Peds Unit 1: Practice Problems

A 4-year-old child is in the emergency room following a minor car accident. Upon assessment, the nurse should alleviate fears by first doing which of the following steps? a.) Allow the child to touch and feel the stethoscope before auscultating lungs and heart sounds. b.) Remind the child that they may need to have an x-ray of their arm to ensure it is not broken. c.) Explain that after the assessment, the nurse will need to start a peripheral intravenous catheter so the child knows to anticipate pain. d.) Have the caregiver leave the room until the nurse is done with the assessment.

a

A nurse is caring for an infant in the hospital who has transitioned from the pediatric intensive care unit to the general floor. Which of the following conveys understanding and proper communication with parents or caregivers? a.) The nurse asks the parents to provide a schedule of routines for feeding, changing, and sleeping to incorporate into the nursing care. b.) Parents or caregivers are placed on a hospital schedule for feeding, bathing, and sleeping so it does not disrupt medications or medical procedures. c.) The nursing assistant leaves the diapers and wipes in the room with a printed schedule and documentation for measuring input and output. d.) A pamphlet of information about the importance of daily routines is left in the room for the parents or caregivers to read.

a

Children learn right from wrong during which stage of development? a.) Initiative vs. guilt b.) Industry vs. inferiority c.) Identity vs. role diffusion d.) Autonomy vs. shame/doubt

a

During a well-child visit, you are providing anticipatory guidance to the parents of a toddler. Which of the following statements is accurate? a.) Temper tantrums can be a sign of illness or stress in a child. b.) Separation anxiety in toddler years is indicative of a developmental delay. c.) Toddler-aged children should not transition to skim milk before their 3rd birthday. d.) Children are able to begin seeing the world through other's viewpoints.

a

During the assessment of Aiden's nose, you observe that his nasal mucosa has a blue appearance. Which of the following conditions is associated with this finding? a.) Allergies b.) Eczema c.) Heart murmur d.) Anemia

a

Growth spurts in boys and girls typically happen over what duration of time? a.) 24-36 months b.) 36-48 months c.) 24-48 months d.) 36-72 months

a

Understanding that basic needs will be met, such as being picked up by a parent when crying, is a task in what psychosocial development stage? a.) Trust vs. mistrust b.) Autonomy vs. shame/doubt c.) Initiative vs. guilt d.) Industry vs. inferiority

a

When assessing a toddler or preschooler, the nurse should keep in mind that children will respond to which of the following measures? a.) Being allowed to touch equipment before the nurse uses it. b.) Standing upright over the child to demonstrate authority. c.) Asking the mother to step out of the room for privacy. d.) Ignoring questions or comments that may be distracting.

a

When providing family-focused care, the nurse should focus on which of the following philosophies? a.) Recognition that the caregivers are experts in caring for their child. b.) Interventions are related to primary, secondary, and tertiary prevention methods. c.) The nurse, child, and family are an interrelated system of personal, interpersonal, and social systems. d.) Humans are an adaptive system striving for balance when unhealthy stressors are present.

a

Which of the following activities is the most appropriate to demonstrate object permanence to an infant? Select all that apply. a.) Hiding an object under a pillow for the infant to search b.) Playing peekaboo c.) Encouraging the infant to hold his or her own bottle d.) Leaving a light on at night e.) Allowing the child to look in the mirror at his or her own image

a, b

After getting Cindy and her mother settled in a patient room, you begin your nursing assessment by first asking Mrs. Williams some questions. Which questions are most appropriate at this time? Select all that apply. a.) When was the last time Cindy was sick, hospitalized, or had surgery? b.) What medications are you giving Cindy at this time? c.) Have you noticed any unusual food sensitivities or reactions to foods? d.) Is Cindy keeping her diaper dry during naptime? e.) How many ounces of skim milk is Cindy drinking?

a, b, c

As you approach the beginning of the physical assessment, which of the following are important considerations for Aiden? Select all that apply. a.) Allowing him to choose whether his mother will be present during the examination b.) Speaking and asking questions directly to Aiden c.) Allowing Aiden privacy to prepare for the examination d.) Placing immunizations on tray in room to be administered after the assessment e.) Conducting the most invasive parts of the examination first

a, b, c

The labor and delivery nurse transfers a baby to the newborn nursery. After the nurse receives report, the nurse should begin her assessment of the newborn. What prophylactic medications should the nurse prepare to give? Select all that apply. a.) Vitamin K b.) Erythromycin eye ointment c.) Hepatitis B vaccine d.) Surfactant e.) RhoGAM

a, b, c

You are a school nurse in a local high school and are concerned about Peter, a student in the 11th grade. He is a 16-year-old male who has been in and out of foster homes due to his primary caregiver's drug use and incarceration. He comes to the school nurse office frequently for complaints of stomach aches and headaches but does not want to call his foster parent. Today, he appears with dyed hair and piercings to both earlobes and tongue. He is once again reporting that his stomach and head hurt, and he just wants to lie down and not return to class or go home. He does not have a fever but admits to nausea and dizziness. He has no verified health issues. His vital signs are within normal limits for his age and gender. Along with his other body piercings, Peter states he plans to pierce his nose soon. Which of the following are considered risks associated with body piercing? Select all that apply. a.) Tobacco and drug use b.) Keloids c.) Allergic reactions d.) Nerve damage e.) Infection

a, b, c, d, e Multiple body piercings are associated with other high-risk behaviors such as tobacco and drug use or sexual activity. Nurses need to educate the adolescent and caregiver about the increased risk of infection, keloid development, allergic reactions to metal piercings, excessive bleeding, nerve damage, and dental complications.

Eutectic mixture of lidocaine and prilocaine (EMLA) cream may be applied to the skin to decrease pain and help Aiden with his fear of immunizations. Which of the following are correct statements about the use of EMLA cream for painful procedures? Select all that apply. a.) Apply a large glob to the skin. b.) Apply at least 45 minutes before the procedure. c.) Do not rub the cream into the skin. d.) Instruct the patient and parent that the cream will wear off about 4 hours. e.) Allow extra time before the procedure for intramuscular injections.

a, b, c, d, e The longer the cream is in place, the deeper it will penetrate the skin. The nurse should apply the cream at least 45 minutes before the procedure and at least 2 hours for intramuscular injections. The effectiveness will begin to wear off after 4 hours. The caregiver or nurse should assess the skin for allergic reactions to the medication, apply a large dose to the skin, and cover with an occlusive dressing. Do not rub, massage, or disturb the area until it is time to perform the procedure. Wipe the medication off the skin and clean the area before the procedure.

During a well-child visit, the nurse would ask about which developmental milestones in a 13-month-old toddler? Select all that apply. a.) Can your child walk or take a few steps on their own? b.) Does your child experience separation anxiety? c.) Is your child able to dress themselves? d.) Which words does your child say? e.) Can your child throw a ball?

a, b, d

Which of the following can serve as barriers to communication with children and families while in the hospital? Select all that apply. a.) Closed-ended questions with yes or no answers b.) Biases about race, age, or ethnicity c.) Direct answers to questions d.) Addressing caregivers when questions are asked by the child e.) Observing verbal and nonverbal cues

a, b, d

A preschool-aged child saw that it started to rain after eating pasta and now believes that it will rain the next time they eat pasta as well. What belief is the child exhibiting? a.) Magical thinking b.) Imaginary play c.) Egocentrism d.) Delayed gratification

a

Which of the following are components of premenstrual syndrome? Select all that apply. a.) Tiredness b.) Pain c.) Anxiety d.) Crying e.) Breast engorgement

a, c, d

A teenager is deciding whether to seek treatment for anxiety and depression. Which group will most likely influence his decision? a.) Peers b.) Hospital staff c.) Parents or caregivers d.) Books and videos provided to them

a

Before discharge, John's mother asks you to explain how she will know if John is having any difficulty breathing due to swelling after the tonsillectomy. What signs and symptoms should the nurse educate the mother to look for? Select all that apply. a.) Retractions or ability to see ribs during inhalation b.) Sitting with head up and out in a tripod position c.) Respirations between 20 and 25 breaths per minute d.) Use of shoulders and abdomen to breathe e.) Child desires a nap during the day

a, b, d

Kya is a 15-year-old female who presents today for her annual physical assessment. She is known to be a good student and is involved in school clubs and participates in cheerleading and track at her high school. She reports many friends and has a new boyfriend per her mother. She is engaging and talkative but states she doesn't want to talk about her boyfriend. She denies any current or history of alcohol or drug use or sexual activity. She started her period at age 10 years and reports her last menstrual period was over three months ago and is no longer regular. Her vital signs are: heart rate, 100 beats per minute; respiratory rate, 14 breaths per minute; blood pressure, 112/68; temperature, 98.0 degrees; height, 68 inches; weight, 105 pounds; BMI, 16 (<5th percentile). Her height has increased 1 inch since her last visit but her weight has dropped by 10 pounds. You review Kya's growth charts from prior years and all show appropriate height and weight gains with the exception of this year. Which of the following findings would increase your suspicion of an eating disorder? Select all that apply. a.) Menstrual period over 3 months ago b.) Positive Russell's sign c.) Mouth ulcers d.) Tooth erosion e.) Brittle and dry hair

a, b, d Cessation of menstrual periods after established regular pattern could indicate a drop in body weight due to excessive exercising, food restrictions/eating disorders, or illness. The erosion of teeth can be caused from induced vomiting, and the presence of cuts and abrasions to the knuckles (Russell's sign) is from sticking the fingers down the throat to induce vomiting. Mouth ulcers may indicate the use of inhalants or smokeless tobacco. Excessive dying or heat styling may cause dry and brittle hair.

Aiden is an 11-year-old boy who visits the pediatrician for a well-visit checkup before starting sixth grade. He is apprehensive about the appointment because he does not like shots and does not want to remove any clothing during the visit. He also does not want to be asked embarrassing questions about his male body parts or girls. His mother is accompanying him to the appointment, and he is not sure he would like her to be in the room. He has a headache and feels a little nauseous after eating breakfast this morning. As the nurse, you enter the room to talk with Aiden and his mother. Which assessments will be included in his appointment today? Select all that apply. a.) Weight, height, and body mass index (BMI) b.) Blood pressure c.) Scoliosis screening d.) Anemia screening e.) Hearing and vision screening

a, b, d, e Scoliosis screenings begin at age 12, so would not apply to an 11-year-old.

A nurse caring for newborns knows that this population is at risk for hyperbilirubinemia. What causes a newborn to be at a higher risk for developing hyperbilirubinemia? Select all that apply. a.) Prematurity b.) Mother has diabetes c.) History of sickle cell disease d.) Feeding shortly after delivery e.) Birth trauma

a, b, e

What effects should the nurse expect when effective communication is demonstrated among the hospitalized child, family, and nurse? Select all that apply. a.) A sense of trust between the family and nursing staff b.) Improved coping strategies by the hospitalized child c.) Increase in pain medication needs d.) No change in stress that other family members experience e.) Decrease in anxiety felt by the patient and/or other family members

a, b, e

You are preparing to discuss weight loss, diet, and exercise routines with Kya prior to the end of the appointment. Which of the following will need to be included in the discussion? Select all that apply. a.) Fad diets and diet pills b.) Dietician referral c.) Increased dietary supplements d.) Risk of sleep apnea e.) Stretching prior to exercise

a, b, e Signs of an eating disorder include vomiting, fad diets, diet pills, and use of laxative to lose weight. Kya should be informed that she needs more calories due to the body's rapid growth and that vitamins and minerals are best obtained by eating a well-balanced diet. If she wants to eat a vegetarian or vegan diet she needs to be educated in the office or referred to a dietician. Encourage stretching prior to vigorous exercise to prevent muscle injury.

You are the nurse at a local pediatrician's office providing care to all children seen for well-child visits today. Cindy Williams is a 1-year-old toddler who lives with her mom and dad. Cindy is their only child. Mrs. Williams expresses concerns over her daughter's nutrition and weight. Prior well-child visits have been normal with no concerns documented. Mrs. Williams is completing the growth and development milestone assessment prior to being seen in the patient room. Which of the following milestones do you expect for Cindy to have met at 1 year of age? Select all that apply. a.) Walking while holding her mother's hands or taking a few steps on own b.) familiar people and objects c.) Speaking in two- or three-word sentences d.) Dressing or undressing oneself e.) stairs while holding on f.) Finding hidden objects

a, b, f

The nurse knows to earn a school-age child's trust by using which techniques? Select all that apply. a.) Explaining procedures truthfully b.) Using medical language c.) Using age-appropriate teaching techniques d.) Allowing child to participate in own care e.) Focusing attention on caregivers

a, c, d

You have completed taking Cindy's vital signs. Which findings are expected? Select all that apply. a.) Heart rate 82 bpm b.) Respirations 47 breaths per minute c.) Blood pressure 95/55 mm Hg d.) Temperature 98.9 degrees Fahrenheit

a, c, d Normal vital sign ranges for a toddler include heart rate, 70-110 bpm; respirations 20-30 breaths/min; systolic blood pressure, 90-105 mm Hg; diastolic blood pressure of 55-70 mm Hg; and temperature less than 101 degrees Fahrenheit.

Aiden is at risk of being bullied at school because of his obesity. What other associated factors increase his risk of becoming a victim of a bully or bullying other children? Select all that apply. a.) Age b.) Parents or caregivers with higher educational levels c.) Lower socioeconomic status d.) Average academic school performance e.) Sexual orientation

a, c, e

Which of the following findings may be indicators of an eating disorder? Select all that apply. a.) Positive Russell's sign b.) Brittle hair c.) Tooth erosion d.) Increased menstruation in girls e.) Excessive exercise

a, c, e

A nurse is caring for a 5-year-old child who needs to undergo a tonsillectomy. Which of the following communication strategies are appropriate for the nurse to use with the client to explain the procedure? Select all that apply. a.) Inform the child and family that the surgeon will be up shortly to explain the procedure and answer questions. b.) Leave a diagram of how the tonsils will be removed on the bedside table for the family to review the procedure. c.) Sit next to the child and use a doll to show the child where the tonsils are located to help the child visualize what is expected. d.) Encourage the child to ask questions directly in the operating room. e.) Support the child's expressions of fears or concerns through self-talk.

a, c, e ?

Which of the following findings are normal in a newborn? Select all that apply. a.) Diamond-shaped anterior fontanel b.) Fontanels are bulging c.) Sunken fontanels are common at rest d.) Slight pulsations in fontanels may be felt f.) Molding of head may cause edema and bleeding

a, d

After obtaining Aiden's weight and height, you calculate his body mass index (BMI) and find that his BMI is greater than 95th percentile. A high BMI is children is linked to which of the following? Select all that apply. a.) Increased insulin levels b.) Normal blood pressure c.) Average risk of atherosclerosis in adulthood d.) Obesity in adulthood e.) Increased lipid levels

a, d, e

As you prepare Cindy for a more in-depth nursing assessment, it is important to provide comfort. Which measures should you ensure during your assessment? Select all that apply. a.) Allow Cindy to touch and feel equipment before using it. b.) Stand over Cindy to demonstrate authority. c.) Avoid eye contact, which may scare Cindy. d.) Permit Cindy to stay in her mother's lap during the assessment. e.) Provide praise when appropriate after completing tasks.

a, d, e

You just started your nursing shift on the pediatric floor at the local hospital. One of your patients is John, a 4-year-old boy who is two days post-operative after a tonsillectomy. His medical team just told his family that he will be discharged today.As you prepare for John's discharge, it is important to go over safety education for caregivers. What should be included in your discharge plan? Select all that apply. a.) Children are at risk of drownings at this age. Be sure your child is never left unattended near water. b.) At this age, expect John to automatically show proper safety around fire. c.) Your hot water tank should be set to 130 degrees Fahrenheit to prevent burns. d.) Be sure to keep hand sanitizer secured away from children as it poses a risk if ingested. e.) Booster seats are needed at this age and should be secured in the back seat.

a, d, e At this age, children are at risk for drownings, motor vehicle accidents, fires or burns, and suffocation; it's important that children not be left unattended around water, streets or crosswalks, or stoves or ovens while in use. Hot water tanks should be set to 120 degrees Fahrenheit. Booster seats are needed for preschool-age children; seats should meet the vehicle and safety seat recommendations and guidelines. Other safety guidelines include keeping all medications and poisonous products such as hand sanitizer in high places or in a locked cabinet and teaching children fire safety as well as plans to follow in case of a fire.

Teaching a child to toilet train is most likely to occur during which psychosocial developmental stage? a.) Trust vs. mistrust b.) Autonomy vs. shame/doubt c.) Initiative vs. guilt d.) Industry vs. inferiority

b

Which of the following is identified as the leading cause of death in school-age children? a.) Heart defects b.) Unintentional injuries c.) Diabetes d.) Alcohol and drug use

b

Which screening tool is useful in identifying alcohol and substance abuse in the adolescent population? a.) HEADDS tool b.) CRAFFT tool c.) CAM assessment d.) Faces tool

b

As the nurse, you want to discuss appropriate health promotion topics and practices with Aiden and his mother. Which of the following should not be included for the school-age child? a.) Proper use of helmets and pads for activities b.) Walking with the flow of traffic for pedestrian safety c.) Being left home alone while a parent runs errands d.) Mild traumatic brain injuries

b pedestrian safety (look both ways when crossing street, use sidewalks and walk against the flow of traffic)

The nurse is caring for a 3-year-old girl in the hospital. The mother requests to stay all night with her daughter. Which of the following responses by the nurse demonstrates family-focused care? a.) Hospital policy dictates visiting hours are between 7 a.m. and 7 p.m. for all patients. b.) We encourage a parent or caregiver to stay with children because they often fear the hospital. c.) Visitors are welcome, but we will ask you to step out for medical procedures. d.) You will need to rotate shifts with another caregiver to decrease stress and anxiety.

b or d?

Kya reports that she and her boyfriend love to run at least 5 miles every day after cheerleading practice and that they have been avoiding all red meat or meat products. She states that she gets angry when her parents and friends give her a hard time about her exercise and eating habits. She reports that she feels fine and doesn't need anyone's advice or opinion. Based on Kya's comments, which of the following statements applies to the psychological characteristics of the adolescent? Select all that apply. a.) Self-image is not dependent on other's opinions b.) Impulsive c.) Knows right from wrong d.) Has mood swings e.) Not willing to compromise with others

b, c, d

When assessing John prior to discharge, you remember which of the following statements are true regarding pain assessment in children? Select all that apply. a.) Nurses should use vital signs as a good indicator of pain in children. b.) Developmental level is important to determine when choosing an appropriate pain scale. c.) Chronic illness may impact the pain scale selected. d.) Caregivers should be asked about their opinion of their child's pain. e.) If pain is uncertain, assume an appropriate level pain.

b, c, d Evaluation of pain must take into account heart rate, blood pressure, and respiratory rate but should not be relied upon as a sole indicator of pain. Behaviors and reactions to pain are additional assessments of pain seen in children.

Which items should the nurse include to determine the family member's satisfaction with the functional status of the family? Select all that apply. a.) Assimilation b.) Partnership c.) Growth d.) Advancement e.) Resolve

b, c, e (APGAR)

The nurse is performing a head-to-toe assessment on a newborn delivered vaginally 22 minutes ago. What finding is concerning, requiring immediate attention? a.) White papules over the nose b.) Bluish discolorations on buttocks c.) Absent or weak suck reflex d.) Symmetrical abduction and extension of arms and legs when startled

c

What information should be included in the discharge instructions for an infant with a cleft palate? a.) Suctioning with a bulb syringe often to keep sutures dry b.) Encouraging use of a pacifier to improve sucking c.) Teaching the signs and symptoms of ear infections in infants d.) Teaching that additional surgeries are not needed unless there are complications

c

You are ready to begin your nursing assessment of Cindy. What nursing consideration is most important at this time? a.) A body mass index measurement is important to detect risk of obesity. b.) Head circumference measurements are no longer needed. c.) Cindy's height should be measured in the recumbent position. d.) Lordosis is a sign of scoliosis and should be reported.

c

Peter admits to cigarette smoking and reports a one-pack-a-day habit for the past year. You decide to use the CRAFFT screening tool to assess Peter for alcohol and drug use. Which of the following are the correct words for the acronym? a.) Car, response, alone, forget, friends, time b.) Conflict, relax, absent, family, friends, traditions c.) Car, relax, alone, forget, friends, trouble d.) Calm, relationships, anxiety, fun, family, time e.) Car, risks, alarmed, friends, family, trouble

c 1. Have you ridden in a Car driven by someone (including yourself) who had been drinking or using drugs? 2. Do you use alcohol or drugs to Relax, feel better about yourself, or fit in? 3. Do you use alcohol or drugs when you're by yourself, Alone? 4. Do you Forget things you did while using alcohol or drugs? 5. Do your family or Friends tell you that you should cut down on your drinking or drug use? 6. Have you gotten into Trouble while using alcohol or drugs?

Which of the following would be an unexpected finding in reviewing Aiden's social development? a.) Enjoys playing football at school b.) Likes to do favorite activities with his best friend Max c.) Admits to being influenced by peers to pull pranks on other kids at school d.) Has daily chores and completes them to avoid loss of privileges

c Being influenced by peer pressure is associated with the social development of adolescents.

John's mother expresses concerns about pain medication. Which of the following statements is accurate? Select all that apply. a.) Watch the respiratory rate to know if your child is in pain. b.) Taking pain medication is a choice that your child should make. c.) You may offer how your child would like to take medication, either liquid or chewable form. d.) Difficulty consoling your child may be a sign they are in pain. e.) If your child isn't asking for pain medication, you should assume they are not in pain.

c, d

Peter states "yes" to all the questions in the CRAFFT screening tool. He is unsure of his actions when he is under the influence and states he may have been sexually abused by an older man, but he is not sure. Based on your knowledge of the increased risk of physical, emotional, and sexual abuse in the adolescent population, which of the following findings are true concerning sexual abuse? Select all that apply. a.) Adolescents are more likely than adults to be injured during a sexual assault. b.) Boys and girls report sexual abuse at the same rates. c.) Nonspecific physical complaints could be an indication of sexual abuse. d.) Adolescents are more likely to report abuse than adults. e.) Alcohol and substance abuse increase the risk of sexual assault.

c, e

Which of the following interventions should the nurse perform when caring for school-age children? Select all that apply. a.) Inform the child of the importance of the medical team and their ability to maintain all care decisions. b.) Limit social time with friends and family to focus on the child's care and hospitalization. c.) Permit the child to make decisions about his or her own care whenever possible. d.) Encourage the child to ask questions only when a parent or caregiver is present. e.) Assign a daily task that allows the child to assist in his or her own care.

c, e

Which of the following screenings would not be considered for Kya during her annual physical assessment? Select all that apply. a.) Vision screening b.) Cholesterol c.) Scoliosis d.) Hearing screening e.) Tuberculosis

c, e Tuberculosis is recommended for high-risk youth who come from countries outside of the United States, may be HIV positive, or have been incarcerated or homeless. Scoliosis screening is performed in school-age children. Cholesterol screenings should be performed at least once during adolescence, sometime between the ages of 11 and 20 years. Vision acuity screenings should be performed at ages 12 and 15 years. Hearing screenings are performed between ages 11 and 14, 15, and 17, and again from 18 to 21 years. Kya is past the age for scoliosis screenings, and she does not meet the requirements for tuberculosis screenings.

Billy is in the emergency room for chronic history of vomiting and diarrhea with unknown origin. The nurse plots the child's measurements, realizing Billy is below the 5th percentile for both weight and height for age. Which statement is most accurate? a.) As long as the child is meeting normal developmental milestones, waiting until illness resolves will allow the child time to increase weight gain. b.) The Department of Human Resources should be notified as this is a sign of abuse. c.) Immunologic conditions typically cause significant decrease in weight and height; Billy's condition should resolve spontaneously. d.) This finding is consistent with a diagnosis of failure to thrive.

d

How is "mild" traumatic brain injury in school-age children defined? a.) Headaches and photosensitivity b.) Nausea and vomiting c.) Stiff neck and blurry vision d.) Headache and problems with concentration

d

How long before the procedure should topical EMLA cream be applied to decrease the pain associated with an intramuscular injection? a.) 45 minutes b.) 4 hours c.) 90 minutes d.) 2 hours

d

Scoliosis screenings should begin at what age? a.) 9 years b.) 11 years c.) 10 years d.) 12 years

d

You discuss the recent changes to Peter's appearance and school performance and determine that he is eligible for counseling. Which of the following would be the best indicator that Peter's overall well-being is improving? a.) Decreased somatic complaints b.) Hair returning to normal color c.) No more body piercings d.) Improved school performance e.) Participation in football

d

A mother is considering potty-training her twin boy and girl children. Which of the following statements should the nurse include in determining readiness? Select all that apply. a.) Both children wear a diaper only at bedtime but stay dry during naps. b.) Boys are able to stand while voiding. c.) Girls should consistently wipe back to front after voiding. d.) Both children should have regular bowel movements. e.) Both children are able to pull pants up and down on their own.

d, e