Round 3 2 of 9(14,6-9,12,15)

The mother of an infant born prematurely at 32 weeks expresses the desire to breastfeed her child. The nurse correctly responds with which statement when the mother asks how long she should breastfeed her baby? **

"Breast milk should be the only food for the first 6 months." Rationale 4: Breast milk should be the only food for the first 6 months, and should continue until 12 months even after solid foods are introduced.

The nurse is assessing an adolescent client whose weight is in the 5th percentile. Based on this information, which question is most appropriate for the nurse to ask the adolescent client?

"Do you have any concerns about your weight?" Rationale 2: The only question that addresses the adolescent's weight, which is below the expected norm, is "Do you have any concerns about your weight?" Asking about school lunches, eating fruits and vegetables, and how many meals eaten each day should be used to obtain a nutritional history; however, those questions do not address the underweight status of the adolescent.

Which assessment question would get the most accurate response when a nurse is assessing learning/reading skills in the early childhood years? **

"Do you keep books for your child readily available?" Global Rationale: Keeping books readily available will stimulate reading skills. This is the question that will provide the most information about learning/reading skills. Language and getting along with others are more communication skills. Rewards are more closely related to discipline.

The nurse is instructing a parent of a newborn on the foods that are to be started based on age. The nurse instructs the parent that the first food given to a newborn is rice cereal. What statement by the parent suggests appropriate understanding of the next food that can be introduced? **

"Fruits should be given next." Rationale 3: Chicken is not given until 8-10 months, eggs are not given until 12 months, whole milk is given at 12 months. Fruits are given after rice cereal.

A nurse asks the mother of a 4-month-old infant to undress the infant. The nurse observes the mother taking off several layers of clothing and knows that the outdoor temperature is 70 degrees Fahrenheit. Which statement by the nurse is most appropriate in this situation? **

"I see that you have many layers of clothing on your baby. This may cause your baby's temperature to rise. " Rationale 3: In this scenario, the mother has overdressed the infant. The nurse needs to gently inform the mother of this problem and to provide information to the mother on why it is a problem. Just making a statement on how warmly the child is dressed will not accomplish this goal or just telling the mother to only put one layer of clothing on the child does not provide a rationale for the mother to make a better decision the next time, so this statement also is not helpful to the mother.

The nurse is providing nutritional guidance to the parents of a toddler. Which comment by the parent would prompt the nurse to provide additional education?

"It is safe to leave my meat red in the center as long as there are no juices running." Rationale 2: Meats should be cooked thoroughly before eating. Meat that is red in the center, with or without running juices, is insufficiently cooked and increases the risk of food-borne illness. Washing hands and using separate utensils help to prevent infection with food-borne pathogens. Raw oysters should be avoided.

Parents of a preschool child report that they find it necessary to spank the child at least once a day. Which response should the nurse make to the parents? **

"Let's talk about other forms of discipline that have a more positive effect on the child." Global Rationale: The behavior reported by the parent was excessive. The only response that is appropriate is to find a more positive way of influencing behavior in this age child. The nurse's response needs to reflect these feelings. To suggest spanking as an appropriate form of discipline is inappropriate, especially when the parent is describing daily spanking of the child.

A nurse observes the parent/child interaction during the 4-year-old well-child checkup and notes that the parent speaks harshly to the child and uses negative remarks when speaking with the nurse. Which statement by the nurse would be most beneficial? **

"Let's talk privately. Let's discuss the way you speak with your child and possible ways to be more positive." Global Rationale: The best approach to this encounter would be for the nurse to discuss concerns with the parent privately, since the nurse wants to help the parent develop a good relationship with the child. The child should not be a part of this conversation. Since the child is only 6 years old, it would be difficult to ask the parent to leave the room. If the nurse also wants to speak alone with the child, the nurse perhaps would escort the child to another area and speak briefly with the child. Referring to counseling without a discussion with the parent is not appropriate. The nurse should not ask the child if she is "unhappy" with the parent.

A parent says to a nurse, "How do you know when my child needs these screening tests the doctor just mentioned?" Which response by the nurse is the most appropriate? **

"Screening tests are administered at the ages when a child is most likely to develop a condition." Rationale 1: Screening tests administered at ages when a child is most likely to develop a condition provide a good basis for health promotion. The remaining answers all provide incorrect information to the parent. Abnormal newborn screening tests require immediate follow-up. Screening tests are done to detect the possibility of problems, not when a problem is suspected; at that point, a child needs diagnostic testing. Screening tests are not done at each office visit.

During a clinic visit, the parents of a 15-month-old ask what disease and injury prevention topics would be appropriate to discuss at this age. Which response by the nurse is the most appropriate? **

"Teaching simple handwashing is a good topic at this age." Global Rationale: Disease and injury prevention are ongoing topics at all ages. Simple handwashing is appropriate for a 15-month-old child. A 15-month-old is too young for bicycle riding, so this can be delayed. A 15-month-old is too young to understand water safety and crossing the street, and should never be left unattended in these situations.

The nurse of an outpatient clinic is sitting with the parents while their adolescent goes for a test. The parents are complaining about their child's behavior. Which statement by the nurse fosters family-centered communication? **

"Tell me what concerns you about your child's behavior." Rationale 4: Using an open-ended question allows the parents to discuss a family concern. All the other questions or statements are blocking statements and would not foster family-centered communication.

A mother of a 2-year-old child becomes very anxious when the child has a temper tantrum in the medical office. Which response by the nurse is the most appropriate?

"What do you usually do or say during a temper tantrum?" Rationale 1: Asking the mother to describe her usual behavior via an open-ended question will encourage the mother to talk about home management and will lead the nurse to assist the mother in making a plan of care for temper tantrums. Ignoring the behavior, instructing the mother to cuddle the child, or sympathizing with the mother ("I know exactly what you are feeling") are not effective ways to problem solve for temper tantrums.

The nurse in the newborn nursery is admitting a neonate. To determine the health and development of the newborn, what will the nurse include in the assessment? Standard Text: Select all that apply. **

1. Head circumference 2. Body length 3. Weight 4. Length of pregnancy Global Rationale: The nurse should assess almost all of these parameters to determine the health of the newborn. However, hearing screens are typically done after the first 12 hours after birth and are not part of newborn assessment.

Parents of a child who will begin enteral feedings ask the nurse what advantage this type of feeding has over other methods. Which responses by the nurse are the most appropriate? Standard Text: Select all that apply. **

1. "Enteral feeding is the closest to natural feeding methods." 2. "The child must be able to absorb nutrients." 5. "Enteral feeding has a high success rate." Global Rationale: Enteral feedings are the closest to natural feeding methods. The child must be able to absorb nutrients. Enteral feeding has a high success rate. It is not complex to administer, and does not require a central venous catheter.

The parents of a toddler are concerned about their child's finicky eating habits. While counseling the parents, which statements by the nurse are the most appropriate? Standard Text: Select all that apply. **

1. "The child is experiencing physiologic anorexia, which is normal for this age group." 3. "It is more appropriate to assess a toddler's nutritional demands over a 1-week period rather than a 24-hour one." 5. "The toddler should drink 16 to 24 ounces of milk daily." Rationale 1: Physiologic anorexia is caused when the extremely high metabolic demands of infancy slow to keep pace with the slower growth of toddlerhood, and it is a very normal finding at this age. It is not unusual for toddlers to have food jags during which they only want one or two food items for that day. So it is more helpful to look at what their intake has been over a week instead of a day. Two to three cups of milk per day are sufficient for a toddler, and more than that can decrease the child's desire for other foods and lead to dietary deficiencies. The correct general guideline for food quantity is one tablespoon of each food per year of age. Food should only be offered at meal and snack times, and children should sit at the table while eating to encourage their socialization skills.

The clinic administrator has asked each nurse to classify the nursing activities as a beginning step of clinic reorganization. Which of these strategies can be identified as health promotion and health maintenance? Standard Text: Select all that apply.

1. Administration of the flu vaccine for infants from 6 months to 23 months old. 2. Daily feeding schedules for infants. 3. Instruction to adolescents on how to use dental floss. Global Rationale: Administering flu vaccines, discussion of feeding schedules, and instructions to adolescents are all health-promotion and/or health-maintenance topics. Treatment of an acute ear infection (otitis media) would not be a topic for health promotion and health maintenance since it is an acute illness.

Which of these aspects of developmental health supervision should be included in each healthcare visit of young children? Standard Text: Select all that apply.

1. Assessment 3. Education 4. Intervention Global Rationale: The main recommendations for developmental health supervision of young children include assessment, education, intervention, and care coordination. This standard framework should be used as guidelines for each healthcare visit. Discipline and toilet training, while important to the care of children, are age specific and not part of the main developmental plans.

The nurse working with a family has observed that the older children have a large number of dental caries and plans to provide the mother with information to prevent the development of dental caries in her new infant. Which interventions will prevent the development of dental caries in the infant? Standard Text: Select all that apply. **

1. Avoiding nursing or giving the infant a bottle at bedtime 3. Using a soft moist gauze for cleaning Global Rationale: The only interventions that will assist in the prevention of dental caries listed in this question are wiping the gums with a soft, moist gauze and avoiding putting the infant to bed with a bottle. Foods high in sugar should be avoided in the infant period. Topical anesthetic should not be applied daily.

The nurse is planning care for a preschool-age child and family. In order to assess the family, what should the nurse plan to do during each health supervision visit? Standard Text: Select all that apply. **

1. Discuss of the child's developmental status 2. Observe interactions among the family members 3. Discuss concerns with the parents Global Rationale: In order to assess the child and family, the nurse would plan to discuss the child's developmental status, observe interactions among the family members, and discuss any concerns with the parents. Administering age appropriate vaccinations and recording height and weight are appropriate interventions, but are not included during the family assessment process.

Rationale 1: Newborns discharged before 48 hours old should be seen within 48 hours of discharge. Waiting one week and/or two weeks after discharge of a 24-hour-old infant increases the chance that several common newborn conditions can go undiagnosed (e.g., jaundice, failure to gain weight). Waiting one month is too long for any infant who is discharged at 24 hours old.

1. Feeding pattern 2. Jaundice 5. Sleep pattern Global Rationale: Feeding pattern, sleep pattern, and jaundice assessment would be appropriate 3 days after discharge. It would not be necessary to do a length or vision screen at this age.

The nurse educator is teaching a group of students about the key concepts of a medical home during the developmental years of the pediatric client. Which items should the educator include in the teaching session? Standard Text: Select all that apply. **

1. Financial accessibility 2. Consistent, ongoing care 3. Coordination of care Global Rationale: All children need a medical home, where accessible, continuous, and coordinated health supervision is provided during the developmental years. Accessibility refers to both financial and geographic access; continuous indicates that the care is ongoing with consistent care providers; coordination refers to the need for communication among health professionals to provide for the needs of the child. Care is individualized and is not paternalistic.

The nurse is conducting a nutritional assessment for a toddler client who is diagnosed with failure to thrive (FTT). Which parameters will the nurse include in the assessment process for this toddler and family? Standard Text: Select all that apply. **

1. Height 2. Weight 3. Hemoglobin and hematocrit 4. Twenty four hour food diary Global Rationale: In order to adequately assess the toddler client's FTT, the nurse would plan to measure height and weight; obtain a hemoglobin and hematocrit; and ask the family for a twenty-four hour food diary. Information regarding maternal dietary intake during pregnancy is not information that is necessary to assess for a toddler diagnosed with FTT.

Which nursing assessment activities should be included for the child and family at each health-supervision visit? Standard Text: Select all that apply. **

1. Interview to obtain an updated health history. 2. Performing an age-appropriate development assessment. 4. Performing age-appropriate screening examinations. Global Rationale: The interview, the developmental assessment, and age-appropriate screenings are all included in the nursing assessment of a child and family during each health-supervision visit. A nurse would not assess the parents' financial status at each health-supervision visit. Physical assessments for genetic abnormalities would be done based on history and/or physical findings, not at each routine visit.

A nursery nurse is planning care for the newborns currently in the newborn nursery. Which activities does the nurse plan for the first 48 hours of life? Standard Text: Select all that apply. **

1. Monitor feeding behaviors. 2. Perform a hearing screening. 3. Perform a heel stick to obtain blood for the newborn screen. Global Rationale: The nurse should assess feeding behaviors of the infant whether the infant is breast-fed or bottle-fed. A hearing screening is performed on all newborn infants prior to discharge. The newborn screen is performed prior to infant discharge from the newborn unit. The nurse, not the mother, performs the first bath to remove blood and amniotic fluids. Vitamin K is administered, not folic acid.

The nurse is asked to teach injury prevention measures to a classroom of 4-year-old preschoolers. Which teaching points are most appropriate at this age? Standard Text: Select all that apply. **

1. Stop, drop and roll if clothes catch fire 2. Never go into the road alone. 4. Safe meeting place outside the house in case of fire 5. Car seat safety Global Rationale: Acceptable places to climb should be introduced in the toddler years when children are learning to walk, climb, and explore. It is not a topic for a preschool class. All the other topics are appropriate for this age.

A mother of an 18-month old asks the nurse whether she can begin to introduce low-fat milk like the rest of the family drinks. The nurse answers the mother based on the knowledge that low-fat milk can safely be introduced at what age? **

18 months Global Rationale: Health promotion for the toddler includes whole milk until age 2. Age 1 is too early for low-fat milk, and it can safely be introduced before ages 3 and 4.

Which health promotion activities can the nurse recommend to the parents of a preschool-age child in order to enhance the child's self-concept? Standard Text: Select all that apply. **

2. Praise the child for staying dry at night. 4. Set aside time for the child each day. 5. Discuss appropriate activities to engage in with the daycare provider. Global Rationale: Health promotion activities focus on development of a healthy self-concept in the toddler and young child by helping parents to set up successful play experiences, to praise the child for successes, to use effective limit-setting techniques, and to realize and appreciate the child's unique characteristics. Health maintenance seeks to avoid the poor self-image that can occur with constant criticism or expectations not in alignment with the toddler's or preschooler's developmental capabilities.

Which of these developmental milestones should the nurse expect to find in children who are between 2 and 3 years old? Standard Text: Select all that apply.

2. Scribbles and draws on paper 3. Kicks a ball 5. Goes up and down stairs Global Rationale: Children between the ages of 2 and 3 years can scribble and draw on paper, kick a ball, and go up and down the stairs. Children who are between the ages of 3 and 4 years can feed themselves. Children between the ages of 4 and 5 years can throw a ball overhand.

A nurse who is the manager of an ambulatory pediatric healthcare center is planning protocols for the routine healthcare visits of the children. Children at this care center have a high incidence of obesity. At which age should the nurses at this clinic calculate the body mass index (BMI) for all pediatric clients?

24 months Global Rationale: The body mass index is first calculated at 2 years of age and gives information about the relationship between the height and weight of the child. With this information, the nurse would be able to develop strategies that may reduce the incidence of obesity.

The nurse is assessing an infant client and parents during a routine health supervision visit at 2 months of age. Which items will the nurse assess to determine if the infant's mental health needs are being addressed? Standard Text: Select all that apply. **

3. Temperament during the visit 4. Feeding schedule 5. Sleep-wake patterns Global Rationale: When addressing mental health issues, the nurse would assess the infant's temperament during the visit, feeding schedule, and sleep-wake patterns. The infant's mental health is related to early experiences, inborn characteristics such as temperament and resilience, and relationships with caregivers. The first year of life provides many opportunities for the infant to develop positive mental health; interventions during this important period can enhance the child's future mental status. The immunization record and the newborn screen results will not provide the needed information for the nurse in terms of whether the infant's mental health needs are being addressed.

The nurse is planning a class for school-age children on prevention of obesity through exercise. It is important to encourage the children to exercise a minimum of how many minutes a day to meet current recommendations? **

60 minutes Rationale 3: The current recommendation is 60 minutes of exercise daily.

An infant weighs 9 pounds, 3 ounces at birth. The nurse plans to make a home visit to the mother and infant when the infant is 7 days old. What is the lowest acceptable weight the infant should be at this age? **

8 pounds, 2 ounces Rationale 2: In the first week of life, most infants lose about one-tenth of their birth weight; therefore, this infant's weight should be 8 pounds, 2 ounces at 7 days of age. A weight loss to 7 pounds, 12 ounces would be too much for this infant. A decline to 8 pounds, 12 ounces is less than the expected one-tenth weight loss after birth, and an infant would not be expected to lose only 3 ounces during the first week of life.

The nurse is evaluating the car seat of a 3-year-old who weighs 42 pounds. Which recommendation should the nurse make about the car seat to the parents? **

A car seat with a harness approved for higher weights and heights Global Rationale: The American Academy of Pediatrics and the National Highway Safety Administration recommend booster seats for children over 40 pounds and 4 years of age. A 3-year-old should be in a regular car seat with approved harness for higher-weight/height children so that she is protected from injury. Rear-facing seats and regular seat with lap and shoulder strap are not appropriate for a 3-year-old.

A 27-month-old toddler who is in the pediatric office for a well-child visit begins to cry the moment he is placed on the examination table. The parent attempts to comfort the toddler; however, nothing is effective. Which of these actions by the nurse takes priority?

Allow the toddler to sit on the parent's lap and begin the assessment. Global Rationale: Toddlers are most comfortable when sitting with the parents. Much of the examination can be completed in this way. Allowing the toddler to stand on the floor is inappropriate. A nurse can assist if the parent is unable to hold the child during the examination of the throat and ears to prevent injury from movement.

A nurse is assessing an 11-month-old infant and notes that the infant's height and weight are at the 5th percentile on the growth chart. Family history reveals that the infant's two siblings are at the 50th percentile for height and at the 75th percentile for weight. Psychosocial history reveals that the parents are separated and are planning to divorce. Which of these nursing diagnoses takes priority?

Alteration in Growth Pattern Related to Parental Anxiety Rationale 1: The scenario reveals parental anxiety due to marital problems. The most appropriate nursing diagnosis is alteration in growth patterns related to parental anxiety. There is no data that indicates familial short stature. Since height and weight are at the 5th percentile, there is no indication of increased nutritional intake. This infant is not at risk for constitutional growth delay.

A school-age client, recently diagnosed with asthma, also has a peanut allergy. The nurse instructs the family to not only avoid peanuts but also to carefully check food label ingredients for peanut products and to make sure dishes and utensils are adequately washed prior to food preparation. The mother asks why this is specific for her child. Based on the client's history, the nurse knows that this client is at an increased risk for which complication? **

Anaphylaxis Rationale 3: Children with food allergies may experience all of the above reactions to a particular food, but the child who also has asthma is most at risk for death secondary to anaphylaxis caused by a food allergy.

The nurse is planning care for clients seen in a newborn clinic. Which is the priority for a newborn client during the first clinic visit?

Assessing the newborn-and-family interactions Rationale 2: The first step in the nursing process is assessment; therefore, the nurse should assess the interactions of the parents with the newborn. Providing pamphlets to help educate the parents should be done at each appropriate office visit; however, the pamphlets would be distributed after assessment of parent needs. While the nurse should be a role model for nurturing behaviors during the office visit, this would not be the first thing the nurse performs at the office visit. While parents are informed of the infant's gains in height and weight, this activity does not take priority.

Which assessment would not be included with a 17-year-old's screening during a routine health supervision visit?

Autism screening Rationale 2: Autism screening would not be appropriate at this age. If autism were present, it would have presented before this age. STI evaluation, hemoglobin test, and vision screening are all appropriate for a 17-year-old.

The nurse is teaching a new mother developmental expectations. Which activity should the nurse expect a newborn to do within the first month of life?

Bring hands to eyes and mouth. Rationale 1: Newborns at one month of age can bring hands to their eyes and mouths, move their heads from side to side when lying on their abdomens, and attempt to lift their heads only when prone. Newborn hands are kept in tight fist position, and the newborn cannot roll over until 4 months of age.

During a well-child physical, an adolescent female has a normal history and physical except for an excessive amount of tooth enamel erosion, a greater-than-normal number of filled cavities, and calluses on the back of her hand. Her body mass index is in the 50th to 75th percentile for her age. Which disorder is the nurse concerned about based on the assessment findings? **

Bulimia nervosa Rationale 3: The erosion of tooth enamel, dental caries, and calluses on the back of her hand all most likely are due to frequent vomiting of gastric acids, which is common with bulimia nervosa as part of a "binge-purge" cycle. Anorexia nervosa is an eating disorder where adolescents literally starve themselves to prevent weight gain; they also exercise excessively and use laxatives and diuretics to lose weight. Anorexia usually manifests as extreme weight loss and an obsession with food. Kwashiorkor is a protein deficiency, usually from malnutrition, that manifests as generalized edema. Marasmus is a lack of energy-producing calories that can be seen in anorexia, and this causes emaciation, decreased energy levels, and retarded development.

While teaching the parents of a newborn about infant care and feeding, which instruction by the nurse is the most appropriate? **

Delay supplemental foods until the infant is 4 to 6 months old. Rationale 1: Four to six months is the optimal age to begin supplemental feedings because earlier feeding of nonformula foods is not needed by the infant and does not promote sleep. Earlier feeding of nonformula foods, regardless of the infant's weight, is more likely to cause the development of food allergies. Also, early feeding is not well tolerated by infants because the necessary tongue control is not well developed and they lack the digestive enzymes to take in and metabolize many food products.

A nurse in the outpatient pediatric clinic is reviewing the records of a preschool-age child and notes that because the parents often miss routine healthcare visits the child has not received the second measles, mumps, and rubella (MMR) vaccine. Which action by the nurse is most appropriate in this situation? **

Call the parents and encourage them to bring the child for recommended care. Rationale 3: The nurse in the pediatric healthcare setting is responsible for reviewing the health supervision of the child. Partnering with the parents and encouraging the parents to follow health-supervision guidelines are the best strategies to use. Speaking firmly with the parents about compliance will alienate the parents at this time. A discussion of the principles of health supervision without an intervention at this visit would mean a delay in needed health care for the child in this example. Discussing with the physician that the immunizations are not up to date is not necessary in an outpatient clinic. Immunizations are given per schedule.

The mother of a toddler is concerned because her child does not seem interested in eating. The child is drinking five to six cups of whole milk per day and one cup of fruit juice. When the weight-to-height percentile is calculated, the child is in the 90th to 95th percentile. What is the best advice the nurse can provide to the mother?

Change from whole milk to 2 percent milk and decrease milk consumption to three to four cups per day and the fruit juice to a half cup per day, offering water if the child is still thirsty in between. Rationale 3: Toddlers require a maximum of about one liter of milk per day. This toddler is consuming most of his or her calories from the milk and thus is not hungry. The high fat content of the milk and the high sugar content of the fruit juice are also contributing to the child's higher weight-to-height percentile. Decreasing the amount and fat content of the milk and decreasing the intake of fruit juice will decrease calories and thus make the child hungry for other foods. The other advice is also appropriate but did not address the problem of excessive milk consumption.

A nurse says to the mother of a 6-month-old infant, "Does the baby sit without assistance, and is the baby crawling?" Which process is the nurse using in this interaction?

Developmental surveillance Rationale 4: The question asked by the nurse is seeking information about developmental milestones; therefore, the nurse is involved in developmental surveillance. While health-promotion and health-maintenance activities are related to developmental surveillance, this question is looking specifically at the milestones; therefore, the answers "health promotion" and "health maintenance" are incorrect. The questions asked in the stem are not classified as disease-surveillance questions.

Which of these measures used by a nurse will help relieve parental anxiety related to the changing appetite in the toddler who is gaining weight along the 50th percentile? **

Discussing the growth of the toddler as compared to the growth chart Global Rationale: Showing the parents the growth pattern of the child as compared to the normal growth chart will help relieve parental anxiety related to eating less food during the toddler years. Toddlers who are at the 50th percentile do not need additional high-calorie foods. Toddlers eat to their personal needs and there is no reason to restrict watching TV or other environmental stimuli during meals. There is no reason to relate timing of discipline and eating.

A pediatric nurse who is employed in a busy ambulatory clinic setting is informed by the nurse manager that average nursing time allocated for each child and family is being reduced to 10 minutes to more efficiently manage the clinic. The nursing activities must include a nursing assessment and discussion on anticipatory guidance. Which of these strategies should the nurse utilize in the plan of care delivery? **

Focus anticipatory guidance strategies on topics that the parent or child have expressed as an area of interest. Rationale 4: With limited time for each visit, the nurse should focus on anticipatory guidance strategies that will most benefit the parent and child during that office visit.

The nurse is providing care to a pediatric client recently diagnosed with celiac disease. Which food choice indicates appropriate understanding of the material presented? **

Fruit plate with Gatorade Rationale 4: A child with celiac disease needs a gluten-free diet. Included on the list are fruits, meats, rice, and vegetables, including corn. Excluded are bread, cake, doughnuts, cookies, crackers, and many processed foods that may contain hidden gluten. Therefore, the child would be allowed to have the fruit plate with Gatorade.

A nurse is helping the parents of 2-year-old twins cope with the daily demands of life in an active household. Which strategy is most appropriate for the nurse to use? **

Health promotion Rationale 2: In health promotion, nurses partner with families to promote family strategies in the areas of lifestyle and coping. The definition of health maintenance and health supervision makes the other answers incorrect. Health protection is another term for health maintenance.

In the pediatric well-child clinic, the nurse explains the reason for an immunization series to the child's mother. This action represents which item? **

Health promotion Rationale 2: The explanation to the mother by the nurse provides an understanding of the immunization series to the mother and enables the mother to make an intelligent choice. While administering immunizations is considered health maintenance, the activity described in the question is clearly health promotion. A health assessment would be completed to determine what immunizations are needed. Health maintenance is the actual administration of the immunization and health screening involves looking at the immunization record to determine which immunizations are needed.

A nurse is preparing to perform a physical assessment on a toddler. Which action is most appropriate for the nurse to take? **

Leave intrusive procedures such as ear and eye examinations until the end. Global Rationale: Intrusive procedures such as examination of the ears, throat, eye, and genital areas should be done last to decrease the anxiety of the child during the initial phases of the examination, which includes the heart and lungs.

While teaching a health promotion class to a group of parents of children in a Head Start class, which information should the nurse include to help decrease the risk of dental caries? **

Offer drinking cups only at meal and snack times. Rationale 2: Offering drinking cups only at meal and snack times encourages drinking when thirsty rather than carrying a cup around. This reduces the risk of dental caries. Delaying the introduction of cow's milk, making homemade baby food, or diluting juice does not decrease dental caries.

The nurse is teaching the parents of a 4-month-old infant about good feeding habits. The nurse emphasizes the importance of holding the baby during feeding and not letting the infant go to sleep with the bottle. Which disorder is associated with propped feedings and going to sleep with the bottle? **

Otitis media Rationale 1: It has been shown in numerous studies that allowing an infant to fall asleep with a bottle in his or her mouth causes pooling of the formula in the mouth, which increases the risk of both dental caries and otitis media. There has been limited data to date showing a positive correlation between bottle propping and increased risk of aspiration, malocclusions, and sleeping disorders.

Injury prevention is an important aspect of parent teaching. Which injury prevention strategy would reduce the risk of suffocation? **

Position the infant on her back to sleep. Global Rationale: Measuring crib slats will reduce strangulation. Not leaving an infant alone in a bath will reduce drowning. Positioning an infant on her back will reduce suffocation. Using approved restraint systems will reduce motor vehicle injury.

A mother brings a child to the pediatric office for a sick visit. Which action by the nurse is the most appropriate? **

Review health-promotion and health-maintenance activities. Rationale 2: A nurse should use every opportunity during an office visit to review health-promotion and health-maintenance activities. Focusing exclusively on the reported illnesses ignores the opportunity to use health-promotion strategies. There is not enough data in this scenario to determine whether the mother should be asked to leave the room. There is not enough information to indicate that a comprehensive history should be taken at this visit.

The nurse is providing anticipatory guidance instructions to the parents of a newborn. Which instruction should the nurse give as a strategy for illness/disease prevention? **

SIDS risk-reduction measures Rationale 4: Several disease-prevention strategies are used during anticipatory guidance for the parents of newborns. Not allowing visitors is unreasonable but screening for illness is appropriate. Smoking outside will not prevent disease. Attending weekly stimulation classes is not a disease prevention strategy. SIDS risk-reduction measures can reduce the risk of sudden infant death syndrome.

Which of these strategies would be most effective for a "teachable moment" during a routine office visit for the parents of a 6-year-old child?

Select one topic and present a brief amount of information on the topic. Rationale 1: Children and families often learn best when presented with small bits of information. Do not give too much information to the parents at one time; therefore, selecting one topic and presenting information is appropriate. It is not appropriate to discuss malnutrition with these parents, since nothing in the stem of the question indicates that the child has a problem with nutrition.

During a 4-month-old's well-child check, the nurse discusses introduction of solid foods into the infant's diet and concerns for foods commonly associated with food allergies. Due to allergies, which foods will the nurse instruction the parents to avoid until after 1 year of age? **

Strawberries, eggs, and wheat Rationale 1: Strawberries, eggs, and wheat, along with corn, fish, and nut products, are all foods that have commonly been associated with food allergies. Carrots, beets, and spinach contain nitrates and should not be given before the age of 4 months. Squash, peas, and tomatoes are acceptable to try after an infant is 4 to 6 months old but should be given one at a time and three to five days after starting a new food. Pork can be tried after the infant is 8 to 10 months old, as meats are harder to digest and have a high protein load.

A nurse is discussing health promotion activities with parents of a 4-year-old client. What health-promotion activity is most appropriate for this family? **

Teach the child the proper method for brushing the teeth. Rationale 4: Teaching proper oral hygiene through proper teeth brushing is a health-promotion activity. Touring the kindergarten might alleviate anxiety, but is not health promotion. A movie afternoon with the big brother is sedentary, and also not a health-promotion activity. Maintaining immunizations is a health-maintenance, not health-promotion, activity.

Celiac disease presents many challenges for a family. What should the nurse emphasize when educating the parents of a newly diagnosed child? **

The child's weight and height should reach normal levels in about 1 year. Rationale 2: Ice cream and many processed foods contain gluten. Payment by insurance is dependent on the plan the family has. Once on a gluten-free diet, the child's height and weight will reach normal range in about 1 year.

At a routine healthcare visit, a nurse measures a toddler and plots the height and weight on the growth charts. The nurse documents that the toddler is above the 95th percentile for weight and is at the 5th percentile for height. How should the nurse interpret these data?

The height and weight are disproportionate, and the toddler needs further evaluation. Global Rationale: Usually height and weight are at approximately the same percentile. When the weight of a child is found to be at the 95th percentile, the child's height is also greater than the 50th percentile. The height and weight for the child described in this question are a concern, and the child may need further endocrine testing.

A nurse assesses the height and weight measurements on an infant and documents these measurements at the 75th percentile. The nurse notes that the previous measurements two months ago were at the 25th percentile. Which interpretation by the nurse is the most accurate? **

The infant has gained a significant amount of weight. Rationale 2: A comparison of these two sets of measurements shows that the infant has crossed two percentiles going from the 25th to the 75th percentile and therefore has gained a significant amount of weight. There is neither indication that the previous measurements are inaccurate nor that the current measurement is inaccurate.

The nurse is performing a well-child exam on a child who turned 4 years old 3 months ago. What can the nurse ask the child to do to assess appropriate milestones for this age?

Throw a ball Global Rationale: Jumping up and down, stacking three or more blocks, and drawing lines on paper are activities that represent milestones for young children. Throwing a ball and observing how it is thrown would assess a milestone for this age. By 4-5 years, a child begins to throw a ball overhand.

A parent questions how her toddler plays with other toddlers. Which response by the nurse displays the best description of the differences in play between the toddler and the preschooler?

Toddlers play side by side, while preschoolers play cooperatively. Global Rationale: Toddlers will play side by side with another child, but they do not interact with the child during play. Preschoolers play cooperatively with other children.

A mother asks which developmental milestones she can expect when her baby is 6 months old. Which response by the nurse is the most appropriate?

Transfers objects from one hand to the other Rationale 3: Lifting head when prone is a milestone at 1 month. A well-developed pincer grasp is a milestone at 12 months. Transferring objects from one hand to the other is a milestone at 6 months. Rolling from front to back is a milestone at 4 months.

A nurse is talking to the mother of an exclusively breast-fed African American 3-month-old infant who was born in late fall. Which supplement will the nurse recommend for this infant?

Vitamin D Rationale 2: An infant's iron stores are usually adequate until about 4 to 6 months of age. The infant should be receiving sufficient amounts of calcium from breast milk, and fluoride supplementation, if needed, does not begin until the child is approximately 6 months old. This infant will have limited exposure to sunlight and thus vitamin D because of the infant's dark skin and decreased sun exposure in the fall and winter months.

While teaching parents of a newborn about normal growth and development, which statement is most appropriate for the nurse to include in the session?

Weight should triple by 1 year of age. Global Rationale: An infant should triple its birth weight by 1 year of age. The other answers are not appropriate weight gains.

A mother who is bottle feeding her newborn asks to be discharged 24 hours post delivery, because she also has twin 2-year-old children at home. When should the nurse schedule the first office visit for this newborn?

Within 48 hours of discharge Rationale 1: Newborns discharged before 48 hours old should be seen within 48 hours of discharge. Waiting one week and/or two weeks after discharge of a 24-hour-old infant increases the chance that several common newborn conditions can go undiagnosed (e.g., jaundice, failure to gain weight). Waiting one month is too long for any infant who is discharged at 24 hours old.