NCLEX-RN (CHILD HEALTH) GROWTH & DEVELOPMENT/MUSCULOSKELETAL

The nurse assessing a 2 year old should expect the child to be able to perform which actions? SATA 1. Build a tower with blocks 2. Draw a square 3. Hop on one foot 4. Say own name 5. Walk without help

1. Build a tower with blocks 4. Say own name 5. Walk without help

A nurse is discussing the concept of parallel play with parents of toddlers. Which statement should the nurse include to describe this type of play? 1. Children play near other children without significant interaction 2. Children playing together are strongly influenced by each other's choice of toy 3. The child primarily plays alone or with familiar people, such as parents 4. When playing in a group, once child will take on a follower role

1. Children play near other children without significant interaction **Toddlers engage in parallel play. Independent play alongside other children, minimal interaction between children.

A 4 year old boy is diagnosed with Duchenne muscular dystrophy. Which nursing teaching is most appropriate to reinforce for this child's parents? 1. Increase intake of foods high in iron 2. Lift weights to strengthen weak muscles 3. Remove throw rugs from the home 4. Take the muscle relaxant baclofen on time

3. Remove throw rugs from the home **Duchenne muscular dystrophy is caused by a lack of protein called dystrophin needed for muscle stabilization.

The parents of a 2 year old client asks how they can help their child cope with hospitalization. Which of the following suggestions should the nurse give the parents? SATA 1. Follows as many home routines as possible 2. Organize a visit from a playgroup friend 3. Sleep in the child's hospital room at night 4. Take child on regular visits to the playroom 5. Tell the child they did not cause the illness

1. Follows as many home routines as possible 3. Sleep in the child's hospital room at night 4. Take child on regular visits to the playroom

The nurse is caring for a hospitalized 6 month old client. Which of the following interventions should the nurse implement to provide developmentally appropriate care for this client? SATA 1. Adhere to the child's home routine when possible during hospitalization 2. Encourage parents to bring the child's favorite toy from home 3. Have the parents step out of the room during procedures 4. Promote a quiet sleep environment with reduced stimuli 5. Provide a parent's shirt for the child to hold during procedures

1. Adhere to the child's home routine when possible during hospitalization 2. Encourage parents to bring the child's favorite toy from home 4. Promote a quiet sleep environment with reduced stimuli 5. Provide a parent's shirt for the child to hold during procedures

The nurse is caring for a 10 year old diagnosed with osteomyelitis. What is the best activity the nurse can suggest to promote age-specific growth and development during hospitalization? 1. Fantasy play with puppets 2. Invite friends to come visit 3. Provide missed schoolwork 4. Watch favorite movies

3. Provide missed schoolwork

The nurse assists with a staff education conference about appropriate non-pharmacological pain management interventions for newborns and infants. Which of the following strategies should be included in the presentation? SATA 1. Administer an oral sucrose solution to a newborn during a circumcision procedure 2. Apply a cold pack to a newborn's heel 30 minutes before performing a heel stick 3. Assist the parent to hold a newborn skin to skin during an immunization injection 4. Offer a pacifier to an infant while performing venipuncture 5. Swaddle an infant while leaving one arm unwrapped during an IV dressing change

1. Administer an oral sucrose solution to a newborn during a circumcision procedure 3. Assist the parent to hold a newborn skin to skin during an immunization injection 4. Offer a pacifier to an infant while performing venipuncture 5. Swaddle an infant while leaving one arm unwrapped during an IV dressing change

The nurse is reviewing the plan of care for a 4 year old client who will receive daily dressing changes for an infected leg wound. Which of the following interventions should the nurse include in the plan of care for a pre-school age child? SATA 1. Allow the child's parent's to stay during the procedure 2. Emphasize that dressing changes are not punishment for misbehavior 3. Encourage the child to voice questions and concerns about the procedure 4. Have the child place bandages on a doll when reinforcing education 5. Introduce the child to other clients with the same health condition

1. Allow the child's parent's to stay during the procedure 2. Emphasize that dressing changes are not punishment for misbehavior 3. Encourage the child to voice questions and concerns about the procedure 4. Have the child place bandages on a doll when reinforcing education

The nurse prepares a 7 year old client for an influenza injection. The nurse explains that the client will receive medicine under the skin, and the client is visibly anxious. Which nursing intervention is appropriate? 1. Ask the child to count to 10 during injection 2. Ask the parent to hold the child's arm tightly 3. Explain to the child that the injection will not hurt 4. Keep the injection needle out of the child's view

1. Ask the child to count to 10 during injection

The parents of a hospitalized 3 month old have to leave the infant while they work. One parent fears that the baby will cry as soon as they walk out. The nurse teaches both parents about separation anxiety. Which statement by the parent indicates that the teaching has been effective? 1. At this age, my baby will not cry because we are leaving 2. I know my baby will feel abandoned when we leave 3. My baby is too young to sense my anxiety about leaving 4. My baby understands that we will return later in the day

1. At this age, my baby will not cry because we are leaving

The nurse is providing teaching to the parents of a child with Marfan Syndrome. Which topic is the priority for the nurse to address? 1. Avoiding participation in contact sports 2. Informing the dentist of the child's condition 3. Monitoring for development of scoliosis 4. Scheduling annual eye examinations

1. Avoiding participation in contact sports **Marfan syndrome is autosomal dominant disorder affected connective tissue of the body. Clients with Marfan are very tall and thin, disproportionately long arms, legs and fingers. **Cardiovascular manifestations such as abnormalities of aorta/cardiac valves, aneurysms, dissections, leaky heart valves that may require repair or replacement. So it is competitive or contact sports are discouraged due to the risk of cardiac injury and sudden death.

A nurse is speaking with the parent of a toddler who believes the child has a hearing deficit. Which findings support this suspected diagnosis? SATA 1. Behavior appears withdrawn 2. Intelligible speech began at age 12 months 3. Monotone speech 4. Seems attentive, nods and smiles when given directions 5. Speaks with a loud voice

1. Behavior appears withdrawn 3. Monotone speech 5. Speaks with a loud voice **Hearing impairment in children can be related to family history, infection, certain meds, or a congenital disorder. **The toddler may appear shy, timid, withdrawn, dreamy, speech is monotone, difficult to understand and displays increased use of gestures and facial expressions.

The nurse is educating a group of parents about ways to decrease the risk of sudden infant death syndrome. Which of the following recommendations should the nurse suggest? SATA 1. Breastfeed the infant 2. Co-sleep with the infant in the parent's bed 3. Ensure the infant's vaccinations are updated 4. Maintain a smoke free environment 5. Place the infant to sleep in a side lying position 6. Provide a firm sleep surface for the infant

1. Breastfeed the infant 3. Ensure the infant's vaccinations are updated 4. Maintain a smoke free environment 6. Provide a firm sleep surface for the infant

What play behavior would the nurse be most likely to observe in a group of 4 year old children? 1. Children playing and borrowing blocks from each other without directing others 2. Children playing and working together to build a castle out of blocks 3. Children playing next to each other with blocks, but not interacting 4. Children playing with blocks by themselves in separate areas of the room

1. Children playing and borrowing blocks from each other without directing others

The nurse is providing care to a 9 year old client who is awaiting surgery. Which intervention is developmentally appropriate for this client's plan of care? 1. Discuss the procedure with the client using simple diagrams with correct anatomical terminology 2. Explore the client's perception of how the surgery will positively affect their future 3. Focus primarily on the client's feelings and concerns regarding surgical scar appearance 4. Provide initial education about the procedure to the client immediately before it is performed

1. Discuss the procedure with the client using simple diagrams with correct anatomical terminology **School age child (6-12) develop a sense of industry so interacting with the child directly and using correct anatomical terminology.

A nurse is planning to complete a physical examination of a toddler. Which approach is an appropriate intervention by the nurse? 1. Encourage the parent to be involved with the child 2. Engage in physical contact by removing the toddler's outer clothing first 3. Have medical equipment lying on a counter within view 4. Perform an examination in a head to toe order

1. Encourage the parent to be involved with the child

The parents of a 5 year old ask the school nurse for advice on how to tell this child about being adopted. Which developmentally appropriate thought about adoption by the child does the nurse counsel the parents to anticipate? 1. Feels responsible for being placed for adoption 2. Imagines what life would be like with a different family 3. Is unable to conceptualize differences between adoptive and biological parents 4. Worries about what peers will say or think

1. Feels responsible for being placed for adoption

The nurse is assessing a 4 year old boy in a pediatric clinic. Which behaviors by the client would concern the nurse for possible Duchenne muscular dystrophy? SATA 1. Frequently trips and falls at home 2. Has painful knees and elbows in the morning 3. Places hands on the thighs to push up to stand 4. Suddenly rigidly extends the arms and legs 5. Walks on tiptoes and has disproportionately large calves

1. Frequently trips and falls at home 3. Places hands on the thighs to push up to stand 5. Walks on tiptoes and has disproportionately large calves **Duchenne muscular dystrophy is an X-linked recessive disorder that causes progressive replacement of dystrophin, a protein needed for muscle stabilization with connective tissue. **Duchenne patient uses Gower sign/maneuver (placing hands on the thighs to push up to stand) and walk on tiptoes. The patient may report frequent tripping and falling

A child is brought to the school nurse after having a permanent tooth knocked out during gym class. Which action by the nurse is appropriate? 1. Gently rinse the tooth with sterile saline and reinsert it into the gingival cavity 2. Gently scrub the root of the tooth to remove any debris, and wrap it in sterile gauze 3. Place the tooth in water and transport the client to the nearest emergency department 4, Wrap the tooth in sterile gauze and advise the parent to arrange for a dental appointment

1. Gently rinse the tooth with sterile saline and reinsert it into the gingival cavity **Dental avulsion (tooth separated from the mouth) of a permanent tooth is dental emergency. The priority action is to rinse and reinsert the tooth into the gingival socket and hold it into place (with a finger) until stabilized by a dentist. Re-implantation within 15 minutes of injury re-establishes blood supply and increases probability of tooth survival.

A nurse is discussing the fine motor abilities of a 10 month old infant with the infant's parent. Which are developmentally appropriate skills for an infant of this age? SATA 1. Grasps a small doll by the arm 2. Stacks 3 wooden blocks 3. Transfers small objects from hand to hand 4. Turns single pages in a book 5. Uses a basic pincer grasp

1. Grasps a small doll by the arm 3. Transfers small objects from hand to hand 5. Uses a basic pincer grasp

The parent of a 2 year old tells the nurse at the well child clinic, "I am concerned because my child does not like to be cuddled, does not respond when called by name and does not make eye contact when being fed." What is the priority question for the nurse to ask when completing the health history? 1. How many words can your child say? 2. Is your child potty trained? 3. What are your child's favorite foods? 4. What kind of toys does your child like to play with?

1. How many words can your child say?

A nurse on a pediatric unit is reviewing interventions for a toddler with a practical nurse who will be caring for this child. Which of the following are appropriate activities to minimize the effect of hospitalization on a toddler? SATA 1. Integrate preferred snack foods in the day's routine 2. Plan quiet play prior to usual nap time 3. Point out body changes that may occur 4. Post a daily schedule by the child's bed 5. Provide 1-2 options when choosing toys

1. Integrate preferred snack foods in the day's routine 2. Plan quiet play prior to usual nap time 5. Provide 1-2 options when choosing toys

The nurse is performing a physical assessment on a 2 year old with cold symptoms and a fever at home of 101.7. The parents is concerned about the child's ability to cooperate during the examination. Place the components of assessment in the order the nurse would perform them. 2. Play with the child using a finger puppet 1. Interact with the parent in a friendly manner 4. Auscultate the child's heart and lungs 5. Take the child's vital signs 3. Measure the child's height and weight

1. Interact with the parent in a friendly manner 2. Play with the child using a finger puppet 3. Measure the child's height and weight 4. Auscultate the child's heart and lungs 5. Take the child's vital signs

The nurse is performing a well child assessment on a sleeping 2 month old client. Organize the assessment in the correct order based on the developmental age of the client. 5. Elicit Moro reflex 2. Auscultate heart and lungs 1. Observe skin color and respiratory pattern 4. Assess pupillary response 3. Palpate fontanelles and abdomen

1. Observe skin color and respiratory pattern 2. Auscultate heart and lungs 3. Palpate fontanelles and abdomen 4. Assess pupillary response 5. Elicit Moro reflex

A nurse is performing an assessment of a 12 month old client. Which of the following findings would the nurse expect? SATA 1. Approaches strangers with ease 2. Birth weight is tripled 3. Can skip and hop on one foot 4. Fully developed pincer grasp 5. Sits from a standing position

2. Birth weight is tripled 4. Fully developed pincer grasp 5. Sits from a standing position

A 2 month old recently diagnosed with developmental dysplasia of the hip (DDH) is beginning treatment with a Pavlik harness. Which instructions should the nurse provide to the parents? SATA 1. Apply lotion under the straps to protect the skin 2. Dress the child in a shirt and knee socks under the straps 3. Lightly massage the skin under the straps daily 4. Place the diaper under the straps 5. Remove the harness during diaper changes

2. Dress the child in a shirt and knee socks under the straps 3. Lightly massage the skin under the straps daily 4. Place the diaper under the straps **A pavlik harness is most common tool to treat (Developmental dysplasia of the hip) DDH. **The nurse should regularly assess skin for redness and breakdown, dress in shirt and knee socks, avoiding lotions, massaging the skin to promote circulation, using 1 diaper at a time and keeping harness clean and dry.

The nurse provides teaching for the parents of a 6 year old client diagnosed with nocturnal enuresis. Which of the following instructions will the nurse include? SATA 1. Allow the child to wear a diaper at bedtime to avoid accidents 2. Encourage the child to help change soiled pajamas and linens 3. Prepare a calendar with the child for logging wet and dry nights 4. Restrict the child's fluids to 8 oz with each meal 5. Wake the child at a specified time each night to void

2. Encourage the child to help change soiled pajamas and linens 3. Prepare a calendar with the child for logging wet and dry nights 5. Wake the child at a specified time each night to void

The pediatric nurse cares for a 16 year old client who is scheduled for an appendectomy in the morning. Which of the following interventions are appropriate to support the client's psychosocial needs? SATA 1. Create a strict daily schedule for the client while hospitalized 2. Encourage the client to have peers visit while hospitalized 3. Ensure parental presence during any client procedure 4. Include the client as an active participant when planning care 5. Support the client in discussing concerns about body image changes

2. Encourage the client to have peers visit while hospitalized 4. Include the client as an active participant when planning care 5. Support the client in discussing concerns about body image changes

The graduate nurse in the emergency department is providing discharge teaching to the parent of a client with a leg fracture who is going home with a newly applied cast. Which of the following statements by the GN require the nurse preceptor to intervene? SATA 1. Elevate your child's leg on a pillow for the first 24-48 hours to reduce swelling 2. For bathing, covering the cast is not necessary. It must simply be held outside of the tub 3. If the pain medication is ineffective, the doctor may need to prescribe something stronger 4. Itching under the cast is common. A blow dryer on a cool setting can provide relief 5. There may be numbness or tingling in the leg or foot, but it should go away in 24 hours

2. For bathing, covering the cast is not necessary. It must simply be held outside of the tub 3. If the pain medication is ineffective, the doctor may need to prescribe something stronger 5. There may be numbness or tingling in the leg or foot, but it should go away in 24 hours

The nurse in a clinic is obtaining a developmental history of an 18 month old during a well child visit. Which activities should the child be able to perform? SATA 1. Calls self by name 2. Goes upstairs while holding a hand 3. Stacks 6 blocks in a tower 4. Turns 2 pages in a book at a time 5. Twists doorknob to open doors

2. Goes upstairs while holding a hand 4. Turns 2 pages in a book at a time

The nurse is teaching the parents of a 4 month old who has developed positional plagiocephaly (flat head syndrome). Which statement by the parents indicates a need for further teaching? 1. I should alternate head positions when the infant is supine 2. I should place the infant in the prone position during naps 3. I will minimize the amount of time the infant is in a car seat 4. I will place interesting toys opposite the affected side

2. I should place the infant in the prone position during naps **Positional plagiocephaly (flat head syndrome) occurs when the infant's soft, pliable skull is placed in the same position for an extended time.

The nurse is evaluating a parent's understanding of home care management for a 2 week client after initial cast placement for treatment of congenital clubfoot. Which of the following statements by the parent indicates a correct understanding? SATA 1. Cradling my baby in my arms may cause stress and damage to the cast 2. I will check my baby's toes several times a day to ensure that they are pink and warm 3. My baby should alternate between sleeping on the stomach and back 4. My baby will need to have a new cast applied weekly for 5-8 weeks 5. When I bathe or diaper my baby, I will be sure to keep the cast dry

2. I will check my baby's toes several times a day to ensure that they are pink and warm 4. My baby will need to have a new cast applied weekly for 5-8 weeks 5. When I bathe or diaper my baby, I will be sure to keep the cast dry **Clubfoot (talipes equinovarus) is a congenital bone deformity and soft tissue contracture manifested by one or both feet being turned inward.

The nurse is assessing a 3 month old during a well child visit. Which developmental finding should the nurse expect to observe in the client? 1. Infant cries and clings to parent when members of the health team come near 2. Infant kicks legs, smiles, and coos when a familiar face comes into view 3. Infant transfers a ball from one hand to the other hand 4. Infant turns from the back to the abdomen

2. Infant kicks legs, smiles, and coos when a familiar face comes into view

What socioeconomic indicators would the nurse identify as risk factors for a 2 month old infant to develop failure to thrive (FTT)? SATA 1. Both caregivers work outside the home 2. Infant lives only with mother, who is currently unemployed 3. Infant's primary caregiver has cognitive disabilities 4. Parents are socially and emotionally isolated 5. Parents liver together but are not married

2. Infant lives only with mother, who is currently unemployed 3. Infant's primary caregiver has cognitive disabilities 4. Parents are socially and emotionally isolated

The nurse is reviewing the medical record of a 4 year old client with failure to thrive. Which of the following risk factors likely contribute to the client's condition? SATA 1. Child is the youngest of four children in the home 2. One parent is incarcerated for spousal abuse 3. One parent was diagnosed with anorexia nervosa prior to having children 4. One parent works full time job outside of the home 5. Parents are concerned about not having enough money to buy food

2. One parent is incarcerated for spousal abuse 3. One parent was diagnosed with anorexia nervosa prior to having children 5. Parents are concerned about not having enough money to buy food

The nurse is assessing a 4 week old infant during a routine office visit. Which assessment finding is most likely to alert the nurse to the presence of right hip developmental dysplasia (DDH) ? 1. Decreased right hip adduction 2. Presence of extra gluteal folds on the right side 3. Right leg is longer than the left leg 4. Right pelvic tilt with lordosis

2. Presence of extra gluteal folds on the right side **Developmental dysplasia of the hip DDH is a set of hip abnormalities ranging from mild dysplasia of the hip joint to full dislocation of the femoral head. **If DDH is not corrected as the child develops and learns to walk. There maybe a notable limp, walking on the toes, positive Trendelenburg sign (pelvis tilts down on unaffected side)

The nurse cares for a 4 year old who is on long-term strict bed rest. Which toy is most appropriate to provide diversion and minimize developmental delays? 1. Board games 2. Puppets 3. Soap bubbles 4. Stacking and nesting toys

2. Puppets

The nurse assesses 4 infants. Which assessment finding would require follow up by the healthcare provider? 1. 3 week old whose anterior fontanelle bulges with crying 2. 4 week old whose posterior fontanelle is soft 3. 6 month old with birth weight of 7 lb 3 oz who now weights 12 lb 4. 12 month old with birth weight of 6 lb 4 oz who now weights 20 lb

3. 6 month old with birth weight of 7 lb 3 oz who now weights 12 lb **Infant growth is fast paced during the first year of life, with birth weight doubling by age 6 months and tripling by 12 months.

A 15 year old parent brings a 4 month old infant for a well baby checkup. The parent tells the nurse that the baby cries all the time; the parent has tried everything to keep the infant quiet but nothing works. What is the priority nursing action? 1. Advise the parent to give a pacifier whenever the infant cries 2. Ask the parent to describe what is done to keep the baby quiet 3. Assess the infant's pattern and frequency of crying 4. Explore the parent's support system

3. Assess the infant's pattern and frequency of crying

A nurse in a pediatric clinic is performing a physical examination of a 30 month old child. Which finding requires further evaluation? 1. Bladder and bowel control achieved 2. Chest circumference is greater than abdominal circumference 3. Current weight is 6 times greater than birth weight 4. Head circumference increased by 1 inch in the past year.

3. Current weight is 6 times greater than birth weight Weight gain tends to slow during the toddler years. By 30 months, the weight should be 4 times greater than the birth.

The clinic nurse is caring for a 3 year old client. Which task, if not observed or reported by the parents as accomplished will cause the nurse concern? 1. Catches a ball at least 50% of the time 2. Copies a square with a pencil or crayon 3. Eats with a spoon 4. Hops on one foot

3. Eats with a spoon ** A 3 year old should be able to eat with a spoon

A nurse is discussing parallel play with the parent of a 2 year old. Which statement by the parent indicates understanding of the discussion? 1. I encourage working in a group to build towers with large blocks 2. I have a chalk board available to teach the alphabet and numbers 3. I set out a basket of various balls in the backyard when other children come to play 4. I try to organize games that involve a team approach

3. I set out a basket of various balls in the backyard when other children come to play ** Parallel play is typical behavior of a toddler that involves activities focused on improving motor skills, imitating and using multiple senses. **Parallel play, involves playing alongside, not with other children.

The nurse is assessing an 8 month client during a well-child visit. Which assessment finding should the nurse report to the health care provider? 1. Infant responds to their name when called but has not spoken any words 2. Infant was gaining 5 oz per week at age 6 months and is now gaining 3oz per week 3. Infant's head stays behind the shoulder when raised from a supine to a sitting position 4. Infant's posterior fontanel is not palpable when performing assessment of the head

3. Infant's head stays behind the shoulder when raised from a supine to a sitting position **A head lag (head falling behind the shoulders when raised from a supine to a seated position) A head lag remaining after age 6 months is an abnormal finding that is associated with cerebral palsy or autism. **The posterior fontanelle closes by age 2 months. Should not be palpable in the infant.

The nurse is admitting an infant who has severe growth deficiency and facial characteristics of indistinct philtrum, a thin upper lip, and short palpebral fissures. Which question should the nurse ask to assess the cause of these clinical findings? 1. Is the mother of advanced age 2. Is there a history of cigarette use during pregnancy 3. Is there a history of exposure to alcohol in utero 4. Is there a maternal history of valproate use

3. Is there a history of exposure to alcohol in utero **Fetal alcohol syndrome is leading cause of intellectual disability and developmental delay

The nurse is performing well child examinations in a pediatric clinic. Which finding requires further evaluation? 1. Bilateral bowlegs (genu varum) in a 15 month old 2. Chest rounded with the anteroposterior diameter equal to the lateral diameter in an infant 3. Lateral curvature to the spine noted on examination of a 10 year old 4. Presence of an S3 heart sound in a 2 year old

3. Lateral curvature to the spine noted on examination of a 10 year old Lateral curvature to the spine may indicate of scoliosis. It is commonly noticed during periods of rapid growth, during early adolescence in girls. **Scoliosis is always abnormal. Early detection and prompt treatment of scoliosis may reduce need for surgical intervention **Genu varum (bowlegs) is the lateral bowing of the legs, which is common in toddlers that are learning to walk.

A 5 year old child is receiving morphine sulfate for pain. Which statement by the caregiver indicates that further teaching is necessary? 1. I will call the nurse if my child begins to act aggressively 2. I'm concerned that my child thinks the pain is punishment 3. My child is playing and so does not need pain medication 4. The FACES pain scale seems to be working very well

3. My child is playing and so does not need pain medication **The child who is playing or sleeping might still be experiencing pain but is using distraction as a coping mechanism.

A 12 month old is found to have a moderately elevated blood lead level. Which of the following is the most serious concern for this child? 1. Gastrointestinal bleeding 2. Growth retardation 3. Neurocognitive impairment 4. Severe liver injury

3. Neurocognitive impairment **Lead based paints found in houses built before 1978, screenings are recommended and levels of more than 5mcg is dangerous in young children. **Prolonged elevated blood level lead can lead to permanent cognitive impairment, seizures, blindness and even death. **Dangerous in young children to immature development of brain and nervous system.

The nurse is caring for an infant with osteogenesis imperfecta admitted with a new fracture. The client also has old fractures in multiple stages of healing but no bruising, abrasions, or redness of the skin. Which nursing intervention should be included in the plan of care? 1. During the diaper changes, carefully life the infant by the ankles 2. Life from under the arms when picking up the infant 3. Obtain blood pressure manually to avoid cuff over tightening 4. Request a social work consultation to assess for child abuse

3. Obtain blood pressure manually to avoid cuff over tightening ** Osteogenesis imperfect is brittle bone disease. resulting in impaired synthesis of collagen by osteoblasts. Collagen allows the bone to be flexible while maintaining strength. Impaired collagen causes bones to be frail and easily fractured.

The summer camp nurse and parent of a 9 year old with juvenile idiopathic arthritis (JIA) are discussing appropriate physical activities for the child. Which of the following activities should be included? SATA 1. Dodgeball 2. Reading a book 3. Stationary bicycling 4. Swimming 5. Yoga

3. Stationary bicycling 4. Swimming 5. Yoga **Children with juvenile idiopathic arthritis have decreased muscle strength and endurance and overall capacity for exercise. ** range of motion and stretching to preserve joint mobility and strengthen muscles are best.

The parent of a newborn is concerned about the possibility of the child developing hip dysplasia. Which intervention should the nurse encourage to help reduce the risk in this newborn? 1. Choose an infant carrier with a narrow seat 2. Place 2 diapers on the infant at all times 3. Swaddle the infant with hips flexed and abducted 4. Use an infant swing that keeps both legs straight

3. Swaddle the infant with hips flexed and abducted Developmental dysplasia of the hip is a range of hip abnormalities that may present at birth or develop during the first few years of life. Preventive measures include proper swaddling with hips bent up and out and avoiding seats that hold the legs straight and together

The nurse is teaching a group of new parents about oral hygiene for their children. One of the parents ask, "When should I take my child to the dentist?" What would be the best response from the nurse? 1. It is recommended that your child's first dental visit be after age 1 2. The first visit should be when all of your child's baby teeth have come in 3. The initial dentist visit should be soon after the child's first tooth appears 4. Your child will need to be taken to the dentist before starting preschool

3. The initial dentist visit should be soon after the child's first tooth appears ** It is recommended that children have their first dental visit within 6 months of first tooth or by their first birthday. **This promotes early assessment, dental care, guidance and education about periodontal disease prevention.

A 10 year old is implementing behavioral strategies to manage nocturnal enuresis. The client tells the nurse, "I want to go to sleep away camp during the summer, but if I have an accident, I'm afraid that other kids will tease me" What's the best response by the nurse? 1. Don't worry. Your problem will be resolved by then 2. It would be better if you thought about going to day camp instead 3. We can ask your healthcare provider about a medication trial that may help 4. You could always wear a pull up just in case

3. We can ask your healthcare provider about a medication trial that may help **Pharmacological interventions like desmopressin and tricyclic antidepressants often used for nocturnal enuresis when there is little to no response to behavioral approaches.

The parent of a 1 year old says to the nurse, "I would like to start toilet training my child as soon as possible." What information does the nurse provide to the parent that correctly describes a child's readiness for toilet training? 1. A good time to start toilet training is when your child can dress and undress autonomously 2. When your child can sit on the toilet until urination occurs, you can start toilet training 3. Your child may be ready to start toilet training when able to communicate and follow directions 4. Your child will be ready to start toilet training at about age 15 months

3. Your child may be ready to start toilet training when able to communicate and follow directions

The nurse is providing health promotion education to the parent of a toddler. Which statement by the parent requires the nurse to clarify teaching? 1. I will offer my child options rather than asking yes or no questions 2. I will wait at least 15 minutes after a play period to offer a meal to my child 3. If my child is having a tantrum, I will have them sit in a quiet area for a short time out 4. If my child refuses a meal, I will have them stay at the table until they eat half the food.

4. If my child refuses a meal, I will have them stay at the table until they eat half the food. **Physiologic anorexia is a decrease in nutritional need and appetite. Parents should avoid forcing food or pressuring toddlers to eat more, since it can lead to poor eating habits in the future.

A 2 month old infant has been admitted to the hospital with suspected shaken baby syndrome (abusive head trauma). In reviewing the infant's chart, the nurse expects to encounter which of these clinical findings? 1. A reported history of recent trauma 2. Abdominal bruising 3. External signs of trauma 4. Irritability and vomiting

4. Irritability and vomiting **Shaken baby syndrome (SBS) is an abusive head injury and severe physical child abuse resulting in violent shaking of an infant by arms, legs or shoulders. The impacting of shaking causes bleeding within the brain or eyes. The signs of SBS are vomiting, irritability, inability to suck or eat, seizures and inconsolable crying.

The public health nurse conducts a teaching program for parents of infants. Which statement by a participant indicates that teaching has been effective? 1, After age 6 months, it is safe to use honey to sweeten my infant's formula 2. I should wait until my infant is 1 year old to introduce egg products 3. I will switch my 1 year old to low fat milk instead of commercial formula 4. My infant should be able to pick up small finger foods by age 10 months

4. My infant should be able to pick up small finger foods by age 10 months ** Formula should NOT be sweetened. Honey is raw and children have an immature gut system **waiting 4-6 months to introduce eggs, fish, peanut to decrease possibility of development for risk of food allergy **Infants should be transitioned to whole milk not low fat. Due to the rapid growth, the child's brains requires nutrition from the fat around the whole milk

The public health nurse has received a referral to make a follow up home visit to a 1 year old recently diagnosed with failure to thrive (FTT). Which intervention is the priority nursing action for this child? 1. Assess overall parenting skills 2. Complete a 24 hour dietary intake 3. Measure the child's height, weight and head circumference 4. Observe the child feeding

4. Observe the child feeding **Observing the child feeding or when hungry will provide the nurse opportunity to identify potential factors contributing to insufficient intake.

The clinic nurse is asked by the mother of a 15 month old, "I am worried about my child's thumb sucking and its effects on tooth alignment. What should I do? What is the nurse's best response? 1. As long as your child's thumb sucking stops by age 2-3 years when all of the primary teeth have erupted, there is little concern 2. Because your child already has teeth, it is important to implement a plan to stop the thumb sucking as soon as possible 3. Newer research shows that thumb sucking has little effect on a child' teeth 4. The risk for misaligned teeth occurs when thumb sucking persists after eruption of permanent teeth

4. The risk for misaligned teeth occurs when thumb sucking persists after eruption of permanent teeth Parents should be taught that teasing and punishing a child for using a pacifier is not effective for getting child to stop. This can increase the child's anxiety and cause child to increase behavior

The clinic nurse reviews teaching provided to the parent of a child being considered for growth hormone replacement therapy at home. Which statement by the parent indicates that teaching has been effective? 1. Treatment will be considered a success when my child grows at a rate equal to peers 2. Treatment will be required throughout my child's life 3. Treatment will begin when my child becomes an adolescent 4. Treatment will require a daily injection under my child's skin

4. Treatment will require a daily injection under my child's skin

The parent of an 8 year old client asks the nurse for guidance on how to help the client cope with the recent death of the other parent. When developing a response to the parent, the nurse considers that a school aged child is most likely to do what? 1. React anxiously to altered daily routines 2. Realize that death eventually affects everyone 3. Think about the religious or spiritual aspects of death 4. Understand that death is permanent but be curious about it

4. Understand that death is permanent but be curious about it

The registered nurse has completed a well-baby assessment of an 18 month old. Which assessment findings prompted the nurse to make a referral for a formal developmental screening test? 1. Cannot climb steps by self, pulls a toy, turns the pages of a book 2. Is bottle fed, can hold a spoon, creeps down stairs 3. Throws a ball, is able to point to 2-3 body parts, cannot draw a picture 4. Uses 2 words, cannot hold a cup, can seat self in a small chair

4. Uses 2 words, cannot hold a cup, can seat self in a small chair

A 14 year old is scheduled for surgery to treat scoliosis. The child will be hospitalized for about a week and then discharged home to recuperate for 3-4 weeks before returning to school. What is the best activity the nurse can recommend to promote age specific growth and development during this time? 1. Attending selected after school events and social activities 2. Keeping up with schoolwork 3. Reading teen magazines 4. Visits from friends

4. Visits from friends