nclex ch 18 Growth, development, & stages of life

A 4 year old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention should be implemented to alleviate the child's fears? 1. Encourage the child's parent to stay with the child. 2. Encourage play with other children of the same age 3. Advise the family to visit only during the scheduled visiting hours 4. Provide a private room, allowing the child to bring favorite toys from home

1 Although the preschooler already may be soending some time away from parents at a day care center or preschool, illness adds a stressor that makes separationmore difficult. The child may ask repeatedly when parents will be coming for a visit or may constantly want to call the parents. Options 3 and 4 increase stress related to separation anxiety. Option 2 is unrelated to the subject of the question and, in addition, may not be appropriate for a child who may be immunocompromised and at risk for infection

The mother of a 3-year-old is concerned because her child still is insisting on a bottle at nap time and at bedtime. Which is the most appropriate suggestion to the mother? 1. Allow the bottle if it contains juice 2. Allow the bottle if it contains water 3. Do not allow the child to have the bottle 4. Allow the bottle during naps but not at bed time

2 A toddler should never be allowed to fall asleep with a bottle containing milk, juice, soda, sweetened water, or any other sweet liquid because of the risk of nursing (bottle mouth) Carie's. If a bottle is allowed at nap time or bed time, it should contain only wate r

The nurse is monitoring a 3 month old infant for signs of increased intracranial pressure. On palpation of the fontanels, the nurse notes that the anterior Fontanel is soft and flat. On the bases of this finding, which nursing action is most appropriate? 1. Increase oral fluids 2. Document the findings 3. Notify the pediatrician 4. Elevate the head of the bed to 90 degrees

2 The anterior fontanel is diamond shaped and located on the top of the head. The fontanel should be soft and flat in a normal infant, and it normally closes by 12-18 months of age. The nurse would document the finding because it is normal. There is no useful reason to increase oral fluids, notify the pediatrician, or elevate the head of the bed to 90 degrees

The nurse assessed the vital signs of a 12 months old infant with a respiratory infection and notes that the respiratory rate is 35 breaths per minute. On the basis of this finding, which action is most appropriate? 1. Administer oxygen 2. Document the findings 3. Notify the pediatrician 4. Reassess the respiratory rate in 15 min

2 The normal respiratory rate in a 12 month old infant is 20-40 breaths per minute.

The nurse is preparing to care for a dying client, and several family members are at the clients bedside. Which therapeutic techniques should the nurse use when communicating with the family? SATA 1. Discouraging reminiscing 2. Make the decisions for the family 3. Encourage expression of feelings, concerns, and fears 4. Explain everything that is happening to all family members 5. Touch and hold the child's or family members hand if appropriate 6. Be honest and let the client and family know they will not be abandoned by the nurse

3, 5, 6 The nurse must determine whether there is a spokesperson for the family and how much the client and family want to know. The nurse needs to allow the family and client the opportunity for informed choices and assist with the decision making process if asked. The nurse should encourage expression of feelings, concerns, and fears and reminiscing. The nurse needs to be honest and let the client and family know they will not be abandoned. The nurse should touch and hold the clients or family members hand if appropriate

A parent brings her 4 month old infant to a well baby clinic for immunizations. The child is up to date with the immunization schedule the nurse should prepare to administer which immunizations to this infant? 1. Varicella, hepatitis B vaccine (HepB) 2. Diphtheria's, tetanus, acellular pertussis (DTaP); measles, mumps, rubella (MMR); inactivated poliovirus vaccine (IPV) 3. MMR, haemophilus influenzas type b (Hib), DTaP 4. DTaP, Hib, IPV, pneumococcal vaccine (PCV), rotavirus vaccine (RV)

4 DTaP, Hib, IPV, PCV, and RV are administered at 4 months of age. DTaP is administered at 2, 4, and 6 months of age; at 15 to 18 months of age; and at 4 to 6 years of age. Hib is administered at 2, 4, and 6 months of age and at 12 to 15 months of age. IPV is administered at 2, 4, and 6 months of age and at 4 to 6 years of age. PCV is administered at 2, 4, and 6 months of age and at 12 to 15 months of age. The first dose of MMR vaccine is administered at 12 to 15 months, the second dose is administered at 4-6 years. The first dose of hepb is administered at birth, the second dose is administered at 1 month, the third d is at 6 months. Varicella zoster vaccine is administered at 12-15 months of age and again at 4-6 years

The nurse is preparing to care for a 5-year-old who has been place in traction following a fracture of the femur. The nurse plans care knowing that which is the most appropriate activity for this child? 1. A radio 2. A sports video 3. Large picture books 4. Crayons and a coloring book

4 In the preschooler, play is simple and imaginative and includes activities such as crayons and coloring books, puppets, felt and magnetic boards, and play-doah. A radio of a sports video is most appropriate for the adolescent. Large picture books are most appropriate for the infant

A child is receiving a series of the hepatitis B vaccine and arrives at the clinic with his parents for the second dose. Before administering the vaccine, the nurse should ask the child and parents about a history of a severe allergy to which substance? 1. Eggs 2. Penicillin 3. Sulfonamides 4. A precious dose of hepatitis B vaccine or component

4 A contraindication to receiving the hepatitis B vaccine is a previous anaphylactic reaction to a previous dose of hepatitis B vaccine or to a component (aluminum hydroxide or yeast protein) of the vaccine. An allergy to eggs, penicillin, and sulfonamides is unrelated to the contraindication to receiving this vaccine

A 2-year-old child is treated in the emergency department for a burn to the chest and abdomen. The child sustained the burn by grabbing a cup of hot coffee that was left in the kitchen counter. The nurse reviews safety principles with the parents before discharge. Which statement by the parents indicates an understanding of measures to provide safety in the home? 1. "We will be sure not to leave hot liquids unattended" 2. "I guess our children need to understand what the word got means" 3. "We will be sure that the children stay in their rooms when we work in the kitchen" 4. "We will install a safety gate as soon as we get home so the children cannot get into the kitchen"

1 Toddlers, with their increased mobility and development of motor skills, can reach hot water or hot objects places in counters and stoves and can reach open fires or stove burners above their eye level. The nurse should encourage parents to remain in the kitchen when preparing a meal, use the back burners in the stove, and turn pot handles inward and toward the middle of the stove. Hot liquids should never be left unattended or within the child's reach, and the toddler should always be supervised. The statements in options 2, 3, and 4 do not indicate an understanding of the principles of safety.

The mother of a 3-year-old asks a clinic nurse about appropriate and safe toys for the child. The nurse should tell the mother that the most appropriate toy for a 3 year old is which? 1. A wagon 2. A golf set 3. A farm set 4. A jack set with marbles

1 Toys for the toddler must be strong, safe, and too large to swallow or place in the ear or nose. Toddlers need supervision at all times. Push pull toys, large balls, large crayons, large trucks, and dolls are some of the appropriate toys. A farm set, a golf set, and jacks with marbles may contain items the child could swallow

A 16-year-old client is admitted to the hospital for acute appendicitis and an appendectomy is performed. Which nursing intervention is most appropriate to facilitate normal growth and development postoperatively? 1. Encourage the client to rest and read 2. Encourage the parents to room in with the client 3. Allow the family to bring in the clients favorite computer games 4. Allow the client to interact with others in his or her same age group

4 Adolescents often are not sure of whether they want their parents with them when they are hospitalized. Because of the importance of their peer group, separation from friends is a source of anxiety. Ideally, the members of the peer group will support their I'll friend. Options 1, 2, and 3 isolate the client from the peer group.

Which interventions are appropriate for the care of an infant? SATA 1. Provide swaddling 2. Talk in a loud voice 3. Provide the infant with a bottle of juice at nap time 4. Hang mobiles with black and white contrast designs 5. Caress the infant while bathing or during diaper changes 6. Allow the infant to cry for at least 10 minutes before responding

1, 4, 5 Holding, caressing, and swallowing provide warmth and tactile stimulation for the infant. To provide auditory stimulation, the nurse should talk to the infant in a soft voice and should instruct the mother to do so also. Additional interventions include playing a music box, radio, or television, or having a ticking clock or metronome nearby. Hanging a bright shiny object in midline within 20-25 cm of the infants face and hanging mobiles with contrasting colors, such as black and white, provide visual stimulation. Crying is an infants way of communicating; therefore, the nurse would respond to the infants crying. The mother is taught to do so also. An infant or child should never be allowed to fall asleep with a bottle containing milk, juice, soda, sweetened water, or another sweet liquid because of the risk of nursing Carie's.

The nurse is evaluating the developmental level of a 2 year old. Which does the nurse expect to observe in this child? 1. Uses a fork to eat 2. Uses a cup to drink 3. Pours own milk into a cup 4. Uses a knife for cutting food

2 By 2 years of age, the child can use a cup and spoon correctly but with some spilling. By age 3-4 years, the child beings to use a fork. By the end of the preschool period, the child should be able to pour milk into a cup and bring to use a knife for cutting

The clinic is assessing a child who is scheduled o receive a live virus vaccine (immunization). What are the general contraindications associated with receiving a live virus vaccine? SATA 1. The child has symptoms of a cold 2. The child had a previous anaphylactic reaction to the vaccine 3. The mother reports that the child is having intermittent episodes of diarrhea 4. The mother reports that the child has not had an appetite and has been fussy 5. The child has a disorder that cause a severely deficient immune system 6. The mother reports that the child has recently been exposed to an infectious disease

2, 5 The general contraindications for receiving live virus vaccines include a previous anaphylactic reaction to an vaccine of a component of a vaccine. In addition, live virus vaccines generally are not administered to individuals with a severely deficient immune system, individuals with a severe sensuality to gelatin, or pregnant women. A vaccine is administered with caution to an individual with a moderate or severe acute illness, with or without fever. Options 1, 3, 4, and 6 are not contraindications to receiving a vaccine

And infant receives a diphtheria, tetanus, and acellular pertussis (DTaP) immunization at a well-baby clinic. The parent returns home and calls the clinic to report that the infant has developed swelling at the site of injection. Which interventions the nurse suggest to the parent? 1. Monitor the infant for a fever 2. Bring the infant back to the clinic 3. Apple a hot pack to the injection site 4. Apple a cold pack to the injection sit

4 On occasion, tenderness, redness, or swelling may occur at true site of the DTaP injection. This can be relieved with cold packs for the first 24 hours, followed by warm or cold compresses if the inflammation persists. Bringing the infant to the clinic is unnecessary. Option 1 may be an appropriate intervention but is not specific to the subject of the question, a localized reaction at the injection site. Hot packs are not applied and can be harmful by causing burning of the skin

A mother arrives at a clinic with her toddler and tells the nurse that she has a difficult time getting the child to go to bed at night. What measure is most appropriate for the nurse to suggest to the mother? 1. Allow the child to set bedtime limits 2. Allow the child to have temper tantrums 3. Avoid letting the chime nap during the day 4. Inform the child of bedtime a few minutes before it is time for bed

4 Toddlers often resist going to bed. Bedtime protests may be reduced by establishing a consistent before bedtime routine and enforcing consistent limits regarding the child's bedtime behavior. Informing the child of bedtime a few minutes before it is time for bed is the most appropriate option. Most toddlers take an afternoon nap and, until their second birthday, also may require a morning nap. Firm, consistent limits are needed for temper tantrums or when toddlers try stalling tactics

Which car safety device should be used for a child who is 8 years old and is 4 feet tall? A. Seat belt B. Booster seat C. Rear-facing convertible seat D. Front-facing convertible seat

B. Booster Seat Rationale: All children whose weight or height is above the forward-facing limit for their car safety seat should use a belt-positioning booster seat until the vehicle seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 years of age. Infants should ride in a car in a semireclined, rear-facing position in an infant-only seat or a convertible seat until they weigh at least 20 pounds and are at least 1 year of age. The transition point for switching to the forward-facing position is defined by the manufacturer of the convertible car safety seat but is generally at a body weight of 9 kg (20 pounds) and 1 year of age.