Pediatric 1

A 17-month-old child should be expected to be in which stage, according to Piaget? a. Preoperations b. Concrete operations c. Tertiary circular reactions d. Secondary circular reactions

c. Tertiary circular reactions A 17-month-old is in the fifth stage of the sensorimotor phase, tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. Concrete operations is the cognitive stage associated with school-age children. The secondary circular reaction stage lasts from about ages 4 to 8 months.

What is probably the most important criterion on which to base the decision to report suspected child abuse? a. Inappropriate response of child b. Inappropriate parental concern for the degree of injury c. Absence of parents for questioning about childs injuries d. Incompatibility between the history and injury observed

d. Incompatibility between the history and injury observed Conflicting stories about the accident are the most indicative red flags of abuse. The child or caregiver may have an inappropriate response, but this is subjective. Parents should be questioned at some point during the investigation.

At a well-child check-up, the nurse notes that an infant with a previous diagnosis of failure to thrive (FTT) is now steadily gaining weight. The nurse should recommend that fruit juice intake be limited to no more than how much? a. 4 oz/day b. 6 oz/day c. 8 oz/day d. 12 oz/day

a. 4 oz/day Restrict juice intake in children with FTT until adequate weight gain has been achieved with appropriate milk sources; thereafter, give no more than 4 oz/day of juice.

A toddler, age 16 months, falls down a few stairs. He gets up and scolds the stairs as if they caused him to fall. What is this an example of? a. Animism b. Ritualism c. Irreversibility d. Delayed cognitive development

a. Animism Animism is the attribution of lifelike qualities to inanimate objects. By scolding the stairs, the toddler is attributing human characteristics to them. Ritualism is the need to maintain sameness and reliability. It provides a sense of comfort to toddlers. Irreversibility is the inability to reverse or undo actions initiated physically. The toddler is acting in an age-appropriate manner.

The nurse is discussing with a parent group the importance of fluoride for healthy teeth. What should the nurse recommend? a. Determine whether the water supply is fluoridated. b. Use fluoridated mouth rinses in children older than 1 year. c. Give fluoride supplements to infants beginning at age 2 months. d. Brush teeth with fluoridated toothpaste unless the fluoride content of water supply is adequate.

a. Determine whether the water supply is fluoridated The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount. It is difficult to teach toddlers to spit out mouthwash. Swallowing fluoridated mouthwashes can contribute to fluorosis. Fluoride supplementation is not recommended until after age 6 months and then only if the water is not fluoridated. Fluoridated toothpaste is still indicated if the fluoride content of the water supply is adequate, but very small amounts are used

The nurse is caring for a child with suspected ingestion of some type of poison. What action should the nurse take next after initiating cardiopulmonary resuscitation (CPR)? a. Empty the mouth of pills, plants, or other material. b. Question the victim and witness. c. Place the child in a side-lying position. d. Call poison control.

a. Empty the mouth of pills, plants, or other material. Emptying the mouth of any leftover pills, plants, or other ingested material is the next step after assessment and initiation of CPR if needed. Questioning the victim and witnesses, calling poison control, and placing the child in a side-lying position are follow-up steps.

The parent of an infant with colic tells the nurse, All this baby does is scream at me; it is a constant worry. What is the nurses best action? a. Encourage the parent to verbalize feelings. b. Encourage the parent not to worry so much. c. Assess the parent for other signs of inadequate parenting. d. Reassure the parent that colic rarely lasts past age 9 months.

a. Encourage the parent to verbalize feelings. Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathetic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parents anxiety. The nurse should reassure the parent that he or she is not doing anything wrong. The infant with colic is experiencing spasmodic pain that is manifested by loud crying, in some cases up to 3 hours each day. Telling the parent that it will eventually go away does not help him or her through the current situation.

Parents tell the nurse that their toddler eats little at mealtime, only sits at the table with the family briefly, and wants snacks all the time. What 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 Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirements associated with the slower growth rate. Parents should assist the child in developing healthy eating habits. Toddlers are often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should be not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat non-nutritious foods in response. A toddler is not able to understand explanations of what is expected of her and comply with the expectations.

What information should be given to the parents of a 12-month-old child regarding appropriate play activities for this age? a. Give large pushpull toys for kinetic stimulation. b. Place a cradle gym across the crib to help develop fine motor skills. c. Provide the child with finger paints to enhance fine motor skills. d. Provide a stick horse to develop gross motor coordination.

a. Give large pushpull toys for kinetic stimulation. A 12-month-old child is able to pull to a stand and walk holding on or independently. Appropriate toys for this age child include large pushpull toys for kinetic stimulation. A cradle gym should not be placed across the crib. Finger paints are appropriate for older children. A 12- month-old child does not have the stability to use a stick horse.

The nurse is teaching a parent with a 2-month-old infant who has been diagnosed with colic about ways to relieve colic. Which statement by the parent indicates the need for additional teaching? a. I should let my infant cry for at least 30 minutes before I respond. b. I will swaddle my infant tightly with a soft blanket. c. I should massage my infants abdomen whenever possible. d. I will place my infant in an upright seat after feeding.

a. I should let my infant cry for at least 30 minutes before I respond Because the infant has been diagnosed with colic, the parent should respond to the infant immediately or any type of interventions to relieve colic may not be effective. Also, the infant may develop a mistrust of the world if his or her needs are not met. The parent should swaddle the baby tightly with a soft blanket, massage the babys abdomen, and place the infant in an upright seat after a feeding to help relieve colic.

The parents of a 2-year-old child tell the nurse they are concerned because the toddler has started to use baby talk since the arrival of their new baby. What should the nurse recommend? a. Ignore the baby talk. b. Tell the toddler frequently, You are a big kid now. c. Explain to the toddler that baby talk is for babies. d. Encourage the toddler to practice more advanced patterns of speech.

a. Ignore the baby talk. Baby talk is a sign of regression in the toddler. Often toddlers attempt to cope with a stressful situation by reverting to patterns of behavior that were successful in earlier stages of development. It should be ignored while the parents praise the child for developmentally appropriate behaviors. Regression is childrens way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism.

What is the leading cause of death during the toddler period? a. Injuries b. Infectious diseases c. Childhood diseases d. Congenital disorders

a. Injuries Injuries are the most common cause of death in children ages 1 through 4 years. It is the highest rate of death from injuries of any childhood age group except adolescence. Congenital disorders are the second leading cause of death in this age group. Infectious and childhood diseases are less common causes of death in this age group.

What may a clinical manifestations of failure to thrive (FTT) in a 13-month-old include? a. Irregularity in activities of daily living b. Preferring solid food to milk or formula c. Weight that is at or below the 10th percentile d. Appropriate achievement of developmental landmarks

a. Irregularity in activities of daily living One of the clinical manifestations of children with FTT is irregularity or low rhythmicity in activities of daily living. Children with FTT often refuse to switch from liquids to solid foods. Weight below the fifth percentile is indicative of FTT. Developmental delays, including social, motor, adaptive, and language, exist.

The nurse is checking reflexes on a 7-month-old infant. When the infant is suspended in a horizontal prone position, the head is raised and the legs and spine are extended. Which reflex is this? a. Landau b. Parachute c. Body righting d. Labyrinth righting

a. Landau When the infant is suspended in a horizontal prone position, the head is raised and the legs and spine are extended; this describes the Landau reflex. It appears at 6 to 8 months and persists until 12 to 24 months. The parachute reflex occurs when the infant is suspended in a horizontal prone position and suddenly thrust downward; the infant extends the hands and fingers forward as if to protect against falling. This appears at age 7 to 9 months and lasts indefinitely. Body righting occurs when turning the hips and shoulders to one side causes all other body parts to follow. It appears at 6 months of age and persists until 24 to 36 months. The labyrinth-righting reflex appears at 2 months and is strongest at 10 months. This reflex involves holding infants in the prone or supine position. They are able to raise their heads.

Which factors will decrease iron absorption and should not be given at the same time as an iron supplement? a. Milk b. Fruit juice c. Multivitamin d. Meat, fish, poultry

a. Milk Many foods interfere with iron absorption and should be avoided when iron is consumed. These foods include phosphates found in milk, phytates found in cereals, and oxalates found in many vegetables. Vitamin Ccontaining juices enhance the absorption of iron. Multivitamins may contain iron; no contraindication exists to taking the two together. Meat, fish, and poultry do not affect absorption.

A child is admitted with a suspected diagnosis of Munchausen syndrome by proxy (MSBP). What is an important consideration in the care of this child? a. Monitoring the parents whenever they are with the child b. Reassuring the parents that the cause of the disorder will be found c. Teaching the parents how to obtain necessary specimens d. Supporting the parents as they cope with diagnosis of a chronic illness

a. Monitoring the parents whenever they are with the child MSBP refers to an illness that one person fabricates or induces in another. The child must be continuously observed for development of symptoms to determine the cause. MSBP is caused by an individual harming the child for the purpose of gaining attention. Nursing staff should obtain all specimens for analyzing. This minimizes the possibility of the abuser contaminating the sample. The child must be supported through the diagnosis of MSBP. The abuser must be identified and the child protected from that individual.

An infant has been diagnosed with an allergy to milk. In teaching the parent how to meet the infants nutritional needs, the nurse states that a. Most children will grow out of the allergy. b. All dairy products must be eliminated from the childs diet. c. It is important to have the entire family follow the special diet. d. Antihistamines can be used so the child can have milk products.

a. Most children will grow out of the allergy Approximately 80% of children with cows milk allergy develop tolerance by the fifth birthday. The child can have eggs. Any food that has milk as a component or filler is eliminated. These foods include processed meats, salad dressings, soups, and milk chocolate. Having the entire family follow the special diet would provide support for the child, but the nutritional needs of other family members must be addressed. Antihistamines are not used for food allergies.

The nurse has just given a subcutaneous injection to a preschool child, and the child asks for a Band-Aid over the site. Which action should the nurse implement? a. Place a Band-Aid over the site. b. Massage the injection site with an alcohol swab. c. Show the child there is no bleeding from the site. d. Explain that a Band-Aid is not needed after a subcutaneous injection.

a. Place a Band-Aid over the site. Despite the advances in body image development, preschoolers have poorly defined body boundaries and little knowledge of their internal anatomy. Intrusive experiences are frightening, especially those that disrupt the integrity of the skin (e.g., injections and surgery). They fear that all their blood and insides can leak out if the skin is broken. Therefore, preschoolers may believe it is critical to use bandages after an injury. The nurse should place a Band-Aid over the site.

What is an appropriate play activity for a 7-month-old infant to encourage visual stimulation? a. Playing peek-a-boo b. Playing pat-a-cake c. Imitating animal sounds d. Showing how to clap hands

a. Playing peek-a-boo Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation. Playing pat-a-cake and showing how to clap hands help with kinetic stimulation. Imitating animal sounds helps with auditory stimulation.

A breastfed infant is being seen in the clinic for a 6-month checkup. The mother tells the nurse that the infant recently began to suck her thumb. Which is the best nursing intervention? a. Reassure the mother that this is normal at this age. b. Recommend the mother substitute a pacifier for her thumb. c. Assess the infant for other signs of sensory deprivation. d. Suggest the mother breastfeed the infant more often to satisfy her sucking needs

a. Reassure the mother that this is normal at this age. Sucking is an infants chief pleasure, and the infant may not be satisfied by bottle-feeding or breastfeeding alone. During infancy and early childhood, there is no need to restrict nonnutritive sucking. The nurse should explore with the mother her feelings about a pacifier versus the thumb. No data support that the child has sensory deprivation.

A boy age 4 1/2 years has been having increasingly frequent angry outbursts in preschool. He is aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8 to 10 weeks. His parent asks the nurse for advice. What is the most appropriate intervention? a. Refer the child for a professional psychosocial assessment. b. Explain that this is normal in preschoolers, especially boys. c. Encourage the parent to try more consistent and firm discipline. d. Talk to the preschool teacher to obtain validation for behavior parent reports.

a. Refer the child for a professional psychosocial assessment The preschool years are a time when children learn socially acceptable behavior. The difference between normal and problematic behavior is not the behavior but the severity, frequency, and duration. This childs behavior meets the definition requiring professional evaluation. Some aggressive behavior is within normal limits, but at 8 to 10 weeks, this behavior has persisted too long. There is no indication that the parent is using inconsistent discipline. A part of the evaluation is to obtain validation for behavior parent reports.

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

a. The quality of the food consumed is more important than the quantity. Parents need to be reassured that the quality of food eaten is more important than the quantity. Children are able to self-regulate their intake when offered foods high in nutritional value. The average daily caloric intake should be approximately 1800 calories. Toddlers and preschoolers have similar nutritional requirements. There is an overall slight decrease in needed calories and fluids during the preschool period.

What statement is correct about young children who report sexual abuse? a. They may exhibit various behavioral manifestations. b. In more than half the cases, the child has fabricated the story. c. Their stories should not be believed unless other evidence is apparent. d. They should be able to retell the story the same way to another person.

a. They may exhibit various behavioral manifestations. Victims of sexual abuse have no typical profile. The child may exhibit various behavioral manifestations, none of which is diagnostic for sexual abuse. When children report potentially sexually abusive experiences, their reports need to be taken seriously. Other children in the household also need to be evaluated. In children who are sexually abused, it is often difficult to identify other evidence. In one study, approximately 96% of children who were sexually abused had normal genital and anal findings. The ability to retell the story is partly dependent on the childs cognitive level. Children who repeatedly tell identical stories may have been coached.

The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurses response should be based on remembering what? a. This is acceptable to encourage head control and turning over. b. This is acceptable to encourage fine motor development. c. This is unacceptable because of the risk of sudden infant death syndrome (SIDS). d. This is unacceptable because it does not encourage achievement of developmental milestones.

a. This is acceptable to encourage head control and turning over. These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs to reduce the risk of SIDS and then be placed on their abdomens when awake to enhance achievement of milestones such as head control. These position changes encourage gross motor, not fine motor, development.

Parents of an 18-month-old boy tells the nurse that he says no to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. What is the nurses best interpretation of this behavior? a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention.

a. This is normal behavior for his age. Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and use of the word no. Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old

According to Piaget, magical thinking is the belief of which? a. Thoughts are all powerful. b. God is an imaginary friend. c. Events have cause and effect. d. If the skin is broken, the insides will come out.

a. Thoughts are all powerful. Because of their egocentrism and transductive reasoning, preschoolers believe that thoughts are all powerful. Believing God is an imaginary friend is an example of concrete thinking in a preschoolers spiritual development. Cause-and-effect implies logical thought, not magical thinking. Believing that if the skin is broken, the insides will come out is an example of concrete thinking in development of body image

The nurse is teaching parents of a preschool child strategies to implement when the child delays going to bed. What strategy should the nurse recommend? a. Use consistent bedtime rituals. b. Give in to attention-seeking behavior. c. Take the child into the parents bed for an hour. d. Allow the child to stay up past the decided bedtime.

a. Use consistent bedtime rituals. For children who delay going to bed, a recommended approach involves a consistent bedtime ritual and emphasizing the normalcy of this type of behavior in young children. Parents should ignore attention-seeking behavior, and the child should not be taken into the parents bed or allowed to stay up past a reasonable hour.

The nurse is teaching parents about instilling a positive body image for the preschool age. What statement made by the parents indicates the teaching is understood? a. We will make sure our child is praised about his or her looks. b. We will help our child compare his or her size with other children. c. We understand our child will have well-defined body boundaries. d. We will be sure our child understands about being little for his or her age.

a. We will make sure our child is praised about his or her looks Because these are formative years for both boys and girls, parents should make efforts to instill positive principles regarding body image. Children at this age are aware of the meaning of words such as pretty or ugly, and they reflect the opinions of others regarding their own appearance. Despite the advances in body image development, preschoolers have poorly defined body boundaries. By 5 years of age, children compare their size with that of their peers and can become conscious of being large or short, especially if others refer to them as so big or so little for their age. Parents should not suggest their child compare him- or herself with other children in regard to size, and parents should not focus on their childs size as being little.

Lactose intolerance is diagnosed in an 11-month-old infant. Which should the nurse recommend as a milk substitute? a. Yogurt b. Ice cream c. Fortified cereal d. Cows milkbased formula

a. Yogurt Yogurt contains the inactive lactase enzyme, which is activated by the temperature and pH of the duodenum. This lactase activity substitutes for the lack of endogenous lactase. Ice cream and cows milkbased formula contain lactose, which will probably not be tolerated by the child. Fortified cereal does not have the nutritional equivalents of milk.

A parent brings a 12-month-old infant into the emergency department and tells the nurse that the infant is allergic to peanuts and was accidentally given a cookie with peanuts in it. The infant is dyspneic, wheezing, and cyanotic. The health care provider has prescribed a dose of epinephrine to be administered. The infant weighs 24 lb. How many milligrams of epinephrine should be administered? a. 0.11 to 0.33 mg b. 0.011 to 0.3 mg c. 1.1 to 3.3 mg d. 11 to 33 mg

b. 0.011 to 0.3 mg The correct dose of epinephrine to use in the emergency management of an anaphylactic reaction is 0.001 mg/kg up to a maximum of 0.3 mg, giving a range of 0.011 to 0.3 mg using a weight of 11 kg (24 lb).

At which age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month b. 2 months c. 3 months d. 4 months

b. 2 months At age 2 months, the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. A 3-month-old infant can recognize familiar faces. At age 4 months, infants can enjoy social interactions.

The nurse is explaining average weight gain during the preschool years to a group of parents. Which average weight gain should the nurse suggest to the parents? a. 1 to 2 kg b. 2 to 3 kg c. 3 to 4 kg d. 4 to 5 kg

b. 2 to 3 kg The average weight gain remains approximately 2 to 3 kg (4.56.5 lb) per year during the preschool period.

The parents of a 2-month-old boy are concerned about spoiling their son by picking him up when he cries. What is the nurses best response? a. Allow him to cry for no longer than 15 minutes and then pick him up. b. Babies need comforting and cuddling. Meeting these needs will not spoil him. c. Babies this young cry when they are hungry. Try feeding him when he cries. d. If he isnt soiled or wet, leave him, and hell cry himself to sleep.

b. Babies need comforting and cuddling. Meeting these needs will not spoil him Parents need to learn that a spoiled child is a response to inconsistent discipline and limit setting. It is important to meet the infants developmental needs, including comforting and cuddling. The data suggest that responding to a childs crying can actually decrease the overall crying time. Allowing him to cry for no longer than 15 minutes and then picking him up will reinforce prolonged crying. Infants at this age have other needs besides feeding. The parents should be taught to identify their infants cues. Counseling parents on letting the baby cry himself to sleep when not soiled or wet refers to sleep issues, not general infant behavior.

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

b. Be persistent through 10 to 15 minutes of food refusal. Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Children with FTT need a structured routine to help establish rhythmicity in their activities of daily living. Many children with FTT are fed exclusively from a bottle. Solids should be fed first. Stimulation is reduced during mealtimes to maintain the focus on eating

What is the most common form of child maltreatment? a. Sexual abuse b. Child neglect c. Physical abuse d. Emotional abuse

b. Child neglect Child neglect, which is characterized by the failure to provide for the childs basic needs, is the most common form of child maltreatment. Sexual abuse, physical abuse, and emotional abuse are individually not as common as neglect.

A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was bad. What is the nurses best interpretation of this comment? a. Sign of stress b. Common at this age c. Suggestive of maladaptation d. Suggestive of excessive discipline at home

b. Common at this age Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think they are directly responsible for events, making them feel guilt for things outside of their control. Children of this age react to stress by regressing developmentally or acting out. Maladaptation is unlikely. This comment does not imply excessive discipline at home.

In terms of fine motor development, what should the 3-year-old child be expected to do? a. Tie shoelaces. b. Copy (draw) a circle. c. Use scissors or a pencil very well. d. Draw a person with seven to nine parts.

b. Copy (draw) a circle. Three-year-old children are able to accomplish the fine motor skill of copying (drawing) a circle. The ability to tie shoelaces, to use scissors or a pencil very well, and to draw a person with seven to nine parts are fine motor skills of 5-year-old children.

A father calls the clinic because he found his young daughter squirting Visine eyedrops into her mouth. What is the most appropriate nursing action? a. Reassure the father that Visine is harmless. b. Direct him to seek immediate medical treatment. c. Recommend inducing vomiting with ipecac. d. Advise him to dilute Visine by giving his daughter several glasses of water to drink

b. Direct him to seek immediate medical treatment. Visine is a sympathomimetic and if ingested may cause serious consequences. Medical treatment is necessary. Inducing vomiting is no longer recommended for ingestions. Dilution will not decrease risk.

What is a clinical manifestation of acetaminophen poisoning? a. Hyperpyrexia b. Hepatic involvement c. Severe burning pain in stomach d. Drooling and inability to clear secretions

b. Hepatic involvement Hepatic involvement is the third stage of acetaminophen poisoning. Hyperpyrexia is a severe elevation in body temperature and is not related to acetaminophen poisoning. Acetaminophen does not cause burning pain in stomach and does not pose an airway threat.

The nurse is discussing development and play activities with the parent of a 2-month-old boy. Which statement by the parent would indicate a correct understanding of the teaching? a. I can give my baby a ball of yarn to pull apart or different textured fabrics to feel. b. I can use a music box and soft mobiles as appropriate play activities for my baby. c. I should introduce a cup and spoon or pushpull toys for my baby at this age. d. I do not have to worry about appropriate play activities at this age.

b. I can use a music box and soft mobiles as appropriate play activities for my baby Music boxes and soft mobiles are appropriate play activities for a 2-month-old infant. A ball of yarn to pull apart or different textured fabrics are appropriate for an infant at 6 to 9 months. A cup and spoon or pushpull toys are appropriate for an older infant. Infants of all ages should be exposed to appropriate types of stimulation.

The parent of a 4-year-old boy tells the nurse that the child believes monsters and bogeymen are in his bedroom at night. What is the nurses best suggestion for coping with this problem? a. Let the child sleep with his parents. b. Keep a night light on in the childs bedroom. c. Help the child understand that these fears are illogical. d. Tell the child that monsters and bogeymen do not exist.

b. Keep a night light on in the childs bedroom. Involve the child in problem solving. A night light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with his parents will not get rid of the fears. A 4- year-old child is in the preconceptual stage and cannot understand logical thought

The nurse is discussing the management of atopic dermatitis (eczema) with a parent. What should be included? a. Dress infant warmly to prevent chilling b. Keep the infants fingernails and toenails cut short and clean. c. Give bubble baths instead of washing lesions with soap. d. Launder clothes in mild detergent; use fabric softener in the rinse.

b. Keep the infants fingernails and toenails cut short and clean The infants nails should be kept short and clean and have no sharp edges. Gloves or cotton socks can be placed over the childs hands and pinned to the shirt sleeves. Heat and humidity increase perspiration, which can exacerbate the eczema. The child should be dressed properly for the climate. Synthetic material (not wool) should be used for the childs clothing during cold months. Baths are given as prescribed with tepid water, and emollients such as Aquaphor, Cetaphil, and Eucerin are applied within 3 minutes. Soap (except as indicated), bubble bath oils, and powders are avoided. Fabric softener should be avoided because of the irritant effects of some of its components.

What is an important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS)? a. Discourage the parents from making a last visit with the infant. b. Make a follow-up home visit to the parents as soon as possible after the childs death. c. Explain how SIDS could have been predicted and prevented. d. Interview the parents in depth concerning the circumstances surrounding the childs death.

b. Make a follow-up home visit to the parents as soon as possible after the childs death. A competent, qualified professional should visit the family at home as soon as possible after the death. Printed information about SIDS should be provided to the family. Parents should be allowed and encouraged to make a last visit with their child. SIDS cannot always be prevented or predicted, but parents can take steps to reduce the risk (e.g., supine sleeping, removing blankets and pillows from the crib, and not smoking). Discussions about the cause only increase parental guilt. The parents should be asked only factual questions to determine the cause of death.

An awake, alert 4-year-old child has just arrived at the emergency department after an ingestion of aspirin at home. The practitioner has ordered activated charcoal. The nurse administers charcoal in which manner? a. Giving half of the solution and then repeating the other half in 1 hour b. Mixing with a flavorful beverage in an opaque container with a straw c. Serving it in a clear plastic cup so the child can see how much has been drunk d. Administering it through a nasogastric tube because the child will not drink it because of the taste

b. Mixing with a flavorful beverage in an opaque container with a straw Although activated charcoal can be mixed with a flavorful sugar-free beverage, it will be black and resemble mud. When it is served in an opaque container, the child will not have any preconceived ideas about its being distasteful. The ability to see the charcoal solution may affect the childs desire to drink the solution. The child should be encouraged to drink the solution all at once. The nasogastric tube would be traumatic. It should be used only in children who cannot be cooperative or those without a gag reflex.

Parents tell the nurse they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. What is the most appropriate recommendation for the nurse to make? a. Punish the children so this behavior stops. b. Neither condone nor condemn the curiosity. c. Get counseling for this unusual and dangerous behavior. d. Allow the children unrestricted permission to satisfy this curiosity.

b. Neither condone nor condemn the curiosity Three-year-old children become aware of anatomic differences and are concerned about how the other sex works. Such exploration should not be condoned or condemned. Children should not be punished for this normal exploration. This is age appropriate and not dangerous behavior. Encouraging the children to ask their parents questions and redirecting their activity is more appropriate than giving permission

After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which pediatric issues? a. Sudden infant death syndrome (SIDS) b. Plagiocephaly c. Failure to thrive d. Apnea of infancy

b. Plagiocephaly Plagiocephaly is a misshapen head caused by the prolonged pressure on one side of the skull. If that side becomes misshapen, facial asymmetry may result. SIDS has decreased by more than 40% with the introduction of the Back to Sleep campaign. Apnea of infancy and failure to thrive are unrelated to the Back to Sleep campaign.

What is a significant secondary prevention nursing activity for lead poisoning? a. Chelation therapy b. Screening children for blood lead levels c. Removing lead-based paint from older homes d. Questioning parents about ethnic remedies containing lead

b. Screening children for blood lead levels Screening children for lead poisoning is an important secondary prevention activity. Screening does not prevent the initial exposure of the child to lead. It can lead to identification and treatment of children who are exposed. Chelation therapy is treatment, not prevention. Removing lead-based paints from older homes before children are affected is primary prevention. Questioning parents about ethnic remedies containing lead is part of the assessment to determine the potential source of lead.

A 3-month-old infant dies shortly after arrival to the emergency department. The infant has subdural and retinal hemorrhages but no external signs of trauma. What should the nurse suspect? a. Unintentional injury b. Shaken baby syndrome c. Congenital neurologic problem d. Sudden infant death syndrome (SIDS)

b. Shaken baby syndrome Shaken baby syndrome causes internal bleeding but may have no external signs. Unintentional injury would not cause these injuries. With unintentional injuries, external signs are usually present. Congenital neurologic problems would usually have signs of abnormal neurologic anatomy. SIDS does not usually have identifiable injuries.

A child age 4 1/2 years sometimes wakes her parents up at night screaming, thrashing, sweating, and apparently frightened, yet she is not aware of her parents presence when they check on her. She lies down and sleeps without any parental intervention. This is most likely what? a. Nightmare b. Sleep terror c. Sleep apnea d. Seizure activity

b. Sleep terror This is a description of a sleep terror. The child is observed during the episode and not disturbed unless there is a possibility of injury. A child who awakes from a nightmare is distressed. She is aware of and reassured by the parents presence. This is not the case with sleep apnea. This behavior is not indicative of seizure activity.

Which is an appropriate recommendation in preventing tooth decay in young children? a. Substitute raisins for candy. b. Substitute sugarless gum for regular gum. c. Use honey or molasses instead of refined sugar. d. When sweets are to be eaten, select a time not during meals.

b. Substitute sugarless gum for regular gum. Regular gum has high sugar content. When the child chews gum, the sugar is in prolonged contact with the teeth. Sugarless gum is less cariogenic than regular gum. Raisins, honey, and molasses are highly cariogenic and should be avoided. Sweets should be consumed with meals so that the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth.

The nurse is interviewing the father of a 10-month-old girl. The child is playing on the floor when she notices an electrical outlet and reaches up to touch it. Her father says no firmly and moves her away from the outlet. The nurse should use this opportunity to teach the father what? a. That the child should be given a time-out b. That the child is old enough to understand the word no c. That the child will learn safety issues better if she is spanked d. That the child should already know that electrical outlets are dangerous

b. That the child is old enough to understand the word no By age 10 months, children are able to associate meaning with words. The father is using both verbal and physical cues to alert the child to dangerous situations. A time-out is not appropriate. The child is just learning about the environment. Physical discipline should be avoided. The 10- month-old child is too young to understand the purpose of an electrical outlet.

The nurse is caring for a hospitalized 4-year-old boy. His parents tell the nurse they will be back to visit at 6 PM. When he asks the nurse when his parents are coming, what would the nurses best response be? a. They will be here soon. b. They will come after dinner. c. Let me show you on the clock when 6 PM is. d. I will tell you every time I see you how much longer it will be.

b. They will come after dinner. A 4-year-old child understands time in relation to events such as meals. Children perceive soon as a very short time. The nurse may lose the childs trust if his parents do not return in the time he perceives as soon. Children cannot read or use a clock for practical purposes until age 7 years. I will tell you every time I see you how much longer it will be assumes the child understands the concepts of hours and minutes, which does not occur until age 5 or 6 years.

The parents of a 7-year-old boy tell the nurse that lately he has been cruel to their family pets and actually caused physical harm. The nurses recommendation should be based on remembering what? a. This is an expected behavior at this age. b. This is a warning sign of a serious problem. c. This is harmless venting of anger and frustration. d. This is common in children who are physically abused.

b. This is a warning sign of a serious problem. Cruelty to family pets is not an expected behavior. Hurting animals can be one of the earliest symptoms of a conduct disorder. Abusing animals does not dissipate violent emotions; rather, the acts may fuel the abusive behaviors. Referral for evaluation is essential. This behavior may be seen in emotional abuse or neglect, not physical abuse

A child is admitted to the hospital with lesions on his abdomen that appear like cigarette burns. What should accurate documentation by the nurse include? a. Two unhealed lesions are on the childs abdomen. b. Two round 4-mm lesions are on the childs lower abdomen. c. Two round symmetrical lesions are on the childs lower abdomen. d. Two round lesions on the childs abdomen that appear to be cigarette burns.

b. Two round 4-mm lesions are on the childs lower abdomen. Burn documentation should include the location, pattern, demarcation lines, and presence of eschar or blisters. The option that includes the size of the lesions is the most accurate.

. In terms of cognitive development, a 5-year-old child should be expected to do which? a. Think abstractly. b. Use magical thinking. c. Understand conservation of matter. d. Understand another persons perspective.

b. Use magical thinking. Magical thinking is believing that thoughts can cause events. An example is thinking of the death of a parent might cause it to happen. Abstract thought does not develop until the school-age years. The concept of conservation is the cognitive task of school-age children, ages 5 to 7 years. A 5-year-old child cannot understand another persons perspective.

Which statement is correct about toilet training? a. Bladder training is usually accomplished before bowel training. b. Wanting to please the parent helps motivate the child to use the toilet. c. Watching older siblings use the toilet confuses the child. d. Children must be forced to sit on the toilet when first learning.

b. Wanting to please the parent helps motivate the child to use the toilet. Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please the parent by holding on rather than pleasing him- or herself by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

At which age should the nurse expect most infants to begin to say mama and dada with meaning? a. 4 months b. 6 months c. 10 months d. 14 months

c. 10 months Beginning at about age 10 months, an infant is able to ascribe meaning to the words mama and dada. Four to 6 months is too young for this behavior to develop. At 14 months, the child should be able to attach meaning to these words. By age 1 year, the child can say three to five words with meaning and understand as many as 100 words.

By which age should the nurse expect that an infant will be able to pull to a standing position? a. 5 to 6 months b. 7 to 8 months c. 11 to 12 months d. 14 to 15 months

c. 11 to 12 months Most infants can pull themselves to a standing position at age 9 months. Infants who are not able to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months, infants have just obtained coordination of arms and legs. By age 8 months, infants can bear full weight on their legs.

At which age does an infant start to recognize familiar faces and objects, such as his or her own hand? a. 1 month b. 2 months c. 3 months d. 4 months

c. 3 months The child can recognize familiar objects at approximately age 3 months. For the first 2 months of life, infants watch and observe their surroundings. The 4-month-old infant is beginning to develop handeye coordination.

At which age do most infants begin to fear strangers? a. 2 months b. 4 months c. 6 months d. 12 months

c. 6 months Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to infants ability to discriminate between familiar and unfamiliar people. At 2 months, infants are just beginning to respond differentially to their mothers. The infant at age 4 months is beginning the process of separation-individuation, which involves recognizing the self and mother as separate beings. Twelve months is too late; the infant requires referral for evaluation if he or she does not fear strangers by this age.

At which age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 12 months

c. 8 months Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months, an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months, the infant can maneuver from a prone to a sitting position.

What is most descriptive of atopic dermatitis (AD) (eczema) in an infant? a. Easily cured b. Worse in humid climates c. Associated with hereditary allergies d. Related to upper respiratory tract infections

c. Associated with hereditary allergies AD is a type of pruritic eczema that usually begins during infancy and is associated with allergy with a hereditary tendency. Approximately 50% of children with AD develop asthma. AD can be controlled but not cured. Manifestations of the disease are worse when environmental humidity is lower. AD is not associated with respiratory tract infections.

The nurse is examining an infant, age 10 months, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions. What is the most likely cause? a. Impetigo b. Urine and feces c. Candida albicans infection d. Infrequent diapering

c. Candida albicans infection C. albicans infection produces perianal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal folds. Impetigo is a bacterial infection that spreads peripherally in sharply marginated, irregular outlines. Eruptions involving the skin in contact with the diaper but sparing the folds are likely to be caused by chemical irritation, especially urine and feces, and may be related to infrequent diapering.

The nurse is talking to the parent of a 5-year-old child who refuses to go to sleep at night. What intervention should the nurse suggest in helping the parent to cope with this sleep disturbance? a. Establish a consistent punishment if the child does not go to bed when told. b. Allow the child to fall asleep in a different room and then gently move the child to his or her bed. c. Establish limited rituals that signal readiness for bedtime. d. Allow the child to watch television until almost asleep.

c. Establish limited rituals that signal readiness for bedtime. An appropriate intervention for a child who resists going to bed is to establish limited rituals such as a bath or story that signal readiness for bed and consistently follow through with the ritual. Punishing the child will not alleviate the resistance problem and may only add to the frustration. Allowing the child to fall asleep in a different room and to watch television to fall asleep are not recommended approaches to sleep resistance.

A child with diazepam (Valium) poisoning has been admitted to the emergency department. What antidote does the nurse anticipate being prescribed? a. Succimer (Chemet) b. EDTA (Versenate) c. Flumazenil (Romazicon) d. Octreotide acetate (Sandostatin)

c. Flumazenil (Romazicon) The antidote for diazepam (Valium) poisoning is flumazenil (Romazicon). Succimer (Chemet) and EDTA (Versenate) are antidotes for heavy metal poisoning. Octreotide acetate (Sandostatin) is an antidote for sulfonylurea poisoning.

What is an appropriate action when an infant becomes apneic? a. Shake vigorously. b. Roll the infants head to the side. c. Gently stimulate the trunk by patting or rubbing. d. Hold the infant by the feet upside down with the head supported.

c. Gently stimulate the trunk by patting or rubbing. If an infant is apneic, the infants trunk should be gently stimulated by patting or rubbing. If the infant is prone, turn onto the back. Vigorous shaking, rolling of the head, and hanging the child upside down can cause injury and should not be done.

Which intervention is the most appropriate recommendation for relief of teething pain? a. Rub gums with aspirin to relieve inflammation. b. Apply hydrogen peroxide to gums to relieve irritation. c. Give the infant a frozen teething ring to relieve inflammation. d. Have the infant chew on a warm teething ring to encourage tooth eruption

c. Give the infant a frozen teething ring to relieve inflammation. Teething pain is a result of inflammation, and cold is soothing. A frozen teething ring or ice cube wrapped in a washcloth helps relieve the inflammation. Aspirin is contraindicated secondary to the risks of aspiration. Hydrogen peroxide does not have an anti-inflammatory effect. Warmth increases inflammation.

At a well-child visit, parents ask the nurse how to know if a daycare facility is a good choice for their infant. Which observation should the nurse stress as especially important to consider when making the selection? a. Developmentally appropriate toys b. Nutritious snacks served to the children c. Handwashing by providers after diaper changes d. Certified caregivers for each of the age groups at the facility

c. Handwashing by providers after diaper changes Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when handwashing and other hygienic measures are not consistently used. Developmentally appropriate toys are important, but hygiene and the prevention of disease transmission take precedence. An infant should not have snacks. This is a concern for an older child. Certified caregivers for each age group may be an indicator of a highquality facility, but parental observation of good hygiene is a better predictor of care.

What signals the resolution of the Oedipus or Electra complex? a. Learns sex differences b. Learns sexually appropriate behavior c. Identifies with the same-sex parent d. Has guilt over feelings toward the father or mother

c. Identifies with the same-sex parent The resolution of the Oedipus or Electra complex is identification with the same-sex parent. Learning sex differences and sexually appropriate behavior is a goal in further differentiation of oneself but does not signal the resolution of the Oedipus or Electra complex. Guilt over feelings toward the father or mother is seen as a stage in the complex, not the resolution.

What is a characteristic of a toddlers language development at age 18 months? a. Vocabulary of 25 words b. Use of holophrases c. Increasing level of understanding d. Approximately one third of speech understandable

c. Increasing level of understanding During the second year of life, the understanding and understanding of speech increase to a level far greater than the childs vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages. An 18-month-old child has a vocabulary of approximately 10 words. At this age, the child does not use the one-word sentences that are characteristic of 1-year-old children. The child has a very limited vocabulary of single words that are comprehensible.

What is an important nursing consideration when a child is hospitalized for chelation therapy to treat lead poisoning? a. Maintain bed rest. b. Maintain isolation precautions. c. Keep an accurate record of intake and output. d. Institute measures to prevent skeletal fracture.

c. Keep an accurate record of intake and output. The iron chelates are excreted though the kidneys. Adequate hydration is essential. Periodic measurement of renal function is done. Bed rest is not necessary. Often the chelation therapy is done on an outpatient basis. Chelation therapy is not infectious or dangerous. Isolation is not indicated. Skeletal weakness does not result from high levels of lead.

What is marasmus? a. Deficiency of protein with an adequate supply of calories b. Syndrome that results solely from vitamin deficiencies c. Not confined to geographic areas where food supplies are inadequate d. Characterized by thin, wasted extremities and a prominent abdomen resulting from edema (ascites)

c. Not confined to geographic areas where food supplies are inadequate Marasmus is a syndrome of emotional and physical deprivation. It is not confined to geographic areas were food supplies are inadequate. Marasmus is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears old, with flabby and wrinkled skin. Marasmus is a deficiency of both protein and calories.

During a well-child visit, the father of a 4-year-old boy tells the nurse that he is not sure if his son is ready for kindergarten. The boys birthday is close to the cut-off date, and he has not attended preschool. What is the nurses best recommendation? a. Start kindergarten. b. Talk to other parents about readiness. c. Perform a developmental screening. d. Postpone kindergarten and go to preschool.

c. Perform a developmental screening. A developmental assessment with a screening tool that addresses cognitive, social, and physical milestones can help identify children who may need further assessment. A readiness assessment involves an evaluation of skill acquisition. Stating the child should start kindergarten or go to preschool and postpone kindergarten does not address the fathers concerns about readiness for school. Talking to other parents about readiness does not ascertain if the child is ready and does not address the fathers concerns.

A 4-year-old child tells the nurse that she doesnt want another blood sample drawn because I need all of my insides and I dont want anyone taking them out. What is the nurses best interpretation of this? a. The child is being overly dramatic. b. The child has a disturbed body image. c. Preschoolers have poorly defined body boundaries. d. Preschoolers normally have a good understanding of their bodies.

c. Preschoolers have poorly defined body boundaries. Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at this age. She truly has fear. Body image is just developing in school-age children. Preschoolers do not have good understanding of their bodies.

What developmental characteristic does not occur until a child reaches age 2 1/2 years? a. Birth weight has doubled. b. Anterior fontanel is still open. c. Primary dentition is complete. d. Binocularity may be established.

c. Primary dentition is complete. Usually by age 30 months, the primary dentition of 20 teeth is complete. Birth weight doubles at approximately ages 5 to 6 months. The anterior fontanel closes at ages 12 to 18 months. Binocularity is established by age 15 months.

According to Piaget, a 6-month-old infant should be in which developmental stage? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata

c. Secondary circular reactions Infants are usually in the secondary circular reaction stage from ages 4 to 8 months. This stage is characterized by a continuation of the primary circular reaction for the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. The use of reflexes stage is primarily during the first month of life. The primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from ages 1 to 4 months. The fourth sensorimotor stage is coordination of secondary schemata, which occurs at ages 9 to 12 months. This is a transitional stage in which increasing motor skills enable greater exploration of the environment.

What dysfunctional speech pattern is a normal characteristic of the language development of a preschool child? a. Lisp b. Echolalia c. Stammering d. Repetition without meaning

c. Stammering Stammering and stuttering are normal dysfluency in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers language.

Although a 14-month-old girl received a shock from an electrical outlet recently, her parent finds her about to place a paper clip in another outlet. Which is the best interpretation of this behavior? a. Her cognitive development is delayed. b. This is typical behavior because toddlers are not very developed. c. This is typical behavior because of toddlers inability to transfer remembering to new situations. d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

c. This is typical behavior because of toddlers inability to transfer remembering to new situations. During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. This is typical behavior for a toddler, who is only somewhat aware of a causal relation between events. Her cognitive development is appropriate for her age.

In terms of gross motor development, what should the nurse expect an infant age 5 months to do? a. Sit erect without support. b. Roll from the back to the abdomen. c. Turn from the abdomen to the back. d. Move from a prone to a sitting position.

c. Turn from the abdomen to the back. Rolling from the abdomen to the back is developmentally appropriate for a 5-month-old infant. The ability to roll from the back to the abdomen is developmentally appropriate for an infant at age 6 months. Sitting erect without support is a developmental milestone usually achieved by 8 months. A 10-month-old infant can usually move from a prone to a sitting position.

During the 2-month well-child checkup, the nurse expects the infant to respond to sound in which manner? a. Respond to name. b. React to loud noise with Moro reflex. c. Turn his or her head to side when sound is at ear level. d. Locate sound by turning his or her head in a curving arc.

c. Turn his or her head to side when sound is at ear level At 2 months of age, an infant should turn his or her head to the side when a noise is made at ear level. At birth, infants respond to sound with a startle or Moro reflex. An infant responds to his or her name and locates sounds by turning his or her head in a curving arc at age 6 to 9 months.

A 1-year-old child is on a pure vegetarian (vegan) diet. This diet requires supplementation with what? a. Niacin b. Folic acid c. Vitamins D and B12 d. Vitamins C and E

c. Vitamins D and B12 Pure vegetarian (vegan) diets eliminate any food of animal origin, including milk and eggs. These diets require supplementation with many vitamins, especially vitamin B6, vitamin B12, riboflavin, vitamin D, iron, and zinc. Niacin, folic acid, and vitamins C and E are readily obtainable from foods of vegetable origin.

A new parent asks the nurse, How can diaper rash be prevented? What should the nurse recommend? a. Wash the infant with soap before applying a thin layer of oil. b. Clean the infant with soap and water every time diaper is changed. c. Wipe stool from the skin using water and a mild cleanser. d. When changing the diaper, wipe the buttocks with oil and powder the creases.

c. Wipe stool from the skin using water and a mild cleanser. Change the diaper as soon as it becomes soiled. Gently wipe stool from the skin with water and mild soap. The skin should be thoroughly dried after washing. Applying oil does not create an effective barrier. Over washing the skin should be avoided, especially with perfumed soaps or commercial wipes, which may be irritating. Baby powder should not be used because of the danger of aspiration.

Which statement best describes colic? a. Periods of abdominal pain resulting in weight loss b. Usually the result of poor or inadequate mothering c. Periods of abdominal pain and crying occurring in infants older than age 6 months d. A paroxysmal abdominal pain or cramping manifested by episodes of loud crying

d. A paroxysmal abdominal pain or cramping manifested by episodes of loud crying Colic is described as paroxysmal abdominal pain or cramping that is manifested by loud crying and drawing up the legs to the abdomen. Weight loss is not part of the clinical picture. There are many theories about the cause of colic. Emotional stress or tension between the parent and child is one component. This is not consistent throughout all cases. Colic is most common in infants younger than 3 months of age

What do the psychosocial developmental tasks of toddlerhood include? a. Development of a conscience b. Recognition of sex differences c. Ability to get along with age mates d. Ability to delay gratification

d. Ability to delay gratification If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that toddlers are concerned with is the ability to delay gratification. Development of a conscience and recognition of sex differences occur during the preschool years. The ability to get along with age mates develops during the preschool and school-age years.

Which characteristic best describes the fine motor skills of an infant at age 5 months? a. Neat pincer grasp b. Strong grasp reflex c. Builds a tower of two cubes d. Able to grasp object voluntarily

d. Able to grasp object voluntarily At age 5 months, the infant should be able to voluntarily grasp an object. The grasp reflex is present in the first 2 to 3 months of life. Gradually, the reflex becomes voluntary. The neat pincer grasp is not achieved until age 11 months. At age 12 months, an infant will attempt to build a tower of two cubes but will most likely be unsuccessful.

Which type of play is most typical of the preschool period? a. Team b. Parallel c. Solitary d. Associative

d. Associative Associative play is group play in similar or identical activities but without rigid organization or rules. School-age children play in teams. Parallel play is that of toddlers. Solitary play is that of infants.

The developmental task with which the child of 15 to 30 months is likely to be struggling is a sense of which? a. Trust b. Initiative c. Intimacy d. Autonomy

d. Autonomy Autonomy versus shame and doubt is the developmental task of toddlers. Trust versus mistrust is the developmental stage of infancy. Initiative versus guilt is the developmental stage of early childhood. Intimacy and solidarity versus isolation is the developmental stage of early adulthood.

A young boy is found squirting lighter fluid into his mouth. His father calls the emergency department. The nurse taking the call should know that the primary danger is what? a. Hepatic dysfunction b. Dehydration secondary to vomiting c. Esophageal stricture and shock d. Bronchitis and chemical pneumonia

d. Bronchitis and chemical pneumonia Lighter fluid is a hydrocarbon. The immediate danger is aspiration. Acetaminophen overdose, not hydrocarbons, causes hepatic dysfunction. Dehydration is not the primary danger. Esophageal stricture is a late or chronic consequence of hydrocarbon ingestion.

The nurse is conducting an assessment of fine motor development in a 3-year-old child. Which is the expected drawing skill for this age? a. Can draw a complete stick figure b. Holds the instrument with the fist c. Can copy a triangle and diamond d. Can copy a circle and imitate a cross

d. Can copy a circle and imitate a cross A 3-year-old child copies a circle and imitates a cross and vertical and horizontal lines. He or she holds the writing instrument with the fingers rather than the fist. A 3-year-old is not able to draw a complete stick figure but draws a circle, later adds facial features, and by age 5 or 6 years can draw several parts (head, arms, legs, body, and facial features). Copying a triangle and diamond are mastered sometime between ages 5 and 6 years.

Where do eczematous lesions most commonly occur in an infant? a. Abdomen, cheeks, and scalp b. Buttocks, abdomen, and scalp c. Back and flexor surfaces of the arms and legs d. Cheeks and extensor surfaces of the arms and legs

d. Cheeks and extensor surfaces of the arms and legs The lesions of atopic dermatitis are generalized in infants. They are most common on the cheeks, scalp, trunk, and extensor surfaces of the extremities. The abdomen and buttocks are not common sites of lesions. The back and flexor surfaces are not usually involved

The nurse is explaining the preconventional stage of moral development to a group of nursing students. What characterizes this stage? a. Children in this stage focus on following the rules. b. Children in this stage live up to social expectations and roles. c. Children in this stage have a concrete sense of justice and fairness. d. Children in this stage have little, if any, concern for why something is wrong.

d. Children in this stage have little, if any, concern for why something is wrong. Young childrens development of moral judgment is at the most basic level in the preconventional stage. They have little, if any, concern for why something is wrong. Following the rules, living up to social expectations, and having a concrete sense of justice and fairness are characteristics in the conventional stage.

Which term refers to the relative lactase deficiency observed in preterm infants of less than 34 weeks of gestation? a. Congenital lactase deficiency b. Primary lactase deficiency c. Secondary lactase deficiency d. Developmental lactase deficiency

d. Developmental lactase deficiency Developmental lactase deficiency refers to the relative lactase deficiency observed in preterm infants of less than 34 weeks of gestation. Congenital lactase deficiency occurs soon after birth after the newborn has consumed lactose-containing milk. Primary lactase deficiency, sometimes referred to as late-onset lactase deficiency, is the most common type of lactose intolerance and is manifested usually after 4 or 5 years of age. Secondary lactase deficiency may occur secondary to damage of the intestinal lumen, which decreases or destroys the enzyme lactase.

An infant, age 6 months, has six teeth. The nurse should recognize that this is what? a. Normal tooth eruption b. Delayed tooth eruption c. Unusual and dangerous d. Earlier than expected tooth eruption

d. Earlier than expected tooth eruption Six months is earlier than expected to have six teeth. At age 6 months, most infants have two teeth. Although unusual, having six teeth at 6 months is not dangerous.

The nurse suspects that a child has ingested some type of poison. What clinical manifestation would be most suggestive that the poison was a corrosive product? a. Tinnitus b. Disorientation c. Stupor, lethargy, and coma d. Edema of the lips, tongue, and pharynx

d. Edema of the lips, tongue, and pharynx Edema of the lips, tongue, and pharynx indicates a corrosive ingestion. Tinnitus is indicative of aspirin ingestion. Corrosives do not act on the central nervous system.

The nurse is planning to bring a preschool child a toy from the playroom. What toy is appropriate for this age group? a. Building blocks b. A 500-piece puzzle c. Paint by number picture d. Farm animals and equipment

d. Farm animals and equipment The most characteristic and pervasive preschooler activity is imitative, imaginative, and dramatic play. Farm animals and equipment would provide hours of self-expression. Building blocks are appropriate for older infants and toddlers. A 500-piece puzzle or a paint by number picture would be appropriate for a school-age child.

At a seminar for parents with preschool-age children, the nurse has discussed anticipatory tasks during the preschool years. Which statement by a parent should indicate a correct understanding of the teaching? a. I should be worried if my 4-year-old child has an increase in sexual curiosity because this is a sign of sexual abuse. b. I should expect my 5-year-old to change from a tranquil child to an aggressive child when school starts. c. I should be concerned if my 4-year-old child starts telling exaggerated stories and has an imaginary playmate, since these could be signs of stress. d. I should expect my 3-year-old child to have a more stable appetite and an increase in food selections.

d. I should expect my 3-year-old child to have a more stable appetite and an increase in food selections. A 3-year-old child exhibits a more stable appetite than during the toddler years and is more willing to try different foods. A 4-year-old child is imaginative and indulges in telling tall tales and may have an imaginary playmate; these are normal findings, not signs of stress. Also a 4- year-old child has an increasing curiosity in sexuality, which is not a sign of child abuse. A 5- year-old child is usually tranquil, not aggressive like a 4-year-old child.

The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their children. Which is most likely lacking in their particular diet? a. Fat b. Protein c. Vitamins C and A d. Iron and calcium

d. Iron and calcium Deficiencies can occur when various substances in the diet interact with minerals. For example, iron, zinc, and calcium can form insoluble complexes with phytates or oxalates (substances found in plant proteins), which impair the bioavailability of the mineral. This type of interaction is important in vegetarian diets because plant foods such as soy are high in phytates. Fat and vitamins C and A are readily available from vegetable sources. Plant proteins are available.

A child with acetaminophen (Tylenol) poisoning has been admitted to the emergency department. What antidote does the nurse anticipate being prescribed? a. Carnitine (Carnitor) b. Fomepizole (Antizol) c. Deferoxamine (Desferal) d. N-acetylcysteine (Mucomyst)

d. N-acetylcysteine (Mucomyst) The antidote for acetaminophen (Tylenol) poisoning is N-acetylcysteine (Mucomyst). Carnitine (Carnitor) is an antidote for valproic acid (Depakote), fomepizole (Antizol) is the antidote for methanol poisoning, and deferoxamine (Desferal) is the antidote for iron poisoning.

A parent asks the nurse about negativism in toddlers. What is the most appropriate recommendation? a. Punish the child. b. Provide more attention. c. Ask child not to always say no. d. Reduce the opportunities for a no answer.

d. Reduce the opportunities for a no answer. The nurse should suggest to the parent that questions should be phrased with realistic choices rather than yes or no answers. This provides a sense of control for the toddler and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young to comply with requests not to say no.

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

d. Remain close by the child but without eye contact. The best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common during this age group as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The presence of the parent is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is what? a. A sign the child is spoiled b. An attempt to exert unhealthy control c. Regression, which is common at this age d. Ritualism, an expected behavior at this age

d. Ritualism, an expected behavior at this age The child is exhibiting the ritualism, which is characteristic at this age. Ritualism is the need to maintain sameness and reliability. It provides a sense of structure and comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. This does not indicate the child has unreasonable expectations but rather is part of normal development. Ritualism is not regression, which is a retreat from a present pattern of functioning.

What do inflicted immersion burns often appear as? a. Partial-thickness, asymmetrical burns b. Splash pattern burns on hands or feet c. Any splash burn with dry linear marks d. Sharply demarcated, symmetrical burns

d. Sharply demarcated, symmetrical burns Immersion burns are sharply demarcated symmetrical burns. Asymmetrical burns and splash burns are often accidental.

The nurse is interviewing the parents of a 4-month-old boy brought to the hospital emergency department. The infant is dead, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. The nurse might initially suspect his death was caused by what? a. Suffocation b. Child abuse c. Infantile apnea d. Sudden infant death syndrome (SIDS)

d. Sudden infant death syndrome (SIDS) The description of how the child was found in the crib is suggestive of SIDS. The nurse is careful to tell the parents that a diagnosis cannot be confirmed until an autopsy is performed.

What characteristic best describes the language skills of a 3-year-old child? a. Asks meanings of words b. Follows directional commands c. Can describe an object according to its composition d. Talks incessantly regardless of whether anyone is listening

d. Talks incessantly regardless of whether anyone is listening Because of the dramatic vocabulary increase at this age, 3-year-old children are known to talk incessantly regardless of whether anyone is listening. A 4- to 5-year-old child asks lots of questions and can follow simple directional commands. A 6-year-old child can describe an object according to its composition.

During the preschool period, the emphasis of injury prevention should be placed on what? a. Limitation of physical activities b. Punishment for unsafe behaviors c. Constant vigilance and protection d. Teaching about safety and potential hazards

d. Teaching about safety and potential hazards Education about safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Limitation of physical activities is not appropriate. Punishment may make children scared of trying new things. Constant vigilance and protection are not practical at this age because preschoolers are becoming more independent.

The parents of a newborn say that their toddler hates the baby. . . . He suggested that we put him in the trash can so the trash truck could take him away. What is the nurses best reply? a. Lets see if we can figure out why he hates the new baby. b. Thats a strong statement to come from such a small boy. c. Lets refer him to counseling to work this hatred out. Its not a normal response. d. That is a normal response to the birth of a sibling. Lets look at ways to deal with this.

d. That is a normal response to the birth of a sibling. Lets look at ways to deal with this. The arrival of a new infant represents a crisis for even the best prepared toddler. Toddlers have their entire schedules and routines disrupted because of the new family member. The nurse should work with the parents on ways to involve the toddler in the newborns care and to help focus attention on the toddler. The toddler does not hate the infant. This is an expected, normal response to the changes in routines and attention that affect the toddler. The toddler can be provided with a doll to imitate parents behaviors. The child can care for the dolls needs at the same time the parent is performing similar care for the newborn.

When only one child is abused in a family, the abuse is usually a result of what? a. The child is the firstborn. b. The child is the same gender as the abusing parent. c. The parent abuses the child to avoid showing favoritism. d. The parent is unable to deal with the childs behavioral style.

d. The parent is unable to deal with the childs behavioral style. The child unintentionally contributes to the abuse. The fit or compatibility between the childs temperament and the parents ability to deal with that behavior style is an important predictor. Birth order and gender can contribute to abuse, but there is not a specific birth order or gender relationship that is indicative of abuse. Being the firstborn or the same gender as the abuser is not linked to child abuse. Avoidance of favoritism is not usually a cause of abuse.

What factor is most important in predisposing toddlers to frequent infections? a. Respirations are abdominal. b. Pulse and respiratory rates in toddlers are slower than those in infants. c. Defense mechanisms are less efficient than those during infancy. d. Toddlers have short, straight internal ear canals and large lymph tissue.

d. Toddlers have short, straight internal ear canals and large lymph tissue. Toddlers continue to have the short, straight internal ear canals of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose toddlers to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy.

Rickets is caused by a deficiency in what? a. Vitamin A b. Vitamin C c. Folic acid and iron d. Vitamin D and calcium

d. Vitamin D and calcium Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent rickets. No correlation exists between rickets and folic acid, iron, or vitamins A and C.

Which characteristic best describes the gross motor skills of a 24-month-old child? a. Skips b. Broad jumps c. Rides tricycle d. Walks up and down stairs

d. Walks up and down stairs A 24-month-old child can go up and down stairs alone with two feet on each step. Skipping and broad jumping are skills acquired at age 3 years. Tricycle riding is achieved at age 4 years.