Ch. 26, 27, 28, 29

The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is: a. Erikson. c. Kohlberg. b. Freud. d. Piaget.

A Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled. Sigmund Freud proposed a psychosexual theory of development. He proposed that certain parts of the body assume psychological significance as foci of sexual energy. The foci shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of development. Lawrence Kohlberg described moral development as having three levels (preconventional, conventional, and postconventional). His theory closely parallels Piaget's. Jean Piaget's cognitive theory interprets how children learn and think and how this thinking progresses and differs from adult thinking. Stages of his theory include sensorimotor, preoperations, concrete operations, and formal operations.

What is probably the single most important influence on growth at all stages of development? a. Nutrition c. Culture b. Heredity d. Environment

A Nutrition is the single most important influence on growth. Dietary factors regulate growth at all stages of development, and their effects are exerted in numerous and complex ways. Adequate nutrition is closely related to good health throughout life. Heredity, culture, and environment all contribute to the child's growth and development; however, good nutrition is essential throughout the life span for optimal health.

The nurse is observing parents playing with their 10-month-old daughter. What should the nurse recognize as evidence that the child is developing object permanence? a. She looks for the toy the parents hide under the blanket. b. She returns the blocks to the same spot on the table. c. She recognizes that a ball of clay is the same when flattened out. d. She bangs two cubes held in her hands.

A Object permanence is the realization that items that leave the visual field still exist. When the infant searches for the toy under the blanket, it is an indication that object permanence has developed. Returning blocks to the same spot on a table is not an example of object permanence. Recognizing a ball of clay is the same when flat is an example of conservation, which occurs during the concrete operations stage from 7 to 11 years. Banging cubes together is a simple repetitive activity characteristic of developing a sense of cause and effect.

Which term refers to those times in an individual's life when he or she is more susceptible to positive or negative influences? a. Sensitive period c. Terminal points b. Sequential period d. Differentiation points

A Sensitive periods are limited times during the process of growth when the organism will interact with a particular environment in a specific manner. These times make the organism more susceptible to positive or negative influences. The sequential period, terminal points, and differentiation points are developmental times that do not make the organism more susceptible to environmental interaction.

The father of a hospitalized child tells the nurse, "He can't have meat. We are Buddhist and vegetarians." The nurse's best intervention is to: a. Order the child a meatless tray. b. Ask a Buddhist priest to visit. c. Explain that hospital patients are exempt from dietary rules. d. Help the parent understand that meat provides protein needed for healing.

A Order the child a meatless tray. It is essential for the nurse to respect the religious practices of the child and family. The nurse should arrange a dietary consultation to ensure that nutritionally complete vegetarian meals are prepared by the hospital kitchen. The nurse should be able to arrange for a vegetarian tray. The nurse should not encourage the child and parent to go against their religious beliefs. Nutritionally complete, acceptable vegetarian meals should be provided.

The nursing process is a method of problem identification and problem solving that describes what the nurse actually does. The five steps include (Select all that apply): a. Assessment. b. Diagnosis. c. Planning. d. Documentation e. Implementation. f. Evaluation

A, B, C, E, F a. Assessment. b. Diagnosis. c. Planning. e. Implementation. f. Evaluation The accepted model is assessment, diagnosis, planning, implementation, and evaluation. The diagnosis phase is separated into two steps: nursing diagnosis and outcome identification. Although documentation is not one of the five steps of the nursing process, it is essential for evaluation. The nurse can assess, diagnose and identify problems, plan, and implement without documentation; however evaluation is best performed with written evidence of progress toward outcomes.

A nurse is caring for an African-American child recently admitted to the hospital. The nurse should be aware of which broad cultural characteristics for this child when planning care (Select all that apply)? a. Silence may indicate a lack of trust. b. Maintaining constant eye contact may be viewed as aggressive. c. Self-care and folk medicine do not play a role in health care. d. Illness may be seen as the "will of God." e. No importance is attached to nonverbal behavior.

A, B, D A nurse should be aware of the African-American broad cultural characteristics, which include the following: initial eye contact shows respect; maintaining eye contact can be viewed as aggressive, silence may indicate a lack of trust, and illness may be seen as the "will of God." Self-care and folk medicine are prevalent in this culture, and importance is placed on nonverbal behavior.

Play serves many purposes. In teaching parents about appropriate activities, the nurse should inform them that play serves the following function (Select all that apply): a. Intellectual development b. Physical development c. Self-awareness d. Creativity e. Temperament development

A, C, D A common statement is that play is the work of childhood. Intellectual development is enhanced through the manipulation and exploration of objects. Self-awareness is the process of developing a self-identity. This process is facilitated through play. In addition, creativity is developed through the experimentation characteristic of imaginative play. Physical development depends on many factors; play is not one of them. Temperament refers to behavioral tendencies that are observable from the time of birth. The actual behaviors but not the child's temperament attributes may be modified through play.

Children are taught the values of their culture through observation and feedback relative to their own behavior. In teaching a class on cultural competence, the nurse should be aware that which factor(s) may be culturally determined (Select all that apply)? a. Degree of competition b. Racial variation c. Determination of status d. Social roles e. Geographic boundaries

A, C, D Each of these factors is determined by the assumptions, beliefs, and practices of the members of the culture. In cultures that value individual resourcefulness, competition would be acceptable. Status is culturally determined and varies according to each culture. Some ascribe higher status to age or socioeconomic status. Social roles also are influenced by the culture. Race and culture are two distinct attributes. The racial grouping describes transmissible traits, whereas the culture is determined by the pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. Cultural development may be limited by geographic boundaries. It is not the boundaries that are culturally determined.

A nurse is preparing to administer a Denver II. Which statement(s) about the Denver II test is (are) accurate (Select all that apply)? a. All items intersected by the age line should be administered. b. There is no correction for a child born prematurely. c. The tool is an intelligence test. d. Toddlers and preschoolers should be prepared by presenting the test as a game. e. Presentation of the toys from the kit should be done one at a time.

A, D, E To identify "cautions," all items intersected by the age line are administered. Toddlers and preschoolers should be tested by presenting the Denver II as a game. Because children are easily distracted, perform each item quickly and present only one toy from the kit at a time. Before beginning the screening, ask whether the child was born preterm and correctly calculate the adjusted age. Up to 24 months of age, allowances are made for preterm infants by subtracting the number of weeks of missed gestation from their present age and testing them at the adjusted age. Explain to the parents and child, if appropriate, that the screenings are not intelligence tests but rather are a method of showing what the child can do at a particular age.

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: a. A normal finding. b. An abnormal finding; the child needs referral to an ophthalmologist. c. A sign of a possible visual defect; the child needs vision screening. d. A sign of small hemorrhages, which usually resolve spontaneously.

ANS: A A brilliant, uniform red reflex is an important normal and expected finding. It rules out many serious defects of the cornea, aqueous chamber, lens, and vitreous chamber.

12. The nurse is interviewing the mother of an infant. She reports, "I had a difficult delivery, and my baby was born prematurely." This information should be recorded under which heading? a. Birth history b. Present illness c. Chief complaint d. Review of systems

ANS: A The birth history refers to information that relates to previous aspects of the child's health, not to the current problem. The mother's difficult delivery and prematurity are important parts of the past history of an infant. The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. Unless the chief complaint is directly related to the prematurity, this information is not included in the history of present illness. The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It would not include the birth information. The review of systems is a specific review of each body system. It does not include the premature birth. Sequelae such as pulmonary dysfunction would be included.

The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the nurse do first? a. Introduce himself or herself. b. Make the family comfortable. c. Explain the purpose of the interview. d. Give an assurance of privacy.

ANS: A The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. During the initial part of the interview the nurse should include general conversation to help make the family feel at ease. Next, the purpose of the interview and the nurse's role should be clarified. The interview should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality.

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

ANS: A These symptoms indicate meningeal irritation and need immediate evaluation. Continuing the assessment is not necessary. No indication of injury is present. This is not descriptive of head lag.

What type of breath sound is normally heard over the entire surface of the lungs, except for the upper intrascapular area and the area beneath the manubrium? a. Vesicular b. Bronchial c. Adventitious d. Bronchovesicular

ANS: A Vesicular breath sounds are heard over the entire surface of lungs, with the exception of the upper intrascapular area and the area beneath the manubrium. Bronchial breath sounds are heard only over the trachea near the suprasternal notch. Adventitious breath sounds are not usually heard over the chest. These sounds occur in addition to normal or abnormal breath sounds. Bronchovesicular breath sounds are heard over the manubrium and in the upper intrascapular regions where trachea and bronchi bifurcate.

When introducing hospital equipment to a preschooler who seems afraid, the nurse's approach should be based on which principle? a. The child may think the equipment is alive. b. The child is too young to understand what the equipment does. c. Explaining the equipment will only increase the child's fear. d. One brief explanation is enough to reduce the child's fear.

ANS: A Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. The child should be given simple concrete explanations about what the equipment does and how it will feel to the child. Simple, concrete explanations help alleviate the child's fear. The preschooler will need repeated explanations as reassurance.

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

ANS: B Adolescents, like all children, need an opportunity to express their feelings. Often they will interject feelings into their words. The nurse must be alert to the words and feelings expressed. Although the peer group is important to this age group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently.

The nurse is taking a sexual history on an adolescent girl. The best way to determine whether she is sexually active is to: 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.

ANS: B Asking the adolescent girl if she is having sex with anyone is a direct question that is well understood. The phrase sexually active is broadly defined and may not provide specific information to the nurse to provide necessary care. The word anyone is preferred to using gender-specific terms such as boyfriend or girlfriend. Because homosexual experimentation may occur, it is preferable to use gender-neutral terms. Questioning about sexual activity should occur when the adolescent is alone.

Binocularity, the ability to fixate on one visual field with both eyes simultaneously, is normally present by what age? a. 1 month b. 3 to 4 months c. 6 to 8 months d. 12 months

ANS: B Binocularity is usually achieved by ages 3 to 4 months. Age 1 month is too young for binocularity. If binocularity is not achieved by 6 months, the child must be observed for strabismus.

Which tool measures body fat most accurately? a. Stadiometer b. Calipers c. Cloth tape measure d. Paper or metal tape measure

ANS: B Calipers are used to measure skin-fold thickness, which is an indicator of body fat content. Stadiometers are used to measure height. Cloth tape measures should not be used because they can stretch. Paper or metal tape measures can be used for recumbent lengths and other body measurements that must be made.

The earliest age at which a satisfactory radial pulse can be taken in children is: a. 1 year b. 2 years c. 3 years d. 6 years

ANS: B Satisfactory radial pulses can be used in children older than 2 years. In infants and young children the apical pulse is more reliable. The radial pulse can be used for assessment at ages 3 and 6 years.

The nurse is taking a health history on an adolescent. What best describes how the chief complaint should be determined? a. Ask for a detailed listing of symptoms. b. Ask the adolescent, "Why did you come here today?" c. Use what the adolescent says to determine, in correct medical terminology, what the problem is. d. Interview the parent away from the adolescent to determine the chief complaint.

ANS: B The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. A listing of symptoms will make it difficult to determine the chief complaint. The adolescent should be prompted to tell which symptom caused him or her to seek help at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention at this time.

The appropriate placement of a tongue blade for assessment of the mouth and throat is the: a. The center back area of the tongue. b. The side of the tongue. c. Against the soft palate. d. On the lower jaw.

ANS: B The side of the tongue is the correct position. It avoids the gag reflex yet allows visualization. Placement on the center back area of the tongue elicits the gag reflex. Against the soft palate and on the lower jaw are not appropriate places for the tongue blade.

What is an important consideration for the nurse who is communicating with a very young child? a. Speak loudly, clearly, and directly. b. Use transition objects such as a doll. c. Disguise own feelings, attitudes, and anxiety. d. Initiate contact with the child when the parent is not present.

ANS: B Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This facilitates communication with this age child. Speaking loudly, clearly, and directly tends to increase anxiety in very young children. The nurse must be honest with the child. Attempts at deception lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children.

With the National Center for Health Statistics (NCHS) criteria, which body mass index (BMI)-for-age percentile indicates a risk for being overweight? a. 10th percentile b. 9th percentile c. 85th percentile d. 95th percentile

ANS: 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 in the 9th and 10th percentiles are within normal limits. Children who are greater than or equal to the 95th percentile are considered overweight.

Which action is most likely to encourage parents to talk about their feelings related to their child's illness? a. Be sympathetic. b. Use direct questions. c. Use open-ended questions. d. Avoid periods of silence.

ANS: C Closed-ended questions should be avoided when attempting to elicit parents' feelings. Open-ended questions require the parent to respond with more than a brief answer. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in the helping relationship. Direct questions may obtain limited information. In addition, the parent may consider them threatening. Silence can be an effective interviewing tool. It allows sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions.

By what age do the head and chest circumferences generally become equal? a. 1 month b. 6 to 9 months c. 1 to 2 years d. 2.5 to 3 years

ANS: C Head circumference begins larger than chest circumference. Between ages 1 and 2 years, they become approximately equal. Head circumference is larger than chest circumference at ages 1 month and 6 to 9 months. Chest circumference is larger than head circumference at age 2.5 to 3 years

When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. This should be considered because these milestones are: a. Unnecessary information because the child is age 3 years. b. An important part of the family history. c. An important part of the child's past growth and development. d. An important part of the child's review of systems.

ANS: C Information about the attainment of developmental milestones is important to obtain. It provides data about the child's growth and development that should be included in the history. Developmental milestones provide important information about the child's physical, social, and neurologic health. The developmental milestones are specific to this child. If pertinent, attainment of milestones by siblings would be included in the family history. The review of systems does not include the developmental milestones.

An appropriate approach to performing a physical assessment on a toddler is to: a. Always proceed in a head-to-toe direction. b. Perform traumatic procedures first. c. Use minimal physical contact initially. d. Demonstrate use of equipment.

ANS: C Parents can remove the child's clothing, and the child can remain on the parent's lap. The nurse should use minimal physical contact initially to gain the child's cooperation. The head-to-toe assessment can be done in older children but usually must be adapted in younger children. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for this age group.

Where is the best place to observe for the presence of petechiae in dark-skinned individuals? a. Face b. Buttocks c. Oral mucosa d. Palms and soles

ANS: C Petechiae, small distinct pinpoint hemorrhages, are difficult to see in dark skin unless they are in the mouth or conjunctiva.

Which age group is most concerned with body integrity? a. Toddler b. Preschooler c. School-age child d. Adolescent

ANS: C School-age children have a heightened concern about body integrity. They place importance and value on their bodies and are overly sensitive to anything that constitutes a threat or suggestion of injury. Body integrity is not as important a concern to children in the toddler, preschooler, and adolescent age groups.

An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to: a. Ask her why she wants to know. b. Determine why she is so anxious. c. Explain in simple terms how it works. d. Tell her she will see how it works as it is used.

ANS: C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. A nurse should respond positively to requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. The child is not exhibiting anxiety, just requesting clarification of what will be occurring. The nurse must explain how the blood pressure cuff works so the child can then observe during the procedure.

When doing a nutritional assessment on an Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. The nurse should recognize that this diet: a. Indicates that they live in poverty. b. Is lacking in protein. c. May provide sufficient amino acids. d. Should be enriched with meat and milk.

ANS: C The diet that contains vegetable, legumes, and starches may provide sufficient essential amino acids, even though the actual amount of meat or dairy protein is low. Many cultures use diets that contain this combination of foods. It does not indicate poverty. Combinations of foods contain the essential amino acids necessary for growth. A dietary assessment should be done, but many vegetarian diets are sufficient for growth.

Where in the health history should the nurse describe all details related to the chief complaint? a. Past history b. Chief complaint c. Present illness d. Review of systems

ANS: C The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. The focus of the present illness is on all factors relevant to the main problem, even if they have disappeared or changed during the onset, interval, and present. Past history refers to information that relates to previous aspects of the child's health, not to the current problem. The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It does not contain the narrative portion describing the onset and progression. The review of systems is a specific review of each body system.

What is the single most important factor to consider when communicating with children? a. The child's physical condition b. The presence or absence of the child's parent c. The child's developmental level d. The child's nonverbal behaviors

ANS: C The nurse must be aware of the child's developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Although the child's physical condition is a consideration, developmental level is much more important. The parents' presence is important when communicating with young children, but it may be detrimental when speaking with adolescents. Nonverbal behaviors vary in importance based on the child's developmental level.

The nurse is testing an infant's visual acuity. By what 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

ANS: C Visual fixation and following a target should be present by ages 3 to 4 months. Ages 1 to 2 months are too young for this developmental milestone. If the infant is not able to fix and follow by 6 months of age, further ophthalmologic evaluation is needed.

The nurse should expect the anterior fontanel to close at age: a. 2 months b. 2 to 4 months c. 6 to 8 months d. 12 to 18 months

ANS: D Ages 2 through 8 months are too early. The expected closure of the anterior fontanel occurs between ages 12 and 18 months; if it closes at these earlier ages, the child should be referred for further evaluation.

The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique may be most helpful? a. Suggest that the child keep a diary. b. Suggest that the parent read fairy tales to the child. c. Ask the parent whether the child is always uncommunicative. d. Ask the child to draw a picture.

ANS: D Drawing is one of the most valuable forms of communication. Children's drawings tell a great deal about them because they are projections of the child's inner self. It would be difficult for a 6-year-old child to keep a diary because the child is most likely learning to read. Reading fairy tales to the child is a passive activity involving the parent and child. It would not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not necessarily uncommunicative.

When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm. The best explanation for this is: a. Some form of cancer. b. Local scalp infection common in children. c. Infection or inflammation distal to the site. d. Infection or inflammation close to the site.

ANS: D Small nontender nodes are normal. Tender, enlarged, and warm lymph nodes may indicate infection or inflammation close to their location. Tender lymph nodes do not usually indicate cancer. A scalp infection usually does not cause inflamed lymph nodes. The lymph nodes close to the site of inflammation or infection would be inflamed.

The nurse is using the NCHS growth chart for an African-American child. The nurse should consider that: a. This growth chart should not be used. b. Growth patterns of African-American children are the same as for all other ethnic groups. c. A correction factor is necessary when the NCHS growth chart is used for non-Caucasian ethnic groups. d. The NCHS charts are accurate for U.S. African-American children.

ANS: D The NCHS growth charts can serve as reference guides for all racial or ethnic groups. U.S. African American-children were included in the sample population. The growth chart can be used with the perspective that different groups of children have varying normal distributions on the growth curves. No correction factor exists.

The most frequently used test for measuring visual acuity is the: a. Denver Eye Screening test. b. Allen picture card test. c. Ishihara vision test. d. Snellen letter chart.

ANS: D The Snellen letter chart, which consists of lines of letters of decreasing size, is the most frequently used test for visual acuity. Single cards (Denver—letter E; Allen—pictures) are used for children age 2 years and older who are unable to use the Snellen letter chart. The Ishihara vision test is used for color vision.

Which parameter correlates best with measurements of the body's total protein stores? a. Height b. Weight c. Skin-fold thickness d. Upper arm circumference

ANS: D Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves as the body's major protein reserve and is considered an index of the body's protein stores. Height is reflective of past nutritional status. Weight is indicative of current nutritional status. Skin-fold thickness is a measurement of the body's fat content.

The nurse observes some children in the playroom. Which play situation exhibits the characteristics of parallel play? a. Kimberly and Amanda sharing clay to each make things b. Brian playing with his truck next to Kristina playing with her truck c. Adam playing a board game with Kyle, Steven, and Erich d. Danielle playing with a music box on her mother's lap

B An example of parallel play is when both children are engaged in similar activities in proximity to each other; however, they are each engaged in their own play, such as Brian and Kristina playing with their own trucks side by side. Sharing clay is characteristic of associative play. A group of children playing a board game is characteristic of cooperative play. Playing alone on the mother's lap is an example of solitary play.

Which "expected outcome" would be developmentally appropriate for a hospitalized 4-year-old child? a. The child will be dressed and fed by the parents. b. The child will independently ask for play materials or other personal needs. c. The child will be able to verbalize an understanding of the reason for the hospitalization. d. The child will have a parent stay in the room at all times.

B Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrate developmental appropriateness. Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. A 4-year-old child cannot be expected to cognitively understand the reason for hospitalization. Expecting the child to verbalize an understanding for hospitalization is an inappropriate outcome. Parents staying with the child throughout a hospitalization is an inappropriate outcome. Although children benefit from parental involvement, parents may not have the support structure to stay in the room with the child at all times.

By the time children reach their twelfth birthday, they should have learned to trust others and should have developed a sense of: a. Identity. c. Integrity. b. Industry. d. Intimacy.

B Industry is the developmental task of school-age children. By age 12 years, children engage in tasks that they can carry through to completion. They learn to compete and cooperate with others, and they learn rules. Identity versus role confusion is the developmental task of adolescence. Integrity and intimacy are not developmental tasks of childhood.

What is characteristic of the preoperational stage of cognitive development? a. Thinking is logical. c. Reasoning is inductive. b. Thinking is concrete. d. Generalizations can be made.

B Preoperational thinking is concrete and tangible. Children in this age group cannot reason beyond the observable, and they lack the ability to make deductions or generalizations. Increasingly logical thought, inductive reasoning, and the ability to make generalizations are characteristic of the concrete operations stage of development, ages 7 to 11 years.

Which statement is true about the basal metabolic rate (BMR) in children? a. It is reduced by fever. b. It is slightly higher in boys than in girls at all ages. c. It increases with the age of child. d. It decreases as proportion of surface area to body mass increases.

B The BMR is the rate of metabolism when the body is at rest. At all ages the rate is slightly higher in boys than in girls. The rate is increased by fever. The BMR is highest in infancy and then closely relates to the proportion of surface area to body mass. As the child grows, the proportion decreases progressively to maturity.

A mother reports that her 6-year-old child is highly active and irritable and that she has irregular habits and adapts slowly to new routines, people, or situations. According to Chess and Thomas, which category of temperament best describes this child? a. Easy child c. Slow-to-warm-up child b. Difficult child d. Fast-to-warm-up child

B This is a description of difficult children, who compose about 10% of the population. Negative withdrawal responses are typical of this type of child, who requires a more structured environment. Mood expressions are usually intense and primarily negative. These children exhibit frequent periods of crying and often violent tantrums. Easy children are even tempered, regular, and predictable in their habits. They are open and adaptable to change. Approximately 40% of children fit this description. Slow-to-warm-up children typically react negatively and with mild intensity to new stimuli and adapt slowly with repeated contact. Approximately 10% of children fit this description. Fast-to-warm-up children is not one of the categories identified by Chess and Thomas.

How does the onset of the pubertal growth spurt compare in girls and boys? a. It occurs earlier in boys. b. It occurs earlier in girls. c. It is about the same in both boys and girls. d. In both boys and girls it depends on their growth in infancy.

B Usually, the pubertal growth spurt begins earlier in girls. It typically occurs between the ages of 10 and 14 years for girls and 11 and 16 years for boys. The average earliest age at onset is 1 year earlier for girls. There does not appear to be a relation to growth during infancy.

The nurse discovers welts on the back of a Vietnamese child during a home health visit. The child's mother says that she has rubbed the edge of a coin on her child's oiled skin. The nurse should recognize that this is: a. Child abuse. b. A cultural practice to rid the body of disease. c. A cultural practice to treat enuresis or temper tantrums. d. A child discipline measure common in the Vietnamese culture.

B A cultural practice to rid the body of disease. A cultural practice to rid the body of disease is descriptive of coining. The welts are created by repeatedly rubbing a coin on the child's oiled skin. The mother is attempting to rid the child's body of disease. The mother was engaged in an attempt to heal the child. This behavior is not child abuse, a cultural practice to treat enuresis or temper tantrums, or a disciplinary measure.

A nurse is working in a clinic that serves a culturally diverse population of children. The nurse should plan care, understanding that the following complementary and alternative practices may be used by this patient population (Select all that apply): a. Seeking another doctor's opinion b. Seeking advice from a curandero or curandera c. Using acupuncture or acupressure as a therapy d. Consulting an herbalist e. Consulting a kahuna

B, C, D, E The curandero (male) or curandera (female) of the Mexican-American community is believed to have healing powers that are a gift from God. The Asian family may consult an herbalist, knowledgeable in medicines, or perhaps a specialized practitioner of Asian therapies, including acupuncture (insertion of needles) or acupressure (application of pressure). Native Hawaiians consult kahunas and practice ho'oponopono to heal family imbalance or disputes. The nurse may encounter use of these practices. Consulting another doctor would not be a complementary or alternative practice expected in a culturally diverse population.

Which behaviors by the nurse indicate a therapeutic relationship with children and families? (Select all that apply.) a. Spending off-duty time with children and families b. Asking questions if families are not participating in the care c. Clarifying information for families d. Buying toys for a hospitalized child e. Learning about the family's religious preferences

B, C, E b. Asking questions if families are not participating in the care c. Clarifying information for families e. Learning about the family's religious preferences Asking questions if families are not participating in the care, clarifying information for families, and learning about the family's religious preferences are positive actions and foster therapeutic relationships with children and families. Spending off-duty time with children and families and buying toys for a hospitalized child are negative actions and indicate overinvolvement with children and families that is nontherapeutic.

A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items such as Jell-O, Popsicles, and juices are left. What would best explain this? a. The parent is trying to feed child only what child likes most. b. The parent is trying to restore normal balance through appropriate "hot" remedies. c. Hispanics believe that the "evil eye" enters when a person gets cold. d. Hispanics believe that an innate energy called chi is strengthened by eating soup.

BThe parent is trying to restore normal balance through appropriate "hot" remedies. In several groups, including Filipino, Chinese, Arabic, and Hispanic cultures, hot and cold describe certain properties completely unrelated to temperature. Respiratory conditions such as pneumonia are "cold" conditions and are treated with "hot" foods. This may be true, but it is unlikely that a toddler would consistently prefer the broth to Jell-O, Popsicles, and juice. The evil eye applies to a state of imbalance of health, not curative actions. Chinese individuals believe in chi as an innate energy.

The intrauterine environment can have a profound and permanent effect on the developing fetus with or without chromosome or gene abnormalities. Most adverse intrauterine effects are the result of teratogens. The nurse is cognizant that this group of agents does not include: a. Accutane c. Amniotic bands b. Rubella d. Alcohol

C Amniotic bands are a congenital anomaly known as a "disruption" that occurs with the breakdown of previously normal tissue. Congenital amputations caused by amniotic bands are not the result of a teratogen. Other agents include Dilantin, warfarin, cytomegalovirus, radiation, and maternal PKU.

Which strategy would be the least appropriate for a child to use to cope? a. Learning problem solving c. Having parents solve problems b. Listening to music d. Using relaxation techniques

C Children respond to everyday stress by trying to change the circumstances or adjust to the circumstances the way they are. Strategies that provide relaxation and other stress-reduction techniques should be used. An inappropriate response would be for the parents to solve the problems. Some children develop socially unacceptable strategies such as lying, stealing, or cheating. Learning problem solving, listening to music, and using relaxation techniques are positive approaches for coping in children.

Frequent developmental assessments are important for which reason? a. Stable developmental periods during infancy provide an opportunity to identify any delays or deficits. b. Infants need stimulation specific to the stage of development. c. Critical periods of development occur during childhood. d. Child development is unpredictable and needs monitoring.

C Critical periods are blocks of time during which children are ready to master specific developmental tasks. The earlier that delays in development are discovered and intervention initiated, the less dramatic their effect will be. Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage. Normal growth and development are orderly and proceed in a predictable pattern on the basis of each individual's abilities and potentials.

Which behavior is most characteristic of the concrete operations stage of cognitive development? a. Progression from reflex activity to imitative behavior b. Inability to put oneself in another's place c. Increasingly logical and coherent thought processes d. Ability to think in abstract terms and draw logical conclusions

C During the concrete operations stage of development, which occurs approximately between ages 7 and 11 years, increasingly logical and coherent thought processes occur. This is characterized by the child's ability to classify, sort, order, and organize facts to use in problem solving. The progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage of development. The inability to put oneself in another's place is characteristic of the preoperational stage of development. The ability to think in abstract terms and draw logical conclusions is characteristic of the formal operations stage of development.

In what type of play are children engaged in similar or identical activity without organization, division of labor, or mutual goal? a. Solitary c. Associative b. Parallel d. Cooperative

C In associative play no group goal is present. Each child acts according to his or her own wishes. Although the children may be involved in similar activities, no organization, division of labor, leadership assignment, or mutual goal exists. Solitary play describes children playing alone with toys different from those used by other children in the same area. Parallel play describes children playing independently but being among other children. Cooperative play is organized. Children play in a group with other children who play activities for a common goal.

By what age does birth length usually double? a. 1 year c. 4 years b. 2 years d. 6 years

C Linear growth or height occurs almost entirely as a result of skeletal growth and is considered a stable measurement of general growth. On average most children have doubled their birth length at age 4 years. One year and 2 years are too young for doubling of length.

The major cause of death for children older than 1 year is: a. Cancer. c. Unintentional injuries. b. Infection. d. Congenital abnormalities.

C Unintentional injuries. Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. Congenital anomalies are the leading cause of death in those younger than 1 year and are less significant in this age group. There have been major declines in deaths attributed infection as a result of improved therapies. Cancer is the second leading cause of death in this age group.

A 13-year-old girl asks the nurse how much taller she will become. She has been growing about 2 inches per year but grew 4 inches this past year. Menarche recently occurred. The nurse should base her response on knowing that: a. Growth cannot be predicted. b. The pubertal growth spurt lasts about 1 year. c. Mature height is achieved when menarche occurs. d. Approximately 95% of mature height is achieved when menarche occurs.

D Although growth cannot be definitely predicted, at the time of the beginning of menstruation or the skeletal age of 13 years, most girls have grown to about 95% of their adult height. They may have some additional growth (5%) until the epiphyseal plates are closed. Responding that the pubertal growth spurt last about 1 year does not address the girl's question. Young women usually will grow approximately 5% more after the onset of menstruation.

Lymphoid tissues such as lymph nodes are: a. Adult size by age 1 year. b. Adult size by age 13 years. c. Half their adult size by age 5 years. d. Twice their adult size by age 10 to 12 years.

D Lymph nodes increase rapidly and reach adult size at approximately age 6 years. They continue growing until they reach maximal development at age 10 to 12 years, which is twice their adult size. A rapid decline in size occurs until they reach adult size by the end of adolescence.

According to Kohlberg, children develop moral reasoning as they mature. What is most characteristic of a preschooler's stage of moral development? a. Obeying the rules of correct behavior is important. b. Showing respect for authority is important behavior. c. Behavior that pleases others is considered good. d. Actions are determined as good or bad in terms of their consequences.

D Preschoolers are most likely to exhibit characteristics of Kohlberg's preconventional level of moral development. During this stage they are culturally oriented to labels of good or bad, right or wrong. Children integrate these concepts based on the physical or pleasurable consequences of their actions. Obeying rules of correct behavior, showing respect for authority, and knowing that behavior that pleases others is considered good are characteristic of Kohlberg's conventional level of moral development.

Which function of play is a major component of play at all ages? a. Creativity c. Intellectual development b. Socialization d. Sensorimotor activity

D Sensorimotor activity is a major component of play at all ages. Active play is essential for muscle development and allows the release of surplus energy. Through sensorimotor play, children explore their physical world by using tactile, auditory, visual, and kinesthetic stimulation. Creativity, socialization, and intellectual development are each functions of play that are major components at different ages.

A toddler playing with sand and water would be participating in _____ play. a. Skill c. Social-affective b. Dramatic d. Sense-pleasure

D The toddler playing with sand and water is engaging in sense-pleasure play. This is characterized by nonsocial situations in which the child is stimulated by objects in the environment. Infants engage in skill play when they persistently demonstrate and exercise newly acquired abilities. Dramatic play is the predominant form of play in the preschool period. Children pretend and fantasize. Social-affective play is one of the first types of play in which infants engage. The infant responds to interactions with people.

Three children playing a board game would be an example of: a. Solitary play c. Associative play b. Parallel play d. Cooperative play

D Using a board game requires cooperative play. The children must be able to play in a group and carry out the formal game. In solitary, parallel, and associative play, children do not play in a group with a common goal.

The nurse is teaching a group of new parents about the experience of role transition. Which statement by a parent indicates a correct understanding of the teaching? a. "My marital relationship can have a positive or negative effect on the role transition." b. "If an infant has special care needs, the parents' sense of confidence in their new role is strengthened." c. "Young parents can adjust to the new role more easily than older parents." d. "A parent's previous experience with children makes the role transition more difficult."

a. "My marital relationship can have a positive or negative effect on the role transition." If parents are supportive of each other, they can serve as positive influences on establishing satisfying parental roles. When marital tensions alter caregiving routines and interfere with the enjoyment of the infant, the marital relationship has a negative effect. Infants with special care needs can be a significant source of added stress. Older parents are usually more able to cope with the greater financial responsibilities, changes in sleeping habits, and reduced time for each other and other children. Parents who have previous experience with parenting appear more relaxed, have less conflict in disciplinary relationships, and are more aware of normal growth and development.

A young child from Mexico is hospitalized for a serious illness. The father tells the nurse that "the child is being punished by God for being bad." The nurse should recognize this as: a. A health belief common in this culture. b. An early indication of potential child abuse. c. A misunderstanding of the family's common beliefs. d. A belief common when fortune tellers have been used.

a. A health belief common in this culture. A common health belief in the Mexican-American cultural group is that health is controlled by the environment, fate, and the will of God. This comment has no relation to child abuse. The father would not misunderstand the family's beliefs. This is a cultural belief. Mexicans may use the services of curanderos (healers), not fortune tellers.

A nurse is planning a class on accident prevention for parents of toddlers. Which safety topic is the priority for this class? a. Appropriate use of car seat restraints b. Safety crossing the street c. Helmet use when riding a bicycle d. Poison control numbers

a. Appropriate use of car seat restraints Motor vehicle accidents (MVAs) continue to be the most common cause of death in children older than 1 year; therefore, the priority topic is appropriate use of car seat restraints. Safety crossing the street and bicycle helmet use are topics that should be included for preschool parents but are not priorities for parents of toddlers. Information about poison control is important for parents of toddlers and would be a safety topic to include but is not the priority over the appropriate use of car seat restraints.

In which cultural group is good health considered to be a balance between yin and yang? a. Asians c. Native Americans b. Australian aborigines d. African-Americans

a. Asians In Chinese health beliefs, the forces termed yin and yang must be kept in balance to maintain health. This belief is not consistent with Australian aborigines, Native Americans, or African-Americans.

What type of family is one in which all members are related by blood? a. Consanguineous c. Family of origin b. Affinal d. Household

a. Consanguineous A consanguineous family is one of the most common types and consists of members who have a blood relationship. The affinal family is one made up of marital relationships. Although the parents are married, they may each bring children from a previous relationship. The family of origin is the family unit that a person is born into. Considerable controversy has been generated about the newer concepts of families (i.e., communal, single-parent or homosexual families). To accommodate these other varieties of family styles, the descriptive term household is frequently used.

From a worldwide perspective, infant mortality in the United States: a. Is the highest of the other developed nations. b. Lags behind five other developed nations. c. Is the lowest infant death rate of developed nations. d. Lags behind most other developed nations.

a. Is the highest of the other developed nations. Although the death rate has decreased, the United States still ranks last among nations with the lowest infant death rates. The United States has the highest infant death rate of developed nations.

Which of the following is descriptive of deaths caused by unintentional injuries? a. More deaths occur in males. b. More deaths occur in females. c. The pattern of deaths varies widely in Western societies. d. The pattern of deaths does not vary according to age and sex.

a. More deaths occur in males. Most deaths from unintentional injuries occur in males. The pattern of death caused by unintentional injuries is consistent in Western societies. Causes of unintentional deaths vary with age and gender.

A 3-year-old girl was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guideline concerning adoption should the nurse use in planning her response? a. Telling the child is an important aspect of their parental responsibilities. b. The best time to tell the child is between ages 7 and 10 years. c. It is not necessary to tell the child who was adopted so young. d. It is best to wait until the child asks about it.

a. Telling the child is an important aspect of their parental responsibilities. It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the child's identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to keep third parties from telling the children before the parents have had the opportunity.

The mother of a school-age child tells the school nurse that she and her spouse are going through a divorce. The child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as: a. Indicative of maladjustment. b. Common reaction to divorce. c. Suggestive of lack of adequate parenting. d. Unusual response that indicates need for referral.

b. Common reaction to divorce. Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. Uncommon responses to parental divorce include indications of maladjustment, the suggestion of lack of adequate parenting, and the need for referral.

Which term best describes a group of people who share a set of values, beliefs, practices, social relationships, law, politics, economics, and norms of behavior? a. Race c. Ethnicity b. Culture d. Social group

b. Culture Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perceptions and judgments. Race is defined as a division of humankind that possesses traits transmissible by descent and sufficient to characterize it as a distinct human type. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. A social group consists of systems of roles carried out in groups. Examples of primary social groups include the family and peer groups.

The type of injury a child is especially susceptible to at a specific age is most closely related to: a. Physical health of the child. b. Developmental level of the child. c. Educational level of the child. d. Number of responsible adults in the home.

b. Developmental level of the child. The child's developmental stage determines the type of injury that is likely to occur. The child's physical health may facilitate his or her recovery from an injury. Educational level is related to developmental level, but it is not as important as the child's developmental level in determining the type of injury. The number of responsible adults in the home may affect the number of unintentional injuries, but the type of injury is related to the child's developmental stage.

In addition to injuries, the leading causes of death in adolescents ages 15 to 19 years are: a. Suicide, cancer. c. Homicide, heart disease. b. Homicide, suicide d. Drowning, cancer.

b. Homicide, suicide In this age group the leading cause of death is accidents, followed by homicide and suicide. Other causes of death include cancer and heart disease.

Which statement best describes the process of critical thinking? a. It is a simple developmental process. b. It is purposeful and goal directed. c. It is based on deliberate and irrational thought. d. It assists individuals in guessing what is most appropriate.

b. It is purposeful and goal directed. Critical thinking is a complex, developmental process based on rational and deliberate thought. When thinking is clear, precise, accurate, relevant, consistent, and fair, a logical connection develops between the elements of thought and the problem at hand.

Which statement regarding childhood morbidity is the most accurate? a. Morbidity does not vary with age. b. Morbidity is not distributed randomly. c. Little can be done to improve morbidity. d. Unintentional injuries do not have an effect on morbidity.

b. Morbidity is not distributed randomly. Morbidity is not distributed randomly in children. Increased morbidity is associated with certain groups of children, including children living in poverty and those who were low birth weight. Morbidity does vary with age. The types of illnesses in children are different for each age group. Morbidity can be decreased with interventions focused on groups with high morbidity and on decreasing unintentional injuries, which also affect morbidity.

The nurse is preparing staff in-service education about atraumatic care for pediatric patients. Which intervention should the nurse include? a. Prepare the child for separation from parents during hospitalization by reviewing a video. b. Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal. c. Help the child accept the loss of control associated with hospitalization. d. Help the child accept pain that is connected with a treatment or procedure.

b. Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal. Preparing the child for any unfamiliar treatments, controlling pain, allowing privacy, providing play activities for expression of fear and aggression, providing choices, and respecting cultural differences are components of atraumatic care. In providing atraumatic care, the separation of child from parents during hospitalization is minimized. The nurse should promote a sense of control for the child. Preventing and minimizing bodily injury and pain are major components of atraumatic care.

Match the sequence of cephalocaudal development that the nurse expects to find in the normal infant with the appropriate step numbers. Begin with the first development expected, sequencing to the final. a. Crawl b. Sit unsupported c. Lift head when prone d. Gain complete head control e. Walk

c, d, b, a, e

Which statement is most descriptive of pediatric family-centered care? a. It reduces the effect of cultural diversity on the family. b. It encourages family dependence on the health care system. c. It recognizes that the family is the constant in a child's life. d. It avoids expecting families to be part of the decision-making process.

c. It recognizes that the family is the constant in a child's life. The key components of family-centered care are for the nurse to support, respect, encourage, and embrace the family's strength by developing a partnership with the child's parents. Family-centered care recognizes the family as the constant in the child's life. The nurse should support the cultural diversity of the family, not reduce its effect. The family should be enabled and empowered to work with the health care system and to be part of the decision-making process.

The leading cause of death from unintentional injuries in children is: a. Poisoning. c. Motor vehicle-related fatalities. b. Drowning. d. Fire- and burn-related fatalities.

c. Motor vehicle-related fatalities. Motor vehicle-related fatalities comprise the leading cause of death in children, as either passengers or pedestrians. Poisoning is the ninth leading cause of death. Drowning is the second leading cause of death. Fire- and burn-related fatalities are the third leading cause of death.

Health beliefs vary among the cultural groups living in the United States. The belief that health is "a state of harmony with nature and the universe" is common in which culture? a. Japanese c. Native American b. African-American d. Hispanic American

c. Native American Many cultures ascribe attributes of health to natural forces. Many individuals of the Native American culture view health as a state of harmony with nature and the universe. This belief is not consistent with Japanese, African-American, or Hispanic American cultural groups.

Which action by the nurse demonstrates use of evidence-based practice (EBP)? a. Gathering equipment for a procedure b. Documenting changes in a patient's status c. Questioning the use of daily central line dressing changes d. Clarifying a physician's prescription for morphine

c. Questioning the use of daily central line dressing changes The nurse who questions the daily central line dressing change is ascertaining whether clinical interventions result in positive outcomes for patients. This demonstrates evidence-based practice (EBP), which implies questioning why something is effective and whether a better approach exists. Gathering equipment for a procedure and documenting changes in a patient's status are practices that follow established guidelines. Clarifying a physician's prescription for morphine constitutes safe nursing care.

A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, "I want to go back to work, but I don't want Eric to suffer because I'll have less time with him." The nurse's most appropriate answer is: a. "I'm sure he'll be fine if you get a good babysitter." b. "You will need to stay home until Eric starts school." c. "You should go back to work so Eric will get used to being with others." d. "Let's talk about the child care options that will be best for Eric."

d. "Let's talk about the child care options that will be best for Eric." "Let's talk about the child care options that will be best for Eric" is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. "I'm sure he'll be fine if you get a good babysitter," "You will need to stay home until Eric starts school," and "You should go back to work so Eric will get used to being with others" are directive statements and do not address the effect of her working on Eric.

Which is now referred to as the "new morbidity"? a. Limitations in the major activities of daily living b. Unintentional injuries that cause chronic health problems c. Discoveries of new therapies to treat health problems d. Behavioral, social, and educational problems that alter health

d. Behavioral, social, and educational problems that alter health The new morbidity reflects the behavioral, social, and educational problems that interfere with the child's social and academic development. It is also referred to a "'pediatric social illness'." Limitations in major activities of daily living and unintentional injuries that result in chronic health problems are included in morbidity data. Discovery of new therapies would be reflected in changes in morbidity data over time.

Which term best describes the emotional attitude that one's own ethnic group is superior to others? a. Culture c. Superiority b. Ethnicity d. Ethnocentrism

d. Ethnocentrism Ethnocentrism is the belief that one's way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of one's ethnic group are superior to those of others. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perception and judgments. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. Superiority is the state or quality of being superior; it does not include ethnicity.

The Vietnamese mother of a child being seen in the clinic avoids eye contact with the nurse. Considering cultural differences, the best explanation for this is that the parent: a. Feels responsible for her child's illness. b. Feels inferior to nurse. c. Is embarrassed to seek health care. d. Is showing respect for nurse.

d. Is showing respect for nurse. In some ethnic groups eye contact is avoided. In the Vietnamese culture an individual may not look directly into the nurse's eyes as a sign of respect. The nurse providing culturally competent care would recognize that the mother does not feel responsible for her child's illness, she does not feel inferior to the nurse, and she is not embarrassed to seek health care as reasons for the mother to avoid eye contact with the nurse.

A clinic nurse is planning a teaching session about childhood obesity prevention for parents of school-age children. The nurse should include which associated risk of obesity in the teaching plan? a. Type I diabetes c. Celiac disease b. Respiratory disease d. Type II diabetes

d. Type II diabetes Childhood obesity has been associated with the rise of type II diabetes in children. Type I diabetes is not associated with obesity and has a genetic component. Respiratory disease is not associated with obesity, and celiac disease is the inability to metabolize gluten in foods and is not associated with obesity.

What factors indicate that parents should seek genetic counseling for their child (Select all that apply)? a. Abnormal newborn screen b. Family history of a hereditary disease c. History of hypertension in the family d. Severe colic as an infant e. Metabolic disorder

A, B, E Factors indicating that parents should seek genetic counseling for their child include an abnormal newborn screen, family history of a hereditary disease, and a metabolic disorder. A history of hypertension or severe colic as an infant is not an indicator of a genetic disease.

The head-to-tail direction of growth is referred to as: a. Cephalocaudal. c. Mass to specific. b. Proximodistal. d. Sequential.

A The first pattern of development is the head-to-tail, or cephalocaudal, direction. The head end of the organism develops first and is large and complex, whereas the lower end is smaller and simpler, and development takes place at a later time. Proximodistal, or near-to-far, is the second pattern of development. Limb buds develop before fingers and toes. Postnatally the child has control of the shoulder before achieving mastery of the hands. Mass to specific is not a specific pattern of development. In all dimensions of growth, a definite, sequential pattern is followed.

At what age do children tend to imitate the religious gestures and behaviors of others without understanding their significance? a. Toddlerhood c. Older school-age period b. Young school-age period d. Adolescence

A Toddlerhood is a time of imitative behavior. Children will copy the behavior of others without comprehending any significance or meaning to the activities. During the school-age period most children develop a strong interest in religion. The existence of a deity is accepted, and petitions to an omnipotent being are important. Although adolescents become more skeptical and uncertain about religious beliefs, they do understand the significance of religious rituals.

The nurse must assess 10-month-old infant. The infant is sitting on the father's lap and appears to be afraid of the nurse and of what may happen next. Which initial action by the nurse would be most appropriate? a. Initiate a game of peek-a-boo. b. Ask the father to place the infant on the examination table. c. Undress the infant while he is still sitting on his father's lap. d. Talk softly to the infant while taking him from his father.

ANS: A Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done while the child is on the father's lap. The nurse should have the father undress the child as needed for the examination.

The nurse has a 2-year-old boy sit in "tailor" position during palpation for the testes. The rationale for this position is that: a. It prevents cremasteric reflex. b. Undescended testes can be palpated. c. This tests the child for an inguinal hernia. d. The child does not yet have a need for privacy.

ANS: A The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity. Undescended testes cannot be predictably palpated. Inguinal hernias are not detected by this method. This position is used for inhibiting the cremasteric reflex. Privacy should always be provided for children.

A nurse is performing an assessment on a school-age child. Which findings suggest the child is receiving an excess of vitamin A (Select all that apply)? a. Delayed sexual development b. Edema c. Pruritus d. Jaundice e. Paresthesia

ANS: A, C, D Excess vitamin A can cause delayed sexual development, pruritus, and jaundice. Edema is seen with excess sodium. Paresthesia occurs with excess riboflavin

Which data would be included in a health history (Select all that apply)? a. Review of systems b. Physical assessment c. Sexual history d. Growth measurements e. Nutritional assessment f. Family medical history

ANS: A, C, E, F The review of systems, sexual history, nutritional assessment, and family medical history are part of the health history. Physical assessment and growth measurements are components of the physical examination.

A nurse is planning to use an interpreter during a health history interview of a non-English speaking patient and family. Which nursing care guidelines should the nurse include when using an interpreter (Select all that apply)? a. Elicit one answer at a time. b. Interrupt the interpreter if the response from the family is lengthy. c. Comments to the interpreter about the family should be made in English. d. Arrange for the family to speak with the same interpreter, if possible. e. Introduce the interpreter to the family.

ANS: A, D, E When using an interpreter, the nurse should pose questions to elicit only one answer at a time, such as: "Do you have pain?" rather than "Do you have any pain, tiredness, or loss of appetite?" Refrain from interrupting family members and the interpreter while they are conversing. Introduce the interpreter to family and allow some time before the interview for them to become acquainted. Refrain from interrupting family members and the interpreter while they are conversing. Avoid commenting to the interpreter about family members because they may understand some English.

The nurse is meeting a 5-year-old child for the first time and would like the child to cooperate during a dressing change. The nurse decides to do a simple magic trick using gauze. This should be interpreted as: a. Inappropriate, because of child's age. b. A way to establish rapport. c. Too distracting, when cooperation is important. d. Acceptable, if there is adequate time.

ANS: B A magic trick or other simple game may help alleviate anxiety for a 5-year-old. It is an excellent method to build rapport and facilitate cooperation during a procedure. Magic tricks appeal to the natural curiosity of young children. The nurse should establish rapport with the child. Failure to do so may cause the procedure to take longer and be more traumatic.

Kimberly is having a checkup before starting kindergarten. The nurse asks her to do the "finger-to-nose" test. The nurse is testing for: a. Deep tendon reflexes. b. Cerebellar function. c. Sensory discrimination. d. Ability to follow directions.

ANS: B The finger-to-nose-test is an indication of cerebellar function. This test checks balance and coordination. Each deep tendon reflex is tested separately. Each sense is tested separately. Although this test enables the nurse to evaluate the child's ability to follow directions, it is used primarily for cerebellar function.

The nurse must check vital signs on a 2-year-old boy who is brought to the clinic for his 24-month checkup. Which criteria should the nurse use in determining the appropriate-size blood pressure cuff (Select all that apply)? a. The cuff is labeled "toddler." b. The cuff bladder width is approximately 40% of the circumference of the upper arm. c. The cuff bladder length covers 80% to 100% of the circumference of the upper arm. d. The cuff bladder covers 50% to 66% of the length of the upper arm.

ANS: B, C Research has demonstrated that cuff selection with a bladder width that is 40% of the arm circumference will usually have a bladder length that is 80% to 100% of the upper arm circumference. This size cuff will most accurately reflect measured radial artery pressure. The name of the cuff is a representative size that may not be suitable for any individual child. Choosing a cuff by limb circumference more accurately reflects arterial pressure than choosing a cuff by length.

A school nurse is screening children for scoliosis. Which assessment findings should the nurse expect to observe for scoliosis (Select all that apply)? a. Complaints of a sore back b. Asymmetry of the shoulders c. An uneven hemline d. Inability to bend at the waist e. Unequal waist angles

ANS: B, C, E The assessment findings associated with scoliosis include asymmetry of the shoulder and hips, trouser pant leg length appearing shorter on one side, or an uneven hemline on a skirt, indicating unequal leg length. The child may also complain of a sore back. The child is able to bend at the waist adequately.

What heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? a. S1, S2 b. S3, S4 c. Murmur d. Physiologic splitting

ANS: C Murmurs are the sounds that are produced in the heart chambers or major arteries from the back-and-forth flow of blood. S1 is the closure of the tricuspid and mitral valves, and S2 is the closure of the pulmonic and aortic valves, and both are considered normal heart sounds. S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If heard, medical evaluation is required. Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding.

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

ANS: C Significant head lag after age 6 months strongly indicates cerebral injury and is referred for further evaluation. Reduction of head lag is part of normal development. Exercises will not be effective. The lack of achievement of this developmental milestone must be evaluated.

What term is used to describe breath sounds that are produced as air passes through narrowed passageways? a. Rubs b. Rattles c. Wheezes d. Crackles

ANS: C Wheezes are produced as air passes through narrowed passageways. The sound is similar when the narrowing is caused by exudates, inflammation, spasm, or tumor. Rubs are the sound created by the friction of one surface rubbing over another. Pleural friction rub is caused by inflammation of the pleural space. Rattles is the term formerly used for crackles. Crackles are the sounds made when air passes through fluid or moisture.

The nurse must assess a child's capillary filling time. This can be accomplished by: a. Inspecting the chest. b. Auscultating the heart. c. Palpating the apical pulse. d. Palpating the skin to produce a slight blanching.

ANS: D Capillary filling time is assessed by pressing lightly on the skin to produce blanching and then noting the amount of time it takes for the blanched area to refill. Inspecting the chest, auscultating the heart, and palpating the apical pulse will not provide an assessment of capillary filling time.

During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is: a. Abnormal and requires further investigation. b. Abnormal unless it occurs in conjunction with knock-knee. c. Normal if the condition is unilateral or asymmetric. d. Normal because the lower back and leg muscles are not yet well developed.

ANS: D Lateral bowing of the tibia (bowlegged) is common in toddlers when they begin to walk, not an abnormal finding. It usually persists until all of their lower back and leg muscles are well developed. Further evaluation is needed if it persists beyond ages 2 to 3 years, especially in African-American children.

The karyotype of a person is 47, XY, +21. This person is a: a. Normal male. c. Normal female. b. Male with Down syndrome. d. Female with Turner syndrome.

B This person is male because his sex chromosomes are XY. He has one extra copy of chromosome 21 (for a total of 47 instead of 46), resulting in Down syndrome. A normal male would have 46 chromosomes. A normal female would have 46 chromosomes and XX for the sex chromosomes. A female with Turner syndrome would have 45 chromosomes; the sex chromosomes would have just one X.

Which statement is true about toy safety? a. Adults should be the only ones who select toys. b. Adults should be alert to notices of recalls by manufacturers. c. Government agencies inspect all toys on the market. d. Evaluation of toy safety is a joint effort between children and adults.

B Adults should be involved in the selection of toys for children to ensure that they are safe and age appropriate. Once the child is using a toy, the adult should be alert to manufacturer recalls. The child and adult should be involved in the joint process of toy selection. Government agencies do not inspect all toys for sale. The U.S. Consumer Products Safety Commission does keep track of potentially dangerous and recalled toys. Children do not have the ability to determine the safety of a toy. It is the adult's responsibility.

The predominant characteristic of the intellectual development of the child ages 2 to 7 years is egocentricity. What best describes this concept? a. Selfishness c. Preferring to play alone b. Self-centeredness d. Inability to put self in another's place

D According to Piaget, this age child is in the preoperational stage of development. Children interpret objects and events not in terms of their general properties but in terms of their relationships or their use to them. This egocentrism does not allow children of this age to put themselves in another's place. Selfishness, self-centeredness, and preferring to play alone do not describe the concept of egocentricity.

An infant who weighs 7 pounds at birth would be expected to weigh how many pounds at age 1 year? a. 14 c. 18 b. 16 d. 21

D In general birth, weight triples by the end of the first year of life. For an infant who was 7 pounds at birth, 21 pounds would be the anticipated weight at the first birthday. Weights of 14, 16, and 18 pounds are less what would be expected for an infant with a birth weight of 7 pounds.

Trauma to which site can result in a growth problem for children's long bones? a. Matrix c. Calcified cartilage b. Connective tissue d. Epiphyseal cartilage plate

D The epiphyseal cartilage plate is the area of active growth. Bone injury at the epiphyseal plate can significantly affect subsequent growth and development. Trauma or infection can result in deformity. The matrix, connective tissue, and calcified cartilage are not areas of active growth. Trauma in these sites will not result in growth problems for the long bones.

A child's skeletal age is best determined by: a. Assessment of dentition. c. Facial bone development. b. Assessment of height over time. d. Radiographs of the hand and wrist.

D The most accurate measure of skeletal age is radiologic examination of the growth plates. These are the epiphyseal cartilage plates. Radiographs of the hand and wrist provide the most useful screening to determine skeletal age. Age of tooth eruption varies considerably in children. It would not be a good determinant of skeletal age. Assessment of height over time will provide a record of the child's height, not skeletal age. Facial bone development does not reflect the child's skeletal age, which is determined by radiographic assessment.