Peds Evolve Questions #1
A 19-month-old boy who has been in the hospital for 2 weeks becomes increasingly withdrawn and mute. What is the most appropriate nursing action? Offering distracting toys Moving him into a room with other children Encouraging the parents to stay with him as much as possible Providing sensory stimulation by assigning different nurses to care for him
C
Which toys should the nurse identify as most appropriate for a 3-year-old child? Select all that apply. Pounding toy Play telephone Seven-piece jigsaw puzzle Box filled with plastic figures Picture to cut out with blunt scissors
A, B, D
A nurse is planning to communicate with a preschool child. What is most important for the nurse to know about the child first? State of health Developmental level Ability for self-expression Fear of authoritarian figures
B
An 18-month-old toddler is admitted to the pediatric unit. The child has never been separated from the mother before this admission. What behavior does the nurse expect from the toddler? Sitting quietly, uninterested in playing Crying relentlessly and consoled by no one but a parent Looking sad but becoming content after meeting roommates Screaming when people enter the room but smiling after several minutes
B
The parents of a newborn arrive for the first clinic appointment. Accompanying them is their 18-month-old toddler. At the beginning of the intake interview the nurse notes that the mother is formula-feeding the infant, the toddler is playing on the floor, and the father is reading a magazine. What should the nurse ask the father to do at this time? A. Give a bottle to the baby. B. Take the toddler for a walk. C. Stay and participate in the discussion. D. Leave the nurse and the mother alone.
C Further assessment is needed; the father may perceive this as the mother's role and may resist any offer to participate. Removing the father from the situation will decrease his participation. Inclusion in the interview will avoid a feeling of ostracism by the father and will foster his cooperation. Asking the father to leave closes off communication with the father. The father is part of the family and should be encouraged to stay.
The nurse finds a 4.5-year-old hospitalized girl, who has several siblings, crying and shouting at her teddy bear, "There! You bad girl! Don't be mad at your brother! Go to the hospital!" What does an understanding of preschooler development lead the nurse to believe that this behavior is based on? Believes the parents love the brother more Is angry at the brother and wishes that he were sick Is missing the brother and wishes that they could be together Thinks that being sick is related to bad thoughts about the brother
D
A boy in kindergarten has experienced urinary incontinence during the first few weeks of school. What should the school nurse do? Suggest that his mother send him to school in training pants Keep a change of clothes available for him in the health office Ask his teachers to remind him several times a day to go to the bathroom Explain to him why it is important to stay dry now that he is old enough to attend school
B
A mother needs to get her blood pressure (BP) checked, but her 4-year-old child is interfering in the process. What should the nurse do to gain the child's cooperation? Ask the mother to restrain the child. Instruct the mother to scold her child. Allow the child to manipulate the instrument. Scare the child by showing an injection needle.
C
A 2-month-old infant is admitted to the pediatric unit for observation after an automobile collision. Family members are unable to stay. How can the nurse best provide psychologic comfort for the infant? Assigning the same nurse to the infant Following a routine to which the infant is accustomed Having the infant listen to the parents' voices over the phone Ensuring that a staff member stays with the infant at all times
B
A 9-year-old child who is undergoing intravenous antibiotic therapy becomes bored and irritable. What activities for school-aged children should the nurse suggest? Select all that apply. Playing solitaire Playing games on a tablet Making a model airplane Doing arithmetic puzzles Watching soap operas on television
B, C
Which nursing actions are developmentally appropriate when caring for a hospitalized preschool-age child? Select all that apply. Providing brochures regarding home care options Using toys for distraction during a painful procedure Knocking on the child's hospital room door prior to entering Offering medical equipment to play with prior to a procedure Providing clear instructions about details of a procedure that will occur near discharge
B, D
What pain scale is used to measure the intensity of pain in preschoolers? FACES scale Visual analogue scale Numerical rating scale Verbal descriptor scale
A
A 1-year-old infant is brought to the well-baby clinic. Which toys should the nurse select from the play area for this infant's growth and developmental level? Select all that apply. A. Push-pull toy B. Nested boxes C. Rocking horse D. Four-piece puzzle E. Squeaking plastic toy
A, B, E A push-pull toy provides tactile, visual, and auditory stimulation and requires active input by the child. Nested boxes challenge the infant and provide tactile and visual stimulation. A plastic toy that squeaks provides auditory, tactile, and visual stimulation. The potential for injury on a rocking horse is too great for a 1-year-old infant. A 1-year-old infant is also too young for a puzzle.
A 15-year-old adolescent with type 1 diabetes arrives at the diabetic outpatient clinic with a parent. The adolescent sits back in the chair with arms folded, frowns, and displays a withdrawn attitude. The adolescent and parent argue in front of the nurse. What is the best approach for the nurse to use? A. Encouraging the adolescent to take more interest in and responsibility for treatment B. Speaking separately with each of them, encouraging them to recognize and vent their anger C. Trying to persuade the two of them to work out their differences together before returning to the clinic D. Asking the parent to stay in the waiting room while the adolescent meets with the clinic's staff members
B Anger interferes with communication; recognition and ventilation of anger help to resolve it and can help increase productive communication. Anger is interfering with the acceptance of responsibility and must be addressed first. The parent and child are too angry with each other to work this out alone; they may continue to express anger toward each other, which will probably cause the conflict in their relationship to escalate. The parent should be involved with the therapy and therefore must be present when treatment is discussed.
Which interventions does the nurse implement to empower a family who has a child with Down syndrome? Select all that apply. A. Ask the family to engage in spiritual activities. B. Help the family recognize the possible stressors. C. Encourage the use of problem-solving strategies. D. Encourage more out-of-home activities for the parents. E. Refer the family to support groups and Internet resources
B,C,E The nurse understands that the family experiences multiple stressors and helps the family recognize those stressors. The nurse encourages the family to use effective problem-solving skills that convey support and care and have a calming influence on the child. The nurse also identifies proper support groups for the family to relieve stress. The use of Internet resources will help the family understand more about the child's disorder. Asking the family to engage in spiritual activities is not appropriate, because spirituality is a personal lifestyle choice. The nurse encourages the parents to spend more time at home to provide care for the child, as opposed to engaging in more out-of-home activities.
A nurse is reviewing the immunization schedule of a 5-month-old infant. What immunizations does the nurse expect the infant to have already received? A. Rubella, polio, tuberculosis, rotavirus, varicella, pertussis B. Pertussis, tetanus, polio, rotavirus, pneumococcal, measles C. Measles, mumps, rubella, rotavirus, pertussis, tuberculosis D. Rotavirus, DTaP, Haemophilus influenzae, polio, pneumococcal
D According to the 2013 Centers for Disease Control and Prevention (Canada: Public Health Agency of Canada) immunization schedule, a 5-month-old infant should have received the following vaccines: rotavirus, DTaP (diphtheria, tetanus, and pertussis), Hib ( Haemophilus influenzae), IPV (polio), and PCV (pneumococcal). The rubella vaccine is not usually administered until an infant is at least 12 months of age. Administration of the varicella vaccine is not recommended until an infant has reached 12 months of age. Measles vaccine is not usually administered until the infant is at least 12 months old. There is no tuberculosis vaccine.
How should a nurse respond to parents who are concerned about separation anxiety in their 15-month-old toddler? "This is an expected developmental reaction." "You may be spending too much time with your child." "It might be helpful to leave your child with someone once in a while." "Toddlers who have separation anxiety may have difficulty when they start school."
A
What behavior does a nurse expect from a toddler subjected to prolonged hospitalization with limited parental visits? A. Cheerful interactions with staff members B. Indications of sadness throughout the day C. Excessive crying when parents are not present D. Limited emotional response to the environment
A Superficial interest in the environment and friendly interactions with strangers are typical responses of a toddler who has experienced prolonged separation from parents because of illness. It is the third stage of separation anxiety, known as detachment. Excessive crying when parents are not present is typical of the first stage of separation anxiety, known as protest. Sadness throughout the day and limited emotional response to the environment are both behaviors that are typical of the second stage of separation anxiety, known as despair.
The nurse is performing physical assessments for children in a daycare center. Which children should require a head circumference in order to monitor growth patterns? Select all that apply. A. A 6-month-old infant who is breastfed B. A 15-month-old toddler who has asthma C. A 3-year-old child whose birthday was the day prior D. A 5-year-old who will attend kindergarten in the fall E. An 8-year-old child who will begin playing soccer next week
A, B, C The nurse includes a head circumference in the physical assessment from birth to 36 months of age; therefore, the 6-month-old infant, the 15-month-old toddler, and the 3-year-old child whose birthday was the day prior will all have their head circumferences measured during the assessment. The 5-year-old and the 8-year-old will not have their head circumferences measured during the assessment process.
A 30-month-old child who was transferred to a regional hospital has not seen the parents for 2 weeks. The child now responds to the staff with friendliness and affection. When the mother visits the child turns away from her and ignores her. What should the nurse explain to the mother? "Your child has adapted so well and loves all of us and is so happy." "Your child misses you very much; give the child time to reach for you." "Toddlers usually cry when they see their mothers; your child is so mature." "Toddlers have such short memories; that's why your child doesn't remember you."
B
What toys should a nurse suggest to the parent of a 4-month-old infant to help promote the child's growth and development? A.Push-pull toys B.Soft squeeze toys C.Nesting blocks and cups D.Wooden hammer and pegboard
B Soft, noisy squeeze toys are appropriate for a 4-month-old; the infant enjoys squeezing and hearing the sound of the squeaker. Push-pull toys are appropriate for a toddler 12 to 24 months of age. Nesting toys are appropriate for a toddler 16 months of age. Banging toys are appropriate for children from 12 to 18 months of age.
"But you don't understand" is a common statement associated with adolescents. What is the nurse's best response when hearing this? "I don't understand what you mean." "I do understand; I was a teenager once too." "It would be helpful to understand; let's talk." "It's you who should try to understand others."
C
The nurse is preparing to administer an intramuscular injection to a preschool-age client. Which is the most appropriate statement by the nurse prior to this procedure? "We will give you your shot when your mommy comes back." "This is a magic sword that will give you your medicine and male you all better." "It is all right to cry. After we are done, you can go to the box and pick out your favorite sticker." "I will wipe your skin with a magic wipe and then hold the needle like this and say 'one, two, three, go' and give you your shot. Are you ready?"
C
Which nursing action is most accurate when assessing the chest circumference of a newborn during the initial physical assessment? Measuring during expiration only Taking three measurements and recording the average Measuring during inspiration and plotting this data on the growth chart Placing the measuring tape around the rib cage at the nipple line
C
The nurse is providing care to a toddler-age client during a health maintenance visit whose parents are expecting the birth of another child. Which statements should the nurse include in the teaching session to prepare the toddler-age client for the arrival of a new sibling? Select all that apply. "You should tell your child that a new playmate will be coming home." "You should begin to prepare your child now so there are no surprises." "You should promise your child that normal bedtime routines will continue after the baby is born." "You should buy your child a doll so that she can take care of her baby while you take care of the new baby." "You should include your child in the normal day to day activities with the new baby, such as helping with diaper changes."
C, D, E
The parents of a 6-month-old infant ask the nurse about the best toy to buy for their baby. What type of toy should the nurse suggest? A. Push-pull B. Wooden blocks C. Shape-matching D. Soft stuffed animals
D A stuffed animal is the most appropriate toy for a 6-month-old infant because it is safe and cuddly and requires only gross motor movement. A push-pull toy is appropriate for the older infant (9 to 12 months) or toddler because it encourages walking. Wooden blocks are inappropriate because an infant puts toys in the mouth; playing with blocks requires motor development beyond the ability of a 6-month-old infant. Shape-matching toys require intellectual and motor development beyond that of an infant.
