eat the same food so focus on intake - parents need to take care of their teeth - limit high carb and sugar before bed - they sleep 11/12 hours a day

how is the toddlers motor development?

- they have an increase in motion to walk, run and climb - they have increased they manual detexetiry where they like to feed themself, attempt spooning, undressing and washing hands

describe the preschooler initiative vs guilt

- they have increase indepdnance and mastery of self care - they want to learn and do new things

what are HUGE step stones for school age children under Piagets CONCRETE stage

- they have reversibility ( can add and subtract) - conservation - classification (mom is female, daughter, mother and teacher) - humor - logic

what is the impact on the siblings of a special needs child?

- they may feel neglected and act out - may feel cheated on time - may take on more responsibilities and act as a caregiver

what are non stimulant drugs that are used to treat ADHD

- tricyclic - alpha 2

what are common concurrent difficulties in adulthood with ADHD

- under employment - low income - legal issues

what are S/S that there is stress in a child

- unhappy - hyperactive - irritable - change in diet/sleep - n/v - headache - bedwetting - drug use - poor school

what do we have to make sure to educate to school age children

- what will happen to their bodies, talk about pregnancy, STI and STD - manage screen time - have a balanced diet with excersie

how do we discipline a school age child?

- withhold privileges - require compensation - impulse penalties - contracts

the infant can have 3-5 words by when

1 year

walk me through fine motor development of an infant

1. grap 2-3 months 2. palmar grasp 6 months 3. transfer objects between hands 7 months 4. pincer grasp 8-10 moths 5. remove objects from container 11 months 6. build blocks 12 months

walk me through the stages of gross motor movements

1. increase coordinations of extremities at 4 months 2. army crawl 6 months 3. crawl 9 months 4. pull to stand 9 months 5. walk with furniture 11 months 6. walk 12 months

what month can an infant usually move from a prone to a sitting position.

10 month

at what month can infants ascribe meaning to a word?

10-11 months

how long should preschoolers sleep a day

12 hours a day

when do anterior fontanels close?

12-18 months

when do post fontanels close?

2 months

preconceptual phase is what years

2-4

intuitive phase is what years

4-7

how long should mothers breastfeed their infant for

6 months

when can infants finally start to try table food?

6 months

at what month can infants understand the term NO

9-10 months

what autism spectrum disorder is this? peculiar behaviors with normal to superior intelligence

Aspergers

how are school age children with moral development

CONVENTIONAL - they conform to rules and want to be seen as a "good boy/girl" - reward and punishment guide choices and they may tell a lie to please an adult - need boundaries to follow

what is an example of a developmental screening tool

Denver 2

what theorist? stage of psychosocial development that describes series of crisis emerging at specific times and all must be resolved before moving on

Erikson

t/f: we can place babies on their belly to sleep

FALSE! they may suffocate and die

how do you care for a baby who has Colic

Hold your baby across your arm or lap while you massage their back. Hold your baby upright, if they have gas. Hold your baby in the evening. Hold your baby while walking. Rock your baby in your arms or by using an infant swing.

why is it important to diagnose ADHD early?

It affects their psychological and emotional development because their behavior evokes negative responses from peers that effects the Childs self concept

what theorist? said that moral development and progressive acceptance of the values and rules of society determine behavior. children want to avoid punishment and judgement

Kohlberg

what are s/s of childhood disintegrative disorder

LOSS OF - expressive language - receptive language - social skills - bowel control - play - motor skills

authoritative parent style

Parenting style in which parents set clear standards for their children's behavior but are also responsive to their children's needs and wishes.

developmental pace

Periods of accelerated and decelerated growth Does not occur in all areas at the same pace Once a skill has been achieved, the focus will shift to another area

what theorist? said how children learn to deal with their environment through thinking and reasoning

Piaget

Why is play important?

Play allows children to use their creativity while developing their imagination, dexterity, and physical, cognitive, and emotional strength. Play is important to healthy brain development. It is through play that children at a very early age engage and interact in the world around them, and teaches them things that parents cannot

what are the normal vitals of an infant?

RR: 30 HR: 120 Temp: 97.5 - 99.3 BP: 95/58

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

a

A burn patient is experiencing anxiety over dressing changes. Which prescription should the nurse expect to be ordered to control anxiety? a. Lorazepam (Ativan) b. Oxycodone (OxyContin) c. Fentanyl (Sublimaze) d. Morphine Sulfate (Morphine)

a

A nurse is teaching parents how to apply time-out as a disciplinary method for their 4 year old. Parents have understood the teaching if they state which formula correctly guides the use of time-out? a. Use the guideline of 1 minute per each year of the childs age. b. Relate the length of the time-out to the severity of the behavior. c. Never use time-out for a child younger than age 4 years. d. Follow the time-out with a treat.

a

A parent tells a nurse that she is worried because her preschool aged child has an imaginary friend. The nurse explains that a. Imaginary friends are not unusual for preschool aged children b. The parent should enroll in parenting classes c. The child should see a child psychologist d. The child should go to daycare only 3 days a week

a

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

a

At what age can most infants sit independently unsupported? a. 8 months b. 6 months c. 11 months d. 4 months

a

Before auscultating a toddler's lungs the nurse should a. Allow the child to play and examine the stethescope b. Palpate the abdomen for an unusual mass c. Ask the parents to leave the room d. Examine the child's ears and throat

a

Children as young as age 3 years can use facial scales for discrimination. What are some suggested anchor words for the preschool age group? a. No hurt. b. Red pain. c. Zero hurt. d. Least pain.

a

Children in Piaget's Concrete Operational Stage a. Are able to classify objects into categories b. Exhibit egocentrism c. Exhibit magical thinking d. Are not able to reverse their thinking

a

During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is which? a. A normal finding b. A sign of a possible visual defect and a need for vision screening c. An abnormal finding requiring referral to an ophthalmologist d. A sign of small hemorrhages, which usually resolve spontaneously

a

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

a

Parents are concerned about the number of hours their teenage daughter spends with peers. The nurse explains that peer relationships are important during adolescence for which reason? a. They provide adolescents with a feeling of belonging. b. Adolescents no longer need parental control. c. They promote a sense of individuality in adolescents. d. Adolescents dislike their parents.

a

The ability to mentally understand that 1 + 3 = 4 and 4 - 1 = 3 occurs in which stage of cognitive development? a. Concrete operations stage b. Formal operations stage c. Preoperations stage d. Intuitive thought stage

a

The nurse is caring for a child receiving a continuous intravenous (IV) low-dose infusion of morphine for severe postoperative pain. The nurse observes a slower respiratory rate, and the child cannot be aroused. The most appropriate management of this child is for the nurse to do which first? a. Administer naloxone (Narcan). b. Discontinue the IV infusion. c. Discontinue morphine until the child is fully awake. d. Stimulate the child by calling his or her name, shaking gently, and asking the child to breathe deeply.

a

The nurse is planning care for a hospitalized toddler. What is the rationale for planning to continue the toddlers rituals while hospitalized? a. To provide security b. To prevent regression c. To prevent dependency d. To decrease negativism

a

The nurse is preparing a pamphlet for parents of adolescents about guidance during the adolescent years. What suggestion should the nurse include in the pamphlet? a. Provide clear, reasonable limits and define consequences when rules are broken. b. Begin to disengage from school functions to allow the adolescent to gain independence. c. Use comparisons with older siblings or extended family to promote good outcomes. d. Provide criticism when mistakes are made or when views are different.

a

The nurse is preparing to perform a physical assessment on a 10-year-old girl. The nurse gives her the option of her mother staying in the room or leaving. This action should be considered which? a. Appropriate because of childs age b. Appropriate, but the mother may be uncomfortable c. Inappropriate because of childs age d. Inappropriate because child is same sex as mother

a

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

a

The nurse is talking to the parent of a 4-year-old child who refuses to go to sleep at night. What intervention should the nurse suggest in helping the parent to cope with this sleep disturbance? a. Establish limited, orderly rituals that signal readiness for bedtime. b. Establish a consistent punishment if the child does not go to bed when told. c. Allow the child to watch television until almost asleep. d. Allow the child to fall asleep in a different room and then gently move the child to his or her bed.

a

The parents of a child born with disabilities ask the nurse for advice about discipline. The nurses response should be based on remembering that discipline is which? a. Essential for the child b. Not needed unless the childs behavior becomes problematic c. Best achieved with punishment for misbehavior d. Too difficult to implement with a special needs child

a

The potential effects of chronic illness or disability on a childs development vary at different ages. What developmental alteration is a threat to a toddlers normal development? a. Hindered mobility b. Limited opportunities for socialization c. Childs sense of guilt that he or she caused the illness or disability d. Limited opportunities for success in mastering toilet training

a

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

a

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

a

What manifestation observed by the nurse is suggestive of parental overprotection? a. Gives inconsistent discipline b. Facilitates the childs responsibility for self-care of illness c. Persuades the child to take on activities of daily living even when not able d. Encourages social and educational activities not appropriate to the childs level of capability

a

What nursing intervention is most appropriate in promoting normalization in a school-age child with a chronic illness? a. Give the child as much control as possible. b. Ask the childs peer to make the child feel normal. c. Convince the child that nothing is wrong with him or her. d. Explain to parents that family rules for the child do not need to be the same as for healthy siblings.

a

Which data should be included in a health history? a. Review of systems b. Physical assessment c. Growth measurements d. Record of vital signs

a

Which of the following behaviors by parents and/or teachers will best assist the child in negotiating the developmental task of industry? a. Structuring the environment so the child can master tasks b. Decreasing expectations to eliminate potential failures c. Asking the child what he wants to achieve d. Identifying failures immediately and asking the child's peers for feedback

a

Which strategy would be the best approach when initiating the physical examination of a 9-month-old male infant? a. Have the parent hold the child on his or her lap. b. Undress the infant and do a head-to-toe examination. c. Ask the parent to leave because the infant will be upset. d. Put the infant on the examination table and begin assessments at the head.

a

by age 2 how is their language a. 300 words and word sentences b. talk with mixed real and fantasy words c. learn bad words and can be aggressive d. can use simple sentences and short talk

a

toddlers characteristic of egocentrism a. all about me b. belief all invert objects are alive c. cant see something in reverse order d. belief in magical things like super heros

a

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

a - A 12-month-old child is able to pull to a stand and walk holding on or independently. Appropriate toys for this age child include large pushpull toys for kinetic stimulation.

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

a - Baby talk is a sign of regression in the toddler. Often toddlers attempt to cope with a stressful situation by reverting to patterns of behavior that were successful in earlier stages of development. It should be ignored while the parents praise the child for developmentally appropriate behaviors. Regression is childrens way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism.

What is descriptive of the nutritional requirements of preschool children? a. The quality of the food consumed is more important than the quantity. b. The average daily intake of preschoolers should be about 3000 calories. c. Nutritional requirements for preschoolers are very different from requirements for toddlers. d. Requirements for calories per unit of body weight increase slightly during the preschool period.

a - Parents need to be reassured that the quality of food eaten is more important than the quantity. Children are able to self-regulate their intake when offered foods high in nutritional value. The average daily caloric intake should be approximately 1800 calories. Toddlers and preschoolers have similar nutritional requirements. There is an overall slight decrease in needed calories and fluids during the preschool period.

A boy age 4 1/2 years has been having increasingly frequent angry outbursts in preschool. He is aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8 to 10 weeks. His parent asks the nurse for advice. What is the most appropriate intervention? a. Refer the child for a professional psychosocial assessment. b. Explain that this is normal in preschoolers, especially boys. c. Encourage the parent to try more consistent and firm discipline. d. Talk to the preschool teacher to obtain validation for behavior parent reports.

a - The preschool years are a time when children learn socially acceptable behavior. The difference between normal and problematic behavior is not the behavior but the severity, frequency, and duration. This childs behavior meets the definition requiring professional evaluation. Some aggressive behavior is within normal limits, but at 8 to 10 weeks, this behavior has persisted too long. There is no indication that the parent is using inconsistent discipline. A part of the evaluation is to obtain validation for behavior parent reports.

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

a - we do not want to attach food to positive or negative rewards because this can start a eating problem down the line

What is an important consideration in preventing injuries during middle childhood? a. Achieving social acceptance is a primary objective. b. The incidence of injuries in girls is significantly higher than it is in boys. c. Injuries from burns are the highest at this age because of fascination with fire. d. Lack of muscular coordination and control results in an increased incidence of injuries.

a -School-age children often participate in dangerous activities in an attempt to prove themselves worthy of acceptance. The incidence of injury during middle childhood is significantly higher in boys compared with girls. Motor vehicle collisions are the most common cause of severe injuries in children. Children have increasing muscular coordination. Children who are risk takers may have inadequate self-regulatory behavior.

what is ADHD?

a behavior disorder marked by mentally inappropriate behaviors of inattention, hyperactivity and impulsivity

solitary play

a child plays alone, unaware of any other children playing nearby - ex: playing with blocks

sensitive period

a point in development when children are particularly susceptible to certain kinds of stimuli in their environments, but the absence of those stimuli does not always produce irreversible consequences - want to be mindful of them

developmental screening

a process designed to identify children who should receive more intensive assessment or diagnosis of potential developmental delays. These delays may be in any of the developmental domains: gross motor, fine motor, language, or social skills. Developmental screening promotes early detection of delays and improves child health and well-being for identified children.

how is the cognitive development of adolescents with abstract thinking?

able to understand later consequences, think beyond present, mental manipulation of multiple variables and concerned about others thoughts

cooperative play

activity in which children actually play with one another ex: hide and seek or tag

parallel play

activity in which children play side by side without interacting

chronic pain - how do you describe it - examples

affect the Childs life to live normally and have predisposed experience with pain and unlikely to resolve quickly - ex: cancer, arthritis, sickle cell anemia

how is the Childs body image ?

as children grow up they like themselves less because they are aware of others bodies and compare so we need to ID their strengths

when can infants have finger foods?

at 9. months

regression or delay in language is a sign of what

autism

what is this? a complex neurodevelopment disorder that affects the way the child sees and interacts with the world

autism

toddlers developmental stage is what

autonomy vs shame and doubt

A 12-year-old girl asks the nurse about an increase in clear white odorless vaginal discharge. What response should the nurse give? a. This may mean a yeast infection. b. This is normal before menstruation starts. c. This is caused by an increase in progesterone. d. This is possibly a sign of a sexually transmitted infection.

b

A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was bad. What is the nurses best interpretation of this comment? a. Sign of stress b. Common at this age c. Suggestive of maladaptation d. Suggestive of excessive discipline at home

b

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

b

A bone marrow aspiration and biopsy are needed on a school-age child. The most appropriate action to provide analgesia during the procedure is which? a. Administer TAC (tetracaine, adrenalin, and cocaine) 15 minutes before the procedure. b. Use a combination of fentanyl and midazolam for conscious sedation. c. Apply EMLA (eutectic mixture of local anesthetics) 1 hour before the procedure. d. Apply a transdermal fentanyl (Duragesic) patch immediately before the procedure.

b

A child age 4 1/2 years sometimes wakes her parents up at night screaming, thrashing, sweating, and apparently frightened, yet she is not aware of her parents presence when they check on her. She lies down and sleeps without any parental intervention. This is most likely what? a. Nightmare b. Sleep terror c. Sleep apnea d. Seizure activity

b

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

b

A feeling of guilt that the child caused the disability or illness is especially common in which age group? a. Toddler b. Preschooler c. School-age child d. Adolescent

b

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

b

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

b

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

b

In terms of cognitive development, a 5-year-old child should be expected to do which? a. Think abstractly. b. Use magical thinking. c. Understand conservation of matter. d. Understand another persons perspective.

b

The child has patient-controlled analgesia (PCA) of morphine with an 8-minute lockout. Teaching by the nurse has been effective if what behavior is seen in this child? A.He pushes the button on the PCA whenever he wants. B.He waits 8 minutes until pushing the button again. C.The nurse pushes the PCA button whenever she is turning him. D.The mother pushes the PCA button whenever the child moans or makes a strange face.

b

The development of sexual orientation during adolescence is what? a. Inflexible b. A developmental process c. Differs for boys and girls d. Proceeds in a defined sequence

b

The nurse is caring for a 10-year-old boy with autism on the pediatric unit, immediately after a spinal fusion with titanium rods implanted. The child is able to communicate a little verbally and attends special classes for children with autism. He has a short attention span, according to the mother. The child's pain management is of great concern to his mother. What information about this child should the nurse take into account when providing medication for pain? A.Children with autism do not perceive pain as do regular children. B.Children with neurologic disorders, such as autism, are at greater risk than other children for undertreatment of pain. C.EMLA cream would be contraindicated for use prior to restarting the child's intravenous line. D.Distraction and guided imagery can be used to help make this child comfortable.

b

The nurse is discussing development and play activities with the parent of a 2-month-old boy. Which statement by the parent would indicate a correct understanding of the teaching? a. I can give my baby a ball of yarn to pull apart or different textured fabrics to feel. b. I can use a music box and soft mobiles as appropriate play activities for my baby. c. I should introduce a cup and spoon or pushpull toys for my baby at this age. d. I do not have to worry about appropriate play activities at this age.

b

The nurse is observing parents playing with their 10-month-old daughter. Which of the following should the nurse recognize as an example that the child is developing object permanency? a. Bangs two cubes held in her hands b. Looks for the toy parents hide under the blanket c. Recognizes that a ball of clay is the same when flattened out d. Returns the blocks to the same spot on the table

b

The nurse is taking a sexual history on an adolescent girl. Which is the best way to determine whether she is sexually active? a. Ask her, Are you sexually active? b. Ask her, Are you having sex with anyone? c. Ask her, Are you having sex with a boyfriend? d. Ask both the girl and her parent if she is sexually active.

b

The parents of a 4-month-old infant cannot visit except on weekends. What action by the nurse indicates an understanding of the emotional needs of a young infant? a. Place her in a room away from other children. b. Assign her to the same nurse as much as possible. c. Tell the parents that frequent visiting is unnecessary. d. Assign her to different nurses so she will have varied contacts.

b

The parents of a preterm infant in a neonatal intensive care unit are concerned about their infant experiencing pain from so many procedures. The nurses response should be based on which characteristic about preterm infants pain? a. They may react to painful stimuli but are unable to remember the pain experience. b. They perceive and react to pain in much the same manner as children and adults. c. They do not have the cortical and subcortical centers that are needed for pain perception. d. They lack neurochemical systems associated with pain transmission and modulation.

b

What do nursing interventions to promote health during middle childhood include? a. Instruct parents to defer questions about sex until the child reaches adolescence. b. Educate parents about the need for good dental hygiene because these are the years in which permanent teeth erupt. c. Advise parents that the child will need increasing amounts of rest toward the end of this period. d. Stress the need for increased calorie intake to meet increased demands.

b

What intervention should be included in the nursing care of a child with autism spectrum disorder (ASD)? a. Assign multiple staff to care for the child. b. Communicate with the child at his or her developmental level. c. Provide a wide variety of foods for the child to try. d. Place the child in a semiprivate room with a roommate of a similar age.

b

What is an important consideration when using the FACES pain rating scale with children? a. Children color the face with the color they choose to best describe their pain. b. The scale can be used with most children as young as 3 years. c. The scale is not appropriate for use with adolescents. d. The FACES scale is useful in pain assessment but is not as accurate as physiologic responses.

b

What is the best age to introduce solid food into an infants diet? a. 2 to 3 months b. 4 to 6 months c. When birth weight has tripled d. When tooth eruption has started

b

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

b

When the nurse interviews an adolescent, which is especially important? a. Focus the discussion on the peer group. b. Allow an opportunity to express feelings. c. Use the same type of language as the adolescent. d. Emphasize that confidentiality will always be maintained.

b

Which family will most likely have the greatest difficulty in coping with an ill child? a. A single-parent mother who has the support of her parents and siblings b. Parents who have just moved to the area and are living in an apartment while they look for a house c. The family of a child who has had multiple hospitalizations related to asthma and has adequate relationships with the nursing staff d. A family in which there is a young child and four older married children who live in the area

b

Which is the priority nursing intervention for the family of a child who has been admitted to the hospital? a. Begin discharge teaching. b. Identify and mobilize internal and external strengths. c. Identify ways in which the family could have prevented their childs hospitalization. d. Instruct the parents on normal growth and development.

b

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

b

by age 5 how is their language a. 300 words and word sentences b. talk with mixed real and fantasy words c. learn bad words and can be aggressive d. can use simple sentences and short talk

b

the nurse has just started assessing a young child who is febrile and appears ill. There is hyperextension of the childs head (opisthotonos) with pain on flexion. Which is the most appropriate action? a. Ask the parent when the neck was injured. b. Refer for immediate medical evaluation. c. Continue assessment to determine the cause of the neck pain. d. Record head lag on the assessment record and continue the assessment of the child.

b

toddlers characteristics of animism a. all about me b. belief all invert objects are alive c. cant see something in reverse order d. belief in magical things like super heros

b

A 13-year-old child with cystic fibrosis (CF) is a frequent patient on the pediatric unit. This admission, she is sleeping during the daytime and unable to sleep at night. What should be a beneficial strategy for this child? a. Administer prescribed sedative at night to aid in sleep. b. Negotiate a daily schedule that incorporates hospital routine, therapy, and free time. c. Have the practitioner speak with the child about the need for rest when receiving therapy for CF. d. Arrange a consult with the social worker to determine whether issues at home are interfering with her care.

b -Childrens response to the disruption of routine during hospitalization is demonstrated in eating, sleeping, and other activities of daily living. The lack of structure is allowing the child to sleep during the day, rather than at night. Most likely the lack of schedule is the problem. The nurse and child can plan a schedule that incorporates all necessary activities, including medications, mealtimes, homework, and patient care procedures. The schedule can then be posted so the child has a ready reference. Sedatives are not usually used with children. The child has a chronic illness and most likely knows the importance of rest. The parents and child can be questioned about changes at home since the last hospitalization.

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, Wait a minute, and, Im not ready. How should the nurse interpret this behavior? a. IV insertions are viewed as punishment. b. This is expected behavior for a school-age child. c. Protesting like this is usually not seen past the preschool years. d. The child has successfully manipulated the nurse in the past.

b -This school-age child is attempting to maintain some control over the hospital experience. The nurse should provide the girl with structured choices about when the IV line will be inserted. Preschoolers can view procedures as punishment; this is not typical behavior of a preschool-age child.

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

b - the others should be accomplished by age 5

how do we discipline children?

based on their age with how many minutes in time out - must be consistent and immediate

why do we use morphine in children with severe pain?

because it has narcan to use to reverse the effects if they become too much on the child

why are preschoolers and toddlers at risk for injury

because their motor development is way more development than their judgement

why dont all children tell the truth about their pain?

because they want to avoid treatment

how do we introduce real food to infants

begin with rice and cereal an duo intervals of 4-7 days to test for allergies

adhd is more common in who

boys

what are the preschooler needs during their hospital stay

bring things from home and let them take initiative when appropriate

A 17-month-old child should be expected to be in which stage, according to Piaget? a. Preoperations b. Concrete operations c. Tertiary circular reactions d. Secondary circular reactions

c

A child is in the intensive care unit after a motor vehicle collision. The child has numerous fractures and is in pain that is rated 9 or 10 on a 10-point scale. In planning care, the nurse recognizes that the indicated action is which? a. Give only an opioid analgesic at this time. b. Increase dosage of analgesic until the child is adequately sedated. c. Plan a preventive schedule of pain medication around the clock. d. Give the child a clock and explain when she or he can have pain medications.

c

A child is in the well baby clinic and the nurse discovers that the baby is significantly delayed in his development. What action should the nurse take: a. Give the mother an appointment to return in 4 weeks to reassess b. Tell the mother to join a baby gym class to strengthen muscle tone c. Inform the pediatrician immediately d. Tell the mother to stimulate the child more often

c

A toddler, age 16 months, falls down after tripping over his stuffed puppy dog. He gets up and "scolds" the toy as if it caused him to fall. What is this an example of? a. Ritualism b. Delayed cognitive development c. Animism d. Irreversibility

c

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

c

An 11 month old infant enjoys picking up pieces of banana one by one with the thumb and index finger and throwing them on the floor. This is an example of a. palmer grasp b. reflexive activity c. pincer grasp d. egocentrism

c

At which age do most infants begin to fear strangers? a. 2 months b. 4 months c. 6 months d. 12 months

c

At which age does an infant start to recognize familiar faces and objects, such as his or her own hand? a. 1 month b. 2 months c. 3 months d. 4 months

c

At which age should the nurse expect most infants to begin to say mama and dada with meaning? a. 4 months b. 6 months c. 10 months d. 14 months

c

Autism is a complex developmental disorder. The diagnostic criteria for autism include delayed or abnormal functioning in which area with onset before age 3 years? a. Parallel play b. Gross motor development c. Ability to maintain eye contact d. Growth below the fifth percentile

c

By which age should the nurse expect that an infant will be able to pull to a standing position? a. 5 to 6 months b. 7 to 8 months c. 11 to 12 months d. 14 to 15 months

c

During a routine health assessment, the nurse notes that an 8-month-old infant has a significant head lag. Which is the most appropriate action? a. Recheck head control at next visit. b. Teach the parents appropriate exercises. c. Schedule the child for further evaluation. d. Refer the child for further evaluation if the anterior fontanel is still open.

c

During an otoscopic examination on an infant, in which direction is the pinna pulled? a. Up and back b. Up and forward c. Down and back d. Down and forward

c

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

c

Parents ask the nurse whether it is common for their school-age child to spend a lot of time with peers. The nurse should respond, explaining that the role of the peer group in the life of school-age children provides: a. time to establish a one-on-one relationship with the opposite sex. b. opportunity to become defiant. c. security as they gain independence from their parents. d. time to remain dependent on their parents for a longer time.

c

Parents ask the nurse, How should we deal with our toddlers regression since our new baby has come home? The nurse should give the parents which response? a. Introduce new areas of learning. b. Use time-out as punishment when regression occurs. c. Ignore the behavior and praise appropriate behavior. d. Explain to the toddler that the behavior is not acceptable.

c

Parents of a hospitalized toddler ask the nurse, What is meant by family-centered care? The nurse should respond with which statement? a. Family-centered care reduces the effect of cultural diversity on the family. b. Family-centered care encourages family dependence on the health care system. c. Family-centered care recognizes that the family is the constant in a childs life. d. Family-centered care avoids expecting families to be part of the decision-making process.

c

The mother of a 7-month-old infant newly diagnosed with cystic fibrosis is rooming in with her infant. She is breastfeeding and provides all the care except for the medication administration. What should the nurse include in the plan of care? a. Ensuring that the mother has time away from the infant b. Making sure the mother is providing all of the infants care c. Determining whether other family members can provide the necessary care so the mother can rest d. Contacting the social worker because of the mothers interference with the nursing care

c

The mother of a 9-month-old infant is concerned because the infant cries when she leaves him. Which of the following is the best response for the nurse to make to the mother? a. "You might consider taking him to the doctor because he may be ill." b. "You could consider leaving the infant more often so he can adjust." c. "This can be a healthy sign of attachment." d. "Have you noticed if the baby is teething?"

c

The nurse is assessing the Tanner stage in an adolescent female. The nurse recognizes that the stages are based on which? a. The stages of vaginal changes b. The progression of menstrual cycles to regularity c. Breast size and the shape and distribution of pubic hair d. The development of fat deposits around the hips and buttocks

c

The nurse is performing an assessment on a 12-month-old infant. Which fine or gross motor developmental skill demonstrates the proximodistal acquisition of skills? a. Standing b. Sitting without assistance c. Fully developed pincer grasp d. Taking a few steps holding onto something

c

The nurse is testing an infants visual acuity. By which age should the infant be able to fix on and follow a target? a. 1 month b. 1 to 2 months c. 3 to 4 months d. 6 months

c

The nurse should expect the apical heart rate of a stabilized newborn to be in which of the following ranges? a. 80-100 beats/min b. 160-180 beats/min c. 120-140 beats/min d. 60-80 beats/min

c

The school nurse is presenting sexual information to a group of school-age girls. What approach should the nurse take when presenting the information? a. Put off answering questions. b. Give technical terms when giving the presentation. c. Treat sex as a normal part of growth and development. d. Plan to give the presentation with boys and girls together.

c

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

c

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

c

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

c

Two hospitalized adolescents are playing pool in the activity room. Neither of them seems enthusiastic about the game. How should the nurse interpret this situation? a. Playing pool requires too much concentration for this age group. b. Pool is an activity better suited for younger children. c. The adolescents may be enjoying themselves but have lower energy levels than healthy children. d. The adolescents lack of enthusiasm is one of the signs of depression

c

Understanding principles of growth and development and preschool age children's fears, which assessment would the nurse perform last when examining a 3-year old child? a. Abdomen b. Heart c. Throat

c

What intervention is most appropriate for fostering the development of a school-age child with disabilities associated with cerebral palsy? a. Provide sensory experiences. b. Help develop abstract thinking. c. Encourage socialization with peers. d. Give choices to allow for feeling of control.

c

What is a characteristic of a toddlers language development at age 18 months? a. Vocabulary of 25 words b. Use of holophrases c. Increasing level of understanding d. Approximately one third of speech understandable

c

What is an important consideration for the school nurse planning a class on injury prevention for adolescents? a. Adolescents generally are not risk takers. b. Adolescents can anticipate the long-term consequences of serious injuries. c. Adolescents need to discharge energy, often at the expense of logical thinking. d. During adolescence, participation in sports should be limited to prevent permanent injuries.

c

What is the best action for a nurse to take when a 5-year old child who requires another 2 days of I.V. antibiotics cries, screams, and resists having his IV restarted? a. Proceed quickly with the IV antibiotics to decrease stress b. Exit the room and leave the child alone until he stops crying c. Let the child decide on what color arm board to use with his IV d. Tell the child big boys and girls don't cry

c

What is the major cause of death for children older than 1 year in the United States? a. Heart disease b. Childhood cancer c. Unintentional injuries d. Congenital anomalies

c

What pain scale would be most appropriate for the nurse to use for the child in Question 1? A.The FLACC Pain Assessment Tool B.The Comfort Scale C.The Wong-Baker FACES Pain Scale D.The Oucher Pain Scale

c

What statement accurately describes physical development during the school-age years? a. The childs weight almost triples. b. Muscles become functionally mature. c. Boys and girls double strength and physical capabilities. d. Fat gradually increases, which contributes to childrens heavier appearance.

c

What statement best describes fear in school-age children? a. Increasing concerns about bodily safety overwhelm them. b. They should be encouraged to hide their fears to prevent ridicule by peers. c. Most of the new fears that trouble them are related to school and family. d. Children with numerous fears need continuous protective behavior by parents to eliminate these fears.

c

When meeting a toddler for the first time, the nurse initiates contact by a. Asking the toddler for their first name b. Telling the toddler that you are her nurse c. Kneeling in front of the toddler and speaking softly to the child

c

When planning a parenting class, the nurse should explain that the leading cause of death in children 1 to 4 years of age in the United States is: a. premature birth. b. congenital anomalies. c. accidental death. d. respiratory tract illness

c

Which client situation fails to meet the first requirement of informed consent? a. The parent does not understand the physicians explanations. b. The physician gives the parent only a partial list of possible side effects and complications. c. No parent is available and the physician asks the adolescent to sign the consent form. d. The infants teenage mother signs a consent form because her parent tells her to.

c

Which intervention is the most appropriate recommendation for relief of teething pain? a. Rub gums with aspirin to relieve inflammation. b. Apply hydrogen peroxide to gums to relieve irritation. c. Give the infant a frozen teething ring to relieve inflammation. d. Have the infant chew on a warm teething ring to encourage tooth eruption.

c

Which is the single most important factor to consider when communicating with children? a. Presence of the childs parent b. Childs physical condition c. Childs developmental level d. Childs nonverbal behaviors

c

Which of following is an appropriate disciplinary intervention for the school-age child? a. Using lengthy dialogue to address the inappropriate behavior b. Using time-out periods c. Using a consequence that is consistent with the inappropriate behavior d. Sharing their behavior with their peers

c

While reviewing nursing documentation on dietary intake for a 7-year-old child of Asian descent, the nurse notes that he consistently refuses to eat the food on his tray. Which assumption is most likely accurate? a. He is a picky eater. b. He needs less food because he is on bed rest. c. He may have culturally related food preferences. d. He is probably eating between meals and spoiling his appetite.

c

by age 4 how is their language a. 300 words and word sentences b. talk with mixed real and fantasy words c. learn bad words and can be aggressive d. can use simple sentences and short talk

c

in terms of gross motor development, what should the nurse expect an infant age 5 months to do? a. Sit erect without support. b. Roll from the back to the abdomen. c. Turn from the abdomen to the back. d. Move from a prone to a sitting position.

c

the nurse is admitting a 7-year-old child to the pediatric unit for abdominal pain. To determine what the child understands about the reason for hospitalization, what should the nurse do? a. Find out what the parents have told the child. b. Review the note from the admitting practitioner. c. Ask the child why he came to the hospital today. d. Question the parents about why they brought the child to the hospital.

c

toddlers characteristic of irreversibility a. all about me b. belief all invert objects are alive c. cant see something in reverse order d. belief in magical things like super heros

c

the parents of 9-year-old twin children tell the nurse, They have filled up their bedroom with collections of rocks, shells, stamps, and bird nests. The nurse should recognize that this is which? a. Indicative of giftedness b. Indicative of typical twin behavior c. Characteristic of cognitive development at this age d. Characteristic of psychosocial development at this age

c - Classification skills involve the ability to group objects according to the attributes they have in common. School-age children can place things in a sensible and logical order, group and sort, and hold a concept in their mind while they make decisions based on that concept. Individuals who are not twins engage in classification at this age. Psychosocial behavior at this age is described according to Eriksons stage of industry versus inferiority.

The nurse is preparing a 9-year-old boy before obtaining a blood specimen by venipuncture. What is an appropriate approach by the nurse? • A. Explain that the procedure will not be painful. B. Suggest that the patient should not worry about losing a little blood. C. Encourage the patient to "help" with the procedure by holding still. D. Provide restraints, and perform the procedure quickly in the patient's room.

c - School-age children are often able to cooperate and help with procedures, especially when they are given developmentally appropriate explanations about what will occur and have support from either the nurse or the family. Children should always be told the truth, in this case, that venipuncture can hurt. Some children are worried about losing any blood or having the skin integrity broken because they do not have abstract thinking ability. Restraints should be avoided if possible, and the procedure should be performed in a treatment room.

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

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

What developmental characteristic does not occur until a child reaches age 2 1/2 years? a. Birth weight has doubled. b. Anterior fontanel is still open. c. Primary dentition is complete. d. Binocularity may be established.

c - aka all of the toddlers baby teeth have grown in

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

c - relates back to Kohlbergs conventional moral development where they want to be seen as a good boy or girl

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

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

With the National Center for Health Statistics criteria, which body mass index (BMI)for-age percentiles should indicate the patient is at risk for being overweight? a. 10th percentile b. 75th percentile c. 85th percentile d. 95th percentile

c -Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children who are greater than or equal to the 95th percentile are considered overweight. Children whose BMI is between the 10th and 75th percentiles are within normal limits.

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

c -Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age, children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play, children learn about competition and the importance of winning, an attribute highly valued in the United States but not in all cultures.

The nurse is explaining about the developmental sequence in childrens capacity to conserve matter to a group of parents. What type of matter is last in the sequence for a child to develop? a. Mass b. Length c. Volume d. Numbers

c -There is a developmental sequence in childrens capacity to conserve matter. Children usually grasp conservation of numbers (ages 5 to 6 years) before conservation of substance. Conservation of liquids, mass, and length usually is accomplished at about ages 6 to 7 years, conservation of weight sometime later (ages 9 to 10 years), and conservation of volume or displacement last (ages 9 to 12 years).

how is the cognitive development of adolescents with logical reasoning?

can differentiate between other perceptual and their own and view social situations from a social perspective

toddlers characteristic of conservation

cant recognize water in two different containers is the same amount

how are adolescents relationship with their family

change from dependent to mutual affection and equality - it involves struggle of privileges and responsibility

what autism spectrum disorder is this? regression after 2 years of normal development usually occurs around 3/4 years old

childhood disintegrative disorder

associative play

children engage in separate activities but exchange toys and comment on one another's behavior

children with special needs are at risk for what?

chronic physical, developmental, behavioral, emotional conditions beyond general needs

A nurse is completing a care plan for a child and is finishing the assessment phase. Which activity is not part of a nursing assessment? a. Writing nursing diagnoses b. Reviewing diagnostic reports c. Collecting data d. Setting priorities

d

A preterm infant has just been admitted to the neonatal intensive care unit. The infants parents ask the nurse about anesthesia and analgesia when painful procedures are necessary. What should the nurses explanation be? a. Nerve pathways of neonates are not sufficiently myelinated to transmit painful stimuli. b. The risks accompanying anesthesia and analgesia are too great to justify any possible benefit of pain relief. c. Neonates do not possess sufficiently integrated cortical function to interpret or recall pain experiences. d. Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates.

d

A spinal tap must be done on a 9-year-old boy. While he is waiting in the treatment room, the nurse observes that he seems composed. When the nurse asks him if he wants his mother to stay with him, he says, I am fine. How should the nurse interpret this situation? a. This child is unusually brave. b. He has learned that support does not help. c. Nine-year-old boys do not usually want a parent present during the procedure. d. Children in this age group often do not request support even though they need and want it.

d

According to Piaget, adolescents tend to be in what stage of cognitive development? a. Concrete operations b. Conventional thought c. Postconventional thought d. Formal operational thought

d

Adolescents often do not use reasoned decision making when issues such as substance abuse and sexual behavior are involved. What is this because of? a. They tend to be immature. b. They do not need to use reasoned decision making. c. They lack cognitive skills to use reasoned decision making. d. They are dealing with issues that are stressful and emotionally laden.

d

At an 8-month-old well-baby visit, the parent tells the nurse that her infant falls asleep at night during the last bottle feeding but wakes up when moved to the infants crib. What is the most appropriate response for the nurse to make? a. You should put your baby to sleep 1 hour earlier without the nighttime feeding but with a pacifier for soothing. b. You could place rice cereal in the last bottle feeding of the day to ensure a longer sleep pattern. c. You should have your partner give the last bottle of the day and observe whether your infant stays awake for your partner. d. You could increase daytime feeding intervals to every 4 hours and put your baby in the crib while the baby is still awake.

d

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

d

Cognitive development influences response to pain. What age group is most concerned with the fear of losing control during a painful experience? a. Toddlers b. Preschoolers c. School-age children d. Adolescents

d

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

d

In most states, adolescents who are not emancipated minors must have parental permission before: a. treatment for drug abuse. b. treatment for sexually transmitted diseases (STDs). c. obtaining birth control. d. surgery.

d

Parents of a preschool child tell the nurse, Our child seems to have many imaginary fears. What suggestion should the nurse give to the parents to help their child resolve the fears? a. Ignore the fears; they will go away. b. Explain to your child the fears are not real. c. Give your child some new toys to allay the fears. d. Help your child to resolve the fears through play activities.

d

The mother of a 10-month-old infant tells the nurse that her infant "really likes cow's milk." Which of the following is the best response to this mother? a. "Limit cow's milk to his bedtime bottle." b. "Mix his cereal with cow's milk and give him formula in a bottle." c. "Milk is good for him." d. "It is best to wait until he is a year old before giving him cow's milk."

d

The mother of a 6 month old is telling the nurse she is worried because this is her 4th child and he is not sitting up well, and all her other children were sitting well independently by this age. The nurse would respond correctly by stating a. Demonstrate exercises to increase muscle tone b. We will schedule an appointment to see a Neurologist c. I will tell the doctor to come in and evaluate your child d. Children develop at different rates within normal parameters of growth and development

d

The nurse is developing a teaching pamphlet for parents of school-age children. What anticipatory guidelines should the nurse include in the pamphlet? a. At age 6 years, parents should be certain that the child is reading independently with books provided by school. b. At age 8 years, parents should expect a decrease in involvement with peers and outside activities. c. At age 10 years, parents should expect a decrease in admiration of the parents with little interest in parentchild activities. d. At age 12 years, parents should be certain that the childs sex education is adequate with accurate information.

d

The nurse is explaining the preconventional stage of moral development to a group of nursing students. What characterizes this stage? a. Children in this stage focus on following the rules. b. Children in this stage live up to social expectations and roles. c. Children in this stage have a concrete sense of justice and fairness. d. Children in this stage have little, if any, concern for why something is wrong.

d

The nurse is preparing a pamphlet for parents of adolescents about guidance during the adolescent years. What suggestion should the nurse include in the pamphlet? a. Provide criticism when mistakes are made or when views are different. b. Use comparisons with older siblings or extended family to promote good outcomes. c. Begin to disengage from school functions to allow the adolescent to gain independence. d. Provide clear, reasonable limits and define consequences when rules are broken.

d

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

d

The nurse should assess which age group for suicide ideation since suicide in which age group is the third leading cause of death? a. Preschoolers b. Young school age c. Middle school age d. Late school age and adolescents

d

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

d

The psychosexual conflicts of preschool children make them extremely vulnerable to which threat? a. Loss of control b. Loss of identity c. Separation anxiety d. Bodily injury and pain

d

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

d

What factor is most important in predisposing toddlers to frequent infections? a. Respirations are abdominal. b. Pulse and respiratory rates in toddlers are slower than those in infants. c. Defense mechanisms are less efficient than those during infancy. d. Toddlers have short, straight internal ear canals and large lymph tissue.

d

What is the nurses best approach when an 8-year-old boy frequently causes a disruption in the playroom by taking toys from other children? a. Exclude the child from the playroom. b. Explain to the children in the playroom that he is very ill and should be allowed to have the toys. c. Approach the child in his room and ask, Would you like it if the other children took your toys from you? d. Approach the child in his room and state, I am concerned that you are taking the other childrens toys. It upsets them and me.

d

What is true concerning the development of autonomy during adolescence? a. Development of autonomy typically involves rebellion. b. Development of autonomy typically involves parentchild conflicts. c. Parent and peer influences are opposing forces in the development of autonomy. d. Conformity to both parents and peers gradually declines toward the end of adolescence.

d

What nursing intervention is especially helpful in assessing feelings of parental guilt when a disability or chronic illness is diagnosed? a. Ask the parents if they feel guilty. b. Observe for signs of overprotectiveness. c. Talk about guilt only after the parents mention it. d. Discuss the meaning of the parents religious and cultural background.

d

What should the nurse determine to be the priority intervention for a family with an infant who has a disability? a. Focus on the childs disabilities to understand care needs. b. Institute age-appropriate discipline and limit setting. c. Enforce visiting hours to allow parents to have respite care. d. Foster feelings of competency by helping parents learn the special care needs of the infant.

d

What statement characterizes moral development in the older school-age child? a. Rule violations are viewed in an isolated context. b. Judgments and rules become more absolute and authoritarian. c. The child remembers the rules but cannot understand the reasons behind them. d. The child is able to judge an act by the intentions that prompted it rather than just by the consequences.

d

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

d

by age 3 how is their language a. 300 words and word sentences b. talk with mixed real and fantasy words c. learn bad words and can be aggressive d. can use simple sentences and short talk

d

he school nurse is discussing after-school sports participation with parents of children age 10 years. The nurses presentation includes which important consideration? a. Teams should be gender specific. b. Organized sports are not appropriate at this age. c. Competition is detrimental to the establishment of a positive self-image. d. Sports participation is encouraged if the type of sport is appropriate to the childs abilities.

d

teaching about safety to school-age children should be geared toward their a. Ability to answer questions b. Chronological age c. Parents d. Cognitive level of development

d

the nurse is assessing a 20-month-old toddler during a well-child visit and notices tooth decay. The nurse should understand that early childhood caries are caused by what? a. Allowing the child to eat citrus foods at bedtime b. A hereditary factor that cannot be prevented c. Poor fluoride supply in the drinking water d. Giving the child a bottle of juice or milk at naptime

d

toddlers characteristic of magical thought a. all about me b. belief all invert objects are alive c. cant see something in reverse order d. belief in magical things like super heros

d

which characteristic best describes the fine motor skills of an infant at age 5 months? a. Neat pincer grasp b. Strong grasp reflex c. Builds a tower of two cubes d. Able to grasp object voluntarily

d

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

d - Because of the dramatic vocabulary increase at this age, 3-year-old children are known to talk incessantly regardless of whether anyone is listening. A 4- to 5-year-old child asks lots of questions and can follow simple directional commands. A 6-year-old child can describe an object according to its composition.

The nurse is planning to bring a preschool child a toy from the playroom. What toy is appropriate for this age group? a. Building blocks b. A 500-piece puzzle c. Paint by number picture d. Farm animals and equipment

d - The most characteristic and pervasive preschooler activity is imitative, imaginative, and dramatic play. Farm animals and equipment would provide hours of self-expression. Building blocks are appropriate for older infants and toddlers. A 500-piece puzzle or a paint by number picture would be appropriate for a school-age child.

What do the psychosocial developmental tasks of toddlerhood include? a. Development of a conscience b. Recognition of sex differences c. Ability to get along with age mates d. Ability to delay gratification

d - all other are preschooler age things

the nurse is teaching parents about expected language development for their 6-month-old infant. The nurse recognizes the parents understand the teaching if they make which statement? a. Our baby should comprehend the word no. b. Our baby knows the meaning of saying mama. c. Our baby should be able to say three to five words. d. Our baby should begin to combine syllables, such as dada.

d - the infant should be able to imitate sounds

A 6-year-old child is admitted to the pediatric unit and requires bed rest. Having art supplies available meets which purpose? a. Allows the child to create gifts for parents b. Provides developmentally appropriate activities c. Is essential for play therapy so the child can work on past problems d. Lets the child express thoughts and feelings through pictures rather than words

d -The art supplies allow the child to draw images that come into the mind. This can help the child develop symbols and then verbalize reactions to illness and hospitalization. The child can make gifts and drawings for parents, but the goal is to allow expression of feelings. Although art is developmentally and situationally appropriate, the child benefits by being able to express feelings nonverbally. The art supplies are not therapeutic play but a mechanism for expressive play. The child will not work on past problems.

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

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

The nurse is caring for an 8-year-old boy who had abdominal surgery 24 hours ago. He is quiet and watching television. The nurse's observations suggest that he is not experiencing pain, but when he is given a pain-rating scale, he indicates that he is experiencing moderate pain. The nurse's actions should be based on which of the following? A. Physiologic responses are the best indicators of pain. B. Children's behavior is a better indicator of pain than their rating of pain. C. School-age children as young as 8 years do not rate pain accurately. D. If children's behavior appears to differ from the rating of pain, their pain rating should be believed.

d Rationale: The pain rating should be believed. Children vary widely in their behavioral responses to pain. This response is affected by the child's coping style, culture, and linguistic abilities. Physiologic manifestations of pain may vary considerably, not providing a consistent measure of pain. Heart rate may increase or decrease. The same signs that may suggest fear, anxiety, or anger also indicate pain. In chronic pain, the body adapts, and these signs decrease or stabilize. When behavior is the only measure of pain used, it often leads to underestimation of the severity and undertreatment. Children as young as 3 years can be taught to use pain-rating scales.

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

d - the other skills are developed at age 3 and 4

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

dT

what is the concrete stage like for school age children

develop understanding between things and ideas - able to make judgement based on reason - increased ability to problem solve

how do you asses a toddler?

do lungs and heart first and throat last because it is most invasive

how do we help a family cope with a child who has special needs?

empower the family and help promote their OWN normal - provide resources for education on special need, give resources for physical, emotional and financial help

myth or fact about child pain? after 20 weeks, fetus recoil from pain

fact

myth or fact about child pain? infants feel pain

fact

myth or fact about child pain? the youngest premature infant can perceive, demonstrate and feel pain

fact

What is plagiocephaly?

flat head syndrome caused by placing the infant one way the entire day. make sure to rotate how you lay your infant so when they go to sleep on their back of their head it doesnt caused plagiocephaly because then they may have to wear a helmet

toddlers characteristic of centration

focus on one aspect of an experiences, ignoring all alternatives

how is the school child self concept

form as they grow up and leads to self respect and happiness - social media can negatively effect this

what theorist? said that there is a stage of pscyhopscoial development and there is a struggle between conscious and unconscious to become an individual

freud

what are the thoughts that cause autism

genetic inheritance and genetic mutation

what factors influence growth

genetics, nutrition, environment, disease

what are the adolescent needs during their hospital stay

give them information about their condition and see if they have any questions or concerns

what are the infants needs during their hospital stay

have consistent love from caregivers and a daily routine like they had at home

what factors influence development

hereditary, gender expectations, prenatal influences, socio status, media and relationships

teenagers developmental stage is what

identity vs identity confusion

how can we tell if there is a delay in puberty for males?

if no enlargement of the testes by 14 years old

what is the goal with pediatrics?

improve the quality of healthcare for children and their families and eliminate disparities - we need to notice that the family is the Childs constant!!!

the increased muscle growth of infants helps with what?

increase control of reflexes and movements

how fast are adolescents growing?

increase growth by 20-25% of total height, achieved during puberty - primary and secondary sex characteristics are acquired through production of reproductive hormones

school age developmental stage is what

industry vs inferiority

obesity can start as early as what

infancy

we would use the skills below for what age groups? - focus on child and be consistent - involve parents when you can - allow child to touch medical equipment - with vital signs take temperature last

infants and toddlers

preschoolers developmental stage is what

intiative vs guilt

how do we effectively communicate with family?

introduce yourself and ensure privacy and confidrenatiliy. use silence and empathy

development refers to what?

it is a qualitative measure in function and capabilities. it proceeds from simple to complex with an increase in capacity through growth, maturation and learning

how can an infant get bottle mouth caries

it is a tooth decay due to prolong bottle feeding at night and can destroy the teeth

Acute pain for children - how do you describe it - examples

it is for a limited period of Time - ex: bodily injury, fracture, after procedure pain

why is the trachea a risk factor for infants?

it is small so there is a risk of infection and aspiration

what is the percentile of growth

its a representation of 100 children and you plot where the child is in reference to it based on their height and weight. each physical you would plot and see how they are doing

describe Males with puberty - when - what happens

its between 9-14 years old with testicular enlargement and pubic hair

describe females with puberty - when - what happens

its between age 8-13 where they have breast buds and pubic hair growth - it will be earlier depending on a poor diet and obese

devlopment leads to what?

learning new activities, motives and behavior

what is the impact on an adolescent who has special needs and their developmental stage

may have a hard time forming a self ID relative to peers and compare themselves and feel different and bad

what is the impact on an school age who has special needs and their developmental stage

may have difficulty achieving industry where they try to navigate school and society, similar to preschool

what are nursing responsibilities for conscious sedation

monitor vitals because its hard to tell how each child will handle the drug - ABC is biggest concern

how do we diagnose ADHD

must have symptoms of inattention of hyperactivity for 6 months and affect them in their home, day care, school or social life

myth or fact about child pain? children can become addicted to narcotics

myth

myth or fact about child pain? children have no memory of pain

myth

myth or fact about child pain? narcotics can easily cause respiratory depression

myth

myth or fact about child pain? neonates do not have pain

myth

myth or fact about child pain? there is a correct amount of pain for an injury

myth

what are s/s of colic in infants

nconsolable crying. Screaming. Extending or pulling up of his legs to his tummy. Passing gas. Enlarged or distended stomach. Arched back. Clenched fists. Reddened face after a long episode of crying.

what is this? minimal sensory stimuli that is perceived as a source of discomfort for pain

pain threshold

how are the relationships of school age children with parents?

parents are the primary influence in shaping the child that provide support and indepdnace

during trust vs mistrust, what does it require?

parents connection with the infant! - the infant needs food, warmth, comfort, oral satisfaction - they need to be able to play with other and be close with their parents

authoritarian parent style

parents impose rules and expect obedience - my way or the highway

permissive parent style

parents who make few rules or demands and usually do not enforce those that are made, allow children to make their own decisions and control their own behavior.

what autism spectrum disorder is this? language delay with social skills delay and language and social skill regression

pervasive developmental disorder

what age group views hospitalization as a punishment for misdeeds and say, "Im sorry I was bad"

preschooler

we would use the skills below for what age groups? - explain what, why and how - allow the chid to touch and practice with the medical equipment - use therapeutic play and ensure personal possessions will not be harmed

preschooler and school age

how do we prevent traumatic stress?

preventing parent/child separation, promote family centered care, promote sense of control

the school age children are in a prepubescene stage, what is that

right before the males and females hit puberty and hormones are on the rise

when do the Eustachian tubes mature which means less risk of ear infection

school age

which age group fears death and abandonment

school age

what stage of Piaget sensory development are infants in?

sensorimotor where the infants need routines! - they learn from putting things in their mouth, engaging, exploring and environmental stimuli

what is the impact on an preschooler who has special needs and their developmental stage

should be in initiate where they separate from parents but disability could affect their ability to interact with environment and do things on their own

regression in children is a sign of what

stress and a way for them to revert back to comfortable behaviors. - parents should ignore it but praise the child when doing developmentally good things for their age

the toddlers autonomy vs shame and doubt consists of the toddler doing what

struggling for a sense of self

what does naive instrumental orientation mean?

the action to satisfy ones own need and less concern for others

how much of the birth weight is counted for by the head?

the brain accounts fo 10-12% of birth weight and by 1 year the brain has doubled in weight

growth refers to what?

the increase in size and weight of the whole or any part - it must be measured

why do infants get dehydrated and have a poor fluid balance?

the renal system is mature

how is th cognitive development of preschoolers

they are able to consider other viewpoints but remain egocentric - language is still developing - concept of time is not understood - concerned with why and how - need social engagement

what are transdermal analgesia?

they are used for IV placements, blood draws and central line access - we use LMX that has 4% lidocaine and works in 30 minutes

describe the identity vs identity confusion that adolescents are in

they develop a personal ID role and sex ID - the goal is to establish autonomy and self perception

how are the relationships of school age children with peers?

they form groups and cliques because of importance of sex roles influencing peer relationships

how is the pain threshold for chronic pain of children

they have a high threshold because they are used to the basic things like IV and needles

why are the infants so susceptible to ear infections

they have a short and straight Eustachian tube

why do the infants get sick often

they have a week immune system,

how is the motor development of adolescents

they have an increase strength, coordination, and focus on competition and social relationships - more involved with athletics

how is the toddlers langauge

they increase level of comprehension and understanding - they have receptive language where they understand before actual speech

what is the impact on an toddler who has special needs and their developmental stage

they should be in autonomy and do things on own, but disability could affect their ability to explore on their own and limit their skills

what is the impact on an infant who has special needs and their developmental stage

they should be in trust and bonding with caregiver, but the disability can make it hard to make connections with eye contact and social cues - also if they are in the hospital for awhile it can impede on the bond that Is supposed to form

how is the adolescent with group ID vs alienation

they want to belong to a crowd and separate themselves from their parents - feel egocentric, invisible, self conscious and impulsive

how is the motor development of school age children (increase in myelination of CNS)

this leads to increase in hand eye coordination, skill in sports increase and start to play musical instruments - they have cooperative team play - improved physical skill, intellectual ability and fantasy

why is a private room desired for a child with autism

to decrease stimulation of noise and other things

what is the purpose of Atraumatic care?

tp prevent and minimize physical stress for the child

t/f: A 10-year-old child exhibits increased feelings of admiration of parents, especially fathers, and parentchild activities should be encouraged.

true

t/f: At 8 years of age, parents should expect their child to show increased involvement with peers and outside activities and should encourage this behavior

true

t/f: Children with ASD do not adapt to changing situations

true

t/f: The same foods should be provided to allow the child to adjust that has autism

true

t/f: children with more severe conditions cope better because they are used to being in the hospital

true

t/f: every ADHD child is different

true

t/f: we can treat physical dependance of children on drugs from weening them off of the drug

true

t/f: we must trust what the child says about their pain and treat it before it gets worse

true

t/f: we use the same rating scale each time with the same child

true

infants developmental stage is what

trust vs mistrust

Childhood Morbidity

unintentional injuries, child maltreatment, infectious diseases

how is the infants weight gaining?

very rapid, they double birth weight by 6 months and then triple by 1 year

how is the adolescents self concept?

want acceptance from peers, but want to ID indepdnantly from parental authority - may compare to others - encourage self confidence and be approachable

onlooker play

watch but dont engage

how are males and females during puberty

worried about whats going on to them and if its normal - they all want a perfect body