PEDs Chapts 2, 8, 9, 11, 12, & 13

A dental home (like a medical home) establishes a continuing comprehensive relationship of care with the child and family. The American Academy of Pediatric Dentistry (AAPD) recommends this dental home be established by the time the child is age: a) 1 year b) 2 years c) 1½ years d) 3 years e) 2½ years

1 year Correct Explanation: The recommendation is by the child's first birthday. This is the time the first dental exam should occur.

The nurse will use the Denver Articulation Screening Exam (DASE) for children in what age range? a) 6 months to one year b) 6 to 10 years c) 2 1/2 to 6 years d) 0 to 2 years

2 1/2 to 6 years Correct Explanation: The DASE is designed for children 2 ½ to 6 years to identify difficulty in producing word sounds (articulation). It is standardized, easy to administer in a brief time and meant only for English-speakers. Those who score below their age group norms should be retested within two weeks and referred for complete language testing if the repeat exam is abnormal.

The child has been hospitalized for failure to thrive. The child weighs 23.2 kg. The child is to receive 120 kilocalories per kg of weight per day. How many kilocalories should the child eat each day? _____ kilocalories

2784 Correct Explanation: 23.2 kilograms x 120 kilocalories/1 kilogram = 2,784 kilocalories

The nurse is planning to teach children about healthy food choices. At what age will the nurse begin to teach the child or children directly? a) 2 years b) 4 years c) 3 years d) 6 years e) 8 years

3 years Explanation: By age 3 years, this young preschooler can begin to learn through brief teaching intervals using age-appropriate, appealing materials to make healthy food choices. A 2-year-old will be unable, cognitively, to do this. All the other ages will benefit from this teaching but do not represent the beginning age.

The infant was born at 32 weeks gestation and is now 9 months old. What is the infant's corrected age? months

7 Correct Explanation: When assessing growth and development of the infant or child who was born prematurely, determine the child's adjusted or corrected age so that you can perform an accurate assessment. 40 weeks-32 weeks is 8 weeks or 2 months. The child was born 2 months early.

A nurse is preparing to administer medication to a preschooler. What can the nurse do to ensure communication with the child is effective? a) Allow the child to determine if he or she wants to take the medication at that time. b) Show the child a video about medication administration. c) Use medical terminology when discussing the medication with the child. d) Allow the child to choose between juice, water, or soda to take the medication.

Allow the child to choose between juice, water, or soda to take the medication. Correct Explanation: Preschool children should be allowed to have choices as appropriate.

Personal space and distance is a cultural perspective that can impact nurse-patient interactions. What is the best way for the nurse to interact with a patient who has a different cultural perspective on space and distance? a) Allow the patient to adopt a position that is comfortable for him or her b) Realize that sitting close to the patient is an indication of warmth and caring c) Adopt a cultural preference similar to that of the patient d) Remember not to intrude into the personal space of the elderly

Allow the patient to adopt a position that is comfortable for him or her Correct Explanation: If the patient appears to position himself or herself too close or too far away, the nurse should consider cultural preferences for space and distance. Ideally, the patient should be permitted to assume a position that is comfortable to him or her in terms of personal space and distance. Options B and D are incorrect because "realizing" and "remembering" are not interactions. Option C is incorrect because adopting a cultural preference different from your own can be very uncomfortable for the nurse, which adds a barrier to nurse-patient interactions.

The nurse is providing hair care for an African-American 10-year-old girl hospitalized with a painful disorder. What should the nurse do first? a) Use commercial detangling solutions prior to brushing. b) Ask the girl and/or her family about any preferences in hair care or for usual procedures used. c) Dry the hair before combing. d) Condition the hair before shampooing.

Ask the girl and/or her family about any preferences in hair care or for usual procedures used. Correct Explanation: Due to the child's ethnicity, her hair is likely to require certain care measures. Often products are used to lubricate the hair and make it easier to handle. Wet hair is easier to comb and a wide-tooth comb is helpful. The family can bring any special preparations needed.

When caring for hospitalized teens, nurses should choose their words and actions carefully since adolescents typically are concerned about: a) Separation from peers and family b) Mobility restrictions c) Mutilation of their body d) Appearing out of control of the situation and/or themselves

Appearing out of control of the situation and/or themselves Correct Explanation: Adolescents are concerned about how others view them. They wish not to do or say "dumb" things or appear babyish. This concern may cause them to worry about postanesthesia behavior or about how they might react to a procedure. Independence is desired yet a concern. Mobility restrictions, mutilation, and separation are more common fears and anxieties in preschoolers and school-age children.

Traditionally, hot and cold are viewed as potential causes of disease by which of the following groups? a) African Americans b) Native Americans c) Arab Americans d) Hispanic Americans

Arab Americans Explanation: The Arab American beliefs often hold hot and cold as being potential cause for illnesses.

Curious parents ask what type of immunity is provided to their child through immunization with various vaccines. What will be the nurse's answer? a) Artificially acquired active immunity b) Naturally acquired active immunity c) Artificially acquired passive immunity d) Naturally acquired passive immunity

Artificially acquired active immunity Correct Explanation: Artificially acquired active immunity develops through vaccine administration of an antigen that stimulates the child's body to produce antibodies against that antigen (pathogen) and to remember the antigen should it reappear. Natural immunity is produced through natural invasion of an antigen (pathogen). Natural and artificial passive immunity involves providing antibodies to fight a pathogen rather than expecting the child's body to produce them. This type of immunity has a short life.

You see a 3-year-old girl in an ambulatory clinic because she has a bad cold. Her mother tells you the girl's problem was caused by her being affected by "mal ojo." Which of the following would be the best action? a) Tell her mother this is not a legitimate illness. b) Explain there is nothing to do for illnesses caused by evil spirits. c) Ask her mother what symptoms her daughter is experiencing. d) Teach her mother that colds are caused by viruses.

Ask her mother what symptoms her daughter is experiencing. Correct Explanation: Respecting cultural values is important for effective nurse-patient relationships.

A nurse is talking with a 10 year old and her parent about the current treatment plan for the child's asthma. The child stands behind the parent and does not ask questions or look at the nurse. What should the nurse consider the child's behavior could indicate? a) The child may be shy and have some reluctance about communicating. b) The child may not want to be treated for the asthma. c) The child may be developmentally delayed and not understand the conversation. d) The child may be angry about the diagnosis of asthma.

Correct response: The child may be shy and have some reluctance about communicating. Explanation: It is difficult to assess how shy children feel when they are reluctant to communicate about such things as the long-term effect a disease will have. If they do not give you much verbal feedback, the tendency is to believe they do not have a concern.

Following a principle of learning, you can anticipate that the children will best learn a skill such as bandaging if they a) receive verbal instructions b) are allowed to practice it c) watch a video on how to do it

are allowed to practice it. Correct Explanation: Children in a concrete cognitive stage learn best if they can actually demonstrate procedures.

The nurse is admitting a 14-year-old girl for a tonsillectomy and is preparing her for the procedure. Which of the following is the best statement or question? a) "Are you wondering about anything related to your tonsillectomy?" b) "Some of the sounds in the hospital can be scary." c) "Are you feeling scared about the surgery?" d) "I have your discharge instructions for you."

"Are you wondering about anything related to your tonsillectomy?" Correct Explanation: For a 14-year-old girl, the best approach would be to ask an open question so that concerns, lack of understanding, or a need for information can be determined. Asking if the teen feels "scared" may get a "yes" or "no" response, which may or may not be honest depending on what the teen expects of herself or believes others expect of her. An adolescent is often reluctant to admit fear. Mentioning scary hospital sounds provides no information and is inappropriate developmentally. Introducing discharge instructions needs to come later after other needs are met. Some discharge information is covered during admission since tonsillectomy is usually day surgery.

The nurse has just finished administering the DTaP vaccine to a 2-month-old and is educating the parent about immunization. Which of the following statements is accurate? a) "There are no side effects from this vaccine." b) "The 'T' stands for tuberculosis." c) "Bring her back for the second dose when she is 4 months old." d) "You need to renew this immunization every 10 years."

"Bring her back for the second dose when she is 4 months old." Correct Explanation: DTaP is given as a series of five injections—at 2, 4, and 6 months; between 15 and 18 months, and between 4 and 6 years. A TdaP booster is needed by 11 to 12 years. There are common side effects such as fever and redness and swelling at the injection site as well as other less common reactions such as seizures. The "T" in the vaccine stands for tetanus.

A nurse is attempting to help a 10 year old focus their anger when learning how to use an insulin pump for newly diagnosed diabetes mellitus. What statement by the nurse can help the child focus this anger? a) "You should be glad that you are a candidate for the use of the pump. What if you had to give yourself shots all of the time?" b) "This pump is here to help regulate your insulin delivery." c) "I know that this is overwhelming for you, so how about if I just teach your parents?" d) "Can you tell me what makes you angry about using the insulin pump?"

"Can you tell me what makes you angry about using the insulin pump?" Correct Explanation: To encourage focusing, ask children to detail why they are angry. Once the subject is out in the open, few children can resist describing the extent of or reason for their anger.

A parent wants to wait outside the room while a procedure is completed on his young child, saying, "I don't think I can stand to see you do this!" The nurse's best response is: a) "This will only take a few minutes. You should be with your child." b) "Stay. It will be less scary for your child." c) "Good. That is what the team doing the procedure would prefer." d) "Certainly. I will stay with your child during the procedure." e) "Come, stand by his head. You won't see much up there"

"Certainly. I will stay with your child during the procedure." Correct Explanation: Excusing the parent from the procedure is the best response. The parent's needs and abilities need to be respected and supported. Children usually receive the most support from parents. However, others can provide effective support including nurses and child life personnel. Consider, also, that an anxious parent usually means an anxious child. Assist the parent to comfort the child after the procedure.

The mother of two school age children is getting divorced. Which would be the best advice for the nurse to give? a) "Discuss how things will work after the divorce." b) "Make your side of the disagreement clear." c) "Move out when the children are in school." d) "It's best to treat your children like adults."

"Discuss how things will work after the divorce." Correct Explanation: Both parents together should discuss with the children how things will work after the divorce. The children should not be expected to act like adults because they are not. Tell them about the divorce ahead of time, and tell them the reasons in nonjudgmental terms that they can understand.

The nurse is discussing the impact of smoking with the mother of a toddler. Which of the following statements by the mother indicates an adequate understanding of the impact of her smoking? a) "Even the clothing I wear when smoking can pose a danger to my son." b) "Exposure to cigarette smoke will be of the greatest danger to my son when he is school age" c) "Smoking outside will protect my child from harm. d) "Smoking will not harm my son as long as I am in another room."

"Even the clothing I wear when smoking can pose a danger to my son." Correct Explanation: Secondhand smoke and other pollutants is a health hazard for children. A recent study found that residual tobacco smoke and carcinogens remain after a cigarette is extinguished (referred to as third hand smoke). These toxins cling to the smoker's hair and clothes and can be present on any surface in the house, such as carpet and cushions. Children are particularly susceptible to third hand smoke since they breathe near, crawl, touch and mouth contaminated surfaces.

The nurse is providing care for a hospitalized child. Rank the following phases in the order of occurrence based on the nurse's statements. "Hi, my name is Cindy and I'm going to be your nurse for today." "Would you like your medicine before or after your mom helps take a bath?" "Let's sit over here and play a game of 'Go Fish'." "You handled that procedure so well! Would you like me to get Mr. Snuggles for you?"

"Hi, my name is Cindy and I'm going to be your nurse for today." "Let's sit over here and play a game of 'Go Fish'." "Would you like your medicine before or after your mom helps take a bath?" "You handled that procedure so well! Would you like me to get Mr. Snuggles for you?" Correct Explanation: Nursing care for a hospitalized child typically occurs in four phases: introduction, building a trusting relationship, decision-making phase, and providing comfort and reassurance.

A mother calls a clinic nurse to ask if her infant born prematurely should receive the seasonal influenza vaccine. The nurse's next question should be: a) "Did your baby have any respiratory problems?" b) "How much premature was your baby?" c) "How old is your baby?" d) "Does your baby have any allergies?"

"How old is your baby?" Correct Explanation: Flu vaccine and all other vaccines are administered according to chronological age. Flu vaccine is recommended for all infants at 6 months of age and given yearly thereafter. An underlying respiratory problem makes flu vaccine important. Awareness of allergies is also necessary, but the first question is chronological age to determine if the infant is old enough to receive the vaccine.

Which statement by the father of a preschooler with special needs indicates to the nurse that additional teaching is needed? a) "I don't take him to the park when the neighbor kids are there. He can't do some things; the kids stare." b) "I hope he'll be toilet trained soon. We are working on it." c) "He enjoys knocking down tall block towers I build. This is something his little brother does, too." d) "He has an imaginary playmate who has a place at our dinner table."

"I don't take him to the park when the neighbor kids are there. He can't do some things; the kids stare." Correct Explanation: A preschooler with special needs should associate with other children. This is a crucial time for the child to learn social skills. A simple explanation given to neighborhood children may encourage their interaction. Toilet training and destroying block towers are behaviors common to the toddler period. This special needs child is developing, just on a slower timeline. Parental acceptance of slowed achievement of skills is healthy for the child. An imaginary playmate is frequently part of the preschool years and serves as a both a source of companionship and "someone" the child can control.

The nurse suspects poor literacy skills in a child's family member when which statement is made? a) "I need you to review once more the best way to be sure he swallowed all his medicine." b) "We communicate with the special education teachers and school daily with a notebook." c) "He gets a suppository every 3 days to prevent constipation." d) "I forgot my glasses, so I'll read this when I get home and let you know if I have questions."

"I forgot my glasses, so I'll read this when I get home and let you know if I have questions." Correct Explanation: Identifying poor literacy or health literacy skills can be difficult. Many will work to hide this lack. "Forgetting" one's glasses could provide an excuse for not reading or questioning and should raise concerns about literacy. If other indicators such as a history of medication errors, English as a second language, an elderly caretaker (grandparent), or numerous missed appointments are present, the index of suspicion is higher. Needing a review, knowing how the suppository was used, and notebook communication with the school would ordinarily not raise a literacy or health literacy concern, although they do not rule it out.

A nurse is telling the parents how to help their 10-year-old daughter deal with an extended hospital stay due to surgery, followed by traction. Which of the following responses indicates a need for further teaching? a) "We must prepare her in advance." b) "She will watch our reactions carefully." c) "She will be sensitive to our concerns." d) "I should not tell her how long she will be here."

"I should not tell her how long she will be here." Correct Explanation: Parents who do not tell children the truth or do not answer their questions confuse, frighten, and may weaken the children's trust in the parent. The other statements are effective forms of communication.

Chapter 8 A nurse is preparing a hospitalized child for a lumbar puncture. The physician states that he will perform the procedure in the child's hospital room. What should the nurse inform the physician to advocate for the child? a) "I will prepare the hospital room for the child, because that room is where the child will feel most comfortable." b) "The parents want to be present during the procedure, and I informed them that this isn't the policy of our facility." c) "I will have the procedure prepared in the treatment room, so that the child may view the hospital room as safe and secure." d) "We will have to have the parents hold the child down because there is not enough assistance on the floor."

"I will have the procedure prepared in the treatment room, so that the child may view the hospital room as safe and secure." Correct Explanation: In the hospital, all invasive procedures should be performed in the treatment room or a room other than the child's room. The child's room should remain a safe and secure area.

The nurse is providing teaching for the parents of an 8-year-old girl who has undergone surgery. The nurse emphasizes the importance of maintaining adequate hydration. Which of the following responses by the mother would indicate a need for further teaching? a) "Ice chips count as fluid intake. One cup of ice equals a half-cup of water." b) "I should offer her small amounts of fluid frequently." c) "Anything that melts at body temperature is counted as a fluid." d) "I will remind her that she will need an IV if she does not drink."

"I will remind her that she will need an IV if she does not drink." Explanation: The child is likely to view an IV both as frightening and as punishment. Intravenous fluids should be seen as therapy. Threat such as this should not be used to achieve compliance with eating or drinking. The other statements show understanding.

Nursing students are learning about the importance of therapeutic communication in their pediatric course. The nursing instructor identifies a need for further teaching when a student makes which of the following statements? a) "It is best to stoop to a child's level when listening." b) "It is good to lean forward when listening." c) "It is best to stand when listening to a patient to demonstrate knowledge." d) "It is good to sit, not stand when listening."

"It is best to stand when listening to a patient to demonstrate knowledge." Correct Explanation: Good listening is not passive but active. Posture reveals greatly whether one is listening. Sitting, not standing, to convey one is not on the run; leaning forward, not backward; and stooping to meet a child's level are ways that one can show listening.

The nurse is providing teaching for the parents of a 7- year-old boy, scheduled for surgery, to help prepare the child for hospitalization. Which of the following statements by the parents indicates a need for further teaching? a) "It is a good idea to read stories about experiences with hospitals or surgery" b) "We should talk about going to the hospital and what it will be like coming home" c) "It is best to wait and let her bring up the surgery or any questions she has" d) "We should visit the hospital and go through the preadmission tour in advance"

"It is best to wait and let her bring up the surgery or any questions she has" Correct Explanation: It is important to be honest and encourage the child to ask questions rather than wait for the child to speak up. The other statements are correct.

The nurse is preparing to admit a 4- year-old who will be having tympanostomy tubes placed in both ears. Which of the following strategies would most likely reduce the child's fears of the procedure? a) "The doctor is going to insert tympanostomy tubes in your ears" b) "Let me show you how tiny these tubes are" c) "Let me show you the operating room" d) "Don't worry, you will be asleep the whole time"

"Let me show you how tiny these tubes are" Correct Explanation: The nurse needs to describe the procedure and equipment in terms the child can understand. For a 4-year-old, a simple explanation along with the chance to touch and feel the tiny tubes would be best. Using the term tympanostomy tubes is not age-appropriate and does not teach. Telling the child that he or she will be asleep the whole time might increase their fears. Showing the child the operating room might increase fear with all of the strange and imposing equipment.

The nurse is working with the 5-day-old baby boy of a young Jewish couple. Interruptions distract the nurse. What comment is not culturally sensitive? a) "What a beautiful little boy!" b) "Oh, I see you have chosen not to have your baby circumcised." c) "I'll make sure he gets a blue blanket." d) "He seems hungry. Go ahead and nurse him."

"Oh, I see you have chosen not to have your baby circumcised." Correct Explanation: Ritual circumcision for Jewish babies takes place on the eighth day of life. All the other comments are acceptable.

During a physical assessment of a 6-year-old child, the nurse observes the child has lost a tooth and uses the opportunity to promote oral health care. Which of the following comments would be included in this discussion? a) "Try to keep the child's hands out of the mouth." b) "Fluoridated water has significantly reduced cavities." c) "Limit the amount of soft drinks in the child's diet." d) "Oral health can affect general health."

"Oral health can affect general health." Correct Explanation: The nurse will advise the mother that poor oral health can have significant negative effects on systemic health. Discussing fluoridation and community health may have little interest to the mother. Placing the hands in the mouth exposes the child to pathogens and is appropriate for personal hygiene promotion. Soft drink consumption is better covered during healthy diet promotion.

Which statement by parents of a teenager with special needs causes the nurse to believe additional teaching would be helpful? a) "Our daughter has friends in her special needs club and also in the youth group at church." b) "Our daughter wants to get her ears pierced. We've told her she can't. She'd have too much trouble with the earrings." c) "Our daughter is embarrassed about needing help with her menstrual periods, but we're troubleshooting ways for her to manage." d) "Our daughter has decided not to participate in hippotherapy this year. We think it helped her balance. She disagrees, so we will go with her decision."

"Our daughter wants to get her ears pierced. We've told her she can't. She'd have too much trouble with the earrings." Correct Explanation: Ear piercing makes the teen feel more like the other adolescents she knows. This is not a harmful practice. It would be wise for parents to honor this desire. The other comments show parental understanding of bodily changes and support for social growth and independent decision making. All are opportunities that foster adolescent development.

The child with special needs and parents return to a health care setting regularly for multiple assessments and interventions. Which statement by the father alerts the nurse that certain changes are needed? a) "Our son had the same x-rays here as were done last week at another clinic." b) "Our child was in the hospital again last week. It's been 2 times so far this year." c) "It's hard to get to this clinic with all the building and road construction." d) "Arrangements for respite care are not yet complete."

"Our son had the same x-rays here as were done last week at another clinic." Correct Explanation: Repeated x-rays could be harmful to the child and point to poor coordination of care. Care coordination is a nursing role. The nurse should work with others involved in this child's care to improve its management. In situations where coordinating professionals are not available, parents can be taught to assume this function. Coordination results in improved care and greater satisfaction of all concerned. The other statements identify issues that may need follow-up but do not require the attention that poor care coordination requires.

Bookish parents have a child with a 3-yearold boy with a difficult temperament. Which guidance will be most successful for the nurse to use? a) "Encourage him to do quiet activities." b) "Spank him for throwing a tantrum." c) "Give him time out for running in the house." d) "Provide a place for him to roughhouse."

"Provide a place for him to roughhouse." Correct Explanation: Suggesting that the parents provide a place where the child can roughhouse would be best for the child and them. Disciplining him for running in the house, encouraging him to do quiet activities, and spanking him if he has a tantrum are counter to his temperament.

A few days after discharge, the parent of an 8-year-old calls the pediatric clinic, concerned about the child's behavior now that she is home. The parent expresses that the child is treating her siblings badly and using language she knows she is not allowed to use. The parent asks the nurse for suggestions regarding how to handle this behavior. Which of the following statements would be most appropriate for the nurse to make to this parent? a) "Children often feel guilty for the attention they've taken away from their siblings and act out as a way of earning the attention." b) "Coming home is a difficult adjustment. Warn your daughter that you expect her to begin to behave better over the next few weeks." c) "Tell her you don't like her behavior and have her to stay in her room until she can be nicer to her siblings." d) "Respond to her behavior in a firm, loving, consistent way."

"Respond to her behavior in a firm, loving, consistent way." Correct Explanation: The return home may be a difficult period of adjustment for the entire family. The older child may demonstrate anger or jealousy of siblings. The family may be advised to encourage positive behavior and to avoid making the child the center of attention because of the illness. Discipline should be firm, loving, and consistent. The child may express feelings verbally or in play activities. The family may be reassured that this is not unusual.

The nurse is working with the caregivers and families of children who are hospitalized. Members of the group make the following statements. Which statement gives an indication of an issue that would likely be a major factor influencing the family's response to the child's illness? a) "Sometimes I wonder if the reason she is sick is because I have so many responsibilities at work and at home." b) "We have really good insurance—it covered everything the last time she was in the hospital." c) "My husband was so relieved when he heard that after the next surgery he will probably not need to have any more and will be fine." d) "When my sister was in the hospital before, the nurse let me get up on her bed while she read me a story."

"Sometimes I wonder if the reason she is sick is because I have so many responsibilities at work and at home." Correct Explanation: The child's family suffers stress for a number of reasons. In this situation the caregiver felt guilt about the illness. The cause of the illness, its treatment, guilt about the illness, past experiences of illness and hospitalization, disruption in family life, the threat to the child's long-term health, cultural or religious influences, coping methods within the family, and financial impact of the hospitalization all may affect how the family responds to the child's illness. Although some of these are concerns of the family and not specifically the child, they nevertheless influence how the child feels.

A nurse is preparing to admit a child for a tonsillectomy. How should the nurse establish rapport? a) "Tell me about your cute stuffed dog you have." b) "Do you understand why you are here?" c) "Let's take a look at your tonsils." d) "Are you scared about having your tonsils out?"

"Tell me about your cute stuffed dog you have." Correct Explanation: The nurse should start the initial contact with children and their families as a foundation for developing a trusting relationship. Asking about a favorite toy would be a good starting point. The nurse should allow the child to participate in the conversation without the pressure of having to comply with a request or undergo any procedures.

Nurse is providing education concerning discipline to the parents of a 2-year-old girl. Which of the nurse's comments follows the strategies for good discipline? a) "Tell her adults can do as they please, children can't." b) "Always have the father do the disciplining." c) "Tell what will result in her being sent to her room." d) "You can modify the discipline when she is sick."

"Tell what will result in her being sent to her room." Correct Explanation: It is important to make the consequence known before the bad behavior. This way the child has the opportunity to avoid misbehaving. Effective discipline is performed in close proximity to the misbehavior. It is important to set a good example and avoid hypocritical behavior.

A mother in the outpatient setting is explaining how she plans to prepare her 5-year-old for hospital admission. What remark indicates the parent requires additional teaching? a) "We found several books for him at the library that talk about being in the hospital." b) "We watched a program for kids on public television about being in the hospital." c) "We have a date to visit pediatrics and tour their department." d) "We told him to use his manners and behave like a big, brave boy."

"We told him to use his manners and behave like a big, brave boy." Correct Explanation: Expecting manners and big, brave behavior is unrealistic. The child's coping skills are not yet well developed. Expressing true feelings should be allowed. The other preparations are helpful and promote understanding of the experience.

An 8-year-old girl with cerebral palsy heard about handicapped horseback riding and is begging to try it. Her mother is frightened of her falling and talks to the nurse. What is the most helpful nursing response? a) "Let me give you a helpful website for stable information." b) "Horseback riding often aids in developing self-esteem." c) "The stable has specially trained staff and employs physical therapists to work with the children to provide a specific and safe program." d) "Hippotherapy can build balance and muscle strength."

"The stable has specially trained staff and employs physical therapists to work with the children to provide a specific and safe program." Correct Explanation: It is most appropriate to respond to the mother's concern about the perceived danger of the activity. The mother has not asked for information about a stable, the benefits of hippotherapy, or the impact on the daughter's self-esteem.

The nurse is discussing measles, mumps, and rubella vaccination with a mother who is concerned about using the combined vaccine for her 12-month-old. Which of the following statements by the nurse will be most helpful to the mother in accepting the vaccine? a) "It is one of the most commonly used childhood vaccines." b) "The vaccine is shown to be effective and safe and will reduce the number of injections your child will need." c) "This vaccine is approved by the American Academy of Pediatrics." d) "This vaccine is recommended by the Centers for Disease Control and Prevention."

"The vaccine is shown to be effective and safe and will reduce the number of injections your child will need." Correct Explanation: The mother may not understand that combining the vaccines creates no safety or effectiveness problems and reduces the number of injections her child must endure. The other statements are true and offer some reassurance as to safety and efficacy but are not as helpful to the parent in understanding how she can protect her child from unnecessary discomfort.

The nurse is working with a group of caregivers of children in a community setting. The topic of hospitalization and the effects of hospitalization on the child are being discussed. Which of the following statements made by the caregivers supports the most effective way for children to be educated about hospitals? a) "Our next door neighbor was sick and died in the hospital. We explained to our son that usually babies are born and people get well in hospitals." b) "My wife brought home several books about hospitalization and surgery, and she and I are reading them to our son." c) "The school nurse set up posters and displays showing pictures of what the inside of a hospital looked like, and we made sure our daughter saw the display." d) "We are going to take our child to an open house at the hospital so she can see the pediatric unit."

"We are going to take our child to an open house at the hospital so she can see the pediatric unit." Correct Explanation: Families are encouraged to help children at an early age develop a positive attitude about hospitals. The family should avoid negative attitudes about hospitals. Some hospitals have regular open house programs for healthy children. Children may attend with parents or caregivers or in an organized community or school group.

A mother tells the nurse that she is newly pregnant and asks about her 15-month-old's need for the chicken pox immunization because her two older children did "fine" when they had the disease. What is the nurse's best response? a) "When chicken pox can be avoided, why not do so?" b) "Your toddler should not receive this live-virus immunization today. It may present a risk to your pregnancy." c) "I realize that the vaccine is somewhat costly, but it is likely to be more economical than dealing with chicken pox." d) "When your child avoids chicken pox, it protects other children from being exposed to the disease. Some cannot be immunized because of their health conditions."

"When your child avoids chicken pox, it protects other children from being exposed to the disease. Some cannot be immunized because of their health conditions." Correct Explanation: The best response explains the impact that chicken pox can have on vulnerable individuals. High immunization levels mean low levels of disease. This reduces exposure for those who are unimmunized and susceptible. The live-virus vaccine given to the toddler does not present risk to the pregnant mother or fetus. Varicella vaccine is not inexpensive. Avenues for providing immunizations to families who cannot afford them are available. The "why not" response is somewhat dismissive and does not address the mother's question.

A nurse is caring for a 6-year-old boy hospitalized due to an infection requiring intravenous antibiotic therapy. The child's motor activity is restricted and he is acting out, yelling, kicking, and screaming. Which of the following responses by the nurse would help promote positive coping? a) "Would you like to read or play video games?" b) "Your medicine is the only way you will get better." c) "Do I need to call your parents?" d) "Let me explain why you need to sit still."

"Would you like to read or play video games?" Correct Explanation: Distraction with books or games would be the best remedy to provide an outlet to distract him from his restricted activity. The other responses would be unlikely to affect a change in the behavior of a 6-year-old.

Julie calls the doctor's office to let them know that her son Jacob has had a fever and a runny nose. Julie wants to know if she should still bring him for his 15-month immunizations. What is the appropriate response from the nurse? a) "No, do not bring Jacob in today." b) "Yes, bring him in, he can still have his shots." c) "No, do not bring him until his symptoms subside." d) "Yes, bring him in, but we will not do his shots today."

"Yes, bring him in, he can still have his shots." Explanation: Low-grade fevers and minor respiratory infections are not contraindications for vaccinations. The only true contraindications are a history of reactions to vaccines or encephalopathy within 7 days after the DTaP vaccine. If Julie does not bring Jacob in, or if he is seen in the office but no immunizations are given, he will be behind on his vaccination schedule.

A nurse is advising a pregnant woman on the importance of calcium intake during her pregnancy. Which of the following would be the most appropriate suggestion for the nurse to make? a) "I see that you are lactose intolerant, so do not worry about your calcium intake; just eat plenty of protein." b) "I recommend you take calcium supplements during your pregnancy." c) "It is important for the health of your baby that you drink plenty of milk during your pregnancy." d) "Your body needs plenty of calcium during pregnancy. Here is a list of foods that are high in calcium."

"Your body needs plenty of calcium during pregnancy. Here is a list of foods that are high in calcium." Correct Explanation: It is important for pregnant women to ingest adequate calcium but be certain not to advise a woman who is lactose intolerant to drink milk as her main source of calcium. Women can obtain this instead through pills or eating other foods high in calcium such as dark green vegetables. While supplements are certainly a valid option, it is better to explain the primary need for calcium and then give her options on how to meet that need, rather than just limit it to one source.

Media is beginning to promote immunizations for the upcoming influenza season. The mother of a premature infant 7 months chronological age and 5 months corrected age asks about immunizing her child. The nurse responds: a) "The child's corrected age makes him too young." b) "Premature infants should not be immunized against the seasonal flu until 1 year old chronologically." c) "No child receives seasonal flu vaccine until age 4 years." d) "Your child as a 7-month-old should be immunized."

"Your child as a 7-month-old should be immunized." Correct Explanation: Infants receive influenza vaccine at 6 months of age. Chronological age is used for premature infants. All the other responses are incorrect.

The nurse is working with the caregivers of a child who is being discharged from a healthcare setting. Which of the following statements is most accurate regarding discharge planning? a) Written instructions should be the basis of discharge information so they can be taken home with the child. b) Arrangements should be make for the caregiver to have help with treatments that appear too complex for the caregiver to manage a few days after the child's discharge. c) A conference to review information and procedures with the family caregivers is important to do as part of discharge planning. d) Discharge planning should be just immediately prior to the child leaving the facility.

A conference to review information and procedures with the family caregivers is important to do as part of discharge planning. Correct Explanation: Shortly before the child is discharged from the hospital, a conference may be arranged to review information and procedures with the family caregivers.

A nurse is attempting to reduce pain that a child is experiencing after an emergency appendectomy. What intervention can the nurse provide to meet this goal?

Assess the child frequently and use pharmacologic and nonpharmacologic methods of pain relief as needed. Correct Explanation: Using the principles of atraumatic care, the nurse may attempt to control pain via frequent assessments and use of pharmacologic and nonpharmacologic interventions.

The nurse is caring for an infant born prematurely. Which intervention is performed based on chronological age? a) Administration of immunizations b) Provision of anticipatory guidance for parents c) Use of an infant formula for full-term babies d) Assessment of growth and development

Administration of immunizations Correct Explanation: Infants born prematurely should receive all immunizations based on their chronological age. The other interventions should be based on the infants' corrected or adjusted age.

What is the key nursing role when managing the healthcare of a child living with a foster family? a) Determining if the child has mental health needs b) Securing proper educational placement c) Advocating for the child and the services needed d) Identifying any developmental delays

Advocating for the child and the services needed Correct Explanation: Advocating for the child is the overarching nursing role. Unmet health needs are likely. Advocacy gives the child a "voice" so that the wide range of healthcare needs often prevalent in foster children can be met. Determining presence of mental health issues and developmental status as well as securing educational placement are specific issues among many that advocacy would address.

A client who immigrated from China and has undergone labor induction with Pitocin has an elevated temperature and dry mucous membranes. She is refusing sips of water and ice. Which is the most appropriate nursing action at this time? a) Ask the client what she would like to drink. b) Offer the client a hot beverage. c) Encourage the client to drink the ice and water. d) Increase the IV Pitocin to 125 mls/hr for hydration.

Ask the client what she would like to drink. Explanation: Although some Asian childbearing women drink only hot beverages, it would be appropriate first to find out what the client wants to drink and determine her preferences. There is a reason she has chosen to not drink the cold beverages, so it is best to ask her what she wants. The nurse should avoid generalizations. Increasing the Pitocin will likely increase her uterine contractions and is not appropriate practice for meeting hydration needs.

The nurse is educating a 15-year-old girl with Grave's disease and her family about the disease and its treatment. Which of the following methods of evaluating learning is least effective? a) Having the child and family demonstrate skills b) Requesting the parent to teach the child skills c) Asking closed-ended questions for specific facts d) Setting up a scenario for them to talk through

Asking closed-ended questions for specific facts Correct Explanation: Asking questions is a valid way to evaluate learning. However, it is far more effective to ask open-ended questions because they will better expose missing or incorrect information. As with teaching, evaluation of learning that involves active participation is more effective. This includes the child and family demonstrating skills, teaching skills to each other, and acting out scenarios.

The nurse is educating the family of a 2-yearold Chinese boy with bronchiolitis about the disorder and its treatment. Which of the following actions, involving an interpreter, can jeopardize the family's trust? a) Using a person who is not a professional interpreter b) Allowing too little appointment time for the translation c) Asking the interpreter questions not meant for the family d) Using an older sibling to communicate with the parents

Asking the interpreter questions not meant for the family Correct Explanation: Asking questions or having private conversations with the interpreter may make the family uncomfortable and destroy the child/nurse relationship. Translation takes longer than a same-language appointment, and must be considered so that the family is not rushed. Using a nonprofessional runs the risk that they won't be able to adequately translate medical terminology. Using an older sibling can upset the family relationships or cause legal problems.

The nurse is promoting achieving the benefits of a healthy weight to an overweight 12-year-old child and her parents. Which of the following approaches is best? a) Suggesting that the child join a little league softball team b) Showing the family the appropriate weight for the child c) Asking what activities she enjoys such as dance or sports d) Pointing out fattening foods and excesses in their diet

Asking what activities she enjoys such as dance or sports Correct Explanation: Asking what activities that promote exercise for the child is best for several reasons. It provides assessment of the child's activity preferences, whether health-centered (positive) or weight centered (negative), and it offers variety. If on option doesn't work, others might. Emphasizing appropriate weight or dietary shortcomings can lead to eating disorders or body hatred. Suggesting only softball limits the success of the healthy weight promotion.

The nurse is caring for a 1-year-old boy who was a premature infant. What must the nurse do to attain accurate developmental assessment data? a) Screen with the Denver II using the child's chronological age. b) Use open-ended questions when discussing the child with his parents. c) Compare the child to his siblings. d) Assess for developmental progress based on the child's corrected or adjusted age.

Assess for developmental progress based on the child's corrected or adjusted age. Correct Explanation: Premature infants should be compared to developmental norms using their corrected age through 3 years' chronological age. Using the child's chronological age when the screening tool is the Denver II will yield inaccurate results. Comparing the child to his siblings will not provide accurate assessment data. Open-ended questions will give parents opportunity to share comprehensive data and may be an aid to gathering better parent assessment of their premature child, but this is not the key to accurate assessment of children born prematurely.

The mother of a 5-year-old with eczema is getting a check-up for her child before school starts. Which of the following will the nurse do during the visit? a) Assess how the family is coping with the chronic illness b) Assess the child's fluid volume c) Change the bandage on a cut on the child's hand d) Discuss systemic corticosteroid therapy

Assess how the family is coping with the chronic illness Explanation: Maintaining proper therapy for eczema can be exhausting both physically and mentally. Therefore it is essential that the nurse assess parents' ability to cope with this stress. Changing a bandage is not part of a health supervision visit. Skin hydration is important for a child with eczema; however, fluid volume is not a concern. Systemic corticosteroid therapy is very rarely used and the success of the current therapy needs to be assessed first.

A 10-year-old girl is living with her grandparents. Which nursing intervention is most important with this family structure? a) Teaching the couple basic child care skills b) Determining who the decision maker is c) Assessing the child for emotional problems d) Helping to access the need for financial aid

Assessing the child for emotional problems Correct Explanation: Children living with their grandparents may experience emotional stress if the biological parents are in and out of the child's life. Teaching basic child care skills is appropriate for the adolescent family. Determining the decision maker is important with an extended family, and financial aid is important for single parents.

What should be the first step in developing a teaching plan for a 9 year old who needs education about a gluten-free diet for the treatment of celiac disease? a) Giving the child a pamphlet about the reason for a gluten-free diet b) Developing outcome standards for the nutritional aspect of the plan c) Collecting data of current dietary likes and dislikes d) Assessing the child's current level of understanding

Assessing the child's current level of understanding Explanation: Important areas for assessment include a child's current level of understanding; cognitive, physical, psychosocial aspects; and how the new knowledge will meld with the child's and family's lifestyle.

The nurse notes that a 5-year-old boy is approaching obesity. Which is the priority intervention? a) Asking about culturally related eating habits b) Assessing the diet of the child and family c) Determining the activity level of the child d) Screening the child for metabolic disorders

Assessing the diet of the child and family Explanation: The greatest influence on the child's behaviors is the family. Therefore, habits of the family are likely to be those of the child. Evaluating the family diet is most important. Determining the activity level of the child ranks next in importance. Sedentary behaviors lead to weight gain. Asking about culturally related eating habits can produce some helpful but limited nutrition information. Screening the child for metabolic disorders would not be done unless there was other evidence that points to this possibility.

The nurse is assessing a woman who is pregnant. Her health history reveals she has three young adult children. Which nursing intervention would be most appropriate according to Duvall's developmental theory? a) Promoting the importance of vaccinations b) Describing nutritional value of breastfeeding c) Assessing the parent's coping abilities d) Providing developmental anticipatory guidance

Assessing the parent's coping abilities Explanation: It would be most appropriate to assess the parent's coping abilities because they are in the wrong stage of the family life cycle to be having another child. Providing anticipatory guidance, describing the nutritional value of breastfeeding, and promoting the importance of vaccinations are interventions for younger parents

The nurse caring for a hospitalized child with failure to thrive (FTT) will focus first on: a) Assisting the child to attain adequate nutrition to demonstrate weight gain b) Determining the quality of the parent-child relationship c) Forming a positive relationship with the child d) Providing appropriate developmental stimulation

Assisting the child to attain adequate nutrition to demonstrate weight gain Correct Explanation: Attaining nutrition to promote weight gain is the primary focus. Special feeding situations and methods may be needed such as desensitizing the child to certain food textures or beginning enteral feedings. All the other options are important in helping the child with FTT but are not the initial focus.

During the health history of a 2-week-old neonate, the nurse discovers the child has not yet had a hearing screening. Which of the following should the nurse schedule? a) Weber test b) Rinne test c) Auditory brain stem response test d) Tympanometry

Auditory brain stem response test Correct Explanation: Auditory brain stem response (ABR) test and the evoked otoacoustic emissions (EOAE) test are indicated for newborns. A child not screened for hearing at birth should be screened before 1 month of age. The Rinne and Weber tests are used with children 6 years and older. Tympanometry is appropriate for children beyond 7 months of age

The nurse is caring for a 7-year-old child who is being treated for multiple fractures after being involved in an automobile accident. The nurse observes that the father frequently takes on the role of nurturer in the family. When planning care, which nursing intervention would most involve the father? a) Staying with the child at the hospital b) Meeting with the discharge planner to discuss plans after discharge c) Assuring medications are received on time d) Bathing the child

Bathing the child Explanation: The nurse would focus on the father for decisions about the course of treatment. Assuring medications are received on time is the family health manager's role. Staying with the child in the hospital will be handled by the family nurturer. All clinical input will be provided to the family gatekeeper for dissemination.

In working with middle to older adolescents with special needs, the nurse teaches the teens when to seek help from a health professional and about the medical insurance process. This nurse is: a) Beginning to prepare the teen for transition to adult care b) Attempting to relieve stressed parents of some responsibility c) Promoting improved use of the present healthcare resources d) Working to reduce the financial burden for the family

Beginning to prepare the teen for transition to adult care Correct Explanation: Preparation of teens for adult care should begin by mid-adolescence. The nurse who assists the teen to better understand and navigate the healthcare system as well as to make sound decisions about when and how to seek care is beginning this process. Advance and gradual preparation makes an often difficult transition smoother. The other options do not reflect the transition to adult care process.

The nurse correctly differentiates race from ethnicity by noting that race is based on which characteristics? a) Religious b) Biological c) Social d) Spiritual

Biological Correct Explanation: The biological characteristics of race are based on either physical appearance or place of origin.

A 6-year-old needs to cough and deep breathe following surgery. To accomplish this, the nurse will: a) Instruct the parents to remind the child to cough and deep breathe every 2 hours. b) Arrange for respiratory therapy to do coughing and deep breathing exercises with the child. c) Blow a pinwheel and bubbles with the child. d) Teach the young school-ager to use an incentive spirometer.

Blow a pinwheel and bubbles with the child. Correct Explanation: All of the measures have potential to get the child to cough and deep breathe to some extent. The most playful and familiar methods of bubbles and a pinwheel will accomplish the most since they are likely to be accepted and even enjoyed.

A nurse is caring for a small child with leukemia who will be hospitalized frequently for chemotherapy. What type of referral can the nurse make that will help the child and family through this time? a) Child life specialist b) Play therapist c) Child psychologist d) Occupational therapist

Child life specialist Correct Explanation: A child life specialist (CLS) is a specially trained individual who provides programs that prepare children for hospitalization, surgery, and other procedures that could be painful. The CLS is a member of the multidisciplinary team and works in conjunction with health care providers and parents to foster an atmosphere that promotes the child's well being.

A nurse is talking with a 10 year old who is saying that his "stomach has been hurting for several days and is worse when he drinks milk." The nurse asks the child, "Let me be sure I understand. The pain gets worse when you drink milk?" What type of therapeutic communication technique is the nurse using? a) Paraphrasing b) Clarifying c) Perception checking d) Reflecting

Clarifying Explanation: Clarifying consists of repeating statements others have made so both of you can be certain you understand them. This is particularly helpful if a child has been describing a set of symptoms or series of actions.

The nurse is caring for a 7-year-old boy and his family, who are immigrants. Which intervention will most significantly affect the success of the care provided? a) Asking about transportation to the appointment b) Inquiring about common health problems in their home country c) Communicating with sensitivity using understandable terms d) Referring them to state and local aid programs

Communicating with sensitivity using understandable terms Correct Explanation: Being understood is essential to the provision of all nursing care. An interpreter may be needed. Speaking slowly and using simple terms is also useful. Inquiring about common health problems in their home country, asking about transportation, and helping them access aid programs are all secondary to and dependent upon effective communication.

A family is anxious for information about the status of their ill infant. The parents do not understand English, but the 14-year-old daughter is competent in spoken and written English. The physician is present, but an interpreter is unavailable. The nurse should: a) Coordinate physician and interpreter schedules and arrange an information-sharing session for later in the day. b) Support the 14-year-old while she interprets for her parents and the physician at the bedside. c) Develop a written account of the infant's status with the physician that the daughter can read and explain to her parents. d) Have the teenage daughter and physician discuss the information thoroughly and help her share this data with her parents.

Coordinate physician and interpreter schedules and arrange an information-sharing session for later in the day. Correct Explanation: An interpreter is essential. Explanations need to be given and questions relayed and answered. The interpreter needs understanding of the healthcare environment, not just the language. The parents are anxious for information and "not knowing" is difficult. However, children in the family should not be used as interpreters. This may upset family dynamics giving a great deal of power to a child.

The nurse has been assigned to care for a child who is on transmission-based precautions. This nurse has not cared for this child before. Which of the following actions would be the best way to help the child feel comfortable with the nurse? a) Remind the child that her caregivers will be in to visit soon. b) Read to the child for a few minutes before starting care. c) Ask the previous nurse to introduce the new nurse. d) Let the child see his or her face before the mask is put on.

Correct response: Let the child see his or her face before the mask is put on. Explanation: If masks or gloves are part of the necessary precautions, the child may experience even greater feelings of isolation. Before putting on the mask, the nurse should allow the child to see his or her face; this process will help the child easily identify the nurse. Being introduced by the previous nurse, reading to the child, or explaining that the caregiver will visit soon are appropriate but are not the best ways to help the child feel less isolated and more comfortable with the nurse in the isolation setting..

What indicator will alert the nurse that the family of the child with special needs is not ready to assume home care? a) Financial stress is significant owing to loss of the caregiver income. b) The home environment includes the essentials but is crowded, which compromises ease and efficiency. c) The parents are new to the community, lack knowledge of its resources, and have no friend/family support. d) The family is anxious but demonstrates accurately the physical care the child requires.

Correct response: The parents are new to the community, lack knowledge of its resources, and have no friend/family support. Explanation: The child should remain as an inpatient until support services are available to the family. All of the other indicators are "adequate" but less than ideal, placing additional stress on caregiving at home. This child and family should have ongoing monitoring and assistance to safely and effectively care for the child.

The nurse is caring for an 18-month-old boy hospitalized with a gastrointestinal disorder. The nurse knows that the child is at risk for separation anxiety. The nurse understands to watch carefully for which of the following behaviors, indicating that the first phase of separation anxiety is occurring? a) Embracing others who attempt to comfort him b) Disinterest in play and food c) Exhibiting apathy and withdrawing from others d) Crying and acting out

Crying and acting out Correct Explanation: Children in the first phase, protest, react aggressively to this separation, and reject others who attempt to comfort the child. The other behaviors are indicators of the second phase, despair.

Which of the following terms represents a view of the world and a set of traditions that a specific social group uses and transmits to the next generation? a) Race b) Cultural values c) Culture d) Ethnicity

Culture Explanation: Culture is a view of the world and a set of traditions that a speci?c social group uses and transmits to the next generation. Cultural values are preferred ways of acting based on those traditions. Ethnicity refers to the cultural group into which a person was born, although the term is sometimes used in a narrower context to mean only race. Race refers to a category of people who share a socially recognized physical characteristic. The term is rarely used today as the research on the human genome shows no basic differences in structure among people.

The nurse is caring for a preoperative pediatric patient. Of the following, which would be best for the nurse to do with this patient? a) Keep the child away from any food or drinks to ensure the child is NPO. b) Determine how much the child knows and is capable of understanding. c) Teach technical terminology to the caregivers so they will understand what is being said postoperatively. d) Explain how therapeutic plan can be used in preparing the child for surgery.

Determine how much the child knows and is capable of understanding. Correct Explanation: The nurse must determine how much the child knows and is capable of learning in order to best prepare the child for surgery. Terminology at the child's and caregivers' level of understanding is important when doing teaching.

The nurse is caring for an Arab American child. The nurse's observations reveal the family follows traditional Arab American cultural values. Which approach would be most successful? a) Coordinating care through the mother b) Dealing exclusively with the father c) Inquiring about folk remedies used d) Promoting preventative health care

Dealing exclusively with the father Correct Explanation: In the Arab American culture, women are subordinate to men and children are subordinate to the parents. The nurse would deal directly and exclusively with the father. This family would not place much emphasis on preventative care either. Inquiring about folk remedies used may be needed with African American families. Coordinating care through the mother is appropriate with a Hispanic family.

Parents report that their 4-year-old is difficult to understand. Which screening tool will the nurse use? a) Goodenough-Harris Drawing Test b) Denver II Developmental Screening Test (Denver II) c) Denver Articulation Screening Exam (DASE) d) Bayley Scale

Denver Articulation Screening Exam (DASE) Correct Explanation: The nurse would administer the DASE. It is given to children 2½ to 6 years of age to detect differences in speech sounds beyond those considered normal. It is standardized, is easy to administer in a brief time, and is meant for English speakers only. Those who score below their age group norms should be retested within 2 weeks and referred for complete language testing if the repeat examination is abnormal. The Denver II includes a language category but is not an articulation screening test. Goodenough-Harris and Bayley are tests of intelligence that do not evaluate speech sounds.

When working in a very busy pediatric office or clinic, nurses could substitute which screening test for the Denver II Developmental Screening Test to detect delays that otherwise could be missed? a) Bayley Scale b) Denver Articulation Screening Exam (DASE) c) Goodenough-Harris Drawing Test d) Denver Prescreening Developmental Questionnaire (R-PDQ)

Denver Prescreening Developmental Questionnaire (R-PDQ) Explanation: The Denver Prescreening Developmental Questionnaire serves as a parental report of items on the Denver II. It is designed to identify children for whom follow-up with a complete Denver II Developmental Screening Test is needed. It is useful for practices with little time to conduct the full Denver II for all infants and young children. The Bayley Scale and the Goodenough-Harris Test focus mainly on intelligence testing and require special training to administer and score. The DASE is designed to assess early speech development.

The nurse is teaching home care to the parents of a 4-year-old girl with asthma. Which information would be least important to the family's immediate needs? a) Explaining what kinds of things can trigger an attack b) Demonstrating how to administer medication with a nebulizer c) Having emergency instructions and phone numbers d) Determining if the child should enroll in a preschool

Determining if the child should enroll in a preschool Correct Explanation: Enrolling in preschool is presently of least priority. Should the child enroll, the nurse can assist in meeting the asthma education needs of the preschool staff through counseling the mother and providing access to sound asthma education materials. The important immediate information for the family is knowing how and when to properly use the nebulizer, knowing about and avoiding triggers, and being well prepared to deal with a possible emergency.

The nurse is preparing a 7-year-old girl recovering from head trauma and receiving gastrostomy feedings for discharge from the hospital. Which activity is most important before the child is discharged home? a) Helping the family to access financial resources b) Assessing the parents' emotional status c) Preparing a list of home equipment and supplies needed d) Determining the parents' ability to administer the enteral feedings

Determining the parents' ability to administer the enteral feedings Correct Explanation: The parents' ability to maintain their child's nutrition is essential to the child's well-being. The transition can go forward while still resolving financial resource adequacy and the emotional status of the parents. Equipment and supplies will be ordered as part of discharge planning and are not needed until the parents can safely administer feedings.

First-time parents are discussing temperament with the nurse. They describe their child as easily frustrated by his toys and withdrawing from anything new. Overall, he is quite physically active and can become irritated easily. The nurse believes this child could be categorized as: a) Difficult b) Intolerant c) Easy d) Slow-to-warm-up

Difficult Correct Explanation: The parents described the difficult child. The easy child is even-tempered, predictable, and positive. The slow-to-warm-up child can be moody and moderately active and may need time to adjust to something new while doing so with mild resistance. Intolerant is not a category of temperament.

The nurse is caring for a technology-dependent school-age child in his home. Which of the following actions best builds a trusting relationship? a) Encouraging the parents to join a support group b) Changing the date and time of the child's physical therapy to fit the family schedule c) Discussing care and treatment with the parent and child together d) Talking with the brother of the child who feels ignored

Discussing care and treatment with the parent and child together Correct Explanation: To build a trusting relationship with the family, the nurse must remember the child is both the patient and a family member. He needs to be included in all discussions. Encouraging parents to join a support group and talking with the sibling of the ill child who feels ignored are important and supportive activities. Changing the date and time of a therapy session to fit the family schedule is a case management activity. These are important elements of family-centered home care, but are not meant specifically to build trust.

The nurse is caring for a Native American child. Which approach would be most consistent with the culture? a) Warning about overuse of analgesics b) Urging parents to arrange respite care through an agency c) Reminding the child to speak respectfully to older adults d) Discussing treatment as reestablishing harmony

Discussing treatment as reestablishing harmony Correct Explanation: Harmony with nature means health and disharmony means illness in the Native American culture. Treatment explained as restoring harmony would be understood. Overuse of analgesics is not likely due to the belief that pain is meant to be tolerated. Respite care would be sought through the tribe and extended family, not an agency. Elders are highly respected in the culture; reminding about respectful speech should not be necessary.

The 4-year-old due for the DTaP, IVP, MMR, and varicella vaccines has a runny nose, slight cough, and temperature of 99°F (37.2°C). What should be the response of the nurse? a) Do the well-child exam and give the immunizations due. b) Reschedule the visit. c) Provide the well-child exam and give all the immunizations except the MMR. d) Suggest fever and cough control for home care, do the well-child exam, and reschedule the immunizations. e) Complete the well-child exam and reschedule the immunizations.

Do the well-child exam and give the immunizations due. Correct Explanation: The well-child exam can proceed and all the immunizations can be given. The child is not at risk for adverse reactions because she has an upper respiratory infection and very slightly elevated temperature. The child is also not at risk for not developing the proper immune response. Slight fever and minor respiratory illness should not postpone immunizations. Those postponed are at risk for not being received. There is no reason to give some of the immunizations and not others (MMR).

The nurse is caring for the family of a medically fragile child in the hospital. Which intervention is most important to the parents? a) Preparing a list of supplies the family will need. b) Assessing the adequacy of the home environment. c) Evaluating the emotional strength of the parents. d) Educating the parents about the course of treatment.

Educating the parents about the course of treatment. Correct Explanation: Nurses can help parents build on their strengths and empower them to care for their child by educating them about the course of treatment and the child's expected outcome. Evaluating emotional strength, assessing the home, and preparing a list of supplies do not empower the parents for the task ahead of them.

During a health maintenance visit, the nurse determines that a 12-year-old boy is overweight for his age and height. Which of the following approaches for promoting healthy weight will help the boy maintain his self-esteem? a) Emphasizing how activity and a nutritious diet promote health b) Showing the boy where he plots on a growth chart c) Encouraging the family to purchase a scale d) Suggesting the boy record his weight weekly on a calendar

Emphasizing how activity and a nutritious diet promote health Correct Explanation: A health-centered rather than a weight-centered approach places the emphasis on health and is best for supporting self-esteem. A combination of diet and exercise is the recommended way to control weight. Showing the boy where he plots on a growth chart, purchasing a scale, and weekly recording of weight all focus on numbers and not on an overall healthy lifestyle.

The nurse is preparing a 4-year-old girl for a lumbar puncture. The child is extremely fearful and crying. The nurse needs to quickly gain the child's cooperation so the procedure can move forward as ordered. Which approach by the nurse should be used? a) Engage the mother in therapeutic hugging. b) Explain to the child that she must calm down. c) Tell the child everyone is trying to help her. d) Apply a mummy restraint.

Engage the mother in therapeutic hugging. Correct Explanation: Often therapeutic hugging will calm a child and keep the youngster still for a procedure. Asking the child to calm down or telling her everyone is trying to help will not assist the child adequately for her to be able to cooperate. Alternate measures should be tried before using a restraint, and the least restrictive type of restraint should be used. A mummy restraint is quite restrictive.

An adolescent remarks rather sarcastically that she feels like a "lab rat." What is the priority nursing action? a) Provide more physical privacy for this teenager. b) Share with the adolescent that everyone on the unit enjoys working with teenagers. c) Enable the teen to stay in contact with peers electronically. d) Arrange for additional bedside activities of the adolescent's choice. e) Ensure information is shared with and decisions about care are made with and not for the teen.

Ensure information is shared with and decisions about care are made with and not for the teen. Correct Explanation: Sharing information openly and honestly plus including the adolescent in all decision making is the priority action. Parents or staff should not be seen as in complete charge. More privacy, connection with peers, and additional diversional activity all support the teen developmentally and need to be part of her care. Telling the adolescent the staff enjoys teens is hollow unless the girl experiences this behavior.

A boy tells you that his family celebrates the Fourth of July by eating out at a local restaurant. He tells you this is a better way to celebrate the holiday than having a picnic like his neighbors. This statement represents which of the following? a) Ethnocentrism b) Cultural assimilation c) Stereotyping d) A taboo

Ethnocentrism Correct Explanation: Ethnocentrism is a belief that one's own culture or customs are superior to those of others.

When the nurse is teaching the child how to self-administer insulin, what should the final step of the process include? a) Teaching the principles of insulin administration b) Assessing the child's willingness to learn c) Evaluating the teaching that has occurred d) Recognizing the actions of the teaching process

Evaluating the teaching that has occurred Correct Explanation: The only way to determine the effectiveness of teaching is to test or evaluate if learning has occurred. Structure the time and method of evaluation when first establishing a teaching plan.

The nurse is providing care for a 2-year-old girl with a chronic respiratory disease present since birth. Which of the following would be of least help in working effectively with the parents? a) Maintain complete honesty with the parents. b) Provide positive feedback to mother and father for care and parenting well done. c) Consider parents equal partners in care. d) Expect parents to perform procedures precisely as taught.

Expect parents to perform procedures precisely as taught. Correct Explanation: Parents often modify procedures to better suit the child/family situation and routine. Parents are not new to this child's care—they have been managing it since birth. However, it is essential that safe physical and psychosocial conditions are maintained. Parents often devise creative approaches to the child's care from which nurses can learn. The other strategies are sound and support a good nurse-family-child working relationship.

A 10-year-old girl with bone cancer is near death. Which action would best minimize her 8-year-old sister's anxiety? a) Correcting her when she says her sister won't die. b) Telling her that her sister won't need food any more. c) Explaining how the morphine drip works. d) Discouraging the child's questions about death.

Explaining how the morphine drip works. Correct Explanation: School-age children need specific details about procedures related to dying. Explaining how a morphine drip keeps her sister comfortable would best minimize the child's anxiety. Saying her sister won't need food any more when she dies is more appropriate for a younger child. School-age children are curious about death and may deny that it is impending. These behaviors should be handled with understanding and patience.

The Cho family has immigrated to the United States recently. They live with their Aunt Sue and her parents. This is an example of which family form? a) Extended b) Nuclear c) Communal d) Blended

Extended Correct Explanation: The extended family is a nuclear family with other family members in the same house.

Infants learn best by affective learning. a) False b) True

False Correct Explanation: Infants learn by exploring the environment with their senses (psychomotor learning).

It is best to emotionally prepare a child for a major surgery all at once rather than in stages. a) True b) False

False Correct Explanation: It is best to prepare a child for a major experience like this in stages rather than all at once because it is difficult to absorb so much information in a short time span.

The mother of a 10-year-old being treated for kidney failure speaks very broken English and is clearly overstressed. What is the priority nursing intervention? a) Assuring her and demonstrating that the child will be well cared for b) Gaining more information about her stress c) Providing her with a bed and food in the child's room d) Encouraging her to go home and get some rest

Gaining more information about her stress Correct Explanation: The priority intervention is to determine the sources of the mother's stressors. What are her fears and concerns? What pressures are present in her life? An interpreter may be necessary to ensure effective communication. Until then, the nurse cannot be sure that the other measures are appropriate, although they are caring.

A young hospitalized patient is crying because his mother is going to work to take care of some important business but has promised to return in a few hours. What could the mother do to allay the child's fear that she will not return? a) Say that the patient can call her on her cell phone anytime. b) Tell him that the nurse has her cell phone number and can call. c) Promise him that she will return. d) Give him her scarf to keep for her.

Give him her scarf to keep for her. Correct Explanation: A caregiver needs to take a break at times and to reassure the child that she will return. The mother can give a personal possession to the child to reassure him that she will return.

The nurse is caring for a 14-year-old child who is scheduled to have surgery the next day. Which of the following would be most appropriate for the nurse to do to help prepare this child for surgery? a) Give the child a book to read which describes the people who are involved in the preoperative, surgical, and postoperative areas. b) Allow the child to use the equipment that will be seen in the operating room, such as masks, gowns, gloves. c) Explain to the caregivers while they are in the room with the child the reason the child will be kept NPO. d) Show the child models of the body that include the organs or parts of the body the child will be having surgery on.

Give the child a book to read which describes the people who are involved in the preoperative, surgical, and postoperative areas. Explanation: The older child or adolescent may have a greater interest in the surgery itself, what is wrong and why, how the repair is done, and the expected postoperative results. Models of a child's internal organs or individual organs, such as a heart, are useful for demonstration, or the patient may be involved in making a drawing showing the process.

A nurse is admitting a 7 year old to the pediatric unit of the hospital. While the nurse is showing the child and parents the room and explaining where things are, the child becomes upset and frightened. What is the best action by the nurse? a) Keep on showing and explaining to the parents and do not include the child. b) Ask the parents to leave the room while explaining procedures to the child. c) Go slowly with the acquaintance process. d) Tell the child that there is nothing to be afraid of and that nobody will hurt the child during hospitalization.

Go slowly with the acquaintance process. Correct Explanation: The child who reacts with fear to well-meaning advances and who clings to the caregiver is telling the nurse to go slowly with the acquaintance process. Children who know that the caregiver may stay with them are more quickly put at ease.

Nurse is teaching techniques for effective discipline to the parents of a 9-year-old girl. Which of the following topics is an example of extinction discipline? a) Going out for ice cream b) Praising her for polite behavior c) Letting her go to a friend's house d) Going home early from shopping

Going home early from shopping Correct Explanation: Going home early from shopping if the child misbehaves is an example of extinction discipline. Positive reinforcement is eliminated for inappropriate behavior. Going out for ice cream, praising her for polite behavior, and letting her go to a friend's house are all types of positive reinforcement.

What action by the nurse best assists parents to accept their child who has special needs? a) Handle the infant with the same care and attention given all babies. b) Acknowledge the child's attractive clothing and toys. c) Tell the parents how enjoyable it is to care for their child. d) Make sure volunteers spend time with the child regularly.

Handle the infant with the same care and attention given all babies. Correct Explanation: Giving similar care and attention models acceptance of their "different" child for the parents and encourages them to do the same. Looking beyond anomalies helps everyone remember the CHILD. Telling parents how you enjoy the child, noting clothing, and securing volunteers are positive interventions but do not have as great an impact as the accepting actions.

A nurse asking questions during an infant's health surveillance visit has the mother tell her: "My baby was premature and weighed 3 pounds at birth." The medical record provides an Apgar score of 5 at 5 minutes and indicates the child received gentamicin in the neonatal intensive care unit (NICU). What should the nurse consider as the greatest risk for this child? a) Visual deficit b) Hypertension c) Hearing deficit d) Eating disorder e) Gross motor problems

Hearing deficit Correct Explanation: The greatest risk is for a hearing deficit. All factors point in that direction: low birth weight, Apgar less than 6 at 5 minutes, and having received an ototoxic medication. This child should have had a hearing evaluation prior to discharge from the NICU and now should be screened periodically at well-child visits. This premature infant is also at risk for anemia, hypertension, feeding problems, visual defects, and gross motor problems that would not be of the same concern in the full-term child.

Parents report that their neonate received intravenous antibiotics while in the newborn nursery. The nurse recognizes this as a potential risk factor for which health problem? a) Hearing impairment b) Difficulty with fine motor skills c) Articulation difficulties d) Visual disorder

Hearing impairment Correct Explanation: The child's hearing is at risk. Determining which antibiotics were administered will be helpful in evaluating the risk. Certain antibiotics are ototoxic. These require regular follow-up to check the child's hearing ability. Having received antibiotics should not increase the risk for the other health problems.

Knowing that caregivers of a special needs child usually give of themselves in almost unending ways, the nurse will assist the parents by: a) Arranging to have the child spend more time in school b) Stepping in and providing additional direct care c) Modifying the care plan to focus on only the basic essentials d) Helping them develop workable health-promoting activities for themselves

Helping them develop workable health-promoting activities for themselves Correct Explanation: Only a small percentage of parents routinely take time to promote their own health. Care for the caregiver is essential or the health of the entire family will suffer. In-home-care nurses need to work with the family and not intrude on family function (stepping in to give more direct care). Reducing care to basic essentials is likely not to meet the child's particular needs. Having the child in school longer hours is appropriate only if this serves the child.

Using the recommended immunization schedule for infants, the nurse administers vaccines in what order from first to last? Influenza Hepatitis B (HepB) Rotavirus (RV) Measles, mumps, rubella (MMR)

Hepatitis B (HepB) Rotavirus (RV) Influenza Measles, mumps, rubella (MMR) Correct Explanation: Hepatitis B is administered IM at birth. Rotavirus is an oral vaccine that is given at 2 months along with several other immunizations. The influenza vaccine can be administered first at 6 months and then is needed yearly. The measles, mumps, rubella immunization (SC) is not administered until the child reaches 12 months.

To assess the sociocultural aspects of the family of an adolescent in an ambulatory clinic, about which of the following would you ask? a) His family structure b) The adolescent's education level c) His mother's occupation d) His mother's attitude toward citizenship

His family structure Correct Explanation: Family structure is a characteristic strongly influenced by culture and ethnicity.

A pediatric nurse will state that the priority reason to have a thorough grasp of the growth and development of children is to: a) Thoroughly enjoy working with the different age groups. b) Interact with children in age-appropriate, nonthreatening ways. c) Give parents anticipatory guidance as their children grow and change. d) Identify developmental risks or delays promptly.

Identify developmental risks or delays promptly. Correct Explanation: Finding risks for developmental delays early allows for prompt intervention likely to result in a more positive outcome. Having thorough knowledge of growth and development does enhance the joy of working with children, does assist with providing anticipatory guidance for parents, and does promote effective communication with the various ages. These are all important, but not the priority.

During a parenting class the nurse gives examples of extinction as a form of discipline. Which of the following would be an example of this technique? a) Spanking a toddler b) Praising desired behavior c) Using verbal reprimand d) Ignoring a temper tantrum

Ignoring a temper tantrum Correct Explanation: The goal of extinction is to reduce parental attention (reinforcement). Ignoring a temper tantrum does that. Loss of privileges and time-out also are extinction techniques. Praising is positive reinforcement. Spanking is corporal punishment, while verbal reprimand is verbal punishment.

The nurse is teaching a 15-year-old boy with diabetes mellitus and his parents how to monitor glucose levels. Which of the following communication techniques is least effective? a) Ignoring the adolescent's tirade about his therapy b) Paraphrasing the parents' comments before responding c) Using the adolescent's words during the conversation d) Using reflection to clarify the parents' understanding

Ignoring the adolescent's tirade about his therapy Correct Explanation: The least effective technique is ignoring the adolescent's tirade about his therapy. He is expressing frustration over his lack of control, and his emotions should be acknowledged. Paraphrasing the parents' comments recognizes their feelings. Using the teen's words during the conversation indicates active listening and interest. Reflection clarifies the parents' understanding and point of view.

A 10-year-old Arab boy is recovering from an appendectomy. Which nursing intervention is seen as most important to the child and parents? a) Bringing immunizations up-to-date b) Immediate and effective pain control c) Receiving home care instructions d) Scheduling the follow-up visit with the surgeon

Immediate and effective pain control Explanation: Pain is viewed as unpleasant and needing control as soon as possible by the culture. Little emphasis tends to be placed on preventive care by Arab Americans. The family will comply with home care instructions and surgical follow-up, but both will receive less present attention by the parents.

The mother of a hospitalized child with special needs frequently seeks out the parent of a similar child for coffee each day. How should the nurse interpret this behavior? a) The nursing staff needs to pay more attention to each parent. b) Misinformation is likely to be shared. c) Important mutual parental support is being given. d) The two are comparing the quality of nursing care given their children.

Important mutual parental support is being given. Correct Explanation: Parents of children with special needs can provide extremely helpful support to one another. These families experience similar challenges, joys, and sorrows and find understanding, empathy, and many practical coping strategies when spending time with each other.

A physician specialist is on a tight time schedule and wishes to share information about the child with special needs with the mother, who is the only parent presently available. What will be the nurse's next action? a) Find a private conference room where the two can sit down together b) Provide the father's phone number so the physician may speak with the father immediately after talking with the mother c) Indicate to the physician when the father will be available, and make plans for the three to talk then d) Soothe the child while the mother and the physician talk in another part of the child's room

Indicate to the physician when the father will be available, and make plans for the three to talk then Explanation: It is best for parents to receive substantial new information about their child together. This prevents one parent from needing to inform or having more information than the other. Together, they are given the same message and can ask questions and hear answers. They can support one another emotionally, and neither will feel "left out." A private room with parents together maintains confidentiality and allows for expression of feelings. Caring for the child frees the mother to listen with less distraction, but she is still in the room without her husband. If the father is at a significant distance and cannot be there physically, telephoning may be an acceptable option.

The written plan that the school nurse would assist in developing with the child, parents, and multidisciplinary team to foster the child's progress in school is called: a) Disabled Children's Plan b) Education Stimulation Plan c) Individualized Education Plan (IEP) d) Special Education Plan e) Remedial Plan for Education

Individualized Education Plan (IEP) Correct Explanation: The Individualized Education Plan (IEP) is required by law for each special needs student receiving services in the public schools between ages 3 years and 21 years and devised to meet preschool, elementary school, and secondary school students' individual needs. Plans carrying other names are not developed to meet this requirement.

The nurse is caring for a 14-year-old girl with terminal cancer and her family. Which of the following interventions would best provide therapeutic communication? a) Presenting options for treatment b) Informing the child in terms she can understand c) Recognizing the parents' desire to use all options d) Supporting the child's desires for treatment

Informing the child in terms she can understand Correct Explanation: Informing the child in terms that she can understand is the best example of therapeutic communication, which is goal, focused, purposeful communication. Recognizing the parents' and child's desire regarding treatment options is part of family-entered care. Presenting options for treatment is vague.

The nurse is doing a health history for a 14-year-old boy during a health supervision visit. The boy says he has outgrown his clothes recently. Which of the following conditions needs to be checked for based on this information? a) Hyperlipidemia b) Systemic hypertension c) Developmental problems d) Iron deficiency anemia

Iron deficiency anemia Correct Explanation: Iron deficiency anemia could be present because the iron stores in the boy's body may have diminished by the adolescent's growth spurt. This would be checked for by blood work. Developmental problems are not caused by the adolescent's growth spurt. Hyperlipidemia could be possible if the child's diet included an excessive amount of fat. Hypertension might be a problem if a family member had the condition in early adulthood or if many family members had this condition.

The nurse is doing a health history for a 14-year-old pregnant girl during a health supervision visit. For which of the following conditions should she be screened? a) Hyperlipidemia b) Iron-deficiency anemia c) Congenital problems d) Lead level

Iron-deficiency anemia Correct Explanation: Iron-deficiency anemia is a definite risk because the iron stores in the girl's body have already been diminished by the adolescent growth spurt, and the deficiency will be exacerbated by the needs of the developing fetus. Congenital problems are a risk factor for the fetus; screening the mother would not address these. The teen's age and pregnancy do not place her at risk for high lead levels or hyperlipidemia.

During the health surveillance of a 13-year-old girl, the nurse recorded the following information: blood pressure 108/48, pulse 70, respirations 18; dieting, dislikes meat; eats yogurt, drinks two glasses low-fat milk daily; gymnastics team member; fairly regular, normal menstrual periods. What risk would the nurse identify? a) Risk for injury b) Inadequate calcium in the diet c) Prehypertension d) Iron-deficiency anemia

Iron-deficiency anemia Correct Explanation: Iron-deficiency anemia is the risk exacerbated by likely low iron intake with dieting and dislike of meat. Gymnastic training raises the need for iron. Menstrual periods (even though not completely regular and normal in length and flow) help to deplete iron. There is adequate calcium in her diet, which is a plus to enhance bone density, yet not an overabundance, which would block iron absorption. Injury may be a risk related to gymnastics, but there are no data to support an unusual risk. Her blood pressure is normal.

A patient who just learned she is pregnant says, "I can no longer eat strawberries, even though they are my favorite." Which of the following best explains this statement? a) It is related to a food preference. b) It is related to culture. c) It is related to finances. d) It is related to the time of year.

It is related to culture. Correct Explanation: People from different cultures tend to eat different types of food. Some women may omit various foods during pregnancy because they believe a particular food will mark the baby (e.g., strawberries cause birthmarks, raisins cause brown spots). Food preferences, selections, and seasons do not explain her sudden omission of strawberries in her diet.

The nurse is preparing to discuss preparations for discharge and follow-up care of an Arab American child. The nurse correctly recognizes: a) The mother will make the majority of health care decisions. b) The viewpoints of the child will be taken into consideration when making health care decisions. c) The family will gather and make health care decisions as a group. d) Items requiring written consent will likely be managed by the child's father.

Items requiring written consent will likely be managed by the child's father. Explanation: The Arab American traditions typically have the male as being superior. Information in most cases will be passed to the man for consent first.

Which of the following will the nurse view as best maintaining normalcy in the life of a 10-year-old boy who is experiencing a lengthy hospitalization? a) Watching daytime television b) Choosing the time of his bath or shower c) Keeping up with his school work d) Writing down his oral intake on the day and evening shifts e) Playing board games with the child life specialist

Keeping up with his school work Correct Explanation: A school-ager is exactly that—someone whose life is centered around school. Doing school and homework assignments is part of his usual day when not hospitalized. Watching daytime TV is not. Choosing the time hygiene activities occur provides him some control, while tracking his oral intake is an opportunity to participate in his care. Playing board games with the child life specialist is an age-appropriate activity that provides distraction. These support him developmentally but do not normalize his day as does keeping up with school assignments. It will be easier for him to return to the classroom and feel more in step with his peers by doing this.

The nurse is caring for the family of a medically fragile 2-year-old girl. Which activity is most effective in building a therapeutic relationship? a) Listening to parents' triumphs and failures. b) Helping access an early intervention program. c) Teaching physiotherapy techniques. d) Getting free samples of the child's medications.

Listening to parents' triumphs and failures. Correct Explanation: A good therapeutic relationship is built on trust and communication. It is strengthened by listening to the parents, acknowledging their triumphs, and supporting them when they fail. Continuing to educate them, helping them access resources, and helping them to save money on medications are

Which action should the nurse take when it is discovered that the refrigerator containing vaccines has been unplugged and is warmer than the proper storage temperature? a) Mobilize the staff to administer as many of the vaccines as possible before they deteriorate b) Not use any of the vaccines and alert others to do likewise c) Use only the vaccines that feel cold to the touch d) Place the vaccines on ice until a replacement refrigerator can be found

Not use any of the vaccines and alert others to do likewise Correct Explanation: Proper storage of vaccines is essential for preserving their efficacy. Temperatures that are too cold or too warm are detrimental. Improperly stored vaccines should not be used. They are ineffective in preventing disease and should not be administered.

The primary care provider has ordered a biophysical profile (BPP) test for a pregnant woman. The nurse quickly discovers that the client and her husband do not read or write English. Which of the following is the best way for the nurse to obtain their consent for the test? a) Allow the primary care provider to deal with this situation. Assume that the client and husband will understand. b) Use nonverbal language (pictures, gestures) to explain what will happen and ensure that the couple understands. c) Locate a bilingual staff member or an interpreter to translate before the couple signs the consent. d) Read the information on the consent form slowly, in English, and instruct the client to sign the consent.

Locate a bilingual staff member or an interpreter to translate before the couple signs the consent. Correct Explanation: Many non-English-speaking families are in the health care system. Interpreters or cultural health brokers can assist with translating services to facilitate effective communication and informed consent. It is prudent to identify a staff member or hospital visitor who is fluent in the language. Consent must be obtained in the language of origin. The other options do not ensure that the client and husband have understood everything about the BPP and can truly give consent to the procedure.

A woman has presented to the clinic with her sick school aged child. The child's mother reports she rarely has enough money to meet the health care needs of her chronically ill child. What information should be provided to the woman? a) Medicaid is a state assistance program that will provide health care for all children under the age of 13. b) Low-income parents and their children may qualify for Medicaid c) Medicare is available to help with the health care needs of indigent children. d) Medicaid is a federal program that is designed to meet the specific c needs of children.

Low-income parents and their children may qualify for Medicaid Correct Explanation: Medicaid is a joint federal and state program that provides health insurance to low-income parents and their children. It is state administered and each state has its own set of guidelines.

Nurses explain that before the parents of a premature infant leave the hospital with their baby, the child must: a) Have no apnea episodes. b) Be immunized against pertussis. c) Be able to nipple feed. d) Maintain oxygenation in a car seat.

Maintain oxygenation in a car seat. Correct Explanation: Maintaining satisfactory oxygenation saturation while sitting in a car seat is necessary prior to hospital discharge for premature infants. Special padding of the seat may be necessary. All immunizations will be given based on chronological age with pertussis first given at 2 months. Premature infants may be discharged from hospital units with feeding tubes and apnea monitors.

The nurse is caring for a single mother and her two preschool age children. Which is the priority intervention? a) Asking the children about their concerns and fears b) Assessing the mother's psychological status c) Referring the mother to Parents Without Partners d) Maintaining the vaccination schedule

Maintaining the vaccination schedule Correct Explanation: The physiological health of the children is of the greatest importance. Assessment of the family's psychological and emotional status should not be overlooked. If mother needs support, a referral to Parents without Partners may be helpful.

The nurse is caring for a 15-year-old boy with cystic fibrosis. Which intervention will help avert risky behavior? a) Urging that he join a support group. b) Encouraging participation in activities. c) Monitoring compliance with treatment. d) Assessing for signs of depression.

Monitoring compliance with treatment. Correct Explanation: The child may be struggling to fit in with his peers by avoiding his treatment regimen in an effort to hide his illness. Monitoring his compliance would disclose this risky behavior. Assessing for depression, encouraging participation in activities, and joining a support group would not address risky behavior.

Which family member involved in care of the child with special needs do nurses recognize as requiring the greatest amount and widest variety of support? a) Siblings b) Fathers c) Grandparents d) Mothers

Mothers Explanation: Mothers usually carry the greatest responsibility for care of the child and for family functioning. They require the greatest amount and widest variety of support. However, sleep, meals, vacations, work, free time, self-care, and more are disrupted for everyone in the family. Grandparents often provide much assistance, which creates similar tensions in their lives.

The mother of a 12-year-old boy is concerned about the dangers of the Internet. Which suggestion by the nurse best targets safety related to this? a) Use the phone for interacting with others. b) Avoid putting a computer in a child's room. c) Never share personal information online. d) Limit daily the time spent online.

Never share personal information online. Correct Explanation: Protecting personal information is key to computer safety. Having the computer in a common family area allows adults to monitor the child's activities and promotes some level of safety. Limiting time spent online is a wise overall strategy to encourage physical activity but not safety. Using the phone also limits computer time but does not address safety.

The nurse is assessing the learning needs of the parents of 5-year-old girl who is scheduled for surgery. Which of the following nonverbal cues shows them that the nurse is interested in what the family members are saying? a) Standing several steps away from parents b) Sitting straight with feet flat on the floor c) Nodding head while the mother speaks d) Looking at child when the father is talking

Nodding head while the mother speaks Correct Explanation: Nodding the head while the other person speaks indicates interest in what they are saying. When children and parents feel they are being heard, it builds trust. Sitting straight with feet flat on the floor, looking away from the speaker, and keeping distance from the family may send a message of disinterest.

A 6-month-old girl is significantly underweight. Which assessment finding will point to an inorganic cause of failure to thrive? a) Checking the health history for risk factors. b) Examining to see if the infant refuses the nipple. c) Asking the mother if the birth was premature. d) Observing to see if the child avoids eye contact.

Observing to see if the child avoids eye contact. Correct Explanation: Watching the interaction between mother and child to see if the child maintains eye contact may indicate that the child is being neglected which is an inorganic cause for failure to thrive. Refusing the nipple is a sign of organic cause for failure to thrive. Prematurity is a risk factor for failure to thrive. Checking the health history may disclose other organic causes for failure to thrive.

A girl comes from a large family that you analyze as being extended. In planning hospital care for her, which factor would be most important for you consider? a) Organizing nursing care at times other than visiting hours b) Restricting visitors to reduce the noise level c) Spending increased time with her yourself to prevent loneliness d) Asking the hospital's visitor program to call on her to prevent loneliness

Organizing nursing care at times other than visiting hours Correct Explanation: Because extended families have many members, support people in time of an illness are usually available.

The nurse is caring for a 12-year-old African American female. The child is in pain as a result of a back injury. The nurse correctly recognizes which of the following beliefs regarding pain to be most consistent with the child's culture? a) Pain may be relieved through prayer and folk healing. b) Pain is best treated by establishing balance within all other areas of life. c) Pain is a part of life and must be endured to increase strength. d) Pain results when there has been negative behavior.

Pain may be relieved through prayer and folk healing. Explanation: African American traditional beliefs include the use of prayer, folk healing and home remedies to promote a return to health and reduction of discomfort.

When working with a child who has special needs, the nurse frequently consults the parents, asking how they handle various aspects of care. What guiding principle is the nurse following? a) Parents should be kept directly involved with the child. b) Active listening helps the nurse to better understand the family. c) Parents are the experts in their child's care. d) Therapeutic communication should be used in the special needs situation.

Parents are the experts in their child's care. Explanation: The nurse is acknowledging the expertise the parents have developed in understanding their child's needs and meeting them. Parents should be considered experts in their child's care and should be regarded as equal partners with the professionals. Adhering to parental methods of care while seeking their input results in better and consistent care for the child. The other suggested "principles" do not directly apply.

A 4-year-old boy is residing permanently with his grandparents. Which situation is unique to this type of family or living arrangement? a) Physical and financial stress on the caregivers b) Obstacles to obtaining informed consent for treatment c) Difficulty obtaining accurate health history and records d) Gaining consensus between the caregivers regarding treatment

Physical and financial stress on the caregivers Correct Explanation: Grandparents, due to age and income levels, are uniquely prone to this type of stress. Difficulty obtaining an accurate health history or records is common in foster families. Obstacles to obtaining informed consent for treatment and gaining consensus between caregivers regarding treatment occur most often in the binuclear family.

A toddler needs to be transported to a far area of the hospital for noninvasive diagnostic testing. The nurse chooses to: a) Place the child on the mother's lap and push the two in a wheelchair. b) Transport the child in his crib surrounded by his toys. c) Have the mother carry the child wrapped in a blanket. d) Use a wheeled cart with sides to provide for safety.

Place the child on the mother's lap and push the two in a wheelchair. Correct Explanation: The mother's arms and lap provide a safe and fun place to ride. Having the mother carry the child is reassuring to the child but may be tiring for the mother. In addition, the child may struggle to walk. A wheeled cart is unfamiliar and large, likely stressful. Transport by crib turns the child's bed into an unsafe place by taking this toddler to an area likely to be seen as frightening.

A 9-year-old patient with rheumatoid arthritis has difficulty moving her painful hands as well as her other joints. She refuses to participate in ordered physical therapy. What would be the best way for the nurse to make sure that the patient continues to exercise her joints? a) Give the patient a pamphlet about the importance of exercise. b) Play a game like "Simon Says" to introduce exercises. c) Show a video about exercising. d) Give the patient a coloring book about arthritis.

Play a game like "Simon Says" to introduce exercises. Correct Explanation: School-aged children love to play games. By playing "Simon Says" and introducing different exercises to help with movement, the nurse may help stimulate the patient to want to be active.

When planning to teach a toddler about coughing and deep breathing, which would be most effective? a) Demonstrating the technique b) Showing an audiovisual c) Discussing the importance of coughing d) Playing a game with coughing and breathing

Playing a game with coughing and breathing Correct Explanation: Toddlers respond best to teaching techniques that include games so they feel as if they are playing instead of learning.

A 6 year old will be hospitalized for a surgical procedure. How can the nurse best ease the stress of hospitalization for this child? a) There is no way to adequately prepare a child for an impending hospitalization. b) Have another child talk with the child to be hospitalized. c) Tell the parents to bring toys for the child from home. d) Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital.

Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital. Correct Explanation: The best way to ease the stress of hospitalization is to ensure that the child has been well prepared for the hospital experience.

A nurse is assessing a family and asks, "On whom does the family depend to provide the solution to problems?" What role is the nurse trying to establish? a) Nurturer b) Problem-solver c) Financial manager d) Gatekeeper

Problem-solver Explanation: The problem-solving role is determined based on whom the family relies on to provide the solution to problems. The gatekeeper is the person in the family who determines what information will be released from the family or what new information can be introduced. The financial manager supervises the family finances. The nurturer is the primary caregiver to children or others in the family with challenges.

A nurse is caring for a child with cystic fibrosis who is concerned about being separated from parents. What interventions can the nurse provide that will prevent or minimize child and family separation? a) Empower the family and child by providing knowledge. b) Promote family-centered care. c) Encourage the child to have a security item present. d) In the hospital, use primary nursing.

Promote family-centered care. Correct Explanation: To prevent or minimize child and family separation the nurse would promote family-centered care. Thus, in the hospital, staff members would provide comfortable accommodations for the parent, allow the family the choice about whether to stay for an invasive procedure, and support them in their decisions.

The nurse is taking a health history and examining a 3-year-old boy. Which alteration is most important for the parents to make? a) Protect the child from all tobacco smoke. b) Reduce the number of hours the television set is turned on. c) Argue less in the child's presence. d) Eat fewer chips and sweets.

Protect the child from all tobacco smoke. Explanation: First-, second-, and third-hand tobacco smoke has been shown to have many detrimental effects on children. This is the first lifestyle change the parents should make. All other alterations are important, and if not changed, can have negative effects on the preschooler's growth and development. However, they are not known to be as harmful as tobacco smoke.

A 14-year-old boy is aware that he is dying. Which action best meets the child's need for self-esteem and sense of worth? a) Providing full participation in decision making. b) Giving direct, honest answers to his questions. c) Initiating conversations about his feelings. d) Listening to his fears and concerns about dying.

Providing full participation in decision making. Correct Explanation: Providing full participation in decision making gives the adolescent a sense of worth and builds his self-esteem. The adolescent may have difficulty initiating conversation, but wants and needs to voice his fears and concerns. He also requires direct, honest answers to his questions. However, these needs are not as effective in meeting his need for sense of self-worth or self-esteem.

A woman 7 weeks pregnant is admitted with vaginal bleeding. She reports she never should have raised her arms above her with this pregnancy. Based upon your knowledge, what is your best response? a) Recognize her cultural beliefs and explain in a nonjudgmental manner the potential causes of miscarriage. b) Explain to the patient that this an unfounded myth c) "I agree. Keeping your arms down will reduce your risk factors." d) Ignore her comment

Recognize her cultural beliefs and explain in a nonjudgmental manner the potential causes of miscarriage. Correct Explanation: Lying to the patient, as in agreeing she should have kept her arms down, is inappropriate. Explaining the patient's feelings as an unfounded myth does not handle the manner in an informative and sensitive manner. Ignoring the patient's comment does nothing to help the patient.

The toddler needs elbow restraints to keep his hands away from a facial wound. What will the nurse do to best ensure their safe use? a) Remove one restraint at a time on a regular basis to check for skin irritation. b) Have the parent check for equal warmth bilaterally in his hands and fingers. c) Apply lotion to the skin prior to putting on the restraints. d) Choose restraints long enough to fit closely under the arm and extend over the wrist.

Remove one restraint at a time on a regular basis to check for skin irritation. Correct Explanation: Removing one restraint at a time provides for control of both hands. A long-sleeve shirt under the elbow restraints also protects the skin, and is a better choice than lotion since lotion will soften the skin and not be protective. The restraints should not extend into the axilla. Movement would create pressure and irritation. The parent can help monitor the restraints, but the nurse is responsible for the safety of their use.

The nurse is providing support to a mother whose religion is Mormon (Church of Jesus Christ of Latter-Day Saints). Her infant child is critically ill. The appropriate support measure for the nurse to use is to: a) Obtain some over-the-counter cough syrup for the mother's cough. b) Stay in the room with the infant so the mother feels free to take a break. c) Bring the mother a cup of coffee. d) Ask if the baby has been baptized.

Stay in the room with the infant so the mother feels free to take a break. Explanation: Staying with the infant offers the mother a brief opportunity for renewal and possibly prayer. Coffee and alcohol (possible ingredient in cough syrup) are not used by Mormons. Mormons bless but do not baptize infants.

While enrolled in a geography course, a student nurse learns that diarrheal illness is deadly for large numbers of infants in Third World countries. What vaccine will this nursing student identify as part of the solution to this problem? a) Hepatitis A (HepA) b) H. influenzae type B (Hib) c) Diphtheria, tetanus, pertussis (DTap) d) Rotavirus (RV)

Rotavirus (RV) Correct Explanation: Rotavirus is a very common cause of gastroenteritis among young children that spreads readily via the fecal-oral route. The disease is most severe in children between 4 and 23 months, causing severe, watery diarrhea that results in dehydration. The other vaccines do not prevent diarrheal illness.

It is difficult for the father of a technologically dependent 7-year-old girl to leave his work. Which nursing intervention would best involve him in family-centered care? a) Leave a voice mail for the father at work. b) Email a status report to the father's office. c) Schedule education sessions in the evening. d) Urge the father to come to the hospital at lunch.

Schedule education sessions in the evening. Correct Explanation: A good way to involve the father and gain his input regarding in the child's care is to schedule education sessions in the evening when he can get away from the office. Leaving voice mails and sending email reports leave him isolated from care group. Lunchtime visits are not long enough for him to focus on the situation.

The nurse is talking with an adopted child and the family. Which statement represents "positive" adoption language? a) When were you given up for adoption? b) The birth mother was how old when your child was born? c) Has your adopted child started kindergarten? d) Are you in touch with your natural parent?

The birth mother was how old when your child was born? Correct Explanation: Birth mother, not natural or real mother, is a positive term for the biological parent, as is simply parent for the adoptive mother or father. The adopted child is just a child and not someone given up or given away. Saying an adoption plan was followed makes a positive statement.

A nurse is developing a preoperative plan of care for a 2-year-old. The nurse understands to pay particular attention to which of the child's age-related fears? a) Loss of control b) Separation from friends c) Separation from parents d) Loss of independence

Separation from parents Correct Explanation: The nurse understands that a toddler is most likely to develop anxiety and fears due to separation from the parents. Separation from friends, loss of control, and loss of independence are fears typically experienced by an adolescent.

A 15-year-old boy with special needs is attending high school. Which nursing intervention will be most beneficial to his education? a) Assessing how attending school will affect his health. b) Collaborating with the school nurse about his care. c) Serving on his individualized education plan (IEP) committee. d) Advocating for financial aid for a motorized wheelchair.

Serving on his individualized education plan (IEP) committee. Correct Explanation: Serving on his individualized education plan committee will be most beneficial to his education because this plan is designed to meet his individual educational needs. Collaborating with the school nurse and assessing the health effects of attending school, and getting a motorized wheel chair do not address his educational needs.

Before administering an immunization to their child, the nurse asks parents to take which priority action? a) Assist in restraining the child b) Sign a consent form c) Reassure the child d) Provide the child's immunization record

Sign a consent form Correct Explanation: Parents must sign a consent form before immunization of the child after receiving full information about the vaccines, their importance, and their administration. Reassuring the child and assisting in restraining are both important but are not the priority. Having the child's immunization record with them allows this record to be updated; otherwise, a full record should be given to the parent.

A nurse is assigned to care for a 6 month old hospitalized with diarrhea and dehydration. Because a child this age does not have developed speech, what can the nurse do to communicate with the child? a) Use a stuffed animal to tell a story. b) Use puppets to communicate with the child. c) Write on a whiteboard. d) Sing to the infant.

Sing to the infant. Explanation: Infants primarily communicate through touch, sight, and hearing. Communication can occur through cuddling, holding, rocking, and singing to the infant.

The nurse has worked diligently with an adolescent to meet his teaching-learning needs and make adaptations for managing his illness to suit his preferences and lifestyle. Even so, there is evidence of noncompliance. The nurse's interpretation is: a) The developmental thinking skills of the adolescent prevent him from seeing the connection between his actions and the effect on his health. b) Some noncompliance should be expected due to the teen's desire for independence, expression of his personal values, and peer acceptance. c) More assistance from the family is needed for the teen to manage his care. d) Because the adolescent did not pay attention during his teaching sessions, he now does not know what to do.

Some noncompliance should be expected due to the teen's desire for independence, expression of his personal values, and peer acceptance. Correct Explanation: Acceptance of some noncompliance by this teen is necessary. Finding compromise to limit noncompliance is important. Developmentally, the adolescent is capable of formal thought. Connecting present and future should not be an issue. There may be some measure of inattentiveness to teaching and some need for more home support, but these do not represent the main reason for noncompliance.

A 15-year-old patient with type 1 diabetes has been noncompliant with his dietary regimen. When educating the teen, what is the most important thing the nurse do to allow the teen to be in control and involved in the decision-making process? a) Offer choices whenever possible. b) Speak directly to the teen and consider his input in the decisions about care and education. c) Praise the patient often. d) Provide information and allow the teen to process and ask questions.

Speak directly to the teen and consider his input in the decisions about care and education. Explanation: A teaching tip for adolescents to allow them control and involvement in the decision-making process is to speak directly to them and consider their input in all decisions about their care and education.

A 15-year-old patient with type 1 diabetes has been noncompliant with his dietary regimen. When educating the teen, what is the most important thing the nurse do to allow the teen to be in control and involved in the decision-making process? a) Provide information and allow the teen to process and ask questions. b) Speak directly to the teen and consider his input in the decisions about care and education. c) Praise the patient often. d) Offer choices whenever possible.

Speak directly to the teen and consider his input in the decisions about care and education. Explanation: A teaching tip for adolescents to allow them control and involvement in the decision-making process is to speak directly to them and consider their input in all decisions about their care and education.

A nurse observes a physician interacting with a new patient, a 9-year-old Asian boy. The physician asks him, "What's your favorite subject in school?" When the boy is slow to respond, the physician says, "I bet you're good at math." The physician's comment is an example of which of the following? a) Acculturation b) Stereotyping c) Assimilation d) Ethnocentrism

Stereotyping Correct Explanation: Stereotyping is expecting a person to act in a characteristic way without regard to his or her individual traits. In this scenario, the physician appears to expect that the boy is good at math simply because he is Asian, which is an example of stereotyping. It is not an example of acculturation, which refers to the loss of ethnic traditions because of disuse, nor is it an example of assimilation, which refers to people blending into a general population or adopting the values of the dominant culture. It is also not an example of ethnocentrism, which is a belief that one's own culture is superior to all others.

An adolescent believes that people from the Bronx are stupid. What does this type of belief represent? a) Group analysis b) Stereotyping c) Ethnocentrism d) Definitive analysis

Stereotyping Correct Explanation: Stereotyping is viewing people and things from preconceived notions.

A parent asks why spanking works so well to stop her toddler's behavior. The nurse explains it is the: a) Suddenness and shock value of the act b) Attention the child receives c) Anxiety created in the child d) Anger of the parent

Suddenness and shock value of the act Correct Explanation: The surprise and shock interrupt the behavior quickly. With repeated use these effects diminish; then the intensity must increase. The American Academy of Pediatrics recommends against spanking due to its many negative effects and lack of effectiveness over other methods. When punishing, the parent should remain calm. Anger may result in injury. Anxiety is one of the negative effects of spanking. The attention is negative; however, a child without appropriate attention may settle for the negative.

The nurse is educating a young child about what to expect during an upcoming procedure. Which of the following statements by the nurse are appropriate to use? Select all that apply. a) "They're going to give you some special medicine to help the doctor see what's happening inside your belly." b) "When they come to get you, you'll get on a special rolling be" c) "This little tube will go in your nose and down into your belly." d) "I'm going to give you this shot and it will put you to sleep." e) "You'll end up in 'ICU' where you'll wake up with some electrodes on your thorax."

Talking one-on-one with the interpreter at numerous points throughout the session with the family Correct Explanation: Side conversations with the interpreter can create discomfort for the family and undermine trust. The other actions all enhance the communication.

An urgent care nurse is cleaning a forehead laceration on a 7-year-old. The mother is present. The child is crying and screaming. The nurse should: a) Ask the child to be less noisy because he is "scaring and bothering other children." b) Review safety measures that could have prevented the injury. c) Have the mother speak firmly to the child to correct the crying and screaming. d) Tell the child, "It's OK to cry, but I need you to hold still." e) Close the door tightly and reassure the child, "I am being gentle and am almost done."

Tell the child, "It's OK to cry, but I need you to hold still." Correct Explanation: Children should be able to express their feelings openly when they are hurt or frightened. Acknowledging the crying/screaming is developmentally sound. Stating the need to hold still is accurate and respects the child's ability to help. Closing the door is a good idea but "gentle" and "almost done" show little understanding of the child's experience. Expecting the mother to discipline the child or for the child to be able to consider others is unrealistic. Discussing injury prevention at this point is inappropriate, is likely to promote guilt, and appears to place blame, which would interfere with relationship building between nurse, child, and family.

Which of the following activities would be most beneficial in educating children regarding hospitals and hospitalization? a) The caregivers take all of the children in the family to an open house at the hospital. b) In an organized group such as Boy or Girl Scouts, children take a tour around the city looking at where buildings such as the hospital, police station, and fire station are. c) A school nurse does a presentation to groups of school child about what it is like to be in the hospital. d) The caregivers check out books and a DVD from the library explaining the admission process and hospitalization and the family watches it together.

The caregivers take all of the children in the family to an open house at the hospital. Correct Explanation: The family and caregivers have the most important role in educating children about hospitals and hospitalization. The child trusts and feels safer most often with the caregiver. During a tour of the hospital a room is set aside where children can handle equipment, try out call bells, try on masks and gowns, have their blood pressure taken to feel the squeeze of the blood pressure cuff, and see a hospital pediatric bed and compare it with their bed at home. The caregivers can reinforce what the child has seen in the home setting.

The nurse is collecting data from the mother of a 3-year-old child. Which of the following reports will warrant further follow-up? a) The child cannot stack five blocks b) The child cannot grasp a crayon with the thumb and fingers c) The child is not able to throw a ball overhand d) The child cannot copy a circle

The child cannot copy a circle Explanation: A 3-year-old child should have the ability to copy a circle. Stacking five blocks, grasping a crayon, and throwing a ball overhand are not reasonable accomplishments for a 3-year-old child.

A nurse is caring for a 12 year old who is very demanding. Within 4 hours, the child has pressed a call light 12 times for multiple reasons. What does the nurse understand may be the reason for this child's demanding behavior? a) The child wants to be sure the nurse is doing what he or she is supposed to be doing. b) The child may be insecure or afraid. c) The child is spoiled at home and is continuing this behavior in the hospital. d) The child is expecting quality care from the nurse.

The child may be insecure or afraid. Correct Explanation: Demanding behavior generally stems from insecurity or fear (so afraid that something will happen while the nurse is away that they constantly find more for the nurse to do to keep the nurse available).

An 8-year-old seeks out the school nurse crying because she was recently told her parents would divorce. What is the most important first idea the nurse will help the child grasp? a) The divorce is not her fault. b) Feeling scared and sad is okay. c) She will feel better after some adjustment time. d) Her situation is not unusual.

The divorce is not her fault. Explanation: Children often believe they have caused a divorce or could have prevented it. They need to be told repeatedly that this is not the case. Knowing her situation isn't unique (40% of marriages fail) and that time aids adjustment is true but not supportive at this time. Knowing feelings of fear and sadness are accepted allows for their free expression and is important to her mental health. However, preventing feelings of guilt needs initial attention.

Nurses understand that the optimal place of care for most children with special needs is a) A group home b) A medical foster home c) The family's home d) A residential setting

The family's home Correct Explanation: The child's family home is the most developmentally appropriate environment for children. It is emotionally nurturing and socially stimulating. Most children want to be cared for at home, and most parents find comfort with this arrangement. However, placement of a child outside the home should not be viewed as a family/parental failure. In some cases, placement is the only way the family can continue to function. Nurses can be helpful in finding suitable living arrangements outside the family home when this represents the best choice.

The nurse is anticipating that health supervision for a 5-year-old child will be challenging. Which of the following indicators supports this concern? a) The home is in a high-crime neighborhood b) The mother dotes on the child c) The child has a number of chores and responsibilities d) Grandparents play a significant role in the family

The home is in a high-crime neighborhood Correct Explanation: Neighborhoods with high crime, high poverty, and lack of resources may contribute to poor health care and illness. If the aged grandparents have healthy lifestyles, they would be positive partners. Developmentally appropriate chores and responsibilities could be positive signs of parental guidance. The doting mother could make a strong health supervision partner.

The nurse is assessing for violence in the home. Which response by the mother represents the greatest risk to the child? a) The boyfriend is very strict with the child b) The mother says she dreads going home c) The mother's partner calls the child names d) The boyfriend may leave for days at a time

The mother's partner calls the child names Correct Explanation: If the mother's partner is being verbally abusive of the child, there is risk of physical violence. There could be a number of reasons other than violence to dread going home. Strictness is not necessarily a sign of abuse. The boyfriend's absence may only be a sign or irresponsibility and not of a violent nature.

Shelley, a mother, is new to the community, and the family is in a low-income bracket with limited transportation options. How could the pediatric nurse help Shelley get her new baby to her well-child visits to promote healthy growth and development? a) The nurse could link Shelley with the community child clinic. b) The nurse could tell Shelley this office is her only option for visits. c) The nurse could give Shelley all information at this visit to save time. d) The nurse could schedule the next visit and hope Shelley can make it.

The nurse could link Shelley with the community child clinic. Correct Explanation: In supervising children's healthcare, the healthcare provider must be a link between the child and family and individualize the health plan for each family. The nurse must focus on the support, community, and resources of the family for health promotion. The other choices do not support Shelley and her family issues. They also do not support compliance with an optimal schedule of well-child visits.

Which of the following is an example of anticipatory guidance of healthcare by the community nurse? a) The nurse teaches hand washing at an elementary school. b) The nurse gives medicine to a 2-year-old. c) The nurse takes an 8-year-old child's vital signs. d) The nurse orders food for a post-op surgery patient.

The nurse teaches hand washing at an elementary school. Correct Explanation: The nurse should take a proactive role in discussing anticipatory guidance issues with children and families. The nurse should be an educator to promote a healthy lifestyle, and any encounters with children and families should be an opportunity to educate. The other choices are basic nursing care tasks.

Due to a certain warning sign, the nurse is anticipating that health supervision for a 7-year-old child will be challenging. Which of the following indicators supports this concern? a) The family maintains a large garden. b) The child has regular chores and responsibilities at home. c) The parents made several negative remarks about the child. d) Older grandparents play a significant role in the family.

The parents made several negative remarks about the child. Correct Explanation: Disparaging remarks about the child is a warning sign. Lack of respect for the child can undermine the nurse-parent-child partnership needed for successful health supervision. Older grandparents who follow a healthy lifestyle are a plus for the child. Developmentally appropriate home responsibilities suggest positive parenting practices. A garden providing fresh produce can support good eating habits.

The nurse is assessing the teaching needs of the parents of an 8-year-old boy with leukemia. Which of the following assessments would disclose a possible health literacy issue? a) The entire family is fluently bi-lingual b) The mother seems to ask most of the questions regarding care c) The parents are taking notes on answers to their questions d) The parents missed the last scheduled appointment

The parents missed the last scheduled appointment Correct Explanation: Missing appointments is one of the red flags to health literacy problems as the parents may not have understood the importance of the appointment or may not have been able to read or understand appointment reminders. Being bi-lingual does not indicate health literacy issues. Taking notes or one-parent being the primary leader of the child's health care are not unusual practices.

The nurse has just taken the blood pressure on a 13-year-old, and the percentile rank is 88%. Why would the nurse categorize the child as prehypertensive? a) The teenager's blood pressure was 122/83. b) The teen gets no regular exercise. c) The teenager was born at 33 weeks' gestation. d) The teenager eats a high-fat diet.

The teenager's blood pressure was 122/83. Correct Explanation: A blood pressure greater than 120/80 is categorized as prehypertensive regardless of the percentile. Preterm birth is a risk factor for hypertension and does not indicate prehypertension itself. A high-fat diet and lack of exercise are risks for cardiovascular disease. Both require the nurse's attention to promote health but are not factors in categorizing the adolescent as prehypertensive.

A nurse is caring for an 18-month-old girl undergoing traction therapy in a rehabilitation unit. The nurse understands that the girl is in the second phase of separation anxiety when she observes what behavior? a) The toddler cries inconsolably. b) The girl acts extremely agitated. c) The girl ignores her. d) The child exhibits signs of anger. e) The toddler is quiet, looks sad, and is disinterested in playing.

The toddler is quiet, looks sad, and is disinterested in playing. Correct Explanation: Despair is the second phase of separation anxiety. During this phase the child appears hopeless, depressed, and apathetic. Exhibiting signs of anger and agitation or crying inconsolably all indicate the first phase of separation anxiety called protest. Denial or detachment is the third phase of separation anxiety. The child uses this to protect against further emotional pain. When parents return the child will ignore them and, instead, has formed superficial relationships with other caretakers. This third stage is seen infrequently when family-centered care is in place.

A nurse is preparing to start an intravenous (IV) line on a 5 year old. Where does the nurse understand the procedure should be performed so that the child's "safe place" will not be disrupted? a) The child's room b) The operating room c) The emergency department d) The treatment room

The treatment room Correct Explanation: Treatments are performed in a treatment room, not in the child's room. Using a separate room to perform procedures promotes the concept that the child's bed is a "safe" place. All treatments, with no exceptions, should be performed in the treatment room to reassure the child.

The nurse is caring for a 10-year-old child admitted for a surgical procedure to be done the next day. The nurse takes the child to a special area in the playroom and lets the child "start" an IV on a stuffed bear. Which of the following is this action an example of? a) Positive reinforcement b) Play therapy c) Therapeutic play d) Age-related activity

Therapeutic play Correct Explanation: Therapeutic play is a play technique used to help the child have a better understanding of what will be happening to him or her in a specific situation.

The nurse working on the pediatric unit is talking with the child-life specialist. The nurse asks the specialist what the technique is called in which activities are used to help the child have a better understanding of what will be happening to him or her in a specific situation. Which of the following best describes what the nurse is discussing? a) Cooperative play b) Onlooker play c) Play therapy d) Therapeutic play

Therapeutic play Correct Explanation: Therapeutic play is a play technique used to help the child have a better understanding of what will be happening to him or her in a specific situation. For instance, the child who will be having an IV started before surgery might be given the materials and encouraged to "start" an IV on a stuffed animal or doll. By observing the child, you can often note concerns, fears, and anxieties the child might express. Therapeutic play is a play technique that play therapists, nurses, child-life specialists, or trained volunteers may use to help the child express feelings, fears, and concerns.

A nurse is using a doll to explain what will be done when starting an intravenous (IV) line on a 4 year old. What type of play is this considered? a) Interactive play b) Parallel play c) Therapeutic play d) Play therapy

Therapeutic play Correct Explanation: Therapeutic play is a technique to help children better understand what will be happening to them in a specific situation. For instance, the child who will have an IV line started before surgery might be given the materials and encouraged to "start" an IV on a stuffed animal or doll.

A family of five seeks care for their preschooler with an upper respiratory infection. The facility has no medical record for the family. Why does the nurse encourage this family to establish a medical home? a) To ensure all the children receive low-cost immunizations b) To receive priority treatment in urgent situations c) To establish a continuing relationship with a physician or nurse practitioner d) To obtain improved health insurance coverage

To establish a continuing relationship with a physician or nurse practitioner Correct Explanation: A medical home is a physician or nurse practitioner with a long-term, comprehensive relationship with the family. This results in better health supervision and overall improved care. Having a medical home does not give special treatment to its constituents in the way of priority or services, insurance coverage, or cost reduction, although, because of the high level of health supervision, some of these benefits could result due to illnesses being prevented or discovered and treated early.

A 16-year-old girl confides in the nurse that her parents are difficult to deal with and that it stresses her out. The nurse responds by saying, "You think that's stressful, you should see some of the patients I have to deal with in here!" Which barrier to communication is this nurse demonstrating? a) Growing defensive b) Topping up c) Showing disapproval d) Cliché advice

Topping up Correct Explanation: "Topping up" is minimizing a child's views by telling a better story. A child tells you, for example, she has a problem; you say, "You want to know what problems really are? Come and work here." Cliché advice (advice given from a formula, not individualized to the situation) is meaningless because it is too general to be helpful. In the same way children who request health care do not enjoy being criticized, neither does the average health care provider. If a child makes a critical remark, therefore, it is easy to respond with a defensive comment or disapproving remark rather than a therapeutic one. Parents and children do not come for health care to be criticized; they come to learn more about how to stay well or recover from illness. If you criticize them, they may not reveal any further information to you because they do not want you to react in the same way you did to their preliminary statements.

The Protestant work ethic stresses all adults should be employed productively. a) False b) True

True

Nurses at conference discuss a mother who has inaccurately accused several of them of "being late with medications" and "acting impatient and uncaring with my child." How might these remarks and similar others best be interpreted? a) The mother is acting as a strong advocate for her child. b) Unmet needs of the mother need to be determined and addressed. c) Staffing numbers for the unit need to be increased. d) The child's nursing care plan should be modified to correct the complaints.

Unmet needs of the mother need to be determined and addressed. Correct Explanation: Nurses need to explore the mother's unmet needs. She may be very physically tired, stressed financially, anxious over changes in the child's condition, frustrated with lack of answers related to prognosis, saddened by seeing other children outdistance hers, or angry over her lack of control. When the mother's needs are identified, intervention can begin.

The nurse at a hospice care facility is caring for a 12-year-old girl. Which intervention best meets the needs of this child? a) Assuring her the illness is not her fault. b) Explaining her condition to her in detail. c) Urging her to invite her friends to visit. d) Acting as the child's personal confidant.

Urging her to invite her friends to visit. Correct Explanation: Young adolescents require time with their peers. Encouraging her to have visitors would best meet this need. Assuring her illness is not her fault and acting as her personal confidant are interventions suited to school-age children. Explaining her condition in detail meets the needs of an older adolescent.

A nurse is caring for an infant admitted with diarrhea. The parent tells the nurse that she has to leave to care for another child at home and will be back shortly. What is the most effective way for the nurse to communicate with the infant and meet the child's needs? a) Tell stories. b) Use a soothing and calming tone when speaking to the infant. c) Use puppets to communicate with the infant. d) Use creativity.

Use a soothing and calming tone when speaking to the infant. Correct Explanation: To communicate effectively with an infant the nurse should respond to crying in a timely fashion, allow the infant time to warm up, use a soothing and calming tone when speaking to the infant, and talk to the baby directly.

A child is preparing to undergo a lumbar puncture in the treatment room. What intervention can the nurse provide to minimize stress during the procedure? a) Use primary nursing. b) Administer heavy sedation to the child so that he or she will not move during the procedure. c) Restrain the child during the procedure. d) Use alternative positioning such as "therapeutic hugging."

Use alternative positioning such as "therapeutic hugging." Correct Explanation: A suggestion for atraumatic care to prevent or minimize physical stressors is to avoid traditional restraint or "holding down" of the child. The nurse should use alternative positioning, such as "therapeutic hugging."

Which nursing intervention is likely to be most effective in keeping the immunization status of children of all ages at its highest possible level? a) Promote immunization through mass media campaigns b) Make immunizations as pain-free as possible c) Use every contact to potentially immunize d) Organize community-wide immunization events

Use every contact to potentially immunize Correct Explanation: Each health care contact with children should be seen as an occasion to give needed immunizations. Children cared for in outpatient departments for minor problems, those seen for injuries, children scheduled for surgery, those hospitalized, and all others should have their immunization records reviewed and immunizations due should be administered unless contraindicated. Assisting with media campaigns, providing a community-wide immunization event, and using measures to reduce pain all encourage immunization but will not have the impact that immunizing at each contact provides.

A nurse getting ready to conduct preoperative teaching with a 9 year old realizes that the best method when teaching young patients is which of the following? a) Give little information quickly. b) Give all information to the parent. c) Discuss everything at once. d) Use short sessions.

Use short sessions. Correct Explanation: When conducting preoperative teaching it should be done in short sessions. The nurse should not try to discuss everything at once. He or she should always include the child in this teaching.

Based on school-aged cognitive development, which teaching technique could you anticipate as being received the best? a) Using containers of water to demonstrate how hemorrhage leads to decreased body fluid b) Explaining elevated and decreased blood pressure as a concept c) Asking children to conceptualize the effect of falling blood pressure d) Asking children to think through "what if" situations and blood pressure

Using containers of water to demonstrate how hemorrhage leads to decreased body fluid Correct Explanation: Children in a concrete cognitive stage learn best by seeing something happen.

The mother of a 2-year-old child questions when she will need to initially have her child's vision screened. What information should be provided by the nurse? a) Vision screening begins at 2 ½ years of age b) Vision screening begins at 2 years of age c) Vision screening begins just prior to kindergarten d) Vision screening begins at 3 years of age

Vision screening begins at 3 years of age Correct Explanation: In the absence of risk factors vision screening should begin in children once they reach the age of 3.

A mother and her 2-week-old infant have arrived for a health supervision visit. Which of the following activities will the nurse perform? a) Take a health history for a minor injury b) Administer a Varicella injection c) Warn against putting the baby to bed with a bottle d) Assess the child for an upper respiratory infection

Warn against putting the baby to bed with a bottle Explanation: The nurse will provide information to prevent injury or disease such as discussing the hazards of putting the baby to sleep with a bottle. Assessing for an infection and taking a health history for an injury are not part of a health supervision visit. Administering a vaccination for Varicella would not occur until 12 months of age.

You view a boy from a large extended family as poor because his father is unemployed. Considering his family structure, which way might he view you as "poor"? a) You own only one student nurse's uniform. b) You stated you value honesty. c) You are planning to be a nurse. d) You are unmarried and live alone.

You are unmarried and live alone. Correct Explanation: A richness of an extended family is the availability of support people in times of family stress.

A boy from the Zulu people of South Africa has recently immigrated to the United States with his mother and is visiting the doctor's office for a physical. The nurse recognizes that which of the following most accurately describes this boy's ethnicity? a) South African b) Zulu c) Black d) African

Zulu Explanation: Ethnicity refers to the cultural group in which a person was born, although the term is sometimes used in a narrower context to mean only race. In this case, Zulu best describes the boy's ethnicity, as this was the cultural group into which he was born. Black and, to a certain extent, African refer to his race. South African refers to his nationality.

A nurse is preparing to teach an 8 year old recently diagnosed with diabetes how to give an insulin injection. Which is the best technique for the nurse to use? a) coloring book about diabetes b) video c) role modeling d) demonstration

demonstration Correct Explanation: The purpose of demonstration is to show how the procedure actually is done. Having to imagine steps is little different than reading about them. School-aged children, because of their stage of cognitive development (concrete operations), learn best by demonstration.

When caring for a woman in her 6th month of pregnancy, she reports her plans to nurse her baby for at least 2 to 3 years like the rest of the women in her family. Based upon your knowledge, you a) encourage her to start the baby on formula after the first year as recommended by many physicians. b) discuss how painful this will be once the baby has teeth. c) advise her to be careful who she discusses this with as many will consider that a type of reportable child abuse. d) document her report but do nothing as this is a cultural belief that should be respected.

document her report but do nothing as this is a cultural belief that should be respected. Correct Explanation: Culturally specific decisions should be respected and incorporated into the plan of care.

How is culture learned by each new generation? a) belonging to a subculture b) ethnic heritage c) religious activities d) family and community

family and community Correct Explanation: Culture is a shared system of beliefs, values, and behavioral expectations that provide social structure for daily living. Culture includes the beliefs, habits, likes and dislikes, and customs and rituals learned from their family and community through a process called enculturation.

A 5-year-old patient whose mother is rooming-in during the child's hospitalization will benefit in which of the following areas? a) feelings of isolation b) feelings of joy c) feelings of good health d) feelings of security

feelings of security Explanation: Rooming-in minimizes the hospitalized child's separation anxiety and depression. One of the biggest advantages of rooming-in is the measure of security the child feels. It does not cause feelings of isolation. It does not necessarily add joy or good health.

During the health history of a 3-month-old, the nurse identified a risk factor for developmental delay and is preparing to assess the child's development. Which of the following risk factors did the nurse find? Select all that apply. a) The infant's mother is a single parent. b) A sibling was born prematurely. c) The mother did not complete high school. d) The infant was delivered via a scheduled cesarean section.

• The infant's mother is a single parent. • The mother did not complete high school. Correct Explanation: Being a single parent and not having a high school education are risk factors that could result in developmental problems for the child. Often poverty is the underlying associated difficulty. The other findings should not intrude negatively on the infant's development.

A patient originally from China is admitted to a medical floor right when lunch trays are being delivered. When the patient says that he is hungry, the nurse informs him that she will order him some rice for lunch. Which of the following is the nurse practicing by telling the patient this? a) assimilation b) ethnocentrism c) prejudice d) stereotyping

stereotyping Correct Explanation: Stereotyping means expecting a person to act in a characteristic way without regard to his or her individual traits. In this case, the nurse expects that all Chinese people like rice. Prejudice is believing that some people matter less than others based on their physical or cultural traits. Assimilation means that people have adopted the values of the dominant culture. Ethnocentrism is the belief that one's own culture is superior to all others.

The nurse working with children and families knows there are certain universal screening tests all children should receive. These include tests for: Select all that apply. a) Lead levels b) Auditory brain stem response c) Phenylketonuria d) Denver II e) Hyperlipidemia

• Auditory brain stem response • Phenylketonuria Correct Explanation: Phenylketonuria (PKU) and auditory brain stem response (ABSR) tests are used universally (throughout the entire population regardless of individual risk). The Denver II is one of several developmental screening exams that can be used between birth and age 6 years. Screening for hyperlipidemia and lead occurs in those children with risk factors (selective screening).

A nurse is preparing to start an intravenous (IV) line on a child and knows that it will cause pain. The nurse obtains EMLA cream to decrease the sensation of the injection. What type of care is the nurse providing? a) Painless care b) Expert care c) Atraumatic care d) Aseptic care

traumatic care Correct Explanation: Atraumatic care is therapeutic care that minimizes or eliminates the psychological and physical distress experienced by children and their families in the health care system.

The child and her mother are receiving discharge instructions from the nurse. Which of the following statements by the child's mother are "red flags" that the mother may have poor literacy skills? Select all that apply. a) "I'm going to take a few notes while you're teaching us." b) "I guess I just forgot to give her the medication the way you told me to." c) "I forgot my glasses today and can't seem to read this form." d) "The receptionist told me that we missed another appointment." e) "I'm going to take these instructions home to read them."

• "I guess I just forgot to give her the medication the way you told me to." • "I forgot my glasses today and can't seem to read this form." • "The receptionist told me that we missed another appointment." • "I'm going to take these instructions home to read them." Correct Explanation: Taking notes is an indicator that the mother is literate. All of the other options are "red flags" that indicate the mother may not be literate.

The student nurse is assisting the more experienced pediatric nurse. Which of the following statements by the student indicate further education is required? a) "Could you give the nauseated child some medicine before it is time for him to start thinking about ordering lunch?" b) "I'm going to redress the child's IV site while she is in the playroom." c) "It would be easy to perform a straight catheterization while the baby is in his crib." d) "I told the child's mom to go ahead and bring in his blanket and stuffed animal." e) "I took our new teenaged child down to show him the playroom."

• "I'm going to redress the child's IV site while she is in the playroom." • "I took our new teenaged child down to show him the playroom." • "It would be easy to perform a straight catheterization while the baby is in his crib." Explanation: Even minor nursing interventions should not be performed in the playroom. The playroom should be referred to as the "activity room" or "social room" instead of "playroom" when speaking with adolescent children. It is inappropriate to perform procedures in the child's crib. It is better to perform procedures in the treatment room. It is important to give anti-emetics prior to mealtimes. Parents can be encouraged to bring in security items to help reduce the child's level of stress.

The child has been diagnosed with vulnerable child syndrome. Which of the following statements by the child's parent is associated with the presence of this syndrome? a) "He was always a sweet and happy baby." b) "She was born with a cleft lip and palat I was so afraid she wasn't getting enough formula." c) "When she was a toddler she developed meningitis and the doctors told me they didn't think she'd make it." d) "I discipline all of three of my kids very fairly." e) "For the first few weeks of his life, he was so yellow I was afraid he would glow."

• "She was born with a cleft lip and palat I was so afraid she wasn't getting enough formula." • "When she was a toddler she developed meningitis and the doctors told me they didn't think she'd make it." • "For the first few weeks of his life, he was so yellow I was afraid he would glow." Correct Explanation: Risk factors for the development of vulnerable child syndrome include newborn jaundice, an illness that the child was not expected to recover from, and congenital anomalies.

Following a principle of learning, you can anticipate that the children will best learn a skill such as bandaging if they a) are shown a photo of someone important doing it. b) have it demonstrated to them by a teacher. c) are criticized for not learning it well. d) are allowed to practice it.

• "This little tube will go in your nose and down into your belly." • "When they come to get you, you'll get on a special rolling be" • "They're going to give you some special medicine to help the doctor see what's happening inside your belly." Explanation: It is appropriate to use the word "tube" and not a "catheter." It is appropriate to call a "gurney" a "rolling bed." It is better to call "dye" special medicine. Terms used in the other options may be misunderstood by the child.

Nurses use standardized materials to administer the Denver II Developmental Screening Test. What are some of the materials included in the test kit? Select all that apply. a) A ball to throw and catch b) Blocks to stack c) Shapes to fit into corresponding openings d) Cards with letters of the alphabet e) Raisins to place in a bottle

• A ball to throw and catch • Blocks to stack • Raisins to place in a bottle Correct Explanation: Contents of the Denver II Developmental Screening Test kit include a ball, blocks, and raisins. Items such as a rattle, a plastic doll, a toy baby feeding bottle, a bell, and others are included as well. No alphabet letters are part of the testing. Shape testing is accomplished by having the preschooler draw geometric forms as demonstrated by the tester.

The nurse in a school housing kindergarten through grade 12 has identified signs of stress in the students that may indicate exposure to domestic violence or child abuse. What has the nurse found? Select all that apply. a) Early-age smoking and drug abuse b) Developmental regression and fearfulness c) Truancy and absenteeism d) Complaints of headaches, stomach aches, and enuresis e) Bullying and poor social skills

• Complaints of headaches, stomach aches, and enuresis • Early-age smoking and drug abuse • Truancy and absenteeism • Developmental regression and fearfulness • Bullying and poor social skills Explanation: All are signs of stress that can indicate exposure to domestic violence or child abuse. The younger the child is and the longer the exposure, the more serious the problems seen. Short-term problems include headaches, stomach aches, enuresis, developmental regression, fears, poor social skills, and bullying. Long-term problems include truancy and absenteeism. A strong correlation exists between the number of exposures to adverse events and early smoking and illicit drug use.

A nurse is working to provide health promotion services throughout the community. What institutions or organizations best serve as important avenues for disseminating health promotion information? Select all that apply. a) Environmental groups b) Day care centers c) Schools (public and private) d) Political organizations e) Churches, synagogues, and mosques

• Day care centers • Schools (public and private) • Churches, synagogues, and mosques Correct Explanation: Religious groups value health and often have a health committee or parish nurse who can participate in a community-wide health promotion effort. Schools teach health in their classrooms and have health promotion activities for students and employees through things such as nutrition and exercise programs. Day care centers work to promote health through the programs developed for their enrollees and parents. Many families can be reached through these venues. Political organizations and environmental groups may well have health-promoting functions, but these are likely to be narrower in focus and directed toward a particular constituent base.

The nurse is caring for a 15-year-old boy with chronic lung disease. Choose the appropriate interventions for this boy. Select all that apply. a) Educate school staff about the teenager's special needs. b) Promote participation in after-school activities. c) Urge the adolescent to make up missed schoolwork. d) Assist the teen in developing effective interpersonal skills. e) Encourage parents to maintain very close supervision of their teen's activities. f) Defer discussing the boy's plans for the future.

• Educate school staff about the teenager's special needs. • Promote participation in after-school activities. • Urge the adolescent to make up missed schoolwork. • Assist the teen in developing effective interpersonal skills. Correct Explanation: Teenagers with special healthcare needs often need to work on interpersonal skills appropriate for their developmental age. Illness, treatments, missed school days, and differences in abilities from their peers interfere with opportunities to practice relational skills with age-mates and others. Educating the school staff, promoting involvement in after-school activities, and keeping up with schoolwork assist in normalizing the teenager's development. Delay in considering the teen's future and having the parents continue close supervision do not help the adolescent move toward independence and are not suitable interventions.

What developmental categories will the nurse assess when screening with the Denver II Developmental Screening Test? Select all that apply. a) Fine motor--adaptive b) Gross motor skills c) Intelligence d) Language e) Personal-social

• Fine motor--adaptive • Gross motor skills • Language • Personal-social Correct Explanation: The Denver II is not a test of intelligence; it is used to assess the child's level of development. This differentiation should be made clear to parents. A task not passed on the Denver II indicates a delay in that area. Further evaluation is needed to determine the reason for this delay.

The parent of a child with cerebral palsy asks how therapeutic horseback riding might benefit his adolescent. The nurse's response includes: Select all that apply. a) Self-esteem and confidence usually get a boost. b) Sleep problems often resolve. c) Appetite tends to be stimulated with riding. d) Flexibility, balance, and muscle strength tend to improve.

• Flexibility, balance, and muscle strength tend to improve. • Self-esteem and confidence usually get a boost. Explanation: Flexibility, muscle strength, and balance are fostered due to the horse movement as the teen rides. Improvement in these areas would be particularly helpful to the adolescent with cerebral palsy. Improved self-esteem and confidence are also developmentally important as the youth works to establish identity. Improved appetite and resolution of sleep problems are not attributed to therapeutic horseback riding.

Nurses should be ready to acknowledge and work with what parental reactions when a child with special needs is diagnosed? Select all that apply. a) Anger b) Resentment c) Love d) Grief e) Fear

• Grief • Anger • Fear • Resentment • Love Explanation: All of these parental reactions are likely. Parents may experience these feelings repeatedly as the child grows, as family circumstances change, and as health needs fluctuate.

An adolescent would benefit from being out of his hospital room. What can the nurse do to promote this? Select all that apply. a) Challenge the adolescent to a video game in the recreation area. b) Invite the adolescent to meet with other teens for lunch in a common space. c) Encourage the teen to investigate the playroom. d) Suggest the adolescent visit other areas within the hospital that are away from the pediatric unit.

• Invite the adolescent to meet with other teens for lunch in a common space. • Challenge the adolescent to a video game in the recreation area. Explanation: A video game in the "recreation area" is more appealing than investigating the "playroom." If only one activity space is available, avoid calling it the playroom to school-agers and teens. Arranging for teens to spend time together and socialize over lunch may stimulate appetites and new supportive friendships. Suggesting the adolescent leave the unit may not be safe based on his knowledge of the hospital or his condition. Doing so accompanied would be appropriate.

A child's medical record contains the diagnosis failure to thrive (FTT). The nurse realizes: Select all that apply. a) It could be related to poverty. b) It may have developmental delay as a contributing factor. c) The cause may be organic or inorganic. d) The growth chart shows an extended period of poor weight gain. e) That special needs children often carry this diagnosis.

• It could be related to poverty. • It may have developmental delay as a contributing factor. • The cause may be organic or inorganic. • The growth chart shows an extended period of poor weight gain. • That special needs children often carry this diagnosis. Correct Explanation: All are true of failure to thrive. Physical or physiologic problems cause organic failure to thrive. Inorganic failure to thrive derives from psychosocial sources. The line between the two may not always be clear, however, since causes of the problem can be mixed.

Which children will the nurse avoid immunizing with a live-virus vaccine? Select all that apply. a) Pregnant teen b) School-age patient with fractured arm c) Toddler with constipation d) Preschooler receiving radiation therapy e) Two-month-old infant

• Pregnant teen • Preschooler receiving radiation therapy Correct Explanation: The immune compromised child undergoing radiation therapy and the pregnant teen should not receive live-virus vaccines. The preschooler could contract the disease. In pregnancy, the virus could cross the placenta and infect the fetus. The other children can safely receive a live-virus vaccine.

The nurse will record what information about each vaccine after immunizing a child? Select all that apply. a) Site and route of vaccine administration b) Whether bacterial or viral c) Lot number and expiration date of vaccine d) How vaccine was stored e) Manufacturer of vaccine

• Site and route of vaccine administration • Lot number and expiration date of vaccine • Manufacturer of vaccine Correct Explanation: Lot number, expiration date, site and route of administration, and the name of the vaccine manufacturer should be recorded. The name and address of the facility and the person administering the vaccine are also documented. In this way, details that can be used to track any untoward events related to the vaccine are available. Proper vaccine storage is important for the efficacy of the vaccine but presently is not recorded at the time of administration. The viral or bacterial nature of the vaccine is already known.

The nurse is meeting an 8-year-old girl with cancer and her family for the first time. Which of the following will best help to establish a relationship with the child and family? Select all that apply. a) Avoiding the use of the parents' and child's descriptors b) Redirecting the conversation to maintain focus c) Listening to the child and family while interjecting one's own knowledge of the events d) Keeping both a relaxed posture and word flow e) Sitting at eye level with the child and parents

• Sitting at eye level with the child and parents • Keeping both a relaxed posture and word flow • Redirecting the conversation to maintain focus Explanation: Sitting at eye level, keeping congruence between verbals and nonverbals, and redirecting the exchange to maintain focus are all good communication techniques and help build a positive working relationship. Listening to the child/family while continuing with the nurse's own agenda will uncover little information and signal a lack of true interest. Not using the family's or child's descriptors (substituting own) is a controlling maneuver on the part of the nurse and disallows reflection and the opportunity to truly understand and show empathy.

A 6 year old with leukemia is placed on reverse isolation. What nursing actions could prevent depression and loneliness in this patient? (Select all that apply.) a) Spend extra time to talk while in the room. b) Play a game while in the room. c) Quickly exit the room when possible. d) Do all nursing tasks at one time. e) Read a story while in the room.

• Spend extra time to talk while in the room. • Read a story while in the room. • Play a game while in the room. Explanation: A child on isolation is subject to loneliness, which can be prevented by arranging to spend extra time in the room during treatments. Also while in the room the nurse might read a story, play a game, or just talk to the child. The other options will increase social isolation and may make the child feel punished.

Development should continue during hospitalization. What play activities will the nurse choose for toddlers to accomplish this? Select all that apply. a) Stacking blocks b) Batting balloons c) Putting together a large-piece puzzle d) Watching a mobile e) Pulling a toy train

• Stacking blocks • Putting together a large-piece puzzle • Pulling a toy train Correct Explanation: Pulling a toy train encourages movement and the development of gross motor skills important to the toddler. Stacking blocks and putting together a puzzle uses fine motor skills and an understanding of shapes and space and is stimulating cognitively. Watching a mobile is appropriate for infants and may be unsafe if the toddler could reach it. Balloons are inappropriate in the hospital setting (latex sensitivity) and are an aspiration risk. Mylar balloons may be considered safe, although attached long strings or ribbons are not.

The nurse will administer which recommended immunizations to an 11- or 12-year-old patient during a wellness visit? Select all that apply. a) Tetanus, diphtheria, pertussis (Tdap) b) Varicella c) Meningococcal vaccine (MCV) d) Human papillomavirus (HPV) e) Hepatitis A (HepA)

• Tetanus, diphtheria, pertussis (Tdap) • Meningococcal vaccine (MCV) • Human papillomavirus (HPV) Correct Explanation: Tdap, HPV, and MCV are the vaccines that would be administered to a school-age patient. Other vaccines may be given as catch-up, and some are administered to children considered at high risk. It is important that the nurse check immunization records at each contact while taking into account changing immunization recommendations to keep children up-to-date.

The child life nurse practitioner has been assigned to assist the hospitalized child and the child's parents. Which of the following are appropriate interventions for the child life specialist to perform? Select all that apply. a) The child life specialist starts the child's intravenous line b) The child life specialist shows the child where the pediatric play room is located c) The child life specialist gives the child an influenza vaccination d) The child life specialist talks to the family about a diagnostic test that the child is scheduled for later in the day e) The child life specialist speaks to the physician as the child's advocate

• The child life specialist shows the child where the pediatric play room is located • The child life specialist talks to the family about a diagnostic test that the child is scheduled for later in the day • The child life specialist speaks to the physician as the child's advocate Correct Explanation: The child life specialist commonly assists with nonmedical preparation for diagnostic testing, provides tours, assists in play therapy, and is the child's advocate. The child's nurse gives medication, vaccines, and starts intravenous lines.

The child has been admitted to a pediatric unit in a hospital. Which of the following nursing interventions indicate that atraumatic care principles are being used? Select all that apply. a) The nurse requests that parent assist the nurse by "holding the child down." b) The nurse shows the parent how to unfold the chair in the child's room into a bed. c) The nurse applies a numbing cream prior to starting the child's intravenous line. d) The nurse encourages the family to bring in the child's favorite stuffed animal from home. e) The nurse asks the child if he would like to take a bath before or after he takes his medication.

• The nurse applies a numbing cream prior to starting the child's intravenous line. • The nurse asks the child if he would like to take a bath before or after he takes his medication. • The nurse encourages the family to bring in the child's favorite stuffed animal from home. • The nurse shows the parent how to unfold the chair in the child's room into a bed. Explanation: When following the principles of atraumatic care, it is appropriate to apply numbing cream prior to starting the child's intravenous line. It is appropriate to empower the child with choices about care, if possible. It is appropriate for the child to have a security item present in the hospital. It is helpful for the family if the parent is able to stay with the child because it helps make the environment less stressful. The nurse should avoid using the phrase "holding the child down" and replace this with "therapeutic hugging."

The nurse is preparing to educate the child about a procedure that the child is scheduled or tomorrow morning. Which of the following techniques used by the nurse indicate the need for further education about communicating with a child? Select all that apply. a) The nurse requests that the parents leave the room while the nurse educates the chil b) The nurse speaks quickly. c) The nurse is patient with the child and looks for nonverbal cues. d) The nurse stands at the foot of the child's bed while teaching the child. e) The nurse uses terms that the child will likely understand.

• The nurse requests that the parents leave the room while the nurse educates the chil • The nurse speaks quickly. • The nurse stands at the foot of the child's bed while teaching the child. Correct Explanation: The nurse should position himself or herself at the child's level. The nurse should speak in an unhurried manner. The nurse should ensure that the child's parents are present during education. It is appropriate to use words that the child will understand. It is appropriate to show patience during the interaction and look for nonverbal cues that indicate understanding or confusion.

A nursing student is asked to provide reasons it is important for the physician or nurse practitioner to have knowledge of the community in which the families and children seen in the practice live. The student replies: Select all that apply. a) Understanding the community promotes improved working relationships between families and physicians or nurse practitioners. b) The community can be a contributor to child-family health or a cause of illness. c) Awareness of agencies serving children results from knowing the community. d) Knowing the community is necessary in developing appropriate health surveillance programs.

• Understanding the community promotes improved working relationships between families and physicians or nurse practitioners. • The community can be a contributor to child-family health or a cause of illness. • Awareness of agencies serving children results from knowing the community. • Knowing the community is necessary in developing appropriate health surveillance programs. Correct Explanation: All reasons are good ones for a physician or nurse practitioner to know the community. Awareness of the strengths and limits within the community helps the physician or nurse practitioner better manage the health of the families served.

Over coffee following a worship service, parents ask the parish nurse for guidance in disciplining their children ages 4 years, 9 years, and 14 years. What concepts will guide the nurse's response? Select all that apply. a) Delay applying consequences to allow time to choose appropriate action. b) Use parental attention as positive reinforcement for desired behaviors. c) Role model appropriate behavior in word and deed. d) Show parental anger when administering consequences of poor behavior. e) Maintain consistency in expectations at all ages.

• Use parental attention as positive reinforcement for desired behaviors. • Maintain consistency in expectations at all ages. • Role model appropriate behavior in word and deed. Explanation: Attention, consistency, and role modeling are all appropriate disciplinary concepts. Showing anger can cause the child to believe the parent is angry at him or her as a person. A calm demeanor helps indicate displeasure with the behavior. Delaying punishment interferes with connecting the behavior to the consequence.

Choose the options below that will assist nurses in overcoming some of the barriers to having children fully immunized. Select all that apply. a) Using every health contact with the child (hospital, urgent care, emergency, and well-child visits) to check status/administer vaccines b) Using combination vaccines to reduce the number of injections children receive c) Using separate vaccines (except the well-known DTaP) so parents can more readily track/understand immunizations received d) Checking the immunization status of siblings who accompany the child who has the healthcare appointment e) Having parents postpone all immunizations when they are concerned about certain vaccines

• Using every health contact with the child (hospital, urgent care, emergency, and well-child visits) to check status/administer vaccines • Using combination vaccines to reduce the number of injections children receive • Checking the immunization status of siblings who accompany the child who has the healthcare appointment Correct Explanation: Checking the status of siblings and using all contacts to immunize children plus employing combination vaccines all assist in improving the immunization status of children. Using separate vaccines to improve understanding and parental record keeping is not substantiated. Postponing immunizations may result in immunizations not given or being improperly spaced. Some experts say, however, that a partially immunized child is safer than one unimmunized, so getting some vaccines and not others may be a realistic compromise with certain parents.

The nurse will assess for bonding between parent and child with special needs on what occasions? Select all that apply. a) While visiting the family at home b) At health maintenance visits c) During hospital admission for illness d) When the parents first see/touch the child e) While teaching the parents feeding techniques

• While visiting the family at home • At health maintenance visits • During hospital admission for illness • When the parents first see/touch the child • While teaching the parents feeding techniques Correct Explanation: All occasions of contact with parents and child should be used to assess boding (attachment). Bonding can be difficult for numerous reasons, including separation, parental fearfulness, shame, and guilt. Often parental feelings are combined with lack of infant responsiveness. Bonding is needed for the health of both child and family. Interventions to support the family's growth are needed as soon as difficulties are identified.