NURS 328 Exam #1

These general approaches can be helpful when performing a physical examination. Select all that apply. A. With toddlers, restraint may be necessary, and requesting a parent's assistance is appropriate. B. When examining a preschooler, giving a choice of which parts to examine may be helpful in gaining the child's cooperation. C. With a school-age child, it is always best to have the parents present when examining. D. Giving explanations about body systems can make adolescents nervous due to their egocentricities. E. An infant physical examination is done head to toe, similarly to the adult.

A and B

A school nurse in middle school (grades 6, 7, and 8) is preparing an outline for a sex education class. Which of these statements represent important concepts to be covered in discussing this topic with this age-group? Select all that apply. A. Consider separating the boys and girls into same-sex groups with a leader of the same sex. B. Answer questions matter-of-factly and honestly and appropriate to the children's level of understanding. C. Use vernacular or slang terms to describe human physiologic functions. D. Avoid discussing sexually transmitted diseases in this age-group. E. Discuss common myths and misconceptions associated with sex and the reproductive process. F. Avoid controversial topics such as birth control.

A, B, and E

The nurse caring for a preschool child understands which of the following developmental concepts? Select all that apply. A. Preschoolers have egocentric thought and believe that everyone thinks as they do. B. Play can be therapeutic and enlightening into a child's level of understanding. C. Explanations are helpful when using detail to allay the preschooler's stress. D. Preschoolers understand inferences and can relate to others' feelings with empathy. E. Preschoolers have magical thinking and believe their thoughts have power.

A, B, and E

At the clinic appointment, a 4-year-old's mother wants to discuss several concerns. Which statements require more teaching by the nurse? Select all that apply. A. My husband feels that TV is okay as long as it is educational. B. I think it is okay for my son to play dress-up along with the girls. C. I told my son that his imaginary playmate moved away because it did not seem normal. D. My mother-in-law thinks I should be working around the house all the time, but I believe playing with my son is very important. E. My neighbor gave me some flash cards with letters and numbers for my son to use, but I said, "What's the rush? He's only 4."

A, C, and E

In terms of social development, the school-age child does which of the following? Select all that apply. A. Begins to explore the environment beyond the family B. Has an increased interest in persons of the opposite sex (gender) C. May actively participate in same-sex groups or clubs D. Strives to be different from those in the peer group E. Begins to form strong relationships with persons of the same sex (gender)

A, C, and E

Which childhood vaccine provides some protection against bacterial meningitis, epiglottitis, and bacterial pneumonia? A. Hib vaccine B. Hepatitis B vaccine C. Varicella vaccine D. Influenza vaccine

A. Hib vaccine

When assessing blood pressure in a child: A. Knowledge of normal mean is important: newborn, 65/41 mm Hg; 1 month to 2 years, 95/58 mm Hg; and 2 to 5 years, 101/57 mm Hg. B. Cuff size is the most important variable and should be measured using limb length. C. The child is considered normotensive if the BP is below the 95th percentile. D. Check upper- and lower-extremity BP to look for abnormalities such as aortic stenosis, which causes lower-extremity BP to be higher than upper-extremity BP.

A. Knowledge of normal mean is important: newborn, 65/41 mm Hg; 1 month to 2 years, 95/58 mm Hg; and 2 to 5 years, 101/57 mm Hg.

School-age children are prone to accidental injury primarily because of: A. Peer pressure and risk-taking behaviors B. Physical awkwardness and clumsiness C. Parents' lack of supervision D. Attempts to impress members of the opposite sex

A. Peer pressure and risk-taking behaviors

One of the key factors in addressing the health concerns and needs of the adolescent in a clinic or primary care office setting is to: A. Provide confidentiality B. Include the parent(s) in a discussion about the adolescent's sexual health C. Ask the adolescent if she or he is sexually active D. Discuss the negative effects of tobacco use

A. Provide confidentiality

The most reliable signs indicating adequate fluid volume replacement in a child admitted for dehydration is: A. Urine output of 1-2ml/kg/hr B. Decreasing hematocrit values C. Absence of thirst D. Vital signs within normal parameters for age

A. Urine output of 1-2ml/kg/hr

A hallmark of cognitive development in the school-age child is in what Piaget describes as concrete operations. In this stage the child: A. Uses thought processes to experience events and actions B. Is unable to see things from another's point of view C. Has a limited perspective of how others' interpretations of a given event differ D. Makes judgments based on what he or she sees

A. Uses thought processes to experience events and actions

Which of the following clients have the highest percentage of water in the body? A. newborn infant B. six-month old C. 2-year-old An adolescent

A. newborn infant

Which of the following immunization booster vaccines should be considered for a 13-year-old adolescent who has completed all recommended routine childhood vaccinations? Select all that apply. A. DTaP vaccine B. Tdap vaccine C. Meningococcal vaccine D. Pneumococcal vaccine E. Hepatitis B vaccine F. Hib vaccine

B and C

According to Jean Piaget, adolescent cognitive development is represented by the stage of formal operational thought that includes which of the following? Select all that apply. A. Believing that thoughts are all-powerful B. Thinking in abstract terms C. Thinking about hypotheses D. Using a future time perspective E. Thinking in the here and now

B, C, and D

While interviewing parents who have just arrived in the health care clinic, the nurse begins the interview. Which of the following statements involve therapeutic communication techniques? Select all that apply. A. Allow the parents to direct the conversation so that they feel comfortable and in control. B. Use broad, open-ended questions so that parents can feel open to discuss issues. C. Redirect by asking guided questions to keep the parents on task. D. Use careful listening, which relies on the use of clues and verbal leads to help move the conversation along. E. Ask carefully worded, detailed questions to get accurate information.

B, C, and D

Because injuries are the most common cause of death and disability in children in the United States, which stage of development correctly determines the type of injury that may occur? Select all that apply. A. A newborn may roll over and fall off an elevated surface. B. The need to conform and gain acceptance from his peers may make a child accept a dare. C. Toddlers who can run and climb may be susceptible to burns, falls, and collisions with objects. D. A preschooler may ride her two-wheel bike in a reckless manner. E. A crawling infant may aspirate due to the tendency to place objects in his mouth.

B, C, and E

As the nurse is getting Nathan ready for surgery, his doctor asked you to explain preemptive analgesic to Nathan's mother. Which response leads you to believe his mother needs more teaching? A. "I understand that preemptive analgesia is giving Nathan pain medication before he has pain and could be given before surgery." B. "This medication will control Nathan's pain so he doesn't feel anything." C. "Giving this medicine early may help prevent complications after surgery." D. "By controlling Nathan's pain, he will be more comfortable and may be able to go home sooner."

B. "This medication will control Nathan's pain so he doesn't feel anything."

An adolescent is dx with Leukemia. He is admitted to the Peds oncology floor. The patient is to receive chemotherapy and high dose steroids. The nurse assigned to the patient should be aware that an adolescent at this age will: A. Like to feel dependent and enjoy the sick role B. Be concerned with altered body image C. Be bothered by limited activities D. Preoccupied by missed schoolwork

B. Be concerned with altered body image

Pain scales for infants and their uses include but are not limited to: A. CRIES: Crying, Requiring increased oxygen, Inability to console, Expression, and Sleeplessness B. FLACC: child's face, legs, activity, cry, and consolability C. NCCPC: parent and health caregiver questionnaire assessing acute and chronic pain D. NPASS: neonatal pain, agitation, and sedation scale for infants from 3 to 6 months

B. FLACC: child's face, legs, activity, cry, and consolability

One of the most common intestinal parasitic pathogens in the United States acquired from a contaminated water source such as a lake or swimming pool is: A. Tinea capitis B. Giardia intestinalis C. Pediculosis capitis D. Enterobiasis

B. Giardia intestinalis

When her preschool son is in the hospital, the parent tells the nurse, "I think there is something wrong with him because he is so skinny." The most appropriate answer by the nurse is: A. Most preschoolers weigh between 10 and 14 kilograms. B. The legs of a preschooler, rather than the trunk, increase in length, which may make him look slimmer. C. Preschoolers usually keep that pot-bellied appearance until about 4 years old. D. Most preschoolers gain 2 to 3 pounds per year.

B. The legs of a preschooler, rather than the trunk, increase in length, which may make him look slimmer.

One of the concerns of the preschool period is adequate nutrition. What can the nurse say to give anticipatory guidance to parents? A. Preschoolers are growing during this period and need to increase their caloric intake to 110 kcal/kg, for an average daily intake of 2200 calories. B. There is some evidence that children self-regulate their caloric intake. If they eat less at one meal, they compensate at another meal or snack. C. To monitor fat intake, dairy and meat should be limited to twice a day. D. For children who do not like milk, consumption of fruit juices is a healthy alternative.

B. There is some evidence that children self-regulate their caloric intake. If they eat less at one meal, they compensate at another meal or snack.

One of the primary reasons for monitoring the toddler's activities and intervening to prevent accidental injury is that: A. Toddlers have oppositional defiant behavior and negativism B. Toddlers do not understand the concept of "cause and effect," so explaining that certain actions will result in serious injury is useless C. Toddlers will often listen to reasoning about why an activity should be avoided D. Toddlers enjoy making their parents worry about their safety and like to see the parents' reactions to the behavior

B. Toddlers do not understand the concept of "cause and effect," so explaining that certain actions will result in serious injury is useless

In relation to developmental milestones, the infant can be expected to roll over from back to abdomen at approximately: A. 2 months B. 4 months C. 6 months D. 8 months

C. 6 months

A 3-year-old boy is seen in the clinic at 8:30 pm with a history of vomiting for 2 days and poor oral intake; he has voided once since the previous day. Examination reveals a lethargic child sitting on the mother's lap. He has a capillary refill of 4 seconds, apical heart rate of 128, respiratory rate of 32, and poor skin turgor. Stated body weight is 25 kg. Based on this information, the nurse anticipates performing which of the following? A. Demonstrating to the mother how to give 5 to 10 ml of Pedialyte by mouth every 5 to 10 minutes B. Administering an intravenous fluid bolus of 450 ml of 5% dextrose in water over 60 minutes C. Administering an intravenous fluid bolus of 500 ml of 0.9% normal saline over 20 minutes D. Administering an intravenous fluid bolus of 1000 ml of 5% dextrose and 0.45% normal saline over 30 minutes

C. Administering an intravenous fluid bolus of 500 ml of 0.9% normal saline over 20 minutes

A nurse looks over her assignment for the day, which includes an infant, a preschool-age child, a third-grader, and a sophomore in high school. Which techniques take into consideration developmental stages when working with pediatric patients? A. Be aware that infants will become agitated because of stranger anxiety around 4 months old. B. When a preschooler is having blood drawn, giving a detailed explanation will be helpful. C. Explain and demonstrate what the BP machine does to the third-grader before taking her blood pressure. D. Using a single consistent approach with the adolescent will help allay anger and hostility.

C. Explain and demonstrate what the BP machine does to the third-grader before taking her blood pressure.

Separation anxiety is something that affects children when they are hospitalized. Each developmental stage has a somewhat different reaction as they deal with this difficulty. Which stage corresponds to the adolescent stage? A. May demonstrate separation anxiety by refusing to eat, experiencing difficulty in sleeping, crying quietly for their parents, continually asking when the parents will visit, or withdrawing from others. B. Separation anxiety comes in stages: protest, despair, and detachment. C. Loss of peer group contact may pose a severe emotional threat because of loss of group status, inability to exert group control or leadership, and loss of group acceptance. D. May need and desire parental guidance or support from other adult figures but may be unable or unwilling to ask for it.

C. Loss of peer group contact may pose a severe emotional threat because of loss of group status, inability to exert group control or leadership, and loss of group acceptance.

Which childhood vaccine provides protection against streptococcal infections such as otitis media, sinusitis, and pneumonia? A. Rotavirus B. Hib C. Pneumococcal D. MMR

C. Pneumococcal

A 4-day-old infant is seen in the emergency department for a possible seizure earlier in the day. The infant was being breastfed but without much success, so an aunt gave him a bottle of water. The infant continued to cry, and the mother was too exhausted to breastfeed, so another bottle of water was given while someone went to the store to purchase infant formula. The pregnancy, delivery, and postpartum history reveal no particular problems for this term infant that might contribute to seizures. The physical examination is unremarkable, with the exception of hypertonic reflexes. The infant is awake, alert, and sucking on his fists. Diagnostic studies are obtained, including an electrocardiogram. The nurse anticipates which of the following as the possible explanation for the infant's condition? A. Serum potassium of 3.9 mEq B. Serum glucose of 69 mg C. Serum sodium of 118 mEq D. Arterial pH of 7.34

C. Serum sodium of 118 mEq

A mother brings her 3-year-old daughter to the well-child clinic and expresses concern that the child's behavior is worrisome and possibly requires therapy or medication at minimum. The mother further explains that the child constantly responds to the mother's simple requests with a "no" answer even though the activity has been a favorite in the recent past. Furthermore, the child has had an increase in the number of temper tantrums at bedtime and refuses to go to bed. The mother is afraid her daughter will hurt herself during a temper tantrum because she holds her breath until the mother picks her up and gives in to her request. The nurse's best response to the mother is that: A. The child probably would benefit from some counseling with a trained therapist. B. The mother and father should evaluate their childrearing practices. C. The child's behavior is normal for a toddler and may represent frustration with control of her emotions; further exploration of events surrounding temper tantrums and possible interventions should be explored. D. The child's behavior is typical of toddlers, and the parents should just wait for the child to finish this phase because this will end soon.

C. The child's behavior is normal for a toddler and may represent frustration with control of her emotions; further exploration of events surrounding temper tantrums and possible interventions should be explored.

An important milestone in the infant's life is the development of object permanence. This milestone is represented by which of these statements? A. The infant smiles at the mother when she talks to him. B. The infant repeatedly flexes and extends his arms and legs when the mother picks him up. C. The infant turns and looks for the mother when she walks out of his view. D. The infant cries when the mother hands him to a babysitter.

C. The infant turns and looks for the mother when she walks out of his view.

An 8 yr old is being prepared for a tonsillectomy the next day. The nurse should approach pre-operative teaching about the surgery by: A. Provide a formal class with peers B. Utilize time for needle play C. Utilize a simple anatomical diagrams D. Give a child a pamphlet to read

C. Utilize a simple anatomical diagrams Remember that 8 year olds are in concrete operations. The best way to approach the child is a simple diagram with concrete examples.

A 7-month old female is admitted with severe dehydration. Which of the following lab data suggests that fluid volume replacement is less than adequate? A.Decreasing hematocrit and increasing urine output B.Falling hematocrit and decreasing urine output C.Rising hematocrit and decreasing urine output D.Decreasing hematocrit and urine output 1.4ml/kg/hour during last 4 hours

C.Rising hematocrit and decreasing urine output

The nurse would assess a 3 year with abdominal pain by: A. Asking the child to give an exact location the pain B. Asking the child when he last had a bowel movement C. Auscultation the abdomen for bowel sounds D. Observe the position and behavior while the child is moving

D. Observe the position and behavior while the child is moving The child with abdominal pain often is side-lying and fetal position/ or self splint when moving A 3 year old may not be able to define the exact location of the pain or tell you when he last had a BM

The nurse is going to give a toddler an IM injection. Which of the following interventions utilizes theories for growth and development in a toddler and is most therapeutic? A. Do not let the parents in the room during the procedure B. Explain in detail what is being done C. Give the toddler a choice of having the injection now or later D. Provide an opportunity for the parents to comfort the child after the procedure

D. Provide an opportunity for the parents to comfort the child after the procedure

Which vaccine do the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists recommend that pregnant adolescents and women who are not protected against pertussis receive optimally between 27 and 36 weeks of gestation or postpartum before discharge from the hospital? A. DTaP B. Td C. IPV D. Tdap

D. Tdap

The mother of a 6 yr old with acute phase of nephrotic syndrome asks about play activities for her child. The nurse should suggest: A. Hula hoop and jump rope B. stuffed animals and large puzzles C. CD player and magazines D. simple card games and water colors

D. simple card games and water colors School age children are competitive and creative. The hula hoop and jump rope will be too much physical activity.

A 8-month old child is undergoing a routine check-up. Select all findings the nurse would expect to find during an assessment of this child? (Select all that apply) a. Presence of the anterior fontanel b. Weight is more than doubled since birth c. Sits with support d. Grabs for rattle

a, b, and d Rationale: The anterior fontanel closes between 13-18 months. By 8 months of age the child should be sitting without support.

A nurse is planning care for a 7-year-old child hospitalized with osteomyelitis. Which activities should the nurse plan to bring from the playroom for the child? (Select all that apply.) a. Paper and some paints b. Board games c. Jack-in-the-box d. Stuffed animals e. Computer games

a, b, and e Rationale: We want to choose activities that are industrious. Think about it from a developmental standpoint.

What vaccinations are included in health promotion during infancy? (Select all that apply.) a. Haemophilus influenzae type b (Hib) b. Hepatitis C virus (HCV) c. Diphtheria, tetanus, and pertussis (DTaP) d. Poliovirus e. Hepatitis B virus (HBV)

a, c, d, and e

Elizabeth's mother is concerned that her baby is not gaining enough weight. The nurse can reassure the parent and provide anticipatory guidance. What statement would be made to Elizabeth's mother? a. "Elizabeth is gaining weight well. At 6 months, an infant is expected to have doubled his or her birth weight. At 1 year, the weight should triple." b. "Elizabeth is gaining weight well. At 6 months, an infant is expected to have tripled his or her birth weight. At 1 year, the weight should triple." c. "Elizabeth is gaining weight well. At 6 months, an infant is expected to have doubled his or her birth weight. At 1 year, the weight should quadruple." d. "Elizabeth is not gaining weight as expected. At 6 months, an infant is expected to have tripled his or her birth weight. At 1 year, the weight should quadruple"

a. "Elizabeth is gaining weight well. At 6 months, an infant is expected to have doubled his or her birth weight. At 1 year, the weight should triple."

A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath the next morning, he asks for Mommy. The nurse's best reply is which of the following? a. "Mommy will be here after lunch." b. "Mommy always comes back to see you." c. "Your mommy told me yesterday that she would be here today about noon." d. "Mommy had to go home for a while, but she will be here today."

a. "Mommy will be here after lunch."

The hepatitis A vaccine is now recommended for the first dose started at what age? a. 1 year b. 1 month c. 12 years d. It is not recommended at any age

a. 1 year

Emma is 4 months old and is scheduled for a well visit. The nurse expects that Emma should have received how many of which immunizations prior to this age? a. 2 HepB; 1 DTaP; 1 Hib; 1 polio; 1 Pneumococcal, 1 Rotovirus b. 1 HebB; 2 DTaP, 3 polio; 2 Hib; 1 Rotovirus c. 2 HepB; 1 Tdap; 1 Hib; 1 polio; 1 Rotovirus d. 1 HepB; 1 DTaP; 2 Hib; 1 polio; 1 Rotovirus; 1 Varicella

a. 2 HepB; 1 DTaP; 1 Hib; 1 polio; 1 Pneumococcal, 1 Rotovirus

Preschoolers' fears can best be dealt with by what interventions? a. Actively involving them in finding practical methods to deal with the frightening experience b. Forcing them to confront the frightening object or experience in the presence of their parents c. Using logical persuasion to explain away their fears and help them recognize how unrealistic the fears are d. Ridiculing their fears so that they understand that there is no need to be afraid

a. Actively involving them in finding practical methods to deal with the frightening experience

An 18-month-old child has just been admitted with croup. His parent is tearful and tells the nurse, "This is all my fault. I should have taken him to the doctor sooner so he wouldn't have to be here." What is appropriate in the care plan for this parent? a. Clarify misconception about the illness. b. Explain to the parent that the illness is not serious. c. Encourage the parent to maintain a sense of control. d. Assess further why the parent has excessive guilt feelings.

a. Clarify misconception about the illness. Guilt is a common response of parents when a child is hospitalized. They may blame themselves for the child's illness or for not recognizing it soon enough. The nurse should clarify the nature of the problem and reassure parents that the child is being cared for. Croup is a potentially serious illness. The nurse should not minimize the parents' feelings. It would be difficult for the parents to maintain a sense of control while their child is seriously ill. No further assessment is indicated at this time; guilt is a common response for parents.

What approach would be best to use to ensure a receptive response from a toddler? a. Focus communication on the child and tell him or her how a procedure will feel. b. Call the toddler's name while picking up him or her. c. Call the toddler's name and say, "I am your nurse." d. Stand by the toddler, addressing him or her by name.

a. Focus communication on the child and tell him or her how a procedure will feel. Toddlers see things only in relation to themselves and from their point of view. A stranger picking up a child up in an unfamiliar environment is very frightening for the toddler. Toddlers will not know the meaning of "nurse." Unknown adults who call the toddler by name can frighten the child.

Parents tell the nurse that their toddler daughter eats little at mealtime, only sits at the table with the family briefly, and wants snacks "all the time." Which intervention should the nurse recommend? a. Give her nutritious snacks. b. Offer rewards for eating at mealtimes. c. Avoid snacks so she is hungry at mealtimes. d. Explain to her in a firm manner what is expected of her.

a. Give her nutritious snacks.

The nurse is providing information to parents asking about selecting a daycare facility for their child. What does the nurse instruct the parents as important to consider when making the selection? a. Health practices of the facility b. Structured learning environment c. Socioeconomic status of the children d. Cultural similarities of the children

a. Health practices of the facility

What type of dehydration is defined as "dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion?" a. Isotonic dehydration b. Hypotonic dehydration c. Hypertonic dehydration d. All types of dehydration in infants and small children

a. Isotonic dehydration

After completion of the physical examination and physiologic measurements, the mother asks what other tests are necessary for Jessica now that she is 3 years old. What is the reply by the nurse? a. It is recommended that she have a vision and hearing screening test and an eye and a dental examination. b. She needs Hib and polio vaccinations. c. It is recommended that she have an eye and hearing examination. d. No other examinations or tests are necessary at this time.

a. It is recommended that she have a vision and hearing screening test and an eye and a dental examination.

What information does the nurse include when teaching parents about nonpharmacologic strategies for pain management in children? 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.

a. May reduce pain perception.

What are the more significant concerns with hypertonic dehydration? a. Neurologic disturbances b. Hypovolemic shock c. Impaired kidney function d. Parenteral therapy complications

a. Neurologic disturbances Cerebral changes in hypertonic dehydration are serious and may result in permanent damage and are therefore the most dreaded potential outcomes. Shock is more likely to occur in hypotonic or isotonic dehydration than in hypertonic dehydration. Renal compensation is impaired by reduced blood flow through the kidneys, which occurs in any form of dehydration. Parenteral therapy complications, such as too rapid initial fluid replacement, can result in cerebral edema in hypertonic dehydration. Therefore, this can be the cause of the dreaded outcome, rather than the outcome itself.

The mother asks about giving the children antidiarrheal medications. What is the appropriate recommendation by the nurse? a. Not recommended b. Recommended for children over age 6 months c. Recommended for children over age 1 year d. Recommended for children over age 4 years

a. Not recommended

The nurse is educating a new nurse on identification of pain in children. What does the nurse teach about physiologic measurements in children's pain assessment? a. Not useful as the only indicator for pain b. Best indicator of pain in children of all ages c. Most value when children also report having pain d. Essential to determine whether a child is telling the truth about pain

a. Not useful as the only indicator for pain Physiologic manifestations of pain may vary considerably, so they do not provide 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 reports pain on an appropriate pain scale, the appropriate interventions should be used.

What would the nurse emphasize when preparing parents to teach their children about human sexuality? a. Parents should determine exactly what the child knows and wants to know before answering a question about sex. b. A parent's words may have a greater influence on the child's understanding than the parent's actions. c. Parents should avoid using correct anatomic terms because they are confusing to preschoolers. d. Parents should allow children to satisfy their sexual curiosity by "playing doctor."

a. Parents should determine exactly what the child knows and wants to know before answering a question about sex.

What nursing intervention is most descriptive of atraumatic care of children? a. Preparing a child before any unfamiliar treatment or procedure b. Preparing a child for separation from parents during hospitalization c. Helping a child accept pain that is associated with a treatment or procedure d. Helping a child accept the loss of control associated with hospitalization

a. Preparing a child before any unfamiliar treatment or procedure

A father brings 15-year-old John into the physician's office for his sports physical examination. This is the first time you have met the family. While performing the health history, you observe that John becomes anxious during the sexual history, avoiding eye contact with you and his father and answering your questions with hesitation. What is the best action for you to take? a. Provide John with the opportunity to complete the health history without the father present. b. Encourage John to complete the questions honestly and openly. c. Assure John that although confidentiality is important, it is good to share this information with his father. d. Continue asking probing questions because you do not want to attract attention to John's behavior.

a. Provide John with the opportunity to complete the health history without the father present.

When a preschool child is hospitalized without adequate preparation, how would the child likely view this hospitalization? a. Punishment b. Loss of parental love c. Threat to child's self-image d. Loss of companionship with friends

a. Punishment If a preschool child is not prepared for hospitalization, a typical fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds. School-age children may see hospitalization as loss of parental love and loss of companionship with friends. A threat to child's self-image is a response characteristic of toddlers when threatened with loss of control.

What is descriptive of toddlers' cognitive development at age 20 months? a. Realize that "out of sight" is not out of reach. b. Search for an object only if they see it hidden. c. Put objects into a container but cannot take them out. d. Understand the passage of time, such as "just a minute" and "in an hour."

a. Realize that "out of sight" is not out of reach. At this age, children are in the final sensorimotor stage. They will now search for an object in several potential places even though they saw only the original hiding place. Children have a more developed sense of objective permanence.

The nurse is caring for a 12-year-old boy who sustained major burns when he put charcoal lighter on a campfire. The nurse observes that he is "very brave" and appears to accept pain with little or no response. What is the most appropriate nursing action? a. Request a psychologic consultation. b. Ask the child why he doesn't have pain. c. Praise the child for ability to withstand pain. d. Encourage continued bravery as a coping strategy.

a. Request a psychologic consultation. A psychologic consultation will help the child verbalize fears. Children in this age-group are concerned with physical appearance. The psychologists can help integrate the issues that the child is facing. It is likely that the child is having pain but not acknowledging the pain. If the child is feeling pain, the nurse should not praise him for hiding it. Encouraging continued bravery may not be an effective coping strategy if the child is in severe pain.

The nurse is assessing an infant brought to the clinic with diarrhea. He is lethargic and has dry mucous membranes. What would the nurse recognize as an early sign of dehydration? a. Tachycardia b. Bulging, tense fontanel c. Decreased blood pressure d. Capillary refill of less than 3 seconds

a. Tachycardia

The nurse is assessing a 7-month old infant during a well baby exam. What does the nurse anticipate for fine motor development for this infant? a. Transfer objects from one hand to the other. b. Use the thumb and index finger in crude pincer grasp. c. Hold a crayon and make a mark on paper. d. Release cubes into a cup.

a. Transfer objects from one hand to the other. The ability to transfer objects from one hand to another occurs at about age 7 months. The infant can use one hand for grasping and hold a cube in the other at the same time. A crude pincer grasp develops by ages 8 to 9 months. The ability to hold a crayon and mark on a piece of paper develops between ages 12 and 15 months. Infants can release a cube into a cup at ages 9 to 12 months.

What is the primary task of development in infancy, according to Erikson's stages? a. Trust b. Industry c. Initiative d. Autonomy

a. Trust

The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. The nurse should interpret this as a(n) a. normal finding. b. finding requiring a referral. c. abnormal finding. d. normal finding, but requires rechecking in 1 month.

a. normal finding.

What assessments would be important to include in Patti's examination? (Select all that apply.) a. Obtain a full set of measurements: height, weight, and head circumference. b. Include a blood pressure (BP) with her vital signs. c. Palpate her anterior fontanel to assess hydration. d. Assess Patti's eyes with the corneal light reflex and the cover test for strabismus.

b and d Height and weight should be obtained to monitor growth over time. Head circumferences are used up to 36 months old and when there are concerns regarding the child's head size.

Patti, a 4-year-old girl, is brought in for her well-child examination by her mother. Patti seems somewhat shy at the beginning of the visit. What would be a suitable initial approach by the nurse? (Select all that apply.) a. Begin the interview with an enthusiastic greeting and a handshake. b. Position yourself so you are at eye level with the child. c. Focus initially on obtaining the history from the mother. d. When you are ready to talk to the child, talk first to her toy, such as a doll, stuffed animal, or puppet.

b, c, and d

When taking a child's blood pressure, the nurse would select a cuff with a bladder width that is large enough to cover what percentage of the upper arm? a. 20% b. 40% c. 60% d. 80%

b. 40%

The nurse is assessing a 6-month-old healthy infant who weighed 3.2 kg at birth. The nurse would expect the infant to now weigh approximately how many kilograms? a. 5.2 b. 6.3 c. 8.7 d. 9.6

b. 6.3

What behavior indicates that an infant has developed object permanence? a. Secures objects by pulling on a string. b. Actively searches for a hidden object. c. Recognizes familiar face, such as mother. d. Recognizes familiar object, such as bottle.

b. Actively searches for a hidden object.

What is descriptive of a preschooler's concept of time? a. Has no understanding of time. b. Associates time with events. c. Can tell time on a clock. d. Uses terms such as "yesterday" appropriately.

b. Associates time with events. In a preschooler's understanding, time has a relation with events such as: "We'll go outside after lunch." Preschoolers develop an abstract sense of time at age 3 years. Children can tell time on a clock at age 7 years. Children do not fully understand use of time-oriented words until age 6 years.

The mother of a child is hepatitis B surface antigen (HBsAg) negative, when would receive his or her first dose of the hepatitis B virus (HBV) vaccine? a. 2 months of age, at the first well-child visit. b. Birth before discharge from the hospital. c. 6 months of age, at the third well-child visit. d. No time (this vaccine is not currently recommended).

b. Birth before discharge from the hospital.

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

b. Cerebellar function

A nurse is assessing several children in the clinic. Which of the following children requires further assessment? a. Child A was born weighing 3 kg. and at 7 months weighs 7 kg. b. Child B is 6 months old and exhibits slight head lag. c. Child C still has a Babinski reflex at 13 months d. Child D is 8 months old and pulls to stand

b. Child B is 6 months old and exhibits slight head lag. Rationale: By the age of 4 months old, a head lag should no longer be present.

Matt is a healthy 2½-year-old boy whose mother asks the nurse for advice about toilet training. Matt's mother is expecting her second child in 4 months and has no previous experience with toilet training a child. The nurse would do what first? a. Ask Matt if he wants to learn to use the toilet. b. Discuss signs that indicate Matt is ready to begin toilet training. c. Encourage the mother to initiate toilet training after the birth of the new baby. d. Assess the mother to determine why she has waited so long to begin toilet training.

b. Discuss signs that indicate Matt is ready to begin toilet training.

When the nurse interviews an adolescent, what is important to help establish a relationship? a. Focus the discussion on the peer group. b. Display a genuine interest in the adolescent. c. Emphasize that confidentiality will always be maintained. d. Use the same type of language as the adolescent.

b. Display a genuine interest in the adolescent. Adolescents accept anyone who shows a genuine interest in them. Although peers are important to this age-group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently.

What is an appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler? a. Provide for privacy. b. Encourage parents to room-in. c. Explain procedures and routines. d. Encourage contact with children of the same age.

b. Encourage parents to room-in. A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room-in as much as possible. Explaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents' presence. Encouraging contact with children of the same age would not substitute for having the parents present.

What is usually the greatest threat to a hospitalized adolescent? a. Fear of pain b. Fear of altered body image c. Restricted motor activity d. Separation from home and family

b. Fear of altered body image Injury, pain, disability, and death are viewed primarily in terms of how each affects the adolescents' views of themselves in the present. Any change that differentiates them from their peers is regarded as a major tragedy. Pain is a concern because it affects body image. Adolescents are able to react with much more self-control than are younger children. Restricted motor activity would be an issue if it affected body image in the long term. Adolescents are able to tolerate separation from family.

What information would the nurse give a mother regarding the introduction of solid foods during infancy? a. Fruits and vegetables should be introduced into the diet first. b. Foods should be introduced one at a time at intervals of 5 to 7 days. c. Solid foods can be mixed in a bottle to make the transition easier for the infant. d. Solid foods should not be introduced until 8 to 10 months when the extrusion reflex begins to disappear.

b. Foods should be introduced one at a time at intervals of 5 to 7 days. One food item is introduced at intervals of 5 to 7 days to allow the identification of food allergies. Iron-fortified cereal should be the first solid food introduced into the infant's diet. Mixing solid foods in a bottle has no effect on the transition to solid food. Solid foods can be introduced earlier than 8 to 10 months. The extrusion reflex usually disappears by age 6 months.

What is the most appropriate method of rehydrating Brian, a mildly dehydrated 4 year old? a. Administer intravenous fluids. b. Give an oral rehydration solution. c. Give soft drinks that have been diluted and decarbonated. d. Give small amounts of gelatin or clear liquids such as juice and water.

b. Give an oral rehydration solution.

Jessica is a 3-year-old child who is brought to the clinic for a well-child visit. As you approach Jessica, you notice that she is clinging to her mother, crying inconsolably. The mother is talking softly to her, assuring her that everything will be OK. What would the nurse consider when starting to assess the child? a. Begin the assessment without allowing time for play or becoming acquainted. b. Gradually focus on the child or a favorite object, such as a favorite doll or toy. c. Remove the child from her mother's arms and proceed with the assessment in a head-to-toe manner. d. Ask the mother to leave the room if the child does not stop crying.

b. Gradually focus on the child or a favorite object, such as a favorite doll or toy.

Elizabeth's mother says her infant reaches for her food. She asks if it is all right to let the baby feed herself. What is the appropriate response? a. Grasping occurs during the first month as a reflex and gradually becomes voluntary. By 4 months, infants can hold their bottles, grasp their feet and pull them to their mouths, and feed themselves crackers. b. Grasping occurs during the first 2 to 3 months as a reflex and gradually becomes voluntary. By 6 months, infants can hold their bottles, grasp their feet and pull them to their mouths, and feed themselves crackers. c. Grasping occurs during the first 4 to 5 months as a reflex and gradually becomes voluntary. By 7 months, infants can hold their bottles, grasp their feet and pull them to their mouths, and feed themselves crackers. d. Grasping occurs during the first 6 to 8 months as a reflex and gradually becomes voluntary. By 9 months, infants can hold their bottles, grasp their feet and pull them to their mouths, and feed themselves crackers.

b. Grasping occurs during the first 2 to 3 months as a reflex and gradually becomes voluntary. By 6 months, infants can hold their bottles, grasp their feet and pull them to their mouths, and feed themselves crackers.

What is the current focus in pediatric care? a. Disease management b. Health promotion and disease prevention c. Anticipatory guidance and disease prevention d. Health promotion

b. Health promotion and disease prevention

Rapid replacement of fluid is essential in the treatment of what types of dehydration? a. Isotonic, osmotic b. Hypotonic, isotonic c. Osmotic, hypertonic d. Hypertonic, hypotonic

b. Hypotonic, isotonic In moderate to severe dehydration, rapid expansion of the intravascular space is necessary. Rapid replacement is indicated in isotonic dehydration. Osmotic is not a type of dehydration. Rapid replacement is contraindicated in hypertonic dehydration.

Sara, age 4 months, was born at 35 weeks of gestation. She appears to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was full term. What response by the nurse is appropriate? a. Infants tend to become more difficult over time. b. Infants become less difficult if they are kept on scheduled feedings and structured routines. c. Behavior is suggestive of failure to completely bond with her parents. d. Difficult temperament is the result of painful experiences in the neonatal period.

b. Infants become less difficult if they are kept on scheduled feedings and structured routines. Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant's unique temperament. Sara's temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to Sara's temperament.

The clinic is loaning a federally approved car seat to a 4.5-kg (10-pounds) infant's family. Where does the nurse teach the family is the most appropriate location to place the infant car seat? a. Back seat facing forward. b. Middle of the back seat facing rearward. c. Front seat with air bags on passenger side. d. Front seat if there is no air bag on the passenger side.

b. Middle of the back seat facing rearward.

What is most appropriate to manage mild dehydration in the home setting? a. Diluted fruit juices b. Oral rehydration fluids c. Water d. Warm milk

b. Oral rehydration fluids Oral rehydration solutions are the fluids of choice for rehydration because of their glucose-mediated and enhanced sodium absorption composition. Fruit juices are not used as rehydrating solutions because of their high carbohydrate content, very low electrolyte content, and high osmolality. Water is not used as a rehydrating fluid because of its hypotonic nature and lack of electrolytes. Cow's milk is not recommended because maldigestion of lactose can occur in children with infectious diarrhea.

An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4 months ago. She has not received any medical care. She smokes but denies any other substance use. What is the priority nursing action? a. Notify her parents. b. Refer her for prenatal care. c. Explain the importance of not smoking. d. Discuss dietary needs for adequate fetal growth.

b. Refer her for prenatal care.

What does the nurse take into consideration when planning sex education and contraceptive teaching for adolescents? a. Both sexual activity and contraception require planning. b. Teenagers frequently lack a fundamental understanding of fertility. c. Most teenagers today are knowledgeable about reproductive anatomy and physiology. d. Most teenagers who become pregnant do so as an act of hostility, especially toward their parents.

b. Teenagers frequently lack a fundamental understanding of fertility.

What statement accurately describes physical development during the school-age years? a. The child's weight almost triples. b. The child grows an average of 5 cm (2 inches) per year. c. Few physical differences are apparent among children of different genders at the end of middle childhood. d. Fat gradually increases, which contributes to the child's heavier appearance.

b. The child grows an average of 5 cm (2 inches) per year.

An important consideration when using the FACES Pain Rating scale with children is: a. Children color the face with the color they choose to best describe their pain. b. The scale can be used with most children as young as 3 years. c. The scale is not appropriate for use with adolescents d. The FACES scale is useful in pain assessment but not as accurate as physiologic responses

b. The scale can be used with most children as young as 3 years.

What is the appropriate site to administer an intramuscular (IM) vaccine to a newborn? a. The dorsal gluteal muscle b. The vastus lateralis muscle c. The ventral gluteal muscle d. The biceps muscle

b. The vastus lateralis muscle

Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. What is the best interpretation of this behavior? a. This is typical behavior because toddlers are aggressive. b. This is typical behavior because toddlers are egocentric. c. Toddlers should know that sharing toys is expected of them. d. Toddlers should have the cognitive ability to know right from wrong.

b. This is typical behavior because toddlers are egocentric. Play develops from the solitary play of infancy to the parallel play of toddlers. A toddler plays alongside other children, not with them. When a child grabs a toy from another child, it is typical behavior of the toddler and is not intentionally aggressive. Shared play is not within their cognitive development. Toddlers do not conceptualize shared play.

A nursing student understands the age that most infants can steadily sit unsupported as a. 4 months b. 6 months c. 8 months d. 10 months

c. 8 months

What statement is true concerning the increased use of telephone triage by nurses? a. Health care costs have increased as a result. b. Emergency department visits are not recommended. c. Access to high-quality health care services has increased. d. Home care is recommended when it is not appropriate.

c. Access to high-quality health care services has increased. With well-designed telephone triage programs, access to high-quality health care services and patient satisfaction have increased. With the reduction in unnecessary emergency department and clinic visits, health care costs have decreased. Emergency department visits are recommended based on the response to screening questions and when the child's condition is in doubt. Guidelines are given for home management if the triage assessment indicates that level of care. Parents are given instructions about changes in the child's condition to report.

Patti becomes more interactive as the history is completed. What would be the recommended method for beginning the physical assessment? a. Ask the parent to step out of the room to ensure privacy. b. Ask the child, "May I examine you now?" c. Allow Patti to examine the equipment as it is used in the assessment. d. Ask Patti, "Can I take your temperature first or your blood pressure first?"

c. Allow Patti to examine the equipment as it is used in the assessment. Giving young children choices gives them some control in the environment. However, children interpret language literally, and asking to them if you can "take" something may be threatening and is not recommended

A 3-year-old child is being admitted for 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." What understanding of the child's age guides the response by the nurse? a. New toys make hospitalization easier. b. New toys are usually better than older ones for children of this age. c. At this age, children often need the comfort and reassurance of familiar toys from home. d. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

c. At this age, children often need the comfort and reassurance of familiar toys from home. Parents should bring favorite items from home for the child. Young children associate inanimate objects with significant people, and they gain comfort and reassurance from these items. Because the parents leave the objects at the hospital, the preschooler knows the parents will return. New toys will not serve the purpose of familiar toys and objects from home. The parents may experience some guilt as a response to the hospitalization, but there is no evidence that it is maladaptive.

The nurse is assessing a 6-month-old infant who is noted to have head lag. What is the appropriate response documentation in the chart related to this finding? a. Normal development b. Cognitive impairment noted, follow-up in 1 month c. Developmental, neurologic evaluation referral d. Teach parents to practice exercises with infant

c. Developmental, neurologic evaluation referral Most infants have only slight head lag when pulled from a lying to a sitting position at 4 months of age. By 6 months, head control should be well established. Developmental neurologic evaluation is indicated to determine why the child is not achieving an expected milestone. The head lag is suggestive of a developmental delay. It does not provide information about cognitive status. As part of normal development, interventions cannot be done until a cause is identified.

What is important understanding for a nurse working in an outpatient surgery center for children? a. Children's anxiety is minimal in such a center. b. Waiting is not stressful for parents in such a center. c. Families need to be prepared for what to expect after discharge. d. Accurate and complete discharge teaching is the responsibility of the surgeon.

c. Families need to be prepared for what to expect after discharge. Parents need explicit instructions when taking their child home. The guidelines should include what observations need to be made and when to call the practitioner about changes in the child's condition. Less stress will exist because of the shortened hospital stay, but the parents will still have anxiety related to the surgery setting. Families will still be waiting during the procedure. This is reported to be one of the most stressful times. The surgeon will provide prescriptions and instructions related to the surgical procedure. The nurse's role is to prepare the family with both written and verbal instructions before discharge.

What is a common initial reaction of parents to illness or injury and hospitalization in their child? a. Relief b. Anger c. Frustration d. Depression

c. Frustration

A 6-year-old child needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her that they are "sick of Mom always sitting with her in the hospital and playing with her. . . . It isn't fair that you get everything and we have to stay with the neighbors." What is the nurse's best assessment of this situation? a. The siblings are immature and probably spoiled. b. The siblings need to better understand their sister's illness and needs. c. Jealousy and resentment are common reactions to the illness and hospitalization of a sibling. d. The family has ineffective coping mechanisms to deal with chronic illness.

c. Jealousy and resentment are common reactions to the illness and hospitalization of a sibling. Siblings experience loneliness, fear, and worry, as well as anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. These comments are common responses by normal siblings. There is no evidence that the family has maladaptive coping.

What is an appropriate nursing action when caring for a child with an intravenous infusion? a. Change the insertion site every 24 hr. b. Use a macrodropper to facilitate the prescribed flow rate. c. Observe the insertion site frequently for signs of infiltration. d. Avoid restraining the child to prevent undue emotional stress.

c. Observe the insertion site frequently for signs of infiltration.

Elizabeth's mother is aware of the importance of play for children. What games and interactions would the nurse recommend? a. Encourage the infant to play with push-pull toys. b. Hang mobiles with black and white designs above the crib. c. Place an unbreakable mirror where the infant can see herself. d. Point to body parts and name each one.

c. Place an unbreakable mirror where the infant can see herself.

The nurse is caring postoperatively for an 8-year-old child with multiple fractures and other traumatic injuries from a motor vehicle crash. The child is experiencing severe pain. What is an important consideration in managing the child's pain? a. Give only an opioid analgesic at this time. b. Increase the dosage of analgesic until the child is adequately sedated. c. Plan a preventive schedule of pain medication around the clock. d. Give the child a clock and explain when she or he can have pain medications.

c. Plan a preventive schedule of pain medication around the clock. For severe postoperative pain, a preventive around-the-clock schedule is necessary to prevent decreased plasma levels of medications. The opioid analgesic will help for the present but is not an effective strategy. Increasing the dosage requires an order. The nurse should give the drug on a regular schedule and evaluate the effectiveness. Giving the child a clock and explaining when she or he can have pain medications is counterproductive. It focuses the child's attention on how long he or she will need to wait for pain relief.

Shannon's dehydration increases and she is hospitalized with parenteral fluid therapy. What replacement is not added until kidney function is reestablished? a. Magnesium b. Sodium chloride c. Potassium d. Sodium bicarbonate

c. Potassium Potassium is not administered until kidney functions are appropriate because of the risk of hyperkalemia, which causes cardiac arrhythmias, respiratory failure, mental confusion, and numbness of extremities. Magnesium is usually decreased with prolonged vomiting or diarrhea, and therefore the risk of excess magnesium is low. Sodium chloride (0.9%) is the initial replacement fluid of choice in the management of dehydration. Sodium bicarbonate can be added to replacement fluid because acidosis is usually associated with dehydration.

An experienced pediatric nurse will understand which one of following techniques as the best one to deal with the negativism of the toddler? a. Quietly and calmly ask the child to comply. b. Provide no choices for the child. c. Provide limited choices for the child. d. Remain serious and intent.

c. Provide limited choices for the child.

What illnesses does respiratory hygiene and cough etiquette by the Centers for Disease Control and Prevention (CDC) prevent? a. HBV, Hib, and pertussis b. HSV, influenza, and HBV c. RSV, influenza, and adenovirus d. RSV, pertussis, and varicella

c. RSV, influenza, and adenovirus

A nurse asks Matt's mother about toilet training. She says, "He has done real well except, since the baby came, he has wanted to wear diapers instead of underpants. I have been letting him wear diapers. He takes them on and off to use the toilet. I hope that is OK." What is the appropriate action of the nurse? a. Assess why the mother decided to let Matt wear diapers. b. Recommend that the mother put Matt back into underpants immediately. c. Reassure the mother that regression such as this is common in toddlers after the birth of a sibling. d. Explain to mother that negativism such as this is common in toddlers who are toilet trained before they are ready.

c. Reassure the mother that regression such as this is common in toddlers after the birth of a sibling.

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. Which is the most appropriate recommendation? a. Punish the child. b. Leave the child alone until the tantrum is over. c. Remain close by the child but without eye contact. d. Explain to child that this is wrong.

c. Remain close by the child but without eye contact. Rationale: We don't want to leave the child alone because of safety. The idea is we don't want to give them attention.

What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Fear of pain b. Loss of control c. Separation anxiety d. Fear of bodily injury

c. Separation anxiety The major stressor of hospitalization for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. Fear of pain, loss of control, and fear of bodily injury are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age-group.

The parents of a 3-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hr during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. What would the nurse suggest to help them deal with this problem? a. Let her cry herself back to sleep. b. Put her in parents' bed to cuddle. c. Start putting her to bed while still awake and while the parent is present. d. Give her a bottle of formula instead of breastfeeding her so often at night.

c. Start putting her to bed while still awake and while the parent is present. Current research suggests that parents be present at bedtime until the child is drowsy. The child should then be allowed to fall asleep alone. This encourages self-soothing behaviors. Children who learn to fall asleep on their own have longer sustained sleep periods than those who fall asleep with parents present. Letting the child cry herself back to sleep is difficult to implement for many parents. Co-bedding could be unsafe at this age. The type of feeding will not affect the child's sleep pattern.

A 12-month-old child presents to the clinic for a well visit after missing several appointments. The child began her immunization schedule but has missed several follow-up appointments and doses of immunizations. What is the most appropriate nursing intervention? a. Administer initial immunizations from the beginning of schedule. b. The child cannot receive missed immunizations if the schedule is not followed and will not be vaccination. c. The child should only receive the missed doses of immunizations based on catch-up schedule. d. The child should receive double-strength immunizations at this well visit.

c. The child should only receive the missed doses of immunizations based on catch-up schedule.

A 5 year old has patient-controlled analgesia (PCA) for pain management after abdominal surgery. What information does the nurse include in teaching the parents about the PCA? a. The child will be pain free. b. Only the child is allowed to push the button for a bolus. c. The pump allows for a continuous basal rate and delivers a constant amount of medication to control pain. d. There is a high risk of overdose, so monitoring is done every 15 minutes.

c. The pump allows for a continuous basal rate and delivers a constant amount of medication to control pain. The PCA prescription can be set for a basal rate for a continued infusion of pain medication to prevent pain from returning during sleep and when the patient cannot control the infusion. Although the goal of PCA is to have effective pain relief, a pain-free state may not be possible. With a child who is 5 years old, the parents and nurse must assess the child to ensure that adequate medication is being given. A child who is 5 years old may not be able to understand the concept of pushing a button. Evidence suggests that effective analgesia can be obtained with the parents and nurse giving boluses as necessary. The prescription for the PCA includes how much medication can be given in a defined period. Monitoring every 1 to 2 hr for patient response is sufficient.

What describes moral development in younger school-age children? a. The standards of behavior now come from within themselves. b. They do not yet experience a sense of guilt when they misbehave. c. They know the rules and behaviors expected of them but do not understand the reasons behind them. d. They no longer interpret accidents and misfortunes as punishment for misdeeds.

c. They know the rules and behaviors expected of them but do not understand the reasons behind them. Children who are ages 6 and 7 years know the rules and behaviors expected of them but do not understand the reasons for these rules and behaviors. Young children do not believe that standards of behavior come from within themselves but that rules are established and set down by others. Younger school-age children learn standards for acceptable behavior, act according to these standards, and feel guilty when they violate them. Misfortunes and accidents are viewed as punishment for bad acts.

What approach is the most appropriate when performing a physical assessment on a toddler? a. Demonstrate use of equipment. b. Perform traumatic procedures first. c. Use minimum physical contact initially. d. Always proceed in a head-to-toe direction.

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

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

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

Which instruction is most developmentally appropriate to the parents of a 7 month old child regarding injury prevention? a. "Balloons make wonderful toys since they are colorful and keep children entertained." b. "You may give a lollipop for the child to suck on to help with teething." c. "The carseat should be facing the front of the car and in the middle of the backseats." d. "Remove all crib toys strung across the top of the crib"

d. "Remove all crib toys strung across the top of the crib"

A parent has a 2-year-old child in the clinic for a well-child checkup. What 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 now that our child is older."

d. "We stopped using the car seat now that our child is older."

A nurse is conducting a teaching session for parents of infants. The nurse explains that which behavior indicates that an infant has developed object permanence? a. Recognizes familiar face, such as mother b. Recognizes familiar object, such as bottle c. Secures objects by pulling on a string d. Actively searches for a hidden object

d. Actively searches for a hidden object

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. What does the nurse recommend based on the American Academy of Pediatrics? a. Skim milk b. Whole cow's milk c. Commercial formula without iron d. Commercial iron-fortified formula

d. Commercial iron-fortified formula

The mother asks what to do about breastfeeding Adam. What is the recommendation by the nurse? a. Stop breastfeeding for 24 hr. b. Stop breastfeeding until diarrhea stops. c. Bottle-feed glucose water, alternating it with breastfeeding. d. Continue breastfeeding and give an oral rehydration solution to replace diarrheal losses.

d. Continue breastfeeding and give an oral rehydration solution to replace diarrheal losses. Breastfeeding should be continued because of its potential to reduce the severity and duration of the illness. Oral rehydration solutions can be given in addition to breastfeeding to replace ongoing losses.

Myelination of the spinal cord is almost complete by 2 years of age. As a result of this, what can gradually be achieved? a. Visual acuity of 20/20 b. Throwing a ball without falling c. Respirations becoming diaphragmatic d. Control of anal and urethral sphincters

d. Control of anal and urethral sphincters

When taking the child's physiologic measurements, the nurse notes that Jessica's blood pressure (BP) is 135/85 mm Hg. What is not an appropriate action for the nurse? a. Confirm that you are using the appropriately sized cuff. b. Calm the child; then allow for touch and examination of the BP equipment. c. Repeat the BP when the child is less anxious and agitated. d. Disregard BP monitoring because it is not recommended for a 3-year-old child.

d. Disregard BP monitoring because it is not recommended for a 3-year-old child.

In terms of fine motor development, which should the 3-year-old child be expected to do? a. Lace shoes and tie shoelaces with a bow. b. Use scissors to cut pictures, and print a few numbers. c. Draw a person with seven parts and correctly identify the parts. d. Draw a circle and name what has been drawn.

d. Draw a circle and name what has been drawn.

In terms of fine motor development, what would a 3-year-old child be expected to do? a. Tie shoelaces. b. Use scissors or a pencil very well. c. Draw a person with seven to nine parts. d. Draw single-line shapes such as circles.

d. Draw single-line shapes such as circles.

What is characteristic of the psychosocial development of school-age children? a. Peer approval is not yet a motivating power. b. A developing sense of initiative is very important. 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.

d. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

A nurse is planning a teaching session for a group of adolescents. The nurse understands that by adolescence the individual is in which stage of cognitive development? a. Concrete operations b. Conventional thought c. Post-conventional thought d. Formal operations

d. Formal operations

What describes the cognitive abilities of school-age children? a. Have developed the ability to reason abstractly. b. Become capable of scientific reasoning and formal logic. c. Progress from making judgments based on what they reason to making judgments based on what they see. d. Have the ability to place things in a logical order, to group and sort, and to hold a concept in their minds while making decisions based on that concept.

d. Have the ability to place things in a logical order, to group and sort, and to hold a concept in their minds while making decisions based on that concept. In Piaget's stage of concrete operations, children have the ability to group and sort and make conceptual decisions. Children cannot reason abstractly until late adolescence. Scientific reasoning and formal logic are skills of adolescents. Progressing from making judgments based on what school-age children reason to making judgments based on what they see is not a developmental skill.

What conditions would cause a decrease of fluid requirements for children? a. Burns b. Fever c. Vomiting d. Increased intracranial pressure

d. Increased intracranial pressure When there is a risk of increased intracranial pressure, the child's fluid balance is carefully monitored to ensure that only required fluids are given. With burns, fever, and vomiting, the child loses fluids at a greater than expected rate. Supplemental fluids need to be given to avoid the risk of dehydration.

The parent of a 10-week-old infant tells the nurse, "She cries sometimes when nothing is wrong—for example, when she is dry and has recently been fed." What is the appropriate response by the nurse? a. Reassure the parent that nothing is wrong. b. Explain how to better interpret infant cues. c. Evaluate for failure of the parent to bond with the infant. d. Reassure the parent that periods of "unexplained fussiness" can be normal.

d. Reassure the parent that periods of "unexplained fussiness" can be normal. A crying infant can be a source of great distress for parents. There is great variability in the amount of crying that can be expected from an infant. Parents should be reassured that some crying without apparent cause is normal. Persistent and inconsolable crying may need further attention. Reassuring the parent that nothing is wrong negates the parent's concern about the child. The parent is responding to cues from the infant by feeding and changing diapers. There is no evidence that an attachment issue exists. The parent is seeking information about how to care for the infant.

What statement explains why it can be difficult to assess a child's dietary intake? a. No systematic assessment tool has been developed. b. Biochemical analysis for assessing nutrition is expensive. c. Families usually do not understand much about nutrition. d. Recall of food consumption is frequently unreliable.

d. Recall of food consumption is frequently unreliable. An individual's recall of food intake, especially amounts eaten, is frequently unreliable. Systematic tools such as the 24-hr recall and detailed dietary history questionnaires are available. Biochemical analysis is not necessary for assessing dietary intake. Family knowledge of nutrition is not required. Detailed questions can elicit the child's patterns of eating and food intake.

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. What is the most appropriate recommendation? a. Punish the child. b. Explain to the child why the tantrum is wrong. c. Leave the child alone until the tantrum is over. d. Remain close by the child but ignore the behaviors.

d. Remain close by the child but ignore the behaviors.

What is an early clinical sign of dehydration? a. Hypotension b. Decreased urinary output c. Capillary refill time over 3 seconds d. Tachycardia

d. Tachycardia Hypotension is a late sign of dehydration that occurs when fluid losses exceed the body's ability to sustain blood volume and blood pressure. Decreased urinary output is a compensatory mechanism caused by decreased blood flow through the kidneys and is not an early sign of dehydration. Capillary refill time over 3 seconds indicates a seriously compromised circulatory system and is an indication of severe dehydration. The earliest detectable sign of dehydration is usually tachycardia, the body's attempt to increase cardiac output because of the low blood volume.

A six year old is admitted with fractured femur. An appropriate toy for the child on complete bed rest would be: A. Set of building blocks B. Checkers C. Coloring book and crayons D. Game of ball and jacks

C. Coloring book and crayons Rationale: A and D would not be appropriate on bed rest

What is defined as the forces that favor filtration from the capillary? a. Diffusion and osmosis b. Active transport c. Capillary hydrostatic pressure and interstitial oncotic pressure d. Hydrostatic pressure

c. Capillary hydrostatic pressure and interstitial oncotic pressure

How can the nurse approach the toddler for the injection? A. You are afraid of the shot, because it will hurt a lot B. Act like superman and it will be done as fast as speeding bullet C. I know this may hurt, but it is important to hold very still D. I brought a friend to hold you down while I give you the medication

C. I know this may hurt, but it is important to hold very still

What statement characterizes toddlers' eating behavior? a. Food fads are common. b. They have increased appetite. c. They have few food preferences. d. Their table manners are predictable.

a. Food fads are common.

What reflexes appear at about 7 to 9 months of age? a. Moro b. Parachute c. Neck righting d. Labyrinth righting

b. Parachute

What self-report pain rating scales can be used in children as young as 3 years of age? a. Poker Chip Tool b. Visual Analog Scale c. FACES Pain Rating Scale d. Word-Graphic Rating Scale

c. FACES Pain Rating Scale

The nurse is starting an IV on a school-age child with cancer. The child says "I have had a million IVs. They hurt." The nurse's response should be based on knowledge that children: a. tolerate pain better than adults. b. become accustomed to painful procedures. c. often lie about experiencing pain. d. often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

d. often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

A 4-month-old infant is brought to the well-child clinic for immunizations. The mother indicates that the infant often strains to have a bowel movement, so she has been giving him honey and has stopped feeding him iron-fortified formula, based on her sister's recommendations. The nurse recognizes that the infant is at risk for the development of which of the following? Select all that apply. A. Obesity B. Iron-deficiency anemia C. Rickets D. Infant botulism E. Cow's milk allergy

B and D

How can the nurse prepare a child for a painful procedure? Select all that apply. A. Be honest and use correct terms so that the child trusts the nurse. B. Involve the child in the use of distraction, such as using bubbles, music, or playing a game. C. Kindly ask parents to leave the room so they don't have to watch the painful procedure. D. Use positive self-talk such as "When I go home, I will feel better and be able to see my friends." E. Use guided imagery that involves recalling a previous pleasurable event.

B, D, and E

A 2 yr old girl has been hospitalized with CHF. The child has generalized edema and oliguric. The factor that will have the greatest impact on the child's adjustment to hospitalization would be: A. Inability to select a variety of food for meals B. Separation from her friends C. Separation from caregivers D. Inability to participate in cooperative play

C. Separation from caregivers

What is the most consistent and commonly used indicator of pain in infants? a. Increased respirations b. Increased heart rate c. Thrashing of arms and legs d. Facial expression of discomfort

d. Facial expression of discomfort Facial expression has consistently been validated as an indicator of pain in infants. Behavioral pain measures are most reliable for sharp procedural pain in infants. Increased heart rate and respirations are indicative of a generalized and complex response to stress. They are not specific for pain in infants. Thrashing of arms and legs is a reliable indicator in young children, not infants.

Toddlers are often known to be finicky eaters and may exhibit abnormal eating patterns that may concern parents. Which of the following actions for feeding toddlers should be suggested so adequate amounts of nutrients for growth and development are consumed? Select all that apply. A. Avoid placing large food portions on the toddler's plate B. Allow the child to graze on nutritious (not "junk" food) snacks during the day C. Insist that the child sit at the table until all persons have completed their meals D. Allow the child to make certain food choices (within reasonable limits)—for example, "Would you like a half peanut butter or ham sandwich?" E. Provide meals at the same time of day as much as possible so the toddler has a sense of consistency F. Make the child eat all of the food provided, and provide disciplinary actions such as a "time-out" if the plate is not cleaned

A, B, D, and E

One indication that the toddler is ready to begin toilet training is: A. Child recognizes urge to void and is able to communicate this sensation to the parent B. Child is able to stay dry all night C. Child demonstrates mastery of dressing and undresssing self D. Child asks parent to have wet or soiled diaper changed

A. Child recognizes urge to void and is able to communicate this sensation to the parent

A common cause of accidental death in children ages 1 to 19 years involves motor vehicle crashes. Evidence from test crashes indicates that the safest action to prevent accidental deaths in toddlers includes: A. Placing the child in a rear-facing weight-appropriate car restraint seat until the child has outgrown the car seat manufacturer's height and weight recommendations B. Allowing the child to ride in the front seat with a lap-shoulder seat restraint to avoid emotional outbursts C. Allowing the child to ride in a forward-facing booster restraint seat after 12 months of age D. Placing the child in the regular seat using the lap-shoulder belt as long as the child weighs at least 45 pounds

A. Placing the child in a rear-facing weight-appropriate car restraint seat until the child has outgrown the car seat manufacturer's height and weight recommendations