I made: Pediatrics

3. Which is the leading cause of death in infants younger than 1 year? a. Congenital anomalies b. Sudden infant death syndrome c. Respiratory distress syndrome d. Bacterial sepsis of the newborn

ANS: A Congenital anomalies account for 20.1% of deaths in infants younger than 1 year. Sudden infant death syndrome accounts for 8.2% of deaths in this age group. Respiratory distress syndrome accounts for 3.4% of deaths in this age group. Infections specific to the perinatal period account for 2.7% of deaths in this age group.

5. Nonpharmacologic strategies for pain management: a. may reduce pain perception. b. make pharmacologic strategies unnecessary. c. usually take too long to implement. d. trick children into believing they do not have pain.

ANS: A Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. Nonpharmacologic techniques should be learned before the pain occurs. With severe pain, it is best to use both pharmacologic and nonpharmacologic measures for pain control. The nonpharmacologic strategy should be matched with the child's pain severity and taught to the child before the onset of the painful experience. Some of the techniques may facilitate the child's experience with mild pain, but the child will still know the discomfort was present.

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

ANS: 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.

8. The nurse is caring for a child receiving intravenous (IV) morphine for severe postoperative pain. The nurse observes a slower respiratory rate, and the child cannot be aroused. The most appropriate management of this child is for the nurse to: a. administer naloxone (Narcan). b. discontinue IV infusion. c. discontinue morphine until child is fully awake. d. stimulate child by calling name, shaking gently, and asking to breathe deeply.

ANS: A The management of opioid-induced respiratory depression includes lowering the rate of infusion and stimulating the child. If the respiratory rate is depressed and the child cannot be aroused, then IV naloxone should be administered. The child will be in pain because of the reversal of the morphine. The morphine should be discontinued, but naloxone is indicated if the child is unresponsive. The child is unresponsive, therefore naloxone is indicated.

1. An infant gains head control before sitting unassisted. The nurse recognizes that this is which type of development? a. Cephalocaudal b. Proximodistal c. Mass to specific d. Sequential

ANS: A The pattern of development that is head-to-tail, or cephalocaudal, direction is described by an infant's ability to gain head control before sitting unassisted. 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 another 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.

6. Which is the leading cause of death from unintentional injuries for females ranging in age from 1 to 14? a. Mechanical suffocation b. Drowning c. Motor-vehicle-related fatalities d. Fire- and burn-related fatalities

ANS: C Motor-vehicle-related fatalities are the leading cause of death for females ranging in age from 1 to 14, either as passengers or as pedestrians. Mechanical suffocation is fourth or fifth, depending on the age. Drowning is the second- or third-leading cause of death, depending on the age. Fire- and burn-related fatalities are the second-leading cause of death.

5. Which is the major cause of death for children older than 1 year? a. Cancer b. Heart disease c. Unintentional injuries d. Congenital anomalies

ANS: C 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. Cancer ranks either second or fourth, depending on the age group, and heart disease ranks fifth in the majority of the age groups.

A child, age 7 years, is being treated at home and has a fever associated with a viral illness. The principal reason for treating the child's fever is a. relief of discomfort. b. reassurance that illness is temporary. c. prevention of secondary bacterial infection. d. prevention of life-threatening complications.

Ans: A The primary reason for treating a fever with pharmacologic (acetaminophen and ibuprofen) or environmental interventions is to relieve discomfort in a child with a viral illness. Fever management does not provide reassurance that the illness is temporary. Fever-reducing medications do not have antibacterial actions and may inhibit the fever-enhancing effects on the immune system. Fever-reducing medications do not prevent life-threatening complications of viral illnesses.

According to Erikson, infancy is concerned with acquiring a sense of a. trust. b. industry. c. initiative. d. separation.

Ans: A The task of infancy is the development of trust. If the infant is not successful with this task, then mistrust develops. Industry versus inferiority is the developmental task of school-age children. Initiative versus guilt is the developmental task of preschoolers. Separation occurs during the sensorimotor stage, as described by Piaget.

2. 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 b. Respiratory disease c. Celiac disease d. Type II diabetes

ANS: D 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.

2. The nurse is caring for a 6-year-old girl who had surgery 12 hours ago. The child tells the nurse that she does not have pain, but a few minutes later she tells her parents that she does. Which should the nurse consider when interpreting this? a. Truthful reporting of pain should occur by this age. b. Inconsistency in pain reporting suggests that pain is not present. c. Children use pain experiences to manipulate their parents. d. Children may be experiencing pain even though they deny it to the nurse.

ANS: D Children may deny pain to the nurse because they fear receiving an injectable analgesic or because they believe they deserve to suffer as a punishment for a misdeed. They may refuse to admit pain to a stranger but readily tell a parent. Truthfully reporting pain and inconsistency in pain reporting suggesting that pain is not present are common fallacies about children and pain. Pain is whatever the experiencing person says it is, whenever the person says it exists. Pain would not be questioned in an adult 12 hours after surgery

4. Physiologic measurements in children's pain assessment are: a. the best indicator of pain in children of all ages. b. essential to determine whether a child is telling the truth about pain. c. of most value when children also report having pain. d. of limited value as sole indicator of pain.

ANS: D Physiologic manifestations of pain may vary considerably, not providing a consistent measure of pain. Heart rate may increase or decrease. The same signs that may suggest fear, anxiety, or anger also indicate pain. In chronic pain, the body adapts, and these signs decrease or stabilize. Physiologic measurements are of limited value and must be viewed in the context of a pain-rating scale, behavioral assessment, and parental report. When the child states that pain exists, it does. That is the truth.

It is time to give a 3-year-old medication. What approach is most likely to receive a positive response from the child? a. "It's time for your medication now. Would you like water or apple juice afterward?" b. "Wouldn't you like to take your medicine now?" c. "You must take your medicine because the doctor says it will make you better." d. "See how nicely your roommate took medicine? Now take yours."

Ans: A This statement provides the child with a structured choice with two acceptable options, which is important for preschoolers. As a question, it allows the child the option of saying no and therefore should be avoided. The statement "you must" can elicit negative behavior from the child. The nurse is also abdicating responsibility to the physician by telling the child, "The doctor said...." Competition is not appropriate for this age group. What one child does or how one child acts should not be used to entice another child to do something, such as taking a medication.

Which characterizes the development of a 2-year-old child? a. Engages in parallel play b. Fully dresses self with supervision c. Has a vocabulary of at least 500 words d. Has attained one third of his or her adult height

Ans: A Two-year-olds play alongside each other, otherwise known as parallel play. Toddlers need help with dressing because this is a task they are just beginning to learn; learning this extends into the preschool years. A toddler commonly has a vocabulary of 300 words. A toddler has attained one half of his or her adult height.

A nurse is presenting a class on injury prevention to parents of preschoolers. Which injuries should the nurse identify as occurring in this age group? (Select all that apply.) a. Falls b. Drowning c. Poisoning d. Sports injuries e. Tricycle and bicycle accidents

Ans: A, B, C, E

When caring for a child with an intravenous (IV) infusion, the most appropriate nursing interventions are to (Select all that apply.) a. use an infusion pump with a microdropper to ensure the prescribed infusion rate. b. check IV fluids and infusion rate with another licensed professional. c. avoid restraining the child to prevent undue emotional stress. d. observe the insertion site frequently for signs of infiltration. e. change the insertion site every 24 hours.

Ans: A, B, D

During a well-baby visit, the parents of a 12-month-old ask the nurse for advice on age-appropriate toys for their child. Based on the nurse's knowledge of developmental levels, the most appropriate toys to suggest are (Select all that apply) a. push-pull toys. b. toys with black-white patterns. c. pop-up toy such as Jack-in-the-box. d. soft toys that can be put in the mouth. e. toys that pop apart and go back together.

Ans: A, C, E

Which is descriptive of the social development of school-age children? a. Identification with peers is minimal b. Children frequently have "best friends" c. Boys and girls play equally with each other d. Peer approval is not yet an influence toward conformity

Ans: B Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid. Identification with the peer group is an important milestone for the school-age child to move toward independence from families. During the school-age years, same-sex peer groups are more prevalent; therefore, there is less interaction between boys and girls. Conforming to the rules is an essential part of group membership and, therefore, an important skill for the school-age child to learn in terms of peer relationships.

A hospitalized toddler clings to a worn, tattered blanket. The toddler screams when anyone tries to take it away. Which is the best explanation for the toddler's attachment to the blanket? a. The blanket encourages immature behavior. b. The blanket is an important transitional object. c. The developmental task of individuation-separation has not been mastered. d. The child and mother have inadequate bonding.

Ans: B The blanket is an important transitional object that provides security when the child is separated from parents. Transitional objects are important to help toddlers separate, and attachment to them does not indicate immature behavior. Transitional objects are helpful when a toddler experiences increased stress such as hospitalization. The attachment to the blanket does not reflect inadequate bonding with the mother.

A parent of a 10-month-old infant tells the nurse that the baby cries and screams whenever the infant is left with the grandparents. Based on the nurse's knowledge of growth and development, the nurse's response is a. the infant is most likely spoiled. b. stranger anxiety is common for an infant of this age. c. separation anxiety should have disappeared between 4 and 8 months of age. d. the grandparents are not responsive to infant.

Ans: B The infant is experiencing stranger anxiety, which is expected for an infant of this age. Stranger anxiety usually develops by between 6 and 8 months of age and begins to disappear at about 1 year of age. The behavior the infant is exhibiting is normal and not indicative of a spoiled child. Separation anxiety is common between 6 and 8 months of age. There are no data to support the conclusion that the grandparents are not responsive to the infant.

When conducting a class on sex and sexual activities with adolescents, the most appropriate approach by the nurse is to a. use dolls to teach the content. b. present normal body functions in a straightforward manner. c. refer the adolescents to their parents for sexual information. d. delay giving information about pregnancy unless the adolescents are sexually active.

Ans: B The nurse should provide accurate and complete information using correct terminology that is understandable to the adolescent. Dolls are appropriate for teaching a younger age-group of children. Using the correct terminology is more appropriate for a group of adolescents. Parents are important for conveying the morals and values surrounding sexual activities, but nurses may provide adolescents with accurate, complete information. Adolescents should have information before they become sexually active about the potential consequences of sex, including the practice of safe sex to prevent pregnancy and the transmission of sexually transmitted diseases.

The nurse should teach parents of toddlers how to prevent poisoning by instructing them to a. consistently use safety caps. b. store poisonous substances in a locked cabinet. c. keep ipecac in the home. d. store poisonous substances out of reach.

Ans: B This is an appropriate action to prevent the curious toddler from getting into poisonous substances and products. Not all poisonous substances have safety caps, and safety caps are not always foolproof. Ipecac does not prevent poisoning and is not recommended as a treatment for poisoning. Toddlers can climb and are curious; therefore, storing substances out of reach only does not eliminate the potential for poisoning.

A 4½-year-old boy has been having increasingly frequent angry outbursts in preschool for approximately 8 to 10 weeks. In addition, he is aggressive toward the other children and teachers. His parents ask the nurse for advice. The most appropriate nursing intervention is to a. explain that this is normal in preschoolers, especially boys. b. refer the child for counseling. c. talk to the preschool teacher to obtain validation for the behavior the parent reports. d. encourage the parent to try more consistent and firm discipline.

Ans: B This is not expected behavior. The child should be referred to a competent professional to deal with his aggression so that an accurate assessment can be made and a care plan determined. Outward aggression to others is not normal behavior and should be evaluated. The validation will be helpful for the referral, but the referral is the priority action. This may be recommended by the professional once an accurate assessment is made.

The onset of puberty in boys is characterized by a. voice changes. b. testicular enlargement. c. growth of dark pubic hair. d. increased size of the penis.

Ans: B This is the first change that signals puberty in boys during Tanner stage 2 of sexual development. Voice changes occur between Tanner stages 3 and 4 of sexual development. Fine pubic hair may occur at the base of the penis early in puberty, but darker hair occurs during Tanner stage 3 of sexual development. The penis enlarges during Tanner stage 3 of sexual development.

A 16-year-old girl tells the school nurse that she has not started to menstruate. The most appropriate nursing intervention is to a. explain that this is not unusual. b. refer the adolescent for an evaluation. c. assume that the adolescent is pregnant. d. suggest the adolescent stop exercising until menarche occurs.

Ans: B This meets the definition of primary amenorrhea and should be evaluated. Menstruation usually begins approximately 2 years after the beginning of secondary sex characteristics. Although pregnancy is a possibility, the nurse should not assume that the girl is pregnant until further assessment is performed. There is no indication that the adolescent is exercising excessively.

A mother tells the nurse that her daughter's favorite toy is a large, empty box that contained a stove. She plays "house" in it with her toddler brother. Based on the nurse's knowledge of growth and development, the nurse recognizes that this is a. unsafe play that should be discouraged. b. creative play that should be encouraged. c. suggestive of limited family resources. d. suggestive of limited adult supervision.

Ans: B This type of play should be encouraged. After children create something new, they can then transfer it to other situations. There should be some supervision to prevent injury or accidents. As long as the play is supervised, it should be encouraged. This is not considered unsafe play. There is no indication of limited resources. There is no indication of limited adult supervision.

A 13-year-old boy is concerned about bilateral breast enlargement. The most appropriate explanation by the nurse is based on knowing that this is a. a sign of too much body fat b. a sign of hormonal imbalance c. a normal occurrence during puberty d. an indication of precocious puberty

Ans: C Gynecomastia, or enlargement of the breast tissue, is common during midpuberty in about one third of boys. For most boys, the breast enlargement disappears within 2 years. Although overweight boys may have excess body weight in the breast area, in boys of normal body weight, gynecomastia is a normal occurrence during puberty. If gynecomastia persists beyond 2 years, then a hormonal cause may need to be investigated. Precocious puberty is the early onset of puberty, before age 9 years in boys, and is not related to the gynecomastia.

Standard precautions for infection control include a. gloves are worn anytime a patient is touched. b. needles are capped immediately after use and disposed of in a special container. c. gloves are worn to change diapers when there are loose or explosive stools. d. masks are needed only when caring for patients with airborne infections.

Ans: C Handling diapers with loose or explosive stools has the greatest risk for exposure to body substances. Gloves are not indicated, unless there is potential for contact with body substances. Needles should never be recapped. They should be immediately disposed of in a rigid, puncture-proof container. Masks are a component of transmission-based precautions, not standard precautions.

The parents of a 4½-year-old girl are worried because she has an imaginary playmate. Based on the nurse's knowledge of the preschooler, the most appropriate response is a. a psychosocial evaluation is indicated. b. an evaluation of possible parent-child conflict is indicated. c. having imaginary playmates is normal and useful at this age. d. having imaginary playmates is abnormal after age 2 years.

Ans: C Imaginary playmates are a part of normal development at this age and serve many purposes, including being a friend in times of loneliness, accomplishing what the preschooler is still attempting, and experiencing what the preschooler wants to forget or remember. Because an imaginary playmate is part of normal development, a psychosocial evaluation is not warranted. Because an imaginary playmate is part of normal development, an evaluation of the parent-child relationship is not warranted. Imaginary playmates are commonly present during the preschool years; therefore, they are not abnormal after the age of 2 years.

A child is admitted to the hospital with a diagnosis of possible meningitis. Which information is the most important to ask at the time of admission? a. "Are there any pets in the household?" b. "Is anyone else in the household ill?" c. "Are the immunizations up to date? d. "Has the child had a recent injury?"

Ans: C Immunizations are one of two public health interventions that have had the greatest impact on world health, with clean public drinking water being the other. Nurses should review individual immunization records at every clinical visit and/or hospitalization. In addition, nurses are responsible for keeping current in changes in immunization schedules, recommendations, and research related to childhood vaccines.

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

Ans: C Increasingly logical and coherent thought processes are characteristic of concrete operations. Children in this stage are able to classify objects. Progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage, which occurs from birth to 2 years of age. Inability to put oneself in another's place is characteristic of the preoperational stage, ages 2 to 7 years. Adolescents, in the formal operations stage, have the ability to think in abstract terms and draw logical conclusions.

What should the nurse include when giving parents guidelines about helping their children in school? a. Help children as much as possible with their homework. b. Punish children who fail to perform adequately. c. Communicate with teachers if there appears to be a problem. d. Accept responsibility for children's successes and failures.

Ans: C Parents should communicate with teachers if there is a problem and not wait for a scheduled conference. Parent involvement is one factor in children's success in school. Children need to do their own homework. This cultivates responsibility. Discipline should be used to help children control behaviors that might be affecting school performance, but failure to perform adequately should not be punished itself. Communicating with the child is a better solution to getting to the "root" of the school performance problem. School-age children need to develop responsibility. Keeping promises and meeting deadlines lays a successful foundation for adulthood and adult responsibilities.

The preschooler's body image has developed to include a. a well-defined body boundary. b. knowledge about his or her internal anatomy. c. fear of intrusive procedures. d. fear of looking different from his or her friends.

Ans: C Preschoolers fear that their insides will come out with intrusive procedures. Preschoolers have poorly defined body images. Preschoolers have little or no knowledge of their internal anatomy. The fear of looking different is a concept that occurs in later school-aged children and adolescents.

According to Erikson, the primary psychosocial task of the preschool period is developing a sense of a. identity. b. intimacy. c. initiative. d. industry.

Ans: C Preschoolers focus on developing initiative. The stage is known as initiative versus guilt. Identity versus role confusion is associated with adolescence. Intimacy versus isolation is associated with young adulthood. Industry versus inferiority is associated with the school-aged child.

The parents of a 9-month-old infant tell the nurse that they are worried about their baby's thumb-sucking. What should the nurse's reply be based on? a. A pacifier should be substituted for the thumb. b. Thumb-sucking should be discouraged by age 12 months. c. Thumb-sucking should be discouraged when permanent teeth begin to erupt. d. There is no need to restrain nonnutritive sucking during infancy.

Ans: C Thumb-sucking reaches its peak at 18 to 20 months of age; it should be discouraged if it persists beyond 4 to 6 years of age. Evidence is inconclusive over whether a pacifier or a thumb better satisfies sucking needs and what the impact of either is on tooth eruption. Thumb-sucking reaches its peak at 18 to 20 months of age; it should be discouraged if it persists beyond 4 to 6 years of age. Nonnutritive sucking reaches its peak at about 18 to 20 months of age. Most toddlers give up nonnutritive sucking on their own.

Informed consent is valid when (Select all that apply) a. universal consent is used b. it is completed only for major surgery c. a person is over the age of majority and competent d. information is provided to make an intelligent decision e. the choice exercised is free of force, fraud, duress, or coercion

Ans: C, D, E

A parent brings a 2-year-old to the clinic for a well-child checkup. Which statement by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention? a. "We locked all the medicines in the bathroom cabinet." b. "We turned the thermostat down on our hot water heater." c. "We placed gates at the top and bottom of the basement steps." d. "We stopped using the car seat and put our child in the seat belt now that he is older."

Ans: D A car seat should be used until the child weighs 18 kilograms (40 pounds) and is approximately 4 years old. Locking up medicines and any other harmful household products is an appropriate action; therefore, there is no need for further instruction. Turning down the thermostat on the hot water heater is an appropriate action; therefore, there is no need for further instruction. Placing gates at the top and bottom of the basement stairs is an appropriate action; therefore, there is no need for further instruction.

The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. What action should the nurse take next? a. Notify the surgeon. b. Perform oral intubation. c. Try inserting a larger tracheostomy tube. d. Try inserting a smaller tracheostomy tube.

Ans: D A smaller tracheostomy tube should be available at the bedside at all times. Insertion of the smaller tube will keep the stoma open until further action can be taken. Notification of the surgeon should be done after the emergent situation is handled. Oral intubation is done if a tracheostomy tube cannot be inserted. A larger tracheostomy tube would cause trauma to the trachea and, therefore, is not used.

A nurse is preparing an educational workshop on atraumatic care in pediatric patient care. The most appropriate nursing intervention to include in the workshop is to a. prepare the child that their parents will not be able stay during hospitalization by watching a video. b. help the child to accept the pain associated with any treatments, procedures, or surgery. c. tell the child that the loss of control and privacy in the hospital is temporary. d. provide the child play activities for expression of fear and aggression.

Ans: D Allowing the child play activities for the expression of fear and aggression are principles of atraumatic care. Atraumatic care is to prevent or minimize the child's separation from the family. Minimizing or preventing bodily injury and pain are principles of atraumatic care. Promoting a sense of control and privacy are components of atraumatic care.

6. Parents express concern that their pubertal daughter is taller than the boys in her class. The nurse should respond with which statement regarding how the onset of pubertal growth spurt compares 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, the pubertal growth spurt depends on growth in infancy.

ANS: 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 school nurse is teaching a class on safety. Which activities require protective athletic gear? (Select all that apply) a. Lacrosse b. Football c. Swimming d. Gymnastics e. Skateboarding

Ans: A, B, E

A nurse is discussing various developmental theories at a parenting class. Which individual is associated with the moral development theory? a. Erikson b. Fowler c. Kohlberg d. Freud

Ans: C Kohlberg developed the theory of moral development sequence for children. It includes how children acquire moral reasoning and is based on cognitive developmental theory. Erikson developed the theory of psychosocial development. Fowler developed the theory of spiritual development. Freud developed the theory of psychosexual development.

For a toddler with sleep problems, the nurse should suggest that the parents a. use a transitional object at bedtime. b. vary the bedtime ritual. c. restrict stimulating activities throughout the day. d. explain away their fears.

Transitional objects may help ease the toddler's anxiety and facilitate sleep. A consistent set of bedtime rituals will facilitate a toddler's sleep. Toddlers should have stimulating physical activity during the daytime in order for them to sleep at night. Toddlers do not understand verbal explanations, so parents cannot explain away their fears.

2. A nurse is using the FLACC scale to evaluate pain in a preverbal child. The nurse makes the following assessment: Face: occasional grimace; Leg: relaxed; Activity: squirming, tense; Cry: no cry; Consolability: content, relaxed. The nurse records the FLACC assessment as which number? (Record your answer as a whole number.)

ANS: 2 The FLACC scale is recorded per the following table: 0 1 2 Face No particular expression or smile Occasional grimace or frown, withdrawn, disinterested Frequent to constant frown, clenched jaw, quivering chin Legs Normal position or relaxed Uneasy, restless, tense Kicking or legs drawn up Activity Lying quietly, normal position, moves easily Squirming, shifting back and forth, tense Arched, rigid, or jerking Cry No cry (awake or asleep) Moans or whimpers, occasional complaint Crying steadily, screams or sobs, frequent complaints Consolability Content, relaxed Reassured by occasional touching, hugging, or talking to; distractible Difficult to console or comfort Because the child has a grimace and is squirming and tense, 2 total points are given. Relaxed legs, no cry, and content and relaxed consolability get 0 points.

1. A dose of oxycodone (OxyContin) 2 mg/kg has been ordered for a child weighing 33 lb. How many milligrams of OxyContin should the nurse administer? (Record your answer as a whole number.)

ANS: 30 The child's weight is divided by 2.2 to get the weight in kilograms. Kilograms in weight are then multiplied by the prescribed 2 mg. 33 lb/2.2 = 15 kg. 15 kg 2 mg = 30 mg.

1. A 2-year-old child has been returned to the nursing unit after an inguinal hernia repair. Which pain assessment tool should the nurse use to assess this child for the presence of pain? a. FACES pain rating tool b. Numeric scale c. Oucher scale d. FLACC tool

ANS: D A behavioral pain tool should be used when the child is preverbal or doesn't have the language skills to express pain. The FLACC (face, legs, activity, cry, consolability) tool should be used with a 2-year-old child. The FACES, numeric, and Oucher scales are all self-report pain rating tools. Self-report measures are not sufficiently valid for children younger than 3 years of age because many are not able to accurately self-report their pain.

1. A nurse is planning a teaching session for parents of preschool children. Which statement explains why the nurse should include information about morbidity and mortality? a. Life-span statistics are included in the data. b. It explains effectiveness of treatment. c. Cost-effective treatment is detailed for the general population. d. High-risk age groups for certain disorders or hazards are identified.

ANS: D Analysis of morbidity and mortality data provides the parents with information about which groups of individuals are at risk for which health problems. Life-span statistics is a part of the mortality data. Treatment modalities and cost are not included in morbidity and mortality data.

7. A 13-year-old girl asks the nurse how much taller she will get. 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 which statement? a. Growth cannot be predicted. b. 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.

ANS: D 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. Although growth cannot be definitively predicted, on average, 95% of adult height has been reached with the onset of menstruation. Pubertal growth spurt lasts about 1 year does not address the girl's question. Young women usually will grow approximately 5% more after the onset of menstruation.

Girls experience an increase in weight and fat deposition during puberty. Nursing considerations related to this include a. giving reassurance that these changes are normal b. suggesting dietary measures to control weight gain c. recommending increased exercise to control weight gain d. encouraging a low-fat diet to prevent fat deposition

Ans: A A certain amount of fat is increased along with lean body mass to fill the characteristic contours of the child's gender. A healthy balance must be achieved between expected healthy weight gain and obesity as related to these normal and expected physical changes. This should not be done unless weight gain is excessive. Eating disorders can develop in this group, and diet management should be considered only under a health care practitioner's care. Exercise is an important component in weight management but should never be done or encouraged in increased amounts or in excess to control weight gain that occurs normally during puberty. Some fat deposition is essential for normal hormonal regulation. Menarche is delayed in girls with body fat contents that are too low; therefore, a low-fat diet is not a recommended intervention.

During their school-age years, children best understand concepts that can be seen or illustrated. The nurse knows this type of thinking is termed as a. concrete operations. b. preoperational. c. school-age rhetoric. d. formal operations.

Ans: A Black-and-white reasoning involves a situation in which only two alternatives are considered, when in fact there are additional options. Preoperational thinking is concrete and tangible. During the school-age years, children deal with thoughts and learn through observation. They do not have the ability to do abstract reasoning and learn best with illustration. Thought at this time is dominated by what the school-age child can see, hear, or otherwise experience. School-age rhetoric simply refers to the type of ideas that arise out of the years children attend school. Formal operations are characterized by the adaptability and flexibility that occurs during the adolescent years.

According to Piaget, at what stage of development do children typically solve problems through trial and error? a. Sensorimotor stage b. Preoperational stage c. Formal operational stage d. Concrete operational stage

Ans: A During the sensorimotor stage, infants and young toddlers develop a sense of cause and effect. Relational problem solving is characteristic of the preoperational stage. Adolescents, in the formal operations stage, can test hypotheses. Children in the concrete operations stage solve problems in a tangible, systematic fashion.

The nurse observes erythema, pain, and edema at a child's intravenous (IV) infusion site with streaking along the vein. The nurse's priority action is to a. immediately stop the infusion. b. check for a good blood return. c. ask another nurse to check the IV site. d. increase IV drip with normal saline for 1 minute and recheck.

Ans: A Erythema, pain, and edema at an IV site describe an extravasation or infiltration. The IV must be stopped to prevent further damage to the child. Blood return suggests that the IV catheter is still in the vein, but this does not address the immediacy of the assessment findings. Reassessment of the IV site by another nurse can be done once the IV has been stopped, which is the priority based on the assessment findings. The IV infusion should not be increased. It will add additional fluid to the child's tissue and could cause further damage.

A 10-year-old child requires daily medications for a chronic illness. The mother tells the nurse that she is always nagging the child to take the medicine before school. The most appropriate nursing intervention to promote the child's compliance is to a. establish a contract with the child, including rewards. b. suggest time-outs when the child forgets her medicine. c. discuss with the child's mother the damaging effects of nagging. d. ask the child to bring her medicine containers to each appointment so that the pills can be counted.

Ans: A For school-age children, behavior contracting with desirable rewards is an effective method of encouraging compliance. Any forms of negative consequences, such as time-outs, should only be used if the behavioral contracting is not successful. Although nagging is not an effective strategy, the nurse needs to assist the mother in problem solving. The technique of counting pills may be tried if the contracting is not successful, but it sends a punitive signal to the child that may make the situation worse.

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

Ans: A It is essential that the child eat a balanced diet with essential nutrients; the amount of food is less important than the quality of the food. Requirements are similar for both toddlers and preschoolers. The caloric requirement decreases slightly for preschoolers. The average intake is about 1800 calories each day for preschoolers.

Based on Piaget's theory of cognitive development, what is one basic concept a child is expected to attain during the first year of life? a. If an object is hidden, that does not mean that it is gone. b. He or she cannot be fooled by changing shapes. c. Parents are not perfect. d. Most procedures can be reversed.

Ans: A Part of learning permanence is learning that although an object is no longer visible, it still exists. At 1 year of age, a child may not be able to understand that an object that changes shape is still the same object. Understanding conservation occurs between ages 7 to 11 years. At 1 year of age, a child is unable to determine or understand that parents make mistakes. At 1 year of age, a child does not understand the idea of reversed trial and error.

The best explanation for using pulse oximetry on young children is that it a. is noninvasive. b. is better than capnography. c. is more accurate than arterial blood gas measurements. d. provides intermittent measurements of oxygen.

Ans: A Pulse oximetry is a noninvasive method for determining oxygen saturation. Capnography measures carbon dioxide exhalation. It does not reflect oxygen perfusion. Pulse oximetry is less invasive and easier to test than arterial blood gases. Pulse oximetry provides continuous or intermittent measurements of oxygen saturation.

How does the onset of the pubertal growth spurt compare in girls and boys? a. In girls, it occurs about 2 years before it appears in boys. b. In girls, it occurs about 3 years before it appears in boys. c. In boys, it occurs about 1 year before it appears in girls. d. It is about the same in both boys and girls.

Ans: A The average age of onset for puberty is 12 years in girls and 14 years in boys. Although this may be true for an individual, the average difference is approximately 2 years. Usually, girls begin puberty and their growth spurt earlier than boys. Usually, girls begin puberty and their growth spurt earlier than boys.

A nurse is examining a toddler and is discussing with the mother psychosocial development according to Erikson's theories. Based on the nurse's knowledge of Erikson, the most age-appropriate activity to suggest to the mother at this stage is to a. feed lunch. b. allow the toddler to start making choices about what to wear. c. allow the toddler to pull a talking-duck toy. d. turn on a TV show with bright colors and loud songs.

Ans: B A toddler is developing autonomy and is able to start making some choices about what he or she can wear. A toddler is developing autonomy and focusing on doing things for himself or herself and therefore would not want the mother to feed him or her. The child is at the stage of autonomy versus shame and doubt, as defined by Erikson. At this age, the mother should provide opportunities for the child to be active and learn by experience and imitation. Providing toys the child can control will help achieve this stage. A toddler might easily become overstimulated by images from TV and loud sounds. Toddlers are more interested in manipulating and learning from objects in the environment.

One of the major tasks of toddlerhood is toilet training. In teaching the parents about a child's readiness for toilet training, it is important for the nurse to emphasize that a. nighttime bladder control develops first, so parents should focus on that in the initial teaching with their toddler. b. bowel control is accomplished before bladder control, so the parent should focus on bowel training first. c. the toddler must have the gross motor skill to climb up to the adult toilet before training is begun. d. the universal age for toilet training to begin is 2 years, and the universal age for completion is 4 years.

Ans: B Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The sensation to defecate is stronger than that of urination. The completion of bowel training will give the toddler a sense of accomplishment that can be carried onto bladder training. Nighttime bladder control normally takes several months to years after daytime training; therefore, this should not be the initial focus of toilet training with a toddler. Nighttime bladder control normally takes several months to years after daytime training; therefore, this should not be the initial focus of toilet training with a toddler. There is no universal right age to begin toilet training or an absolute deadline to complete training. One of the nurse's most important responsibilities is to help parents identify the readiness signs in their child.

Which statement is most characteristic of the motor skills of a 24-month-old child? a. The toddler walks alone but falls easily. b. The toddler's activities begin to produce purposeful results. c. The toddler is able to grasp small objects but cannot release them at will. d. The toddler's motor skills are fully developed but occur in isolation from the environment.

Ans: B Gross and fine motor mastery occurs with other activities that have a purpose, such as walking to a particular location or putting down one toy and picking up a new toy. By 2 years of age, children are able to walk up and down stairs without falling. Grasping small objects without being able to release them is a task of infancy. Interaction with the environment is essential for mastery of both fine and gross motor skills at this age and beyond.

An important consideration in preventing injuries during middle childhood is that a. peer pressure is not strong enough to affect risk-taking behavior. b. most injuries occur in or near school or home. c. injuries from burns are the highest at this age because of fascination with fire. d. lack of muscular coordination and control results in an increased incidence of injuries.

Ans: B Most children in the middle years spend the majority of their time in and around school or home; therefore, the risk for injuries is increased in and around these areas. Peer pressure as an impetus for risk-taking behavior begins in the school-age years but is more significant in adolescence. Burn injuries are higher in the toddler years, when children are curious and mobile. They may expose themselves to objects capable of burning them (e.g., hot pots of water in the kitchen). Automobile accidents, either as a pedestrian or passenger, account for the majority of severe accidents in the middle years. School-age children have more refined muscle development, which results in an overall decrease in the number of accidents. Lack of muscular coordination and control leading to injuries occurs in younger children.

The parents of a 5-month-old child complain to the nurse that they are exhausted because the infant still wakes up as often as every 1 to 2 hours during the night. When the child awakens, they change the diaper and the mother nurses the child back to sleep. Which should the nurse suggest to help the parents deal with this problem? a. Put the child in the parents' bed to cuddle. b. Start putting the infant to bed while still awake. c. Allow the infant to cry for 30 minutes, and then rock the infant back to sleep before putting the infant back in the crib. d. Give the infant a bottle of formula instead of breastfeeding so often at night.

Ans: B Parents need to develop bedtime rituals that involve putting the child in bed when awake. This will allow the infant to become accustomed to falling asleep somewhere besides the parent's arms or in the parent's presence. The issue of a child sleeping with the parents should be discussed fully. Having the infant in bed with them may still interfere with their sleep and increases the risk of injury to an infant of this age. The extinction of crying episodes should be done progressively, beginning with checking on the infant every 5 minutes during the first night and extending this interval by 5 minutes on subsequent nights. This will allow the infant to learn to self-soothe. Providing formula in a bottle at night will contribute to bottle-mouth caries. Additionally, 5-month-old infants generally do not wake up during the night to feed but rather to be soothed. Using feeding as a mechanism to soothe begins a pattern that may lead to eating problems later in childhood.

The best approach for effective communication with a preschooler is through a. speech. b. play. c. drawing. d. actions.

Ans: B Preschoolers' most effective means of communication is through play. Play allows preschoolers to understand, adjust to, and work out life's experiences through their imagination and ability to invent and imitate. Speech is not effective, because preschoolers assume that everyone thinks as they do and that a brief explanation of their thinking makes them understood by others, which is often not true. Also, preschoolers often do not understand the meaning of words and often take statements literally. Drawing is still being developed as a fine motor skill; therefore, it is not the most effective means of communication. Actions are not an appropriate means of communication for a preschooler.

During a well-child visit, the father of a 4-year-old child tells the nurse that he is not certain if his child is ready for kindergarten. The child's birthday is close to the cutoff date, and the child has not attended preschool. The most appropriate recommendation by the nurse is to a. Encourage the father to have the child start kindergarten b. Recommend to the father that he postpone kindergarten and send the child to preschool c. Refer the child for developmental screening and make a recommendation based on the results d. Have the father observe a kindergarten class and then decide if his child would enjoy the experience

Ans: C A developmental screening will provide the necessary information to help the family determine readiness. Encouraging the father to have the child start kindergarten does not address the father's concern about readiness and suggests that his concerns are not warranted. Recommending to the father that he postpone kindergarten and send the child to preschool assumes that the child is not ready for kindergarten, but the recommendation is not based on any data or facts. Recommending to the father that he simply place his child in preschool may lead to the child's boredom with school. Having the father observe a kindergarten class and then decide if the child would enjoy the experience will provide information about kindergarten but not about whether his child is ready to begin and thrive there.

At what age would the nurse expect an infant to be able to say "mama" and "dada" with meaning? a. 4 months b. 6 months c. 10 months d. 14 months

Ans: C At 10 months of age, infants say sounds with meaning. Consonants, such as n, k, g, p, and b, are made by an infant at 4 months of age. Babbling resembling one-syllable sounds occurs at 6 months of age. Age 14 months is late for the development of sounds with meaning. Between the age of 1 and 2 years, the number of words should increase from approximately 4 words to 300 words.

Nursing interventions to promote health during middle childhood should include a. stressing the need for increased calorie intake to meet the increased demands on the body. b. instructing parents to defer questions about sex until the child reaches adolescence. c. educating the child and parents about the need for effective dental hygiene because these are the years in which permanent teeth erupt. d. advising parents that the child will need decreasing amounts of rest toward the end of this period.

Ans: C Because the permanent teeth are present, it is important for the child to learn how to care for these teeth. Caloric needs are diminished in relation to body size during the middle years; however, a balanced diet is important to prepare for the adolescent growth spurt. Parents should approach sex education with a life span approach and ANS questions appropriate to the child's age. School-age children often need to be reminded to go to sleep.

Which strategy might be recommended to increase caloric intake in an infant with failure to thrive? a. Use developmental stimulation by a specialist during feedings. b. Avoid solids until after the bottle is well accepted. c. Be persistent through 10 to 15 minutes of food refusal. d. Vary the schedule for routine activities on a daily basis.

Ans: C Calm perseverance is important. Parents often cannot persist through the child's refusals, but they should be encouraged to do so and supported. Feeding should take place in a nonstimulating environment so that the focus is on feeding, enhancing the chances of increasing caloric intake. Solids should be introduced slowly to decrease dependence on the bottle, beginning at 6 months of age. The feeding schedule should be structured for the infant to have consistency and develop a routine for feeding.

The school nurse is discussing dental health with some children in first grade. Which should be included? a. Teach how to floss teeth properly. b. Recommend a toothbrush with hard nylon bristles to get in between the teeth. c. Emphasize the importance of brushing before bedtime. d. Recommend nonfluoridated toothpaste.

Ans: C Children should be taught to brush their teeth after meals and snacks and before bedtime to prevent dental caries. Parents should help with flossing until children develop the dexterity required, when they are in about the third grade. A toothbrush with soft nylon bristles is recommended to prevent damage to the gums. The American Dental Association recommends fluoridated toothpaste for this age-group.

The parents of 9-year-old twins tell the nurse, "They have filled up their bedroom with collections of rocks, shells, stamps, and cars." The nurse should recognize that this behavior is characteristic of a. giftedness. b. typical "twin" behavior. c. cognitive development at this age. d. psychosocial development at this age.

Ans: C Classification skills are developed during the school-age years. This age-group enjoys sorting objects according to shared characteristics. Giftedness is not measured simply by a school-age child's ability to classify objects, which is an expected cognitive skill for this age-group. Giftedness signs include specific academic aptitudes, advanced memory skills, creative thinking, ability in the visual or performing arts, and psychomotor ability, either individually or in combination. The development of classification skills is characteristic of the school-age child and is not related to the behavior of twins. Psychosocial development of the school-age child is focused on accomplishment or industry, not the cognitive skills of classification that are described.

A parent tells the nurse, "I am worried about my 13-year-old son. He hasn't started puberty, and my daughter did when she was 11 years of age." The most appropriate explanation by the nurse is a. "This is unusual and requires further evaluation of your son." b. "This is unusual because the onset of pubescence is usually the same in siblings." c. "This is normal because the onset of pubescence is usually earlier in girls than it is in boys." d. "This is abnormal because the onset of pubescence is usually earlier in boys than it is in girls."

Ans: C Girls begin puberty on average approximately 2 years before boys. Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, no further evaluation is necessary at this time. The age of pubescence is gender related, with the average age of puberty onset being 12 years for girls and 14 years for boys. Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, her son is not having an abnormal onset of puberty.

The nurse notices that a toddler is more cooperative taking medicine from a small cup than from a large cup. This is an example of which characteristic of preoperational thought? a. Egocentrism b. Irreversibility c. Inability to conserve d. Transductive reasoning

Ans: C The smaller cup makes it look like less medicine to the child at this stage of cognitive development. The inability to see situations from other perspectives, besides their own, does not facilitate medication administration. The inability to reverse or undo actions physically initiated does not facilitate medication administration. Focusing on particulars does not explain the cooperation with the smaller medication cup.

Parents of a 4-month-old infant bring the infant to the clinic for a well-baby checkup. Which instruction should the nurse include at this time about injury prevention? a. "Never shake baby powder directly on the infant because it can be aspirated into the lungs." b. "Do not permit the child to chew paint from window ledges, because the child might absorb too much lead." c. "When the child learns to roll over, you must offer supervision whenever the child is on a surface from which the child might fall." d. "Keep doors of appliances closed at all times."

Ans: C Rolling over from the abdomen to the back occurs between 4 and 7 months of age. This statement is the appropriate anticipatory guidance for this age related to the prevention of injuries. "Never shake baby powder directly on the infant because it can be aspirated into the lungs" is appropriate guidance for a first-month well-baby checkup related to injury prevention. Information on lead, and lead sources, should be included at the 9-month visit when the child is beginning to crawl and pull himself or herself to a standing position. Guidance regarding appliances and keeping doors of appliances closed should be included at the 9-month visit when the child is beginning to crawl and pull himself or herself to a standing position.

Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which should the nurse consider when discussing this issue with the parents? a. Changing self-esteem is difficult after about age 5 years. b. Self-esteem is the objective judgment of one's worthiness. c. Transitory periods of lowered self-esteem are expected developmentally. d. High self-esteem develops when parents show adequate love for the child.

Ans: C Self-esteem changes with development. Transient declines are expected and, with positive encouragement and support, are only temporary. Self-esteem is influenced throughout adolescence. One aspect of self-esteem is a subjective judgment of one's worthiness. Self-esteem is based on several factors, including competence, sense of control, moral worth, and worthiness of love and acceptance.

A neonate had corrective surgery 3 days ago for esophageal atresia. The nurse notices that after gastrostomy feedings, there is often a backup of feeding into the tube. The most appropriate intervention by the nurse is to a. position the child in a supine position after feedings. b. position the child on the left side after feedings. c. leave the gastrostomy tube open and suspended after feedings. d. leave the gastrostomy tube clamped after feedings.

Ans: C The formula is backing up into the tube because of delayed emptying. By keeping the tube open to air, it will prevent the buildup of pressure on the operative site and the subsequent backup of feeding into the tube. The child should be positioned on the right side with the head elevated approximately 30 degrees after feeding. The child should be positioned on the right side with the head elevated approximately 30 degrees after feeding. Leaving the gastrostomy tube clamped after feedings will create pressure on the operative site and increase the risk of backup of the feedings.

The nurse is assessing a 6-month-old infant who smiles, coos, and has strong head lag. Based on the nurse's knowledge of growth and development, the nurse recognizes that a. this is normal development for a 6-month-old. b. the child is probably mentally retarded. c. a developmental and neurologic evaluation is needed. d. the parent needs to work with the infant to stop the head lag.

Ans: C The head lag should be almost gone by 4 months of age. This child requires further evaluation to determine whether there is a developmental or neuromuscular deficit that needs to be addressed. Smiling and cooing should have developed by 4 to 5 months of age. A 6-month-old should be imitating sounds, babbling, and vocalizing to toys and a mirror image. Without further evaluation, no determination of mental retardation can be made based on three assessment findings alone. Teaching the parents muscle strengthening exercises may be an intervention of choice once further evaluation is completed.

The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. Based on the nurse's knowledge of this age-group, the most appropriate recommendation is a. Organized sports, such as soccer, are not appropriate at this age b. Competition is detrimental to the establishment of a positive self-image c. Sports participation is encouraged if the sport is appropriate to the child's abilities d. Girls should compete only against girls because at this age boys are larger and have more muscle mass

Ans: C The parents should help the child select a sport that is suitable to her capabilities and interests. Team sports contribute to the school-age child's social, intellectual, and skill growth. Organized sports for school-age children can provide safe, appropriate activities with supportive parents and coaches. The desire to participate in competitive team sports develops out of a need for peer interaction for the school-age child. A sport should be selected that meets the child's capabilities and interests. The physical changes in boys described take place during puberty, later in the school-age years; therefore, there is no reason for boys and girls to compete separately at age 8 years.

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

Ans: C The physical, sensory, and psychomotor development of adolescents provides a sense of strength and confidence. There is also an increase in energy coupled with risk taking that puts them at risk, because they often ignore logical thinking. Adolescents tend to be risk takers because of their feelings of indestructibility. The feelings of indestructibility that accompany adolescence interfere with understanding the consequences of their behavior, thus increasing their potential for injuries. Sports can be a useful way to discharge energy and should not be limited. Care must be taken to avoid overuse injuries and to use appropriate protective equipment.

A 2-year-old child has recently started having temper tantrums where breath holding occurs and occasionally fainting. The most appropriate action by the nurse is to a. Refer the child for a respiratory evaluation b. Refer the child for a psychological evaluation c. Explain to the parent that this is not harmful d. Explain to the parent that the child is spoiled

Ans: C The rising carbon dioxide levels restart the breathing process when a child holds his or her breath; therefore, the process is self-limiting and not harmful. A respiratory evaluation is not indicated for this toddler. Temper tantrums are part of this developmental stage as the toddler asserts his or her independence. A psychological evaluation is not warranted. Temper tantrums are part of this developmental stage as the toddler asserts independence. There are no data to indicate that the child is spoiled.

The parent of a 12-month-old says to the nurse, "He pushes the teaspoon right out of my hand when I feed him. I can't let him feed himself; he makes too much mess." The most appropriate response by the nurse is a. "It's important not to give in to this kind of temper tantrum at this age." b. "Maybe you need to try a different type of spoon, one designed for children." c. "It's important to let him make a mess. Just don't worry about it so much." d. "He is at the age when he should begin to feed himself. Let's think of ways to make the mess more tolerable."

Ans: D At 12 months, children should be self-feeding. Because they eat primarily finger foods, providing some concrete strategies for the parent as to how to minimize the mess would be helpful. The child is developmentally ready for self-feeding, and his behavior reflects his desire to be autonomous. Infants between the ages of 9 and 12 months begin to self-feed; therefore this behavior should be encouraged. The child is developmentally ready for self-feeding, and this behavior should be encouraged. Most infants begin self-feeding with finger foods, so the use of a spoon is generally not required, limiting the "mess." "It's important to let him make a mess. Just don't worry about it so much." minimizes the parents' concerns about the mess created by self-feeding, blocks communication, and misses a teaching-learning opportunity.

The nurse needs to give an injection to a 4-year-old in the deltoid muscle. Based on the nurse's knowledge of preschool development, the most appropriate approach by the nurse is to a. smile while giving the injection to help the child relax. b. the child that you will be so quick, the injection won't even hurt. c. explain that child will experience "a little stick in the arm." d. explain with concrete terms such as "putting medicine under the skin."

Ans: D By using concrete terms, the nurse helps the child understand what the nurse is going to do. Facial expressions are too abstract. The young child will not correlate a smile with relaxation. Distraction techniques are more appropriate. The nurse does not know that the injection will not hurt the child. Lying or distorting the truth is never appropriate. This response will block trust, especially if the injection does hurt the child. The child may visualize an actual stick being placed in the arm. Children at this age are very literal.

By what age would the nurse expect most children to use sentences of four or five words? a. 18 months b. 24 months c. 3 years d. 4½ years

Ans: D Children ages 4 to 5 years use sentences of four or five words. An 18-month-old child has a vocabulary of approximately 10 words. A 24-month-old child uses two- or three-word phrases. A 3-year-old child uses sentences of three or four complete words.

What is an important consideration related to childhood stress? a. Children should be protected from stress. b. Children do not have coping strategies. c. Parents cannot prepare children for stress. d. Some children are more vulnerable to stress than others.

Ans: D Children's age, temperament, life situation, and state of health affect their vulnerability, reactions, and ability to handle stress. It is not feasible to protect children from all stress. Children can be taught coping strategies. Supportive interpersonal relationships are essential to the psychological well-being of children. Adults need to recognize signs of stress before they become overwhelming. Providing children with interpersonal security helps them develop coping strategies for dealing with stress.

The nurse is preparing a plan to teach a mother how to administer 11/2 teaspoons of medicine to her 6-month-old child. Based on the nurse's knowledge of administering pediatric medications, the nurse teaches the parent to use a a. household measuring spoon. b. regular silverware teaspoon. c. paper cup measure in 5-ml increments. d. plastic syringe (without needle) calibrated in milliliters.

Ans: D Plastic calibrated syringes, without a needle, offer the most accurate measurement for medication administration in the infant. The nurse should teach the mother to give the child 7.5 mL of the medication. Household measuring spoons can be used if other, more precise devices are not available, but they are not the preferred method of medication administration for an infant. Regular silverware teaspoons are not acceptable for medication administration, because household teaspoons vary greatly in size. A paper cup marked with 5-mL increments does not contain calibration for the additional 2.5 mL that is needed for this infant's required dosage, and its use would therefore limit the accuracy of the dosage.

The school nurse is asked to speak with the parents of a 10-year-old boy who has been bullying other children. The nurse's response should be based on knowledge that a. Bullying at this age is considered normal b. Children who bully others usually join gangs c. Bullying is a short-term problem that is generally outgrown by the end of the school-age years d. Bullying often manifests itself in children who are different or have poor academic or social skills

Ans: D Poor relationships with peers and a lack of group identification, such as looking different or having poor academic or social skills, contribute to bullying behavior. Bullying is a maladaptive response to poor relationships with peers and lack of group identification; therefore, it is not considered normal behavior. Children who chronically bully tend to be impulsive, easily frustrated, and at increased risk for dropping out of school, but there is no direct correlation between bullies and joining gangs. Children who bully may be at risk for long-term psychological disturbances and psychiatric symptoms. Future problems for bullies may include violence, substance abuse, and criminal convictions, which often occur in adulthood.

Which characteristic best describes the fine motor skills of a 5-month-old infant? a. Transfers objects from one hand to another b. Crude pincer grasp c. Able to build a tower of two cubes d. Able to grasp an object voluntarily

Ans: D The ability to grasp objects voluntarily is an appropriate fine motor skill for a 5-month-old infant. Transferring objects from one hand to another is an appropriate fine motor skill for a 7-month-old. A crude pincer grasp is an appropriate fine motor skill for an 8- to 9-month-old. The ability to build a tower of two cubes is an appropriate fine motor skill for a 15-month-old.

The nurse needs to take the blood pressure of a preschooler for the first time. What action would be best for gaining the child's cooperation? a. Take the blood pressure when a parent is there to comfort the child. b. Tell the child that this procedure will help the child to get well faster. c. Explain to the child how blood flows through the arm and why taking the blood pressure is important. d. Permit the child to handle equipment and see the dial move before putting the cuff in place.

Ans: D The best approach for a preschooler is to allow the child to play out the experience ahead of time, thereby decreasing the child's anxiety. The parent's presence will be helpful, but it will not alleviate fear of the unknown. Telling a child that the procedure will help the child to get well faster is not a true statement, and the child will not be able to understand the relationship between the blood pressure and feeling better. The explanation of how blood pressure is determined physiologically is too complex an explanation for this age group.

Which nursing intervention would be most effective in decreasing mortality from unintentional injury? a. Teaching children the dangers of contact sports b. Encouraging potential parents to obtain genetic counseling c. Educating parents-caretakers about the benefits of immunizations d. Teaching parents-caretakers about proper use of vehicle restraint seats

Ans: D The most common cause of death for the age group 1-19 years is unintentional injuries such as motor vehicle accidents, drowning, and firearms. Teaching the dangers of contact sports will not decrease mortality from unintentional injuries such as motor vehicle accidents. Genetic counseling does not decrease mortality from unintentional injuries. The most common cause of mortality in children is unintentional injuries. Immunization education is not most effective.

The nurse is doing preoperative teaching with a child and the parents. The parents say the child "is dreading the shot for before surgery." On which of the following facts should the nurse's response be based? a. Preanesthetic medication can only be given intramuscularly. b. In children, the intramuscular (IM) route is safer than the intravenous (IV) route. c. The child will have no memory of the injection because of amnesia. d. Preanesthetic medication should be "atraumatic," using oral, existing IV, or rectal routes.

Ans: D The necessity of premedication is being investigated. If necessary, numerous drug regimens and routes exist; the route is not limited to the IM route. Preanesthetic medicines can be given in a variety of routes other than intramuscularly. The IV route is preferable to the IM route for premedication. The muscle may be sore after the injection. Therefore, the child may have a memory, and telling the child otherwise will create distrust between the nurse and the child or family.

Ashley, age 4½ years, is afraid of dogs. What should the nurse recommend to her parents to help her with this fear? a. Keep her away from dogs. b. Buy her a stuffed dog toy. c. Force her to touch a dog briefly. d. Let her watch other children play with a dog.

Ans: D The parents should actively seek ways to deal with fear. By observing other children at play with dogs, the child can adapt. Keeping their child away from dogs avoids the object of fear rather than addressing the fear and finding solutions. Buying a child a stuffed dog toy avoids the object of fear rather than addressing the fear and finding solutions. Forcing the child to touch a dog without working up to it may increase the level of fear.

Which is characteristic of the psychosocial development of school-age children? a. A developing sense of initiative is important. b. Peer approval is not yet a motivating factor. c. Motivation comes from extrinsic rather than intrinsic sources. d. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

Ans: D The school-age child is eager to develop skills and participate in activities. All children are not able to do all tasks well, and the child must be prepared to accept some feelings of inferiority, as highlighted in Erikson's stage for this age-group of industry versus inferiority. Initiative versus guilt is the stage characteristic of preschoolers. Peer group formation is one of the major characteristics of school-age children. School-age children gain satisfaction from independent behaviors that are internally driven and accomplished.

The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy? a. Help the toddler complete tasks. b. Provide opportunities for the toddler to play with other children. c. Help the toddler learn the difference between right and wrong. d. Encourage the toddler to do things for himself or herself when he or she is capable of doing them.

Ans: D Toddlers have an increased ability to control their bodies, themselves, and the environment. Autonomy develops when children complete tasks of which they are capable. To successfully achieve autonomy, the toddler needs to have a sense of accomplishment. This does not occur if parents complete tasks. Children at this age engage in parallel play. This will not foster autonomy. This concept is too advanced for toddlers and will not contribute to autonomy.

Which statement characterizes toddlers' eating behavior? a. They have increased appetites. b. They have few food preferences. c. Their table manners are predictable. d. They become fussy eaters.

Ans: D Toddlers have physiologic anorexia, which contributes to picky, fussy eating. This usually begins at about 18 months of age. They have a decrease in appetite known as physiologic anorexia at this age. They have strong taste preferences at this age. Use of finger foods contributes to the unpredictable table manners of toddlers.