Peds: Chapter 35 & 26

5. The 11-year-old arrives in the emergency department presenting with the following: nosebleed with no apparent trauma, disoriented, confused, difficulty walking, nausea, and coughing. The nurse should question the child concerning which potential activity? A. falling on the playground at school B. experimenting with an inhalant C. eating a food he is allergic to D. exposure to a respiratory disease

B. experimenting with an inhalant

25. A symptom often seen in the child diagnosed with Haemophilus influenza meningitis occurs when the child has a stiff neck. This symptom is referred to as which of the following? A. opisthotonos B. nuchal rigidity C. encephalopathy D. purpuric rash

B. nuchal rigidity

14. The nurse is preparing an in-service training session on Erikson's theories for the pediatric nurses. Which task should the nurse prioritize as an example for the school-aged child? A. insists on doing things their way instead of their caregivers B. will work on a picture until it is finished C. wants to tie their own shoes no matter how long it takes D. understands the need for discipline

B. will work on a picture until it is finished

1. The 6-year-old at a well-child office visit tells the nurse, "I can't play on teams because I am not as good at doing things as my big sister is." What suggestion should the nurse point out to the caregiver that will help increase the child's feelings of self-confidence? A. Ask the child's older siblings to compliment her more often. B. Praise the child for trying even when she can't complete the same activities as the older sibling. C. Set up some playdates that include projects or activities in which the child can be successful. D. Start a rock collection with the child to show her that she can have fun doing activities that don't involve other children.

C. Set up some playdates that include projects or activities in which the child can be successful.

16. The nursing instructor is conducting a class discussion exploring the normal dentition progression of the school-aged child. The instructor determines the session is successful when the students correctly choose which factor as most likely occurring in 10-year-olds? A. All four central incisors have erupted. B. The child has only six permanent teeth. C. Two of the cuspid teeth have erupted. D. There are eight molars.

C. Two of the cuspid teeth have erupted.

2. The nurse is preparing a variety of projects for the pediatric clients on the unit to work on in the playroom. In deciding on projects, the nurse determines the 8-year- old will be best suited to work on which activity? A. stack blocks in a tower B. build a sandcastle with a water-filled moat C. form vases from blocks of clay D. put together a model plane

C. form vases from blocks of clay

12. The nurse is monitoring a playgroup of children on the pediatric unit. The nurse predicts the school-age child will most likely be participating in which activity? A. pretending to be mommies and daddies in the playhouse B. playing with the plastic vacuum cleaner, pushing it around the room C. painting pictures in the art corner of the room D. watching a movie with other children their age

C. painting pictures in the art corner of the room

19. The nursing students working with a group of 8-year-olds have determined they will illustrate the concept of conservation of weight. Which activity would best help these children grasp this concept? A. weighing and measuring each child and comparing the number of pounds to the number of inches for each person B. using a balance scale to weigh a variety of objects and counting how many pennies must be used to balance the scales C. weighing a pound of oranges and a pound of bricks and counting how many of each make a pound D. measuring the weight of a handful of popcorn and then the weight of a handful of pennies

C. weighing a pound of oranges and a pound of bricks and counting how many of each make a pound

14. The nurse is observing a child following an eye injury. Which symptom should alert the nurse to the possibility that the child's uninjured eye may be exhibiting signs of an inflammatory reaction? A. swelling or dryness B. brightness of vision C. discharge of purulent drainage D. an intolerance to light

D. an intolerance to light

13. The nurse is caring for an 8-year-old hospitalized child who is visually impaired. Which nursing intervention would be the highest priority in helping this child reduce anxiety related to hospitalization? A. The nurse takes the child to the playroom and lets her touch the toys. B. The nurse talks to the child when entering and leaving the room. C. The nurse encourages the child to call her friends on the telephone. D. The nurse stays with the child during meals and helps her eat.

B. The nurse talks to the child when entering and leaving the room.

2. The caregiver of a 2-year-old calls the clinic concerned that her child may have pushed paper into her ears, and she asks the nurse what to do. The mother found the child pushing on her ears with torn paper on the floor in front of her. What would be the appropriate response by the nurse? A. "Wait for a day or two to see if the child's ears seem irritated. If they do, bring her in." B. "Sterilize a pair of narrow tweezers. While someone else holds the child's head still, carefully insert the tweezers and remove the paper if there is any." C. "The child should be seen by a care provider. Don't put anything in her ear and bring her in right away." D. "Wash her ear out using warm water and an ear syringe then the paper will flush out with the water."

C. "The child should be seen by a care provider. Don't put anything in her ear and bring her in right away."

10. The nurse is discussing the ears and hearing in a child with a group of peers. Which statement is most accurate related to this topic? A. The eustachian tube in the infant is straighter and wider than in the adult. B. The infant usually responds to sounds around the age of 6 months. C. The eardrum is located between the middle and the internal ear. D. Most children do not have acutely developed hearing until the age of 5 years.

A. The eustachian tube in the infant is straighter and wider than in the adult.

6. The nurse is discussing discipline issues with a group of caregivers of preschool- aged children who have a cognitive impairment. One father tells the group that after he tells his child to stop doing something, the child just continues. Parents in the group make the following statements. Which statement indicates an understanding of disciplining the cognitively impaired child? A. "We hold a family meeting to explain to our other children that she gets away with things they will not get away with because of her impairment." B. "We wait until a behavior happens a second time and immediately put our child in time-out." C. "We always take away a privilege our child has been looking forward to, such as going to a movie next weekend." D. "My wife and I just ignore the behavior and if there is a mess, clean up the mess. He doesn't understand that he has an impairment."

B. "We wait until a behavior happens a second time and immediately put our child in time-out."

29. The nurse is reinforcing teaching with the caregivers of a child who has had a head injury and is being discharged. Which statement made by the caregiver indicates an accurate understanding of the follow-up care for this child? A. "If he falls asleep, we will wake him up every 15 minutes." B. "We can give him acetaminophen for a headache, but no aspirin." C. "Even if the flashlight bothers him, we will check his eyes." D. "If he vomits again, we will bring him back immediately."

C. "Even if the flashlight bothers him, we will check his eyes."

10. The nurse is admitting a 10-year-old for surgery. What action should the nurse prioritize when caring for this child? A. Offer to help with bathing. B. Answer questions regarding pain. C. Encourage family caregivers to stay with the child. D. Avoid prolonged discussions about the child's anxiety.

B. Answer questions regarding pain.

8. What information is most correct regarding the nervous system of the child? A. The child's nervous system is fully developed at birth. B. As the child grows, the gross and fine motor skills increase. C. The child has underdeveloped fine motor skills and well-developed gross motor skills. D. The child has underdeveloped gross motor skills and well-developed fine motor skills.

B. As the child grows, the gross and fine motor skills increase.

20. The nurse is preparing a presentation for a community health fair on the topic of helping school-aged children develop the self-confidence they will need to mature into responsible adults. Which suggestion should the nurse prioritize to caregivers to enable them to help their children in this area? A. Encourage the child to cheer on their friends at games. B. Caregivers should maintain consistent rules and expectations. C. Ensure that the child has the best teacher possible. D. Encourage older siblings to include the child in their activities.

B. Caregivers should maintain consistent rules and expectations.

18. The nurse is working with a group of 8-year-olds who are learning about the concept of conservation of numbers. Which activity will help teach this concept to these school-aged children? A. Stacking blocks in a tower and counting how many can be stacked without falling B. Rearranging a group of coins first into a circle, then a triangle and then a square C. Forming vases from blocks of clay that are of various weights D. Measuring the weight of a handful of popcorn and then the weight of a handful of pennies

B. Rearranging a group of coins first into a circle, then a triangle and then a square

26. In caring for the child with meningitis, the nurse recognizes that which nursing diagnosis would be most important to include in this child's plan of care? A. Delayed growth and development related to physical restrictions B. Risk for injury related to seizure activity C. Risk for acute pain related to surgical procedure D. Ineffective airway clearance related to history of seizures

B. Risk for injury related to seizure activity

35. The nurse asks the caregivers of a child diagnosed with cerebral palsy whether the child "seems to be in a state of constant motion." The question is designed to identify what form of cerebral palsy? A. ataxic B. athetoid C. rigidity D. spastic

B. athetoid

15. The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with otitis media. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of otitis media? A. "When you look at the ear of the infant, pull the ear up and back." B. "They usually are fussy, but they rarely have a fever." C. "After the eardrum ruptures, the child's pain is relieved." D. "Antibiotics don't have much effect, so they aren't used for treatment."

C. "After the eardrum ruptures, the child's pain is relieved."

17. The nurse is collecting data on an 18-month-old child admitted with a diagnosis of possible seizures. When interviewing the caregivers, which questions would be most important for the nurse to ask? A. "Is your child up to date on his immunizations?" B. "Has anyone in your family been sick recently" C. "What type of activities was your child doing today?" D. "Have you checked your child's temperature?"

D. "Have you checked your child's temperature?"

5. The caregivers of a child who has had difficulty learning to walk notice that when the child attempts to pull himself up to stand, he can't seem to get his legs uncrossed and beside each other. When he is in a standing position, he stays up on his toes. This is different from what they saw with their older children and they are concerned. Further diagnostic tests indicate the child has cerebral palsy. When instructing on the types of cerebral palsy, which type will the nurse present? A. ataxic cerebral palsy B. athetoid cerebral palsy C. rigidity cerebral palsy D. spastic cerebral palsy

D. spastic cerebral palsy

24. The school nurse is discussing obesity with a group of caregivers of school-aged children. Which statement by the caregivers best illustrates that they are prepared to help their child prevent obesity? A. "I always cook foods that are low in fat." B. "We eat fast foods only on weekends because we are too busy to cook." C. "Neither my husband nor I have ever had any concerns with weight." D. "I keep lots of snacks on hand because my child eats all day long."

A. "I always cook foods that are low in fat."

16. In children with otitis media, a procedure known as a myringotomy may be performed. Which statement is most accurate regarding this procedure? A. During this procedure, small tubes are inserted into the tympanic membrane. B. This procedure is performed as soon as otitis media is diagnosed. C. A small incision is made in the earlobe during this procedure. D. The purpose of this procedure is to decrease or stop the drainage.

A. During this procedure, small tubes are inserted into the tympanic membrane.

25. The nursing instructor is leading a discussion on school-aged children. The instructor determines the session is successful when the students correctly choose which factor as being a priority for the school-aged child? A. Needs 10 to 12 hours of sleep per night B. Should brush their teeth at bedtime C. Have a routine physical exam every 6 months D. Be screened for scoliosis once a year

A. Needs 10 to 12 hours of sleep per night

4. A 7-year-old client has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when she first said she had a headache, the child's father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which statement would be the best response by the nurse? A. "This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome." B. "This is a serious problem. Aspirin is likely to cause Reye syndrome, and she should be admitted to the hospital for observation as a precaution." C. "This is unlikely to be a problem. Half an aspirin is not enough to cause harm. Reye syndrome generally only develops from prolonged use of aspirin in connection with a virus." D. "This might or might not be a problem. Watch your daughter for signs of nasal discharge, sneezing, itching of the nose, or dark circles under the eyes. If you notice any of these, bring her to the emergenc

A. "This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome."

30. A child is home with the caregivers following a treatment for a head injury. The caregiver should contact the care provider if the child makes which statement? A. "You look funny. Well, both of you do. I see two of you." B. "My stomach is upset. I feel like I might throw up." C. "I am glad that my headache is getting better." D. "It will be nice when you will let me take a long nap. I am sleepy."

A. "You look funny. Well, both of you do. I see two of you."

7. The nurse is assessing a 9-year-old girl during her well-child checkup and notes the child weighs 86 lb (39 kg). After noting she weighed 9.5 lb (4.30 kg) at birth and her growth has been within normal patterns, the nurse determines this girl is within which category? A. slightly underweight B. slightly overweight C. significantly overweight D. significantly underweight

B. slightly overweight

17. A 6-year-old male has come to the clinic for a routine well-child visit. The nurse, after noting in the medical record that this child has followed basic growth and development standards, anticipates documenting which common assessment finding? A. flat abdomen B. swayed back C. long legs D. slender body

B. swayed back

31. Which of these age groups has the highest actual rate of death from drowning? A. infants B. toddlers C. preschool children D. school-aged children

B. toddlers

37. The nurse cares for a 7-year-old child with new-onset seizure disorder. Which prescription will the nurse anticipate for this client? A. frequent temperature assessment B. use of anticonvulsant medications C. ketogenic diet D. vagus nerve stimulation

B. use of anticonvulsant medications

4. The school nurse is preparing to conduct routine health screenings of the elementary school students. Which screening will the nurse prioritize for studentsages 6 to 8? A. signs of scoliosis B. vision and hearing C. review immunization records D. nutritional needs

B. vision and hearing

23. The nurse is presenting information about school-aged children at a community event. Which statement from the group should the nurse prioritize to address with further teaching and more information? A. "Sometimes we have to be firm, but our children wash their hands before eating." B. "I make sure they have good teeth by giving them calcium and phosphorus." C. "Food is so expensive, we always make our children eat everything on their plates." D. "Even if the weather is cool and cloudy, our children play outside every day."

C. "Food is so expensive, we always make our children eat everything on their plates."

33. The health care provider orders amoxicillin 35 mg/kg/day in three divided doses for a child with otitis media. The child weighs 44 lb and the medication is available in a suspension of 50 mg/ml. What is the total daily dosage in ml for this child? A. 0.4 ml B. 1.4 ml C. 14.0 ml D. 140 ml

C. 14.0 ml

9. The nurse is addressing a caregiver's concerns regarding adequate sleep for an 11-year-old child who gets up at 6:30 a.m. each morning. The nurse should point out which time as the most appropriate bedtime for this child? A. 7:30 p.m. B. 8:00 p.m. C. 9:00 p.m. D. 10:00 p.m.

C. 9:00 p.m.

27. Haemophilus influenzae meningitis is usually spread by which method of transmission? A. intravenous B. fecal C. droplet D. contact

C. droplet

23. The nurse caring for a 3-year-old child with a history of seizures observes the child having a seizure. What information should the nurse document concerning the event? Select all that apply. A. Time the seizure started B. Factors present before seizure started C. Persons in attendance during seizure D. Number of seizures child has had in the last 48 hours E. Eye position and movement F. Incontinence of urine or stool

A. Time the seizure started B. Factors present before seizure started E. Eye position and movement F. Incontinence of urine or stool

7. The mother of a child newly diagnosed with an intellectual disability tells the nurse that her partner disagrees with the diagnosis and believes that the child is perfectly normal. The mother shares with the nurse that she finds this reaction frustrating and confusing. Which action by the nurse would be appropriate in supporting this mother? A. Reassure the mother that her partner's reaction is a normal stage in the grieving process. B. Offer to speak with the partner to explain how the diagnosis was reached. C. Suggest that the couple get a second opinion about the child's condition. D. Recommend that the couple consider placing the child in foster care until they adjust to the diagnosis.

A. Reassure the mother that her partner's reaction is a normal stage in the grieving process.

21. The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be: A. The child is in status epilepticus. B. The child is having generalized seizures. C. The child's history indicates she has infantile seizures. D. The child may begin to have absence seizures every day.

A. The child is in status epilepticus.

12. The caregiver of a 2-year-old child tells the nurse, "They told me my daughter has an eye disorder called hyperopia." Which statement made by the mother indicates she has an understanding of this child's current condition? A. "She can see better close up than at a distance." B. "Now I know why when she is working on puzzles she says her eye is sleepy." C. "She has to have glasses right away." D. "At least by the time she gets married maybe she can have contacts."

B. "Now I know why when she is working on puzzles she says her eye is sleepy."

22. The caregiver of a child who has a history of seizures reports that her child was complaining of being dizzy, and the caregiver noted the child seemed drowsy and was clumsy. The nurse recognizes that the description of the child's behavior was most likely which stage of a tonic-clonic seizure? A. aura B. clonic C. postictal D. prodromal

D. prodromal

32. The nurse is talking with the mother of a 4-year-old boy who will soon be going to a pre-kindergarten program. The child has had the Snellen vision test done at home, and he was unable to distinguish the pictures at the distance that would indicate his vision is normal. The child's mother asks the nurse if he will need glasses. Which statement made by the nurse would be most appropriate regarding the child's vision? A. "He might be suffering from hyperopia and probably will need glasses now." B. "A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness." C. "He is likely to have a slight astigmatism, which almost always needs to be corrected by glasses." D. "His vision problem will get in the way of his learning, so he will probably have to have glasses before he starts school."

B. "A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness."

28. The nurse is observing a group of children diagnosed with various types of cerebral palsy. One of the children has an awkward and wide-based gait. The nurse recognizes this characteristic as common in which type of cerebral palsy? A. ataxic cerebral palsy B. athetoid cerebral palsy C. rigidity cerebral palsy D. spastic cerebral palsy

A. ataxic cerebral palsy

15. The school nurse is assessing a 6-year-old child's dentition. Which assessment should the nurse prioritize for this child? A. has first permanent molars B. has at least six permanent teeth C. has two cuspid or canine teeth D. has lost all deciduous teeth

A. has first permanent molars

36. The nurse is providing education to the caregivers of a child recently diagnosed with tonic-clonic seizure disorder. What instructions should the nurse provide related to the tonic stage of this type of seizure? A. Be prepared for the child to report being dizzy. B. Ask the child whether he or she is experiencing any unusual sensory sensations. C. Monitor the child's breathing closely. D. Be prepared for the child to be temporarily confused.

C. Monitor the child's breathing closely.

3. An 8-year-old boy's foster mother is concerned about three recent cavities found in his permanent teeth and reports the child eats a nutritional diet, doesn't eat junk food, and the town water supply is fluoridated. Which suggestion should the nurse prioritize to this mother in regard to the child's dental health? A. Encourage the child to abstain from eating sugary snacks at school. B. Accept that the child is genetically predisposed to having more cavities than most children. C. Ensure that the child brushes his teeth after each meal and snacks. D. Have the child's teeth professionally cleaned every 3 months.

C. Ensure that the child brushes his teeth after each meal and snacks.

11. The nurse is teaching a group of parents about eyes and eye concerns. The nurse tells these caregivers about a condition that occurs when unequal curvatures in the cornea bend the light rays in different directions and this causes images to be blurred. The condition the nurse is referring to is: A. Refraction B. Myopia C. Astigmatism D. Hyperopia

C. Astigmatism

34. When caring for a child who has a history of seizures, which nursing interventions would be appropriate? Select all that apply. A. The nurse pads the crib or side rails before a seizure. B. The nurse positions the child on the side during a seizure. C. The nurse places a washcloth in the mouth to prevent injury during seizure. D. The nurse stays with the child and calls for help when a seizure begins. E. The nurse has oxygen available to use during a seizure. F. The nurse teaches the caregivers regarding seizure precautions.

A. The nurse pads the crib or side rails before a seizure. B. The nurse positions the child on the side during a seizure. D. The nurse stays with the child and calls for help when a seizure begins. E. The nurse has oxygen available to use during a seizure. F. The nurse teaches the caregivers regarding seizure precautions.

11. The nurse is preparing a care plan for a school-age child to address the child's hospitalization. Which factor should the nurse incorporate into this plan? A. increased attention span and interest in an activity for a long length of time B. can take in new information at a rapid rate and asks "why" and "how" a lot C. insists he or she can "do it" and then reverts to being dependent D. Grows and develops skills more rapidly than at any other time in his or her life

A. increased attention span and interest in an activity for a long length of time

22. The caregiver of a 6-year-old is concerned the child is not getting proper nutrition because on some days, the child will only eat one type of food. Which response should the nurse prioritize for this caregiver? A. "It is important that each time she eats, she has a variety of foods." B. "Food jags are common in this age. This probably won't last long." C. "Try having her eat with the family and she will want what others are eating." D. "She should be discouraged from having food likes or dislikes. Have her eat everything."

B. "Food jags are common in this age. This probably won't last long."

19. The nurse is collecting data from the caregivers of a child admitted with seizures. Which statement indicates the child most likely had an absence seizure? A. "His arms had jerking movements in his legs and face." B. "He was just staring into space and was totally unaware." C. "He kept smacking his lips and rubbing his hands." D. "He usually is very coordinated, but he couldn't even walk without falling."

B. "He was just staring into space and was totally unaware."

20. The nurse is caring for a child admitted with focal onset motor seizures (simple partial motor seizures). Which clinical manifestation would likely have been noted in the child with this diagnosis? A. The child had jerking movements in the legs and facial muscles. B. The child had shaking movements on one side of the body. C. The child was rubbing the hands and smacking the lips. D. The child was dizzy and had decreased coordination.

B. The child had shaking movements on one side of the body.

8. The school nurse is meeting with a 10-year-boy who is concerned about his weight. He reports he doesn't eat much candy but loves fruit, pasta, potatoes, and bread. Which suggestion should the nurse prioritize to help him maintain a healthy weight? A. Encourage portion control at each meal B. Change to a very low-fat and no-carbohydrate diet. C. Encourage activities that will increase his physical activity. D. Encourage the child to not worry about weight until he is older.

C. Encourage activities that will increase his physical activity.

3. The nurse caring for a deaf child is preparing to give the child an intramuscular injection in the child's upper arm. The child's attention is focused on the caregiver on the opposite side of the bed. Before administering the injection, it would be most important for the nurse to do which of the following? A. Pat the child gently on the shoulder to get his attention and point to her own armso he knows she is giving him the injection. B. Ask his caregiver to point out that the nurse is there. C. Move around the bed and make eye contact, then show the child the syringe and indicate that the shot is going to be given. D. Ask the caregiver to keep the child's attention focused on her.

C. Move around the bed and make eye contact, then show the child the syringe and indicate that the shot is going to be given.

18. The nurse is caring for a child admitted with focal onset impaired awareness seizure (complex partial seizure). Which clinical manifestation would likely have been noted in the child with this diagnosis? A. The child had jerking movements and then the extremities stiffened. B. The child had shaking movements on one side of the body. C. The child was rubbing the hands and smacking the lips. D. The child was dizzy and had decreased coordination.

C. The child was rubbing the hands and smacking the lips.

6. The mother of a 6-year-old is asking the nurse how to handle the child's lying and fabricated stories when confronted with questionable actions. Which response would be most appropriate by the nurse? A. "Your child could be in serious trouble in school if he continues to tell lies." B. "The child should have privileges taken away for several days each time he tells a lie." C. "Is there any possibility he is telling the truth and you just don't know it is the truth?" D. "Children this age sometimes can't distinguish between fantasy and reality."

D. "Children this age sometimes can't distinguish between fantasy and reality."

9. The nurse recognizes that if the infant is following normal development, the infant will be able to focus and follow an object with the eyes by what age? A. 7 days of age B. 21 days of age C. 1 month of age D. 2 months of age

D. 2 months of age

24. The nurse is preparing discharge education for the caregivers of a child with a seizure disorder. Which goal of treatment is priority for this client? A. The caregivers will be prepared to care for the child at home. B. The child will have an understanding of the disorder. C. The family will understand seizure precautions. D. The child will remain free from injury during a seizure.

D. The child will remain free from injury during a seizure.

13. A 7-year-old seen in the clinic for a routine well-child visit is noted on assessment to have gained 5 lb (2.26 kg) and grown 5 in (12.70 cm) over the past year. The nurse determines this child is within which parameters? A. Weight and height are within expected patterns of growth. B. Weight is within expected range and height is less than expected. C. Weight is above expected range and the height is within an expected range. D. Weight is within expected range and height is above expected range.

D. Weight is within expected range and height is above expected range.

1. When caring for an infant who is hospitalized with Haemophilus influenzae meningitis, an important nursing intervention for the child would be for the nurse to: A. restrain the child before and during a seizure. B. place the child in a side-lying position and keep the position using pillows. C. monitor intake and output and increase fluid intake every 4 hours. D. check the child's neurologic status every 2 hours.

D. check the child's neurologic status every 2 hours.

21. The nurse notes a school-aged child in the pediatric unit playroom is busy sorting through the Legos and putting them in certain groupings. The nurse determines this child is illustrating which developmental concept? A. conservation of numbers B. decentration C. reversibility D. hierarchical arrangement

D. hierarchical arrangement