PEDS EXAM #1
The nurse is teaching a parent with a 2-month-old infant who has been diagnosed with colic about ways to relieve colic. Which statement by the parent indicates the need for additional teaching?
"I should let my infant cry for at least 30 minutes before I respond." (Because the infant has been diagnosed with colic, the parent should respond to the infant immediately or any type of interventions to relieve colic may not be effective. Also, the infant may develop a mistrust of the world if his or her needs are not met. The parent should swaddle the baby tightly with a soft blanket, massage the baby's abdomen, and place the infant in an upright seat after a feeding to help relieve colic.)
The nurse is teaching parents guidelines for feeding their 8-month-old infant with failure to thrive (FTT). Which statement by the parents indicates a need for further teaching?
"We will be sure to give our infant at least 8 oz of juice every day." (Juice intake in infants with FTT should be withheld until adequate weight gain has been achieved with appropriate milk sources; thereafter, no more than 4/oz day of juice should be given. Further teaching is needed if the parents indicate 8 oz of juice is allowed. For infants with FTT, 24-kcal/oz formulas may be provided to increase caloric intake. Because maladaptive feeding practices often contribute to growth failure, parents should follow specific step-by-step directions for formula preparation, as well as a written schedule of feeding times. Statements by the parents indicating they will use a 24-kcal/oz formula, follow directions for formula preparation, and feed their infant on schedule are accurate statements.)
The nurse is teaching parents about caring for their infant with seborrheic dermatitis (cradle cap). Which statement by the parents indicates understanding of the teaching?
"We will use a fine-tooth comb to help remove the loosened crusts from the strands of hair."(A fine-tooth comb or a soft facial brush helps remove the loosened crusts from the strands of hair after shampooing. This is an accurate statement. Shampoo should applied to the scalp and allowed to remain on the scalp until the crusts soften. Shampoo should not be rinsed off quickly. The crusts should be removed, and shampooing with antiseborrheic shampoo should be done daily, not every other day.)
Negativism
-"no" or "me do" -"May I listen to your heart" vs. "I am going to listen to your heart"
Erikson
-Autonomy vs. shame and doubt -Their behavior is their own with predictable effect on others -Emotions become strongly expressed, usually in rapid mood swings
Cognitive Development: Piaget
-Awareness of casual relationships between 2 events (can not transfer that knowledge to new situations) -Learns spatial relationships (use active play with blocks and shape sorters)
Temper Tantrums
-Inability to control emotions -Autonomy is frustrated by adult figures or lack of motor and cognitive skills -parents should ignore the behavior (if child is not in danger) but remain present
Common illnesses among toddlers
-URI -otitis media -tonsillitis (Short, straight ear internal ear canal and large lymph tissue)
Personal social behavior of toddlers
-feeding themselves -playing -dressing & undressing themselves
Egocentric
-sees things from their perspective only -want things their way, inability to share toys
A parent brings a 12-month-old infant into the emergency department and tells the nurse that the infant is allergic to peanuts and was accidentally given a cookie with peanuts in it. The infant is dyspneic, wheezing, and cyanotic. The health care provider has prescribed a dose of epinephrine to be administered. The infant weighs 24 lb. How many milligrams of epinephrine should be administered?
0.011 to 0.3 mg. (The correct dose of epinephrine to use in the emergency management of an anaphylactic reaction is 0.001 mg/kg up to a maximum of 0.3 mg, giving a range of 0.011 to 0.3 mg using a weight of 11 kg (24 lb).)
Front facing car seat
1-7 years
Walk alone using wide stance for extra balance
12 months
Growth rate slows at
12-18 months
Toddler age range
12-36 months
Protein needed per day
13 grams
Retain urine for up to 2 hours or longer by age
14-18 months
Prefer using their fingers until
18 months
Throws ball
18 months
Try to run but fall easily
18 months
Control of the anal and urethral sphincters by age
18-24 months
Final Sensorimotor stage
19-24 months -imitation of behaviors -domestic mimicry (cleaning) -Limited attention span
Preconceptual Phase
2 to 7 years -Transition between self-satisfying behavior and socialized relationships -Mental symbolization -Fear related to memory & association -I.E. dentist, uniforms
Multiword sentences of 2-to-3 words (mama go bye-bye; all gone) by age
2 years old
Recognize gender differences at _____ y/o
2 years old
Walk up and down stairs
2 years old
Visual acuity of ____ is acceptable
20/40
Height increases about
3 inches/year
Daily intake for toddler
3 meals & 2 snacks per day
Gender identity at age
3 years old
Simple sentences, begin to master grammatical rules, acquire five or six new words daily, know their age and gender, can count 3 objects correctly by age
3 years old
At a well-child check-up, the nurse notes that an infant with a previous diagnosis of failure to thrive (FTT) is now steadily gaining weight. The nurse should recommend that fruit juice intake be limited to no more than how much?
4 oz/day. (Restrict juice intake in children with FTT until adequate weight gain has been achieved with appropriate milk sources; thereafter, give no more than 4 oz/day of juice.)
Booster seat
4-12 years
Weight gain slows to
4-6 lbs/yr
The nurse is collecting a stool sample from an infant with lactose intolerance. Which fecal pH should the nurse expect as the result?
5.5. (An acidic pH (5-5.5) indicates malabsorption, which occurs with lactose intolerance. The normal pH of the stool is 7.0 to 7.5. A finding of 8 would be alkaline.)
Seat belt
8-13+ years
A common cause of accidental death in children aged 1 to 19 years involves motor vehicle crashes. Evidence from test crashes indicates that the safest action to prevent accidental deaths in toddlers includes: A. Placing the child in a rear-facing weight-appropriate car restraint seat until age 24 months B. Allowing the child to ride in the front seat with a lapshoulder seat restraint to avoid emotional outbursts C. Allowing the child to ride in a forward-facing booster restraint seat after 12 months of age D. Placing the child in the regular seat using the lap-shoulder belt as long as the child weighs at least 45 pounds
A
A hallmark of cognitive development in the school-age child is in what Piaget describes as concrete operations. In this stage the child: A. Uses thought processes to experience events and actions B. Is unable to see things from another's point of view C. Has a limited perspective of how others' interpretations of a given event differ D. Makes judgments based on what he or she sees
A
In terms of social development, the school-age child does which of the following? Select all that a 2-day-old infant in the newborn nursery is diagnosed with developmental dysplasia of the hip, and treatment is started by the orthopedist. The nurse assists the parents by providing home care instructions that include: A. Return to the orthopedist's office in 2 weeks to remove the hip spica cast B. The infant's bilateral foot casts should be elevated on pillows as much as possible C. Remove the Pavlik harness once a day for no more than 2 hours and inspect skin D. Remove the Pavlik harness while the infant is awake to allow "tummy time" A. Begins to explore the environment beyond the family B. Has an increased interest in persons of the opposite sex (gender) C. May actively participate in same-sex groups or clubs D. Strives to be different from those in the peer group E. Begins to form strong relationships with persons of the same sex (gender)
A
One indication that the toddler is ready to begin toilet training is: A. Child recognizes urge to let go and hold on and is able to communicate this sensation to the parent B. Child is able to stay dry all night C. Child demonstrates mastery of dressing and undresssing self D. Child asks parent to have wet or soiled diaper changed
A
One of the key factors in addressing the health concerns and needs of the adolescent in a clinic or primary care office setting is to: A. Provide confidentiality B. Include the parent(s) in a discussion about the adolescent's sexual health C. Ask the adolescent if she or he is sexually active D. Discuss the negative effects of tobacco use
A
School-age children are prone to accidental injury primarily because of: A. Peer pressure and risk-taking behaviors B. Physical awkwardness and clumsiness C. Parents' lack of supervision D. Attempts to impress members of the opposite sex
A
Which statement best describes colic?
A paroxysmal abdominal pain or cramping manifested by episodes of loud crying. (Colic is described as paroxysmal abdominal pain or cramping that is manifested by loud crying and drawing up the legs to the abdomen. Weight loss is not part of the clinical picture. There are many theories about the cause of colic. Emotional stress or tension between the parent and child is one component. This is not consistent throughout all cases. Colic is most common in infants younger than 3 months of age.)
Which of the following are the primary causes of mortality among adolescents in the United States? Select all that apply. A. Injuries B. Suicide C. Congenital anomalies D. Homicide E. Chronic illness
A, B, D
Toddlers are often known to be finicky eaters and may exhibit abnormal eating patterns that may concern parents. Which of the following actions for feeding toddlers should be suggested so adequate amounts of nutrients for growth and development are consumed? Select all that apply. A. Avoid placing large food portions on the toddler's plate B. Allow the child to graze on nutritious (not "junk" food) snacks during the day C. Insist that the child sit at the table until all persons have completed their meals D. Allow the child to make certain food choices (within reasonable limits)—for example, would you like a half peanut butter or ham sandwich? E. Provide meals at the same time of day as much as possible so the toddler has a sense of consistency F. Make the child eat all of the food provided, and provide disciplinary actions such as a "time-out" if the plate is not cleaned
A, B, D, E
A school nurse in middle school (grades 6, 7, and 8) is preparing an outline for a sex education class. Which of these statements represent important concepts to be covered in discussing this topic with this age group? Select all that apply. A. Consider separating the boys and girls into same-sex groups with a leader of the same sex. B. Answer questions matter-of-factly and honestly and appropriate to the children's level of understanding. C. Use vernacular or slang terms to describe human physiologic functions. D. Avoid discussing sexually transmitted diseases in this age group. E. Discuss common myths and misconceptions associated with sex and the reproductive process. F. Avoid controversial topics such as birth control.
A, B, E
The nurse caring for a preschool child understands which of the following developmental concepts? Select all that apply. A. Preschoolers have egocentric thought and believe that everyone thinks as they do. B. Play can be therapeutic and enlightening into a child's level of understanding. C. Explanations are helpful when using detail to allay the preschooler's stress. D. Preschoolers understand inferences and can relate to others' feelings with empathy. E. Preschoolers have magical thinking and believe their thoughts have power.
A, B, E
Which of the following hormones have the most impact on the development of puberty in females and males? Select all that apply. A. Follicle stimulating hormone (FSH) B. Insulin C. Luteinizing hormone (LH) D. Estrogen E. Testosterone
A, C
At the clinic appointment, a 4-year-old's mother wants to discuss several concerns. Which statements require more teaching by the nurse? Select all that apply. A. My husband feels that TV is okay as long as it is educational. B. I think it is okay for my son to play dress-up along with the girls. C. I told my son that his imaginary playmate moved away because it did not seem normal. D. My mother-in-law thinks I should be working around the house all the time, but I believe playing with my son is very important. E. My neighbor gave me some flash cards with letters and numbers for my son to use, but I said, "What's the rush? He's only 4."
A, C, E
18. When a child requires medication in school, authorization is required from: a. parents. b. pharmacist. c. school administrators. d. prescribing practitioner.
ANS: A A child who requires medication during the school day requires written authorization from the parent or guardian. Most schools also require that the medication be in the original container appropriately labeled by the pharmacist or physician. Some schools allow children to receive over-the-counter medications with parental permission. The pharmacist may be asked to appropriately label the medication for use at the school, but authorization is not required. The school administration should have a policy in place that facilitates the administration of medications for children who need them. The prescribing practitioner is responsible for the ensuring that the medication is appropriate for the child. Since the child is a minor, parental consent is required. DIF: Cognitive Level: Comprehension REF: p. 674 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Which of the following is an appropriate play activity for a 7-month-old infant to encourage visual stimulation? a. Playing peek-a-boo b. Playing pat-a-cake c. Imitating animal sounds d. Showing how to clap hands
ANS: A Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation.
The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven and will be able to heat the baby's formula faster. The nurse should recommend which of the following? a. Never heat a bottle in a microwave oven. b. Heat only 10 ounces or more. c. Always leave bottle top uncovered to allow heat to escape. d. Shake bottle vigorously for at least 30 seconds after heating.
ANS: A Bottles cannot be heated safely in microwave ovens even if safe guidelines are followed.
The nurse is interviewing the father of 10-month-old Megan. She is playing on the floor when she notices an electric outlet and reaches up to touch it. Her father says "no" firmly and removes her from near the outlet. The nurse should use this opportunity to teach the father that Megan: a. is old enough to understand the word "no." b. is too young to understand the word "no." c. should already know that electric outlets are dangerous. d. will learn safety issues better if she is spanked
ANS: A By age 10 months, children are able to associate meaning with words. The father is using both verbal and physical cues to alert the child to dangerous situations.
In terms of fine motor development, what should the infant of 7 months be able to do? a. Transfer objects from one hand to the other and bang cubes on a table. b. Use thumb and index finger in crude pincer grasp and release an object at will. c. Hold a crayon between the fingers and make a mark on paper. d. Release cubes into a cup and build a tower of two blocks.
ANS: A By age 7 months, infants can transfer objects from one hand to the other, crossing the midline, and bang objects on a hard surface.
4. An 8-year-old girl tells the nurse that she has cancer because God is punishing her for "being bad." The nurse should interpret this as being which of the following? a. A common belief at this age b. Indicative of excessive family pressure c. Faith that forms the basis for most religions d. Suggestive of a failure to develop a conscience
ANS: A Children at this age may view illness or injury as a punishment for a real or imagined misbehavior. School-age children expect to be punished and tend to choose a punishment that they think "fits the crime." This is a common belief and not related to excessive family pressure. Many faiths do not include a God that causes cancer in response for "bad" behavior. This statement reflects the child's belief in what is right and wrong. DIF: Cognitive Level: Comprehension REF: p. 650 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
The nurse is guiding parents in selecting a daycare facility for their infant. Which of the following is especially important to consider when making the selection? a. Health practices of facility b. Structured learning environment c. Socioeconomic status of children d. Cultural similarities of children
ANS: A Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when hand washing and other hygienic measures are not adhered to.
Sara, age 4 months, was born at 35 weeks of gestation. She seems to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was term. The nurse should explain that: a. infants' temperaments are part of their unique characteristics. b. infants become less difficult if they are not kept on scheduled feedings and structured routines. c. Sara's behavior is suggestive of failure to bond completely with her parents. d. Sara's difficult temperament is the result of painful experiences in the neonatal period.
ANS: A Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant's unique temperament.
27. Which is probably the single most important influence on growth at all stages of development? A. Nutrition b. Heredity c. Culture d. Environment
ANS: A Nutrition is the single most important influence on growth. Dietary factors regulate growth at all stages of development, and their effects are exerted in numerous and complex ways. Adequate nutrition is closely related to good health throughout life. Heredity, culture, and environment contribute to the child's growth and development. However, good nutrition is essential throughout the life span for optimal health.
27. Which is probably the single most important influence on growth at all stages of development? A. Nutrition b. Heredity c. Culture d. Environment
ANS: A Nutrition is the single most important influence on growth. Dietary factors regulate growth at all stages of development, and their effects are exerted in numerous and complex ways. Adequate nutrition is closely related to good health throughout life. Heredity, culture, and environment contribute to the child's growth and development. However, good nutrition is essential throughout the life span for optimal health.
5. The nurse is observing parents playing with their 10-month-old child. Which should the nurse recognize as evidence that the child is developing object permanence? a. Looks for the toy that parents hide under the blanket b. Returns the blocks to the same spot on the table c. Recognizes that a ball of clay is the same when flattened out d. Bangs two cubes held in her hands
ANS: A Object permanence is the realization that items that leave the visual field still exist. When the infant searches for the toy under the blanket, it is an indication that object permanence has developed. Returning the blocks to the same spot on the table is not an example of object permanence. Recognizing that a ball of clay is the same when flattened out is an example of conservation, which occurs during the concrete operations stage from 7 to 11 years. Banging two cubes together is a simple repetitive activity characteristic of developing a sense of cause and effect.
5. The nurse is observing parents playing with their 10-month-old child. Which should the nurse recognize as evidence that the child is developing object permanence? a. Looks for the toy that parents hide under the blanket b. Returns the blocks to the same spot on the table c. Recognizes that a ball of clay is the same when flattened out d. Bangs two cubes held in her hands
ANS: A Object permanence is the realization that items that leave the visual field still exist. When the infant searches for the toy under the blanket, it is an indication that object permanence has developed. Returning the blocks to the same spot on the table is not an example of object permanence. Recognizing that a ball of clay is the same when flattened out is an example of conservation, which occurs during the concrete operations stage from 7 to 11 years. Banging two cubes together is a simple repetitive activity characteristic of developing a sense of cause and effect.
19. Which of the following is an important consideration in preventing injuries during middle childhood? a. Achieving social acceptance is a primary objective. b. Incidence of injuries in girls is significantly higher than it is in boys. c. Injuries from burns are the highest at this age because of fascination with fire. d. Lack of muscular coordination and control results in an increased incidence of injuries.
ANS: A School-age children often participate in dangerous activities in an attempt to prove themselves worthy of acceptance. The incidence of injury during middle childhood is significantly higher in boys compared with girls. Motor vehicle collisions are the most common cause of severe injuries in children. The child has increasing muscular coordination. Those children who are risk takers may have inadequate self-regulatory behavior. DIF: Cognitive Level: Application REF: p. 676 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance
2. Which refers to those times in an individual's life when he or she is more susceptible to positive or negative influences? a. Sensitive period b. Sequential period c. Terminal points d. Differentiation points
ANS: A Sensitive periods are limited times during the process of growth when the organism will interact with a particular environment in a specific manner. These times make the organism more susceptible to positive or negative influences. The sequential period, terminal points, and differentiation points are developmental times that do not make the organism more susceptible to environmental interaction.
2. Which refers to those times in an individual's life when he or she is more susceptible to positive or negative influences? a. Sensitive period b. Sequential period c. Terminal points d. Differentiation points
ANS: A Sensitive periods are limited times during the process of growth when the organism will interact with a particular environment in a specific manner. These times make the organism more susceptible to positive or negative influences. The sequential period, terminal points, and differentiation points are developmental times that do not make the organism more susceptible to environmental interaction.
13. A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her school work satisfactorily, but lately has been somewhat aggressive and stubborn in the classroom. The school nurse should recognize this as which of the following? a. Signs of stress b. Developmental delay c. Lack of adjustment to school environment d. Physical problem that needs medical intervention
ANS: A Signs of stress include stomach pains or headache, sleep problems, bed-wetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to earlier behaviors. The child is completing school work satisfactorily; any developmental delay would have been diagnosed earlier. The teacher reports that this is a departure from the child's normal behavior. Adjustment issues would most likely be evident soon after a change. Medical intervention is not immediately required. Recognizing that this constellation of symptoms can indicate stress, the nurse should help the child identify sources of stress and how to use stress reduction techniques. The parents are involved in the evaluation process. DIF: Cognitive Level: Comprehension REF: p. 664 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
What information could be given to the parents of a 12-month-old child regarding appropriate play activities for this age? a. Give large push-pull toys for kinetic stimulation. b. Place cradle gym across crib to facilitate fine motor skills. c. Provide child with fingerpaints to enhance fine motor skills. d. Provide stick horse to develop gross motor coordination.
ANS: A The 12-month-old child is able to pull to standing and walk holding on or independently. Appropriate toys for this age child include large pull toys for kinesthetic stimulation.
4. By what age does the posterior fontanel usually close? a. 6 to 8 weeks b. 10 to 12 weeks c. 4 to 6 months d. 8 to 10 months
ANS: A The bones surrounding the posterior fontanel fuse and close by age 6 to 8 weeks.
Which of the following would be the best play activity for a 6-month-old infant to provide tactile stimulation? a. Allow to splash in bath. b. Give various colored blocks. c. Play music box, tapes, or CDs. d. Use infant swing or stroller.
ANS: A The feel of the water while the infant is splashing will provide tactile stimulation
The nurse notices that a 10-month-old infant being seen in the clinic is wearing expensive, inflexible, high-top shoes. The nurse should explain that: a. soft and flexible shoes are generally better. b. high-top shoes are necessary for support. c. inflexible shoes are necessary to prevent in-toeing and out-toeing. d. this type of shoe will encourage the infant to walk sooner.
ANS: A The main purpose of the shoe is protection. Soft, well-constructed, athletic-type shoes are best for infants and children.
An infant gains head control before sitting unassisted. The nurse recognizes that this is which type of development? a. Cephalocaudal b. Proximodistal c. Mass to specific d. Sequential
ANS: A The pattern of development that is head-to-tail, or cephalocaudal, direction is described by an infant's ability to gain head control before sitting unassisted. The head end of the organism develops first and is large and complex, whereas the lower end is smaller and simpler, and development takes place at a later time. Proximodistal, or near to far, is another pattern of development. Limb buds develop before fingers and toes. Postnatally, the child has control of the shoulder before achieving mastery of the hands. Mass to specific is not a specific pattern of development. In all dimensions of growth, a definite, sequential pattern is followed.
An infant gains head control before sitting unassisted. The nurse recognizes that this is which type of development? a. Cephalocaudal b. Proximodistal c. Mass to specific d. Sequential
ANS: A The pattern of development that is head-to-tail, or cephalocaudal, direction is described by an infant's ability to gain head control before sitting unassisted. The head end of the organism develops first and is large and complex, whereas the lower end is smaller and simpler, and development takes place at a later time. Proximodistal, or near to far, is another pattern of development. Limb buds develop before fingers and toes. Postnatally, the child has control of the shoulder before achieving mastery of the hands. Mass to specific is not a specific pattern of development. In all dimensions of growth, a definite, sequential pattern is followed.
The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as which of the following? a. Normal finding b. Questionable finding—indicates infant should be rechecked in 1 month c. Abnormal finding—indicates need for immediate referral to practitioner d. Abnormal finding—indicates need for developmental assessment
ANS: A This is a normal finding. The anterior fontanel closes between ages 12 and 18 months.
A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. The nurse should interpret this as: a. normal development. b. significant developmental lag. c. slightly delayed development due to prematurity. d. suggestive of a neurologic disorder such as cerebral palsy.
ANS: A This is indicative of normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary.
In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? (Select all that apply.) a. Roll from abdomen to back b. Put feet in mouth when supine c. Roll from back to abdomen d. Sit erect without support e. Move from prone to sitting position f. Adjust posture to reach an object
ANS: A, B Rolling from abdomen and to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant.
acifiers can be extremely dangerous because of the frequency of use and the intensity of the infant's suck. In teaching the parents about appropriate pacifier selection, select all of the characteristics the pacifier should have. a. Easily grasped handle b. One-piece construction c. Ribbon or string to secure to clothing d. Soft, pliable material e. Sturdy, flexible material
ANS: A, B, E A good pacifier should be easily grasped by the infant. One-piece construction is necessary to avoid having the nipple and guard separate. The material should be sturdy and flexible.
1. Which of the following growth and development milestones are expected between the ages of 8 and 9? Select all that apply. a. Can help with routine household tasks b. Likes the reward system for accomplished tasks c. Uses the telephone for practical purposes d. Chooses friends more selectively e. Goes about home and community freely, alone or with friends f. Enjoys family time and is respectful of parents
ANS: A, B, E Children between the age of 8 and 9 accomplish many growth and development milestones, including helping with routine household tasks, liking the reward system when a task is accomplished well, and going out with friends or alone more independently and freely. Using the telephone for practical reasons, choosing friends more selectively, and finding enjoyment in family with new-found respect for parents are tasks accomplished between the ages of 10 and 12. DIF: Cognitive Level: Application REF: p. 659 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
2. What factors indicate parents should seek genetic counseling for their child? (Select all that apply.) a. Abnormal newborn screen b. Family history of a hereditary disease c. History of hypertension in the family d. Severe colic as an infant e. Metabolic disorder
ANS: A, B, E Factors that are indicative parents should seek genetic counseling for their child include an abnormal newborn screen, family history of a hereditary disease, and a metabolic disorder. A history of hypertension or severe colic as an infant is not an indicator of a genetic disease.
2. What factors indicate parents should seek genetic counseling for their child? (Select all that apply.) a. Abnormal newborn screen b. Family history of a hereditary disease c. History of hypertension in the family d. Severe colic as an infant e. Metabolic disorder
ANS: A, B, E Factors that are indicative parents should seek genetic counseling for their child include an abnormal newborn screen, family history of a hereditary disease, and a metabolic disorder. A history of hypertension or severe colic as an infant is not an indicator of a genetic disease.
1. Play serves many purposes. In teaching parents about appropriate activities, the nurse should inform them that play serves which of the following function? (Select all that apply.) a. Intellectual development b. Physical development c. Socialization d. Creativity e. Temperament development
ANS: A, C, D A common statement is that play is the work of childhood. Intellectual development is enhanced through the manipulation and exploration of objects. Socialization is encouraged by interpersonal activities and learning of social roles. In addition, creativity is developed through the experimentation characteristic of imaginative play. Physical development depends on many factors; play is not one of them. Temperament refers to behavioral tendencies that are observable from the time of birth. The actual behaviors, but not the child's temperament attributes, may be modified through play.
1. Play serves many purposes. In teaching parents about appropriate activities, the nurse should inform them that play serves which of the following function? (Select all that apply.) a. Intellectual development b. Physical development c. Socialization d. Creativity e. Temperament development
ANS: A, C, D A common statement is that play is the work of childhood. Intellectual development is enhanced through the manipulation and exploration of objects. Socialization is encouraged by interpersonal activities and learning of social roles. In addition, creativity is developed through the experimentation characteristic of imaginative play. Physical development depends on many factors; play is not one of them. Temperament refers to behavioral tendencies that are observable from the time of birth. The actual behaviors, but not the child's temperament attributes, may be modified through play.
3. A nurse is preparing to administer a Denver II. Which is a correct statement about the Denver II? (Select all that apply.) a. All items intersected by the age line should be administered. b. There is no correction for a child born prematurely. c. The tool is an intelligence test. d. Toddlers and preschoolers should be prepared by presenting the test as a game. e. Presentation of the toys from the kit should be done one at a time.
ANS: A, D, E To identify "cautions," all items intersected by the age line are administered. Toddlers and preschoolers should be tested by presenting the Denver II as a game. Because children are easily distracted, perform each item quickly and present only one toy from the kit at a time. Before beginning the screening, ask whether the child was born preterm and correctly calculate the adjusted age. Up to 24 months of age, allowances are made for preterm infants by subtracting the number of weeks of missed gestation from their present age and testing them at the adjusted age. Explain to the parents and child, if appropriate, that the screenings are not intelligence tests but rather are a method of showing what the child can do at a particular age.
3. A nurse is preparing to administer a Denver II. Which is a correct statement about the Denver II? (Select all that apply.) a. All items intersected by the age line should be administered. b. There is no correction for a child born prematurely. c. The tool is an intelligence test. d. Toddlers and preschoolers should be prepared by presenting the test as a game. e. Presentation of the toys from the kit should be done one at a time.
ANS: A, D, E To identify "cautions," all items intersected by the age line are administered. Toddlers and preschoolers should be tested by presenting the Denver II as a game. Because children are easily distracted, perform each item quickly and present only one toy from the kit at a time. Before beginning the screening, ask whether the child was born preterm and correctly calculate the adjusted age. Up to 24 months of age, allowances are made for preterm infants by subtracting the number of weeks of missed gestation from their present age and testing them at the adjusted age. Explain to the parents and child, if appropriate, that the screenings are not intelligence tests but rather are a method of showing what the child can do at a particular age.
At what age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month b. 2 months c. 3 months d. 4 months
ANS: B At age 2 months, the infant has a social, responsive smile.
12. A mother reports that her 6-year-old child is highly active, irritable, and irregular in habits and that the child adapts slowly to new routines, people, or situations. The nurse should chart this type of temperament as: a. easy. b. difficult. c. slow-to-warm. d. fast-to-warm.
ANS: B Being highly active, irritable, irregular in habits, and adapting slowly to new routines, people, or situations is a description of difficult children, which compose about 10% of the population. Negative withdrawal responses are typical of this type of child, who requires a more structured environment. Mood expressions are usually intense and primarily negative. These children exhibit frequent periods of crying and often violent tantrums. Easy children are even tempered, regular, and predictable in their habits. They are open and adaptable to change. Approximately 40% of children fit this description. Slow-to-warm-up children typically react negatively and with mild intensity to new stimuli and adapt slowly with repeated contact. Approximately 10% of children fit this description. "Fast-to-warm-up" is not one of the categories identified.
12. A mother reports that her 6-year-old child is highly active, irritable, and irregular in habits and that the child adapts slowly to new routines, people, or situations. The nurse should chart this type of temperament as: a. easy. b. difficult. c. slow-to-warm. d. fast-to-warm.
ANS: B Being highly active, irritable, irregular in habits, and adapting slowly to new routines, people, or situations is a description of difficult children, which compose about 10% of the population. Negative withdrawal responses are typical of this type of child, who requires a more structured environment. Mood expressions are usually intense and primarily negative. These children exhibit frequent periods of crying and often violent tantrums. Easy children are even tempered, regular, and predictable in their habits. They are open and adaptable to change. Approximately 40% of children fit this description. Slow-to-warm-up children typically react negatively and with mild intensity to new stimuli and adapt slowly with repeated contact. Approximately 10% of children fit this description. "Fast-to-warm-up" is not one of the categories identified.
The nurse is assessing a 6-month-old healthy infant who weighed 7 pounds at birth. The nurse should expect the infant to now weigh approximately how many pounds? a. 10 b. 15 c. 20 d. 25
ANS: B Birth weight doubles at about age 5 to 6 months. At 6 months, a child who weighed 7 pounds at birth would weigh approximately 15 pounds.
11. The school nurse is providing guidance to families of children who are entering elementary school. Essential information to include is: a. meet with teachers only at scheduled conferences. b. encourage growth of a sense of responsibility in children. c. provide tutoring for child to ensure mastery of material. d. homework should be done as soon as child comes home from school.
ANS: B By being responsible for school work, children learn to keep promises, meet deadlines, and succeed in their jobs as adults. Parents should meet with the teachers at the beginning of the school year, scheduled conferences, and whenever information about the child or parental concerns need to be shared. Tutoring should be provided only in special circumstances in elementary school, such as in response to prolonged absence. The parent should not dictate the study time, but establish guidelines to ensure that homework is done. DIF: Cognitive Level: Comprehension REF: p. 660 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
20. A school nurse notes that school-age children generally obey the rules at school. The nurse recognizes that the children are displaying which stage of moral development? a. Preconventional b. Conventional c. Post-conventional d. Undifferentiated
ANS: B Conventional stage of moral development is described as obeying the rules, doing one's duty, showing respect for authority, and maintaining the social order. This stage is characteristic of school-age children's behavior. The preconventional stage is characteristic of the toddler and preschool age. At this stage, the child has no concept of the basic moral order that supports being good or bad. The post-conventional level is characteristic of an adolescent and occurs at the formal stage of operation. Undifferentiated describes an infant's understanding of moral development.
20. A school nurse notes that school-age children generally obey the rules at school. The nurse recognizes that the children are displaying which stage of moral development? a. Preconventional b. Conventional c. Post-conventional d. Undifferentiated
ANS: B Conventional stage of moral development is described as obeying the rules, doing one's duty, showing respect for authority, and maintaining the social order. This stage is characteristic of school-age children's behavior. The preconventional stage is characteristic of the toddler and preschool age. At this stage, the child has no concept of the basic moral order that supports being good or bad. The post-conventional level is characteristic of an adolescent and occurs at the formal stage of operation. Undifferentiated describes an infant's understanding of moral development.
6. Which of the following is descriptive of the social development of school-age children? a. Identification with peers is minimum. b. Children frequently have "best friends." c. Boys and girls play equally with each other. d. Peer approval is not yet an influence for the child to conform.
ANS: B Identification with peers is a strong influence in children's gaining independence from parents. Interaction among peers leads to the formation of close friendships with same-sex peers—"best friends." Daily relationships with age-mates in the school setting provide important social interaction for school-age children. During later school years, groups are composed predominantly of children of the same sex. Conforming to the rules of the peer group provides children with a sense of security and relieves them of the responsibility of making decisions. DIF: Cognitive Level: Comprehension REF: p. 652 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
13. A 12-year-old child enjoys collecting stamps, playing soccer, and participating in Boy Scout activities. The nurse recognizes that the child is displaying which developmental task? a. Identity b. Industry c. Integrity d. Intimacy
ANS: B Industry is engaging in tasks that can be carried through to completion, learning to compete and cooperate with others, and learning rules. Industry is the developmental task characteristic of the school-age child. Identity is the developmental task of adolescence. Integrity and intimacy are not developmental tasks of childhood.
13. A 12-year-old child enjoys collecting stamps, playing soccer, and participating in Boy Scout activities. The nurse recognizes that the child is displaying which developmental task? a. Identity b. Industry c. Integrity d. Intimacy
ANS: B Industry is engaging in tasks that can be carried through to completion, learning to compete and cooperate with others, and learning rules. Industry is the developmental task characteristic of the school-age child. Identity is the developmental task of adolescence. Integrity and intimacy are not developmental tasks of childhood.
The nurse is discussing development and play activities with the parent of a 2-month-old boy. Recommendations should include giving him his first rattle at about what age? a. 2 months b. 4 months c. 7 months d. 9 months
ANS: B It is recommended that a brightly colored toy or rattle be given to the child at age 4 months. Grasping has begun as a deliberate act, and the infant grasps, holds, and begins shaking to hear a noise.
What information should the nurse give a mother regarding the introduction of solid foods during infancy? a. Solid foods should not be introduced until 8 to 10 months, when the extrusion reflex begins to disappear. b. Foods should be introduced one at a time, at intervals of 4 to 7 days. c. Solid foods can be mixed in a bottle to make the transition easier for the infant. d. Fruits and vegetables should be introduced into the diet first.
ANS: B One food item is introduced at intervals of 4 to 7 days to allow the identification of food allergies.
What is the best age for solid food to be introduced into the infant's diet? a. 2 to 3 months b. 4 to 6 months c. When birth weight has tripled d. When tooth eruption has started
ANS: B Physiologically and developmentally, the 4- to 6-month-old is in a transition period. The extrusion reflex has disappeared, and swallowing is a more coordinated process. In addition, the gastrointestinal tract has matured sufficiently to handle more complex nutrients and is less sensitive to potentially allergenic food. Infants of this age will try to help during feeding.
23. The nurse observes some children in the playroom. Which play situation exhibits the characteristics of parallel play? a. Kimberly and Amanda sharing clay to each make things b. Brian playing with his truck next to Kristina playing with her truck c. Adam playing a board game with Kyle, Steven, and Erich d. Danielle playing with a music box on her mother's lap
ANS: B Playing with trucks next to each other but not together is an example of parallel play. Both children are engaged in similar activities in proximity to each other; however, they are each engaged in their own play. Sharing clay to make things is characteristic of associative play. Friends playing a board game together is characteristic of cooperative play. A child playing with something by herself on her mother's lap is an example of solitary play.
23. The nurse observes some children in the playroom. Which play situation exhibits the characteristics of parallel play? a. Kimberly and Amanda sharing clay to each make things b. Brian playing with his truck next to Kristina playing with her truck c. Adam playing a board game with Kyle, Steven, and Erich d. Danielle playing with a music box on her mother's lap
ANS: B Playing with trucks next to each other but not together is an example of parallel play. Both children are engaged in similar activities in proximity to each other; however, they are each engaged in their own play. Sharing clay to make things is characteristic of associative play. Friends playing a board game together is characteristic of cooperative play. A child playing with something by herself on her mother's lap is an example of solitary play.
15. A school-age child has begun to sleepwalk. The nurse advises the parents to: a. wake the child and help determine what is wrong. b. leave the child alone unless he or she is in danger of harming self or others. c. arrange for psychologic evaluation to identify the cause of stress. d. keep the child awake later in the evening to ensure sufficient tiredness for a full night of sleep.
ANS: B Sleepwalking is usually self-limiting and requires no treatment. The child usually moves about restlessly and then returns to bed. Usually the actions are repetitive and clumsy. The child should not be awakened unless in danger. If there is a need to awaken the child, it should be done by calling the child's name to gradually bring to a state of alertness. Some children, who are usually well behaved and tend to repress feelings, may sleepwalk due to strong emotions. These children usually respond to relaxation techniques before bedtime. If a child is overly fatigued, sleepwalking can increase. DIF: Cognitive Level: Application REF: p. 668 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Integrity: Basic Care and Comfort
What is normally the earliest age at which an infant begins teething with eruption of lower central incisors? a. 4 months b. 6 months c. 8 months d. 12 months
ANS: B Teething usually begins at age 6 months with the eruption of the lower central incisors.
22. The American Academy of Pediatrics recommends that children under the age of 16 years be prohibited from participating in: a. skateboarding. b. snowmobiling. c. trampoline use. d. horseback riding.
ANS: B The American Academy of Pediatrics views the use of snowmobiles and all-terrain vehicles as major health hazards for children. This group opposes the use of these vehicles by children less than 16 years of age. The academy recommends that children under the age of 10 not use skateboards without parental supervision. Protective gear is always suggested. Trampoline use has increased along with injuries. Adults should supervise use. Horseback riding injuries are a source of concern. Parents should determine the instructor's safety record with students. DIF: Cognitive Level: Comprehension REF: p. 679 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance
11. Which statement is true about the basal metabolic rate (BMR) in children? a. It is reduced by fever. b. It is slightly higher in boys than in girls at all ages. c. It increases with age of child. d. It decreases as proportion of surface area to body mass increases.
ANS: B The BMR is the rate of metabolism when the body is at rest. At all ages, the rate is slightly higher in boys than in girls. The rate is increased by fever. The BMR is highest in infancy and then closely relates to the proportion of surface area to body mass. As the child grows, the proportion decreases progressively to maturity.
11. Which statement is true about the basal metabolic rate (BMR) in children? a. It is reduced by fever. b. It is slightly higher in boys than in girls at all ages. c. It increases with age of child. d. It decreases as proportion of surface area to body mass increases.
ANS: B The BMR is the rate of metabolism when the body is at rest. At all ages, the rate is slightly higher in boys than in girls. The rate is increased by fever. The BMR is highest in infancy and then closely relates to the proportion of surface area to body mass. As the child grows, the proportion decreases progressively to maturity.
29. What should the nurse consider when discussing language development with parents of toddlers? a. Sentences by toddlers include adverbs and adjectives. b. The toddler expresses himself or herself with verbs or combination words. c. The toddler uses simple sentences. d. Pronouns are used frequently by the toddler.
ANS: B The first parts of speech used are nouns, sometimes verbs (e.g., "go"), and combination words (e.g., "bye-bye"). Responses are usually structurally incomplete during the toddler period. The preschool child begins to use adjectives and adverbs to qualify nouns followed by adverbs to qualify nouns and verbs. Pronouns are not added until the later preschool years. By the time children enter school, they are able to use simple, structurally complete sentences that average five to seven words.
29. What should the nurse consider when discussing language development with parents of toddlers? a. Sentences by toddlers include adverbs and adjectives. b. The toddler expresses himself or herself with verbs or combination words. c. The toddler uses simple sentences. d. Pronouns are used frequently by the toddler.
ANS: B The first parts of speech used are nouns, sometimes verbs (e.g., "go"), and combination words (e.g., "bye-bye"). Responses are usually structurally incomplete during the toddler period. The preschool child begins to use adjectives and adverbs to qualify nouns followed by adverbs to qualify nouns and verbs. Pronouns are not added until the later preschool years. By the time children enter school, they are able to use simple, structurally complete sentences that average five to seven words.
5. Parents of an 8-year-old child ask the nurse how many inches their child should grow each year. The nurse bases the answer on the knowledge that after age 7 years, school-age children usually grow what number of inches per year? a. 1 b. 2 c. 3 d. 4
ANS: B The growth velocity after age 7 years is approximately 5 cm (2 inches) per year. One inch is too small an amount. Three and 4 inches are greater than the average yearly growth after age 7 years.
5. Parents of an 8-year-old child ask the nurse how many inches their child should grow each year. The nurse bases the answer on the knowledge that after age 7 years, school-age children usually grow what number of inches per year? a. 1 b. 2 c. 3 d. 4
ANS: B The growth velocity after age 7 years is approximately 5 cm (2 inches) per year. One inch is too small an amount. Three and 4 inches are greater than the average yearly growth after age 7 years.
21. Which of the following is an important consideration for the school nurse who is planning a class on bicycle safety? a. Most bicycle injuries involve collision with an automobile. b. Head injuries are the major causes of bicycle-related fatalities. c. Children should wear a bicycle helmet if they ride on paved streets. d. Children should not ride double unless the bicycle has an extra large seat.
ANS: B The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. Although motor vehicle collisions do cause injuries to bicyclists, most injuries result from falls. The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission. Children should not ride double unless it is a tandem bike (built for two). DIF: Cognitive Level: Comprehension REF: p. 677 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance
The clinic is lending a federally approved car seat to an infant's family. The nurse should explain that the safest place to put the car seat is: a. front facing in back seat. b. rear facing in back seat. c. front facing in front seat with airbag on passenger side d. rear facing in front seat if an air bag is on the passenger side.
ANS: B The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck. The middle of the back seat is the safest position for the child.
26. Parents are asking the clinic nurse about an appropriate toy for their toddler. Which response by the nurse is appropriate? a. "Your child would enjoy playing a board game." b. "A toy your child can push or pull would help develop muscles." c. "An action figure toy would be a good choice." d. "A 25-piece puzzle would help your child develop recognition of shapes."
ANS: B Toys should be appropriate for the child's age. A toddler would benefit from a toy he or she could push or pull. The child is too young for a board game, action figure, or 25-piece puzzle.
26. Parents are asking the clinic nurse about an appropriate toy for their toddler. Which response by the nurse is appropriate? a. "Your child would enjoy playing a board game." b. "A toy your child can push or pull would help develop muscles." c. "An action figure toy would be a good choice." d. "A 25-piece puzzle would help your child develop recognition of shapes."
ANS: B Toys should be appropriate for the child's age. A toddler would benefit from a toy he or she could push or pull. The child is too young for a board game, action figure, or 25-piece puzzle.
17. A visitor arrives at a daycare center during lunch time. The preschool children think that every time they have lunch a visitor will arrive. Which preoperational characteristic is being displayed? Egocentrism b. Transductive reasoning c. Intuitive reasoning d. Conservation
ANS: B Transductive reasoning is when two events occur together, they cause each other. The expectation that every time lunch is served a visitor will arrive is descriptive of transductive reasoning. Egocentrism is the inability to see things from any perspective than their own. Intuitive reasoning (e.g., the stars have to go to bed just as they do) is predominantly egocentric thought. Conservation (able to realize that physical factors such as volume, weight, and number remain the same even though outward appearances are changed) does not occur until school age.
17. A visitor arrives at a daycare center during lunch time. The preschool children think that every time they have lunch a visitor will arrive. Which preoperational characteristic is being displayed? a. Egocentrism b.Transductive reasoning c. Intuitive reasoning d. Conservation
ANS: B Transductive reasoning is when two events occur together, they cause each other. The expectation that every time lunch is served a visitor will arrive is descriptive of transductive reasoning. Egocentrism is the inability to see things from any perspective than their own. Intuitive reasoning (e.g., the stars have to go to bed just as they do) is predominantly egocentric thought. Conservation (able to realize that physical factors such as volume, weight, and number remain the same even though outward appearances are changed) does not occur until school age.
6. Parents express concern that their pubertal daughter is taller than the boys in her class. The nurse should respond with which statement regarding how the onset of pubertal growth spurt compares in girls and boys? a. It occurs earlier in boys. b. It occurs earlier in girls. c. It is about the same in both boys and girls. d. In both boys and girls, the pubertal growth spurt depends on growth in infancy.
ANS: B Usually, the pubertal growth spurt begins earlier in girls. It typically occurs between the ages of 10 and 14 years for girls and 11 and 16 years for boys. The average earliest age at onset is 1 year earlier for girls. There does not appear to be a relation to growth during infancy.
6. Parents express concern that their pubertal daughter is taller than the boys in her class. The nurse should respond with which statement regarding how the onset of pubertal growth spurt compares in girls and boys? a. It occurs earlier in boys. b. It occurs earlier in girls. c. It is about the same in both boys and girls. d. In both boys and girls, the pubertal growth spurt depends on growth in infancy.
ANS: B Usually, the pubertal growth spurt begins earlier in girls. It typically occurs between the ages of 10 and 14 years for girls and 11 and 16 years for boys. The average earliest age at onset is 1 year earlier for girls. There does not appear to be a relation to growth during infancy.
20. When teaching injury prevention during the school-age years, the nurse should include which of the following? a. Teach child about need to fear strangers. b. Teach basic rules of water safety. c. Avoid letting child cook in microwave ovens. d. Caution child against engaging in competitive sports.
ANS: B Water safety instruction is an important component of injury prevention at this age. The child should be taught to swim, select safe and supervised places to swim, swim with a companion, check sufficient water depth for diving, and use an approved flotation device. Teach stranger safety, not fear of strangers. This includes telling the child not to go with strangers, not to wear personalized clothing in public places, to tell parents if anyone makes child feel uncomfortable, and to say no in uncomfortable situations. Teach the child safe cooking. Caution against engaging in dangerous sports such as jumping on trampolines. DIF: Cognitive Level: Application REF: p. 675 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance
At what age do most infants begin to fear strangers? a. 2 months b. 4 months c. 6 months d. 12 months
ANS: C Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and unfamiliar people.
1. Which of the following statements accurately describes physical development during the school-age years? a. Child's weight almost triples. b. Muscles become functionally mature. c. Boys and girls double strength and physical capabilities. d. Fat gradually increases, which contributes to child's heavier appearance.
ANS: C Boys and girls double both strength and physical capabilities. Their consistent refinement in coordination increases their poise and skill. In middle childhood, growth in height and weight occurs at a slower pace. Between the ages of 6 and 12 years, children grow 5 cm/yr and gain 3 kg/yr. Their weight will almost double. Although the strength increases, muscles are still functionally immature when compared with those of adolescents. This age-group is more easily injured by overuse. Children take on a slimmer look with longer legs in middle childhood. DIF: Cognitive Level: Comprehension REF: p. 645 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
2. The parents of 9-year-old twin children tell the nurse, "They have filled up their bedroom with collections of rocks, shells, stamps, and bird nests." The nurse should recognize that this is which of the following? a. Indicative of giftedness b. Indicative of typical twin behavior c. Characteristic of cognitive development at this age d. Characteristic of psychosocial development at this age
ANS: C Classification skills involve the ability to group objects according to the attributes they have in common. School-age children can place things in a sensible and logical order, group and sort, and hold a concept in their mind while they make decisions based on that concept. Individuals who are not twins engage in classification at this age. Psychosocial behavior at this age is described according to Erikson's stage of industry versus inferiority. DIF: Cognitive Level: Comprehension REF: p. 650 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
16. A father tells the nurse that his child is "filling up the house with collections" like seashells, bottle caps, baseball cards, and pennies. The nurse should recognize that the child is developing: a. object permanence. b. preoperational thinking. c. concrete operational thinking. d. ability to use abstract symbols.
ANS: C During concrete operations, children develop logical thought processes. They are able to classify, sort, order, and otherwise organize facts about the world. This ability fosters the child's ability to create collections. Object permanence is the realization that items that leave the visual field still exist. This is a task of infancy and does not contribute to collections. Preoperational thinking is concrete and tangible. Children in this age group cannot reason beyond the observable, and they lack the ability to make deductions or generalizations. Collections are not typical for this developmental level. The ability to use abstract symbols is a characteristic of formal operations, which develops during adolescence. These children can develop and test hypotheses.
16. A father tells the nurse that his child is "filling up the house with collections" like seashells, bottle caps, baseball cards, and pennies. The nurse should recognize that the child is developing: a. object permanence. b. preoperational thinking. c. concrete operational thinking. d. ability to use abstract symbols.
ANS: C During concrete operations, children develop logical thought processes. They are able to classify, sort, order, and otherwise organize facts about the world. This ability fosters the child's ability to create collections. Object permanence is the realization that items that leave the visual field still exist. This is a task of infancy and does not contribute to collections. Preoperational thinking is concrete and tangible. Children in this age group cannot reason beyond the observable, and they lack the ability to make deductions or generalizations. Collections are not typical for this developmental level. The ability to use abstract symbols is a characteristic of formal operations, which develops during adolescence. These children can develop and test hypotheses.
18. Which behavior is most characteristic of the concrete operations stage of cognitive development? a. Progression from reflex activity to imitative behavior b. Inability to put oneself in another's place c. Increasingly logical and coherent thought processes d. Ability to think in abstract terms and draw logical conclusions
ANS: C During the concrete operations stage of development, which occurs approximately between ages 7 and 11 years, increasingly logical and coherent thought processes occur. This is characterized by the child's ability to classify, sort, order, and organize facts to use in problem solving. The progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage of development. The inability to put oneself in another's place is characteristic of the preoperational stage of development. The ability to think in abstract terms and draw logical conclusions is characteristic of the formal operations stage of development.
18. Which behavior is most characteristic of the concrete operations stage of cognitive development? a. Progression from reflex activity to imitative behavior b. Inability to put oneself in another's place c. Increasingly logical and coherent thought processes d. Ability to think in abstract terms and draw logical conclusions
ANS: C During the concrete operations stage of development, which occurs approximately between ages 7 and 11 years, increasingly logical and coherent thought processes occur. This is characterized by the child's ability to classify, sort, order, and organize facts to use in problem solving. The progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage of development. The inability to put oneself in another's place is characteristic of the preoperational stage of development. The ability to think in abstract terms and draw logical conclusions is characteristic of the formal operations stage of development.
Which of the following behaviors indicates that an infant has developed object permanence? a. Recognizes familiar face, such as mother b. Recognizes familiar object, such as bottle c. Actively searches for a hidden object d. Secures objects by pulling on a string
ANS: C During the first 6 months of life, infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows an object exists even when it is not visible.
14. Which one of the following statements best describes fear in the school-age child? a. Increasing concerns about bodily safety overwhelm them. b. They should be encouraged to hide their fears to prevent ridicule by peers. c. Most of the new fears that trouble them are related to school and family. d. Children with numerous fears need continuous protective behavior by parents to eliminate these fears.
ANS: C During the school-age years, children experience a wide variety of fears, but new fears related predominantly to school and family bother children during this time. Parents and other persons involved with children should discuss children's fear with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding the fears does not end them and may lead to phobias. DIF: Cognitive Level: Application REF: p. 664 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
The parent of 2-week-old Sarah asks the nurse if Sarah needs fluoride supplements, because she is exclusively breast-fed. The nurse's best response is which of the following? a. "She needs to begin taking them now." b. "They are not needed if you drink fluoridated water." c. "She may need to begin taking them at age 6 months." d. "She can have infant cereal mixed with fluoridated water instead of supplements."
ANS: C Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 6 months if the child is not drinking adequate amounts of fluoridated water.
A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should recommend that the infant be given: a. skim milk. b. whole cow's milk. c. commercial iron-fortified formula. d. commercial formula without iron.
ANS: C For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should be used.
Which of the following statements best describes the infant's physical development? a. Anterior fontanel closes by age 6 to 10 months. b. Binocularity is well established by age 8 months. c. Birth weight doubles by age 5 months and triples by age 1 year. d. Maternal iron stores persist during the first 12 months of life.
ANS: C Growth is very rapid during the first year of life. The birth weight has approximately doubled by age 5 to 6 months and triples by age 1 year.
22. In which type of play are children engaged in similar or identical activity, without organization, division of labor, or mutual goal? a. Solitary b. Parallel c. Associative d. Cooperative
ANS: C In associative play, no group goal is present. Each child acts according to his or her own wishes. Although the children may be involved in similar activities, no organization, division of labor, leadership assignment, or mutual goal exists. Solitary play describes children playing alone with toys different from those used by other children in the same area. Parallel play describes children playing independently but being among other children. Cooperative play is organized. Children play in a group with other children who play in activities for a common goal.
22. In which type of play are children engaged in similar or identical activity, without organization, division of labor, or mutual goal? a. Solitary b. Parallel c. Associative d. Cooperative
ANS: C In associative play, no group goal is present. Each child acts according to his or her own wishes. Although the children may be involved in similar activities, no organization, division of labor, leadership assignment, or mutual goal exists. Solitary play describes children playing alone with toys different from those used by other children in the same area. Parallel play describes children playing independently but being among other children. Cooperative play is organized. Children play in a group with other children who play in activities for a common goal.
According to Piaget, the 6-month-old infant would be in what developmental stage? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata
ANS: C Infants are usually in the secondary circular reaction stage from age 4 to 8 months. This stage is characterized by a continuation of the primary circular reaction for the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking.
4. By what age does birth length usually double? a. 1 year b. 2 years c. 4 years d. 6 years
ANS: C Linear growth or height occurs almost entirely as a result of skeletal growth and is considered a stable measurement of general growth. On average, most children have doubled their birth length at age 4 years. One and 2 years are too young for doubling of length. Most children will have achieved the doubling by age 4 years.
4. By what age does birth length usually double? a. 1 year b. 2 years c. 4 years d. 6 years
ANS: C Linear growth or height occurs almost entirely as a result of skeletal growth and is considered a stable measurement of general growth. On average, most children have doubled their birth length at age 4 years. One and 2 years are too young for doubling of length. Most children will have achieved the doubling by age 4 years.
By what age should the nurse expect an infant to be able to pull to a standing position? a. 6 months b. 8 months c. 11 to 12 months d. 14 to 15 months
ANS: C Most infants can pull themselves to a standing position at age 9 months. Infants who are not able to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip.
12. Which of the following is characteristic of dishonest behavior in children ages 8 to 10 years? a. Cheating during games is now more common. b. Stealing can occur because their sense of property rights is limited. c. Lying is used to meet expectations set by others that they have been unable to attain. d. Dishonesty results from the inability to distinguish between fact and fantasy.
ANS: C Older school-age children may lie to meet expectations set by others to which they have been unable to measure up. Cheating usually becomes less frequent as the child matures. Young children may lack a sense of property rights; older children may steal to supplement an inadequate allowance, or it may be an indication of serious problems. In this age-group, children are able to distinguish between fact and fantasy. DIF: Cognitive Level: Comprehension REF: p. 661 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
8. A parent asks about whether a 7-year-old is able to care for a dog. Based on the child's age, the nurse suggests: a. caring for an animal requires more maturity than the average 7-year-old possesses. b. this will help the parent identify the child's weaknesses. c. a dog can help the child develop confidence and emotional health. d. cats are better pets for school-age children.
ANS: C Pets have been observed to influence a child's self-esteem. They can have a positive effect on physical and emotional health and can teach children the importance of nurturing and nonverbal communication. Most 7-year-olds are capable of caring for a pet with supervision. Caring for a pet should be a positive experience. It should not be used to identify weaknesses. The pet chosen does not matter as much as the child's being responsible for a pet. DIF: Cognitive Level: Comprehension REF: p. 654 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
10. Which of the following is descriptive of the play of school-age children? a. They like to invent games, making up the rules as they go. b. Individuality in play is better tolerated than at earlier ages. c. Knowing the rules of a game gives an important sense of belonging. d. Team play helps children learn the universal importance of competition and winning.
ANS: C Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age, children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play, children learn about competition and the importance of winning, an attribute highly valued in the United States but not in all cultures. DIF: Cognitive Level: Comprehension REF: p. 656 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
7. Which of the following statements best describes the relationship school-age children have with their families? a. Ready to reject parental controls b. Desire to spend equal time with family and peers c. Need and want restrictions placed on their behavior by the family d. Peer group replaces the family as the primary influence in setting standards of behavior and rules
ANS: C School-age children need and want restrictions placed on their behavior, and they are not prepared to cope with all the problems of their expanding environment. Although increased independence is the goal of middle childhood, they feel more secure knowing that an authority figure can implement controls and restriction. In the middle-school years, children prefer peer-group activities to family activities and want to spend more time in the company of peers. Family values usually take precedence over peer value systems. DIF: Cognitive Level: Comprehension REF: p. 653 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
24. The nurse is teaching a class on nutrition to a group of parents of 10- and 11-year-old children. Which of the following statements by one of the parents would indicate a correct understanding of the teaching? a. "My child does not need to eat a variety of foods, just his favorite food groups." b. "My child can add salt and sugar to foods to make them taste better." c. "I will serve foods that are low in saturated fat and cholesterol." d. "I will continue to serve red meat three times per week for extra iron."
ANS: C School-age children should be eating foods that are low in saturated fat and cholesterol in order to prevent long-term consequences. The child's diet should include a variety of foods, include moderate amounts of extra salt and sugar, emphasize consumption of lean protein (chicken and pork), and limit red meat. DIF: Cognitive Level: Application REF: p. 667 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Integrity: Basic Care and Comfort
At what age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 10 months
ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months.
28. A nurse is counseling an adolescent, in her second month of pregnancy, about the risk of teratogens. The adolescent has understood the teaching if she makes which statement? a. "I will be able to continue taking isotretinoin (Accutane) for my acne." b. "I can continue to clean my cat's litter box." c. "I should avoid any alcoholic beverages." d. "I will ask my physician to adjust my phenytoin (Dilantin) dosage."
ANS: C Teratogens are agents that cause birth defects when present in the prenatal period. Avoidance of alcoholic beverages is recommended to prevent fetal alcohol syndrome. Isotretinoin (Accutane) and phenytoin (Dilantin) have been shown to have teratogenic effects and should not be taken during pregnancy. Cytomegalovirus, an infection agent and a teratogen, can be transmitted through cat feces, and cleaning the litter box during pregnancy should be avoided.
28. A nurse is counseling an adolescent, in her second month of pregnancy, about the risk of teratogens. The adolescent has understood the teaching if she makes which statement? a. "I will be able to continue taking isotretinoin (Accutane) for my acne." b. "I can continue to clean my cat's litter box." c. "I should avoid any alcoholic beverages." d. "I will ask my physician to adjust my phenytoin (Dilantin) dosage."
ANS: C Teratogens are agents that cause birth defects when present in the prenatal period. Avoidance of alcoholic beverages is recommended to prevent fetal alcohol syndrome. Isotretinoin (Accutane) and phenytoin (Dilantin) have been shown to have teratogenic effects and should not be taken during pregnancy. Cytomegalovirus, an infection agent and a teratogen, can be transmitted through cat feces, and cleaning the litter box during pregnancy should be avoided.
At what age is it safe to give infants whole milk instead of commercial infant formula? a. 6 months b. 9 months c. 12 months d. 18 months
ANS: C The American Academy of Pediatrics does not recommend the use of cow's milk for children younger than 12 months.
At about what age does an infant start to recognize familiar faces and objects, such as a feeding bottle? a. 1 month b. 2 months c. 3 months d. 4 months
ANS: C The child can recognize familiar objects at approximately age 3 months.
9. The school nurse has been asked to begin teaching sex education in the fifth grade. The nurse should recognize that: a. questions need to be discouraged in this setting. b. most children in the fifth grade are too young for sex education. c. sexuality is presented as a normal part of growth and development. d. correct terminology should be reserved for children who are older.
ANS: C When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development. They should be encouraged to ask questions. At 10 to 11 years old, fifth graders are not too young to speak about physiologic changes in their bodies. Preadolescents need precise and concrete information. DIF: Cognitive Level: Comprehension REF: p. 655 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance
23. The nurse is developing a teaching pamphlet for parents of school-age children. Which of the following anticipatory guidelines should the nurse include in the pamphlet? a. At age 6, parents should be certain that the child is reading independently with books provided by school. b. At age 8, parents should expect a decrease in involvement with peers and outside activities. c. At age 10, parents should expect a decrease in admiration of the parents with little interest in parent-child activities. d. At age 12, parents should be certain that the child's sex education is adequate with accurate information.
ANS: D A 12-year-old child should have been introduced to sex education and parents should be certain that the information is adequate and accurate and that the child is not embarrassed to talk about sexual feelings or other aspects of sex education. At age 6, a child does not need to be reading independently and usually still needs help with reading and enjoys being read to. At 8 years of age parents should expect their child to show increased involvement with peers and outside activities and should encourage this behavior. A 10-year-old exhibits increased feelings of admiration of parents, especially fathers, and parent-child activities should be encouraged. DIF: Cognitive Level: Application REF: p. 680 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance
14. A nurse is conducting parenting classes for parents of children ranging in ages 2 to 7 years. The parents understand the term egocentrism when they indicate it means: a. selfishness. b. self-centeredness. c. preferring to play alone. d. unable to put self in another's place.
ANS: D According to Piaget, children ages 2 to 7 years are in the preoperational stage of development. Children interpret objects and events not in terms of their general properties but in terms of their relationships or their use to them. This egocentrism does not allow children of this age to put themselves in another's place. Selfishness, self-centeredness, and preferring to play alone do not describe the concept of egocentricity.
14. A nurse is conducting parenting classes for parents of children ranging in ages 2 to 7 years. The parents understand the term egocentrism when they indicate it means: a. selfishness. b. self-centeredness. c. preferring to play alone. d. unable to put self in another's place.
ANS: D According to Piaget, children ages 2 to 7 years are in the preoperational stage of development. Children interpret objects and events not in terms of their general properties but in terms of their relationships or their use to them. This egocentrism does not allow children of this age to put themselves in another's place. Selfishness, self-centeredness, and preferring to play alone do not describe the concept of egocentricity.
7. A 13-year-old girl asks the nurse how much taller she will get. She has been growing about 2 inches per year but grew 4 inches this past year. Menarche recently occurred. The nurse should base her response on which statement? a. Growth cannot be predicted. b. Pubertal growth spurt lasts about 1 year. c. Mature height is achieved when menarche occurs. d. Approximately 95% of mature height is achieved when menarche occurs.
ANS: D At the time of the beginning of menstruation or the skeletal age of 13 years, most girls have grown to about 95% of their adult height. They may have some additional growth (5%) until the epiphyseal plates are closed. Although growth cannot be definitively predicted, on average, 95% of adult height has been reached with the onset of menstruation. Pubertal growth spurt lasts about 1 year does not address the girl's question. Young women usually will grow approximately 5% more after the onset of menstruation.
7. A 13-year-old girl asks the nurse how much taller she will get. She has been growing about 2 inches per year but grew 4 inches this past year. Menarche recently occurred. The nurse should base her response on which statement? a. Growth cannot be predicted. b. Pubertal growth spurt lasts about 1 year. c. Mature height is achieved when menarche occurs. d. Approximately 95% of mature height is achieved when menarche occurs.
ANS: D At the time of the beginning of menstruation or the skeletal age of 13 years, most girls have grown to about 95% of their adult height. They may have some additional growth (5%) until the epiphyseal plates are closed. Although growth cannot be definitively predicted, on average, 95% of adult height has been reached with the onset of menstruation. Pubertal growth spurt lasts about 1 year does not address the girl's question. Young women usually will grow approximately 5% more after the onset of menstruation.
Parents tell the nurse that their 1-year-old son often sleeps with them. They seem unconcerned about this. The nurse's response should be based on which of the following? a. Children should not sleep with their parents. b. Separation from parents should be completed by this age. c. Daytime attention should be increased. d. This is a common and accepted practice, especially in some cultural groups.
ANS: D Co-sleeping, or sharing the family bed, in which the parents allow the children to sleep with them, is a common and accepted practice in many cultures. Parents should evaluate the options available and avoid conditions that place the infant at risk.
he parents of a 12-month-old child ask the nurse if the child can eat hot dogs as do their other children. The nurse's reply should be based on which of the following? a. Child is too young to digest hot dogs. b. Child is too young to eat hot dogs safely. c. Hot dogs must be sliced into sections to prevent aspiration. d. Hot dogs must be cut into small, irregular pieces to prevent aspiration.
ANS: D Hot dogs are of a consistency, diameter, and round shape that may cause complete obstruction of the child's airway. If given to young children, the hot dog should be cut into small irregular pieces rather than served whole or in slices.
3. An infant who weighs 7 pounds at birth would be expected to weigh how many pounds at age 1 year? a. 14 b. 16 c. 18 d. 21
ANS: D In general, birth weight triples by the end of the first year of life. For an infant who was 7 pounds at birth, 21 pounds would be the anticipated weight at the first birthday; 14, 16, or 18 pounds is below what would be expected for an infant with a birth weight of 7 pounds.
3. An infant who weighs 7 pounds at birth would be expected to weigh how many pounds at age 1 year? a. 14 b. 16 c. 18 d. 21
ANS: D In general, birth weight triples by the end of the first year of life. For an infant who was 7 pounds at birth, 21 pounds would be the anticipated weight at the first birthday; 14, 16, or 18 pounds is below what would be expected for an infant with a birth weight of 7 pounds.
10. A nurse has completed a teaching session for adolescents regarding lymphoid tissue growth. Which statement, by the adolescents, indicates understanding of the teaching? a. The tissue reaches adult size by age 1 year. b. The tissue quits growing by 6 years of age. c. The tissue is poorly developed at birth. d. The tissue is twice the adult size by ages 10 to 12 years.
ANS: D Lymphoid tissue continues growing until it reaches maximal development at ages 10 to 12 years, which is twice its adult size. A rapid decline in size occurs until it reaches adult size by the end of adolescence. The tissue reaches adult size at 6 years of age but continues to grow. The tissue is well developed at birth.
10. A nurse has completed a teaching session for adolescents regarding lymphoid tissue growth. Which statement, by the adolescents, indicates understanding of the teaching? a. The tissue reaches adult size by age 1 year. b. The tissue quits growing by 6 years of age. c. The tissue is poorly developed at birth. d. The tissue is twice the adult size by ages 10 to 12 years.
ANS: D Lymphoid tissue continues growing until it reaches maximal development at ages 10 to 12 years, which is twice its adult size. A rapid decline in size occurs until it reaches adult size by the end of adolescence. The tissue reaches adult size at 6 years of age but continues to grow. The tissue is well developed at birth.
3. Which of the following statements characterizes moral development in the older school-age child? a. Rule violations are viewed in an isolated context. b. Judgments and rules become more absolute and authoritarian. c. The child has knowledge of the rules, but cannot understand the reasons behind them. d. The child is able to judge an act by the intentions that prompted it rather than just by the consequences.
ANS: D Older school-age children are able to judge an act by the intentions that prompted the behavior rather than just by the consequences. Rule violation is likely to be viewed in relation to the total context in which it appears. Rules and judgments become less absolute and authoritarian. The situation and the morality of the rule itself influence reactions. DIF: Cognitive Level: Comprehension REF: p. 650 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
5. What is the role of the peer group in the life of school-age children? a. Decreases their need to learn appropriate sex roles b. Gives them an opportunity to learn dominance and hostility c. Allows them to remain dependent on their parents for a longer time d. Provides them with security as they gain independence from their parents
ANS: D Peer-group identification is an important factor in gaining independence from parents. Through peer relationships, children learn ways to deal with dominance and hostility. They also learn how to relate to people in positions of leadership and authority and how to explore ideas and the physical environment. A child's concept of appropriate sex roles is influenced by relationship with peers. DIF: Cognitive Level: Comprehension REF: p. 651 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
19. According to Kohlberg, children develop moral reasoning as they mature. Which statement is most characteristic of a preschooler's stage of moral development? a. Obeying the rules of correct behavior is important. b. Showing respect for authority is important behavior. c. Behavior that pleases others is considered good. d. Actions are determined as good or bad in terms of their consequences.
ANS: D Preschoolers are most likely to exhibit characteristics of Kohlberg's preconventional level of moral development. During this stage, they are culturally oriented to labels of good or bad, right or wrong. Children integrate these concepts based on the physical or pleasurable consequences of their actions. Obeying the rules of correct behavior, showing respect for authority, and engaging in behavior that pleases others are characteristics of Kohlberg's conventional level of moral development.
19. According to Kohlberg, children develop moral reasoning as they mature. Which statement is most characteristic of a preschooler's stage of moral development? a. Obeying the rules of correct behavior is important. b. Showing respect for authority is important behavior. c. Behavior that pleases others is considered good. d. Actions are determined as good or bad in terms of their consequences.
ANS: D Preschoolers are most likely to exhibit characteristics of Kohlberg's preconventional level of moral development. During this stage, they are culturally oriented to labels of good or bad, right or wrong. Children integrate these concepts based on the physical or pleasurable consequences of their actions. Obeying the rules of correct behavior, showing respect for authority, and engaging in behavior that pleases others are characteristics of Kohlberg's conventional level of moral development.
24. A nurse is planning play activities for school-age children. Which type of a play activity should the nurse plan? a. Solitary b. Parallel c. Associative d. Cooperative
ANS: D School-age children engage in cooperative play where it is organized and interactive. Playing a game is a good example of cooperative play. Solitary play is appropriate for infants, parallel play is an activity appropriate for toddlers, and associative play is an activity appropriate for preschool-age children.
24. A nurse is planning play activities for school-age children. Which type of a play activity should the nurse plan? a. Solitary b. Parallel c. Associative d. Cooperative
ANS: D School-age children engage in cooperative play where it is organized and interactive. Playing a game is a good example of cooperative play. Solitary play is appropriate for infants, parallel play is an activity appropriate for toddlers, and associative play is an activity appropriate for preschool-age children.
25. Which following function of play is a major component of play at all ages? a. Creativity b. Socialization c. Intellectual development d. Sensorimotor activity
ANS: D Sensorimotor activity is a major component of play at all ages. Active play is essential for muscle development and allows the release of surplus energy. Through sensorimotor play, children explore their physical world by using tactile, auditory, visual, and kinesthetic stimulation. Creativity, socialization, and intellectual development are each functions of play that are major components at different ages.
25. Which following function of play is a major component of play at all ages? a. Creativity b. Socialization c. Intellectual development d. Sensorimotor activity
ANS: D Sensorimotor activity is a major component of play at all ages. Active play is essential for muscle development and allows the release of surplus energy. Through sensorimotor play, children explore their physical world by using tactile, auditory, visual, and kinesthetic stimulation. Creativity, socialization, and intellectual development are each functions of play that are major components at different ages.
A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. The nurse should explain that: a. this cannot be prevented. b. infants do not feel pain as adults do. c. this is not a good reason for refusing immunizations. d. a topical anesthetic, EMLA, can be applied before injections are given.
ANS: D Several topical anesthetic agents can be used to minimize the discomfort associated with immunization injections. These include EMLA (eutectic mixture of local anesthetic) and vapor coolant sprays.
Which of the following statements is true concerning susceptibility to pertussis? a. Neonates will be immune the first few months. b. If mother has had the disease, infant will receive passive immunity. c. Children younger than 1 year seldom contract this disease. d. Most children are highly susceptible from birth.
ANS: D The acellular pertussis vaccine is recommended by the American Academy of Pediatrics beginning at age 6 weeks. Infants are at greater risk for complications of pertussis. The vaccine is not given after age 7 years, when the risks of the vaccine become greater than those of pertussis.
9. Trauma to which site can result in a growth problem for children's long bones? a. Matrix b. Connective tissue c. Calcified cartilage d. Epiphyseal cartilage plate
ANS: D The epiphyseal cartilage plate is the area of active growth. Bone injury at the epiphyseal plate can significantly affect subsequent growth and development. Trauma or infection can result in deformity. The matrix, connective tissue, and calcified cartilage are not areas of active growth. Trauma in these sites will not result in growth problems for the long bones.
9. Trauma to which site can result in a growth problem for children's long bones? a. Matrix b. Connective tissue c. Calcified cartilage d. Epiphyseal cartilage plate
ANS: D The epiphyseal cartilage plate is the area of active growth. Bone injury at the epiphyseal plate can significantly affect subsequent growth and development. Trauma or infection can result in deformity. The matrix, connective tissue, and calcified cartilage are not areas of active growth. Trauma in these sites will not result in growth problems for the long bones.
The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infant's stools. The nurse's explanation of this is based on which of the following? a. Child should not be given fibrous foods until digestive tract matures at age 4 years. b. Child should not be given any solid foods until this digestive problem is resolved. c. This is abnormal and requires further investigation. d. This is normal because of the immaturity of digestive processes at this age.
ANS: D The immaturity of the digestive tract is evident in the appearance of the stools. Solid foods are passed incompletely broken down in the feces. An excess quantity of fiber predisposes the child to large, bulky stools.
8. A child's skeletal age is best determined by: a. assessment of dentition. b. assessment of height over time. c. facial bone development. d. radiographs of the hand and wrist.
ANS: D The most accurate measure of skeletal age is radiologic examinations of the growth plates. These are the epiphyseal cartilage plates. Radiographs of the hand and wrist provide the most useful screening to determine skeletal age. Age of tooth eruption has considerable variation in children. It would not be a good determinant of skeletal age. Assessment of height over time will provide a record of the child's height but not skeletal age. Facial bone development will not reflect the child's skeletal age, which is determined by radiographic assessment.
8. A child's skeletal age is best determined by: a. assessment of dentition. b. assessment of height over time. c. facial bone development. d. radiographs of the hand and wrist.
ANS: D The most accurate measure of skeletal age is radiologic examinations of the growth plates. These are the epiphyseal cartilage plates. Radiographs of the hand and wrist provide the most useful screening to determine skeletal age. Age of tooth eruption has considerable variation in children. It would not be a good determinant of skeletal age. Assessment of height over time will provide a record of the child's height but not skeletal age. Facial bone development will not reflect the child's skeletal age, which is determined by radiographic assessment.
17. Nursing interventions to promote health during middle childhood include which of the following? a. Stress the need for increased calorie intake to meet increased demands. b. Instruct parents to defer questions about sex until the child reaches adolescence. c. Advise parents that the child will need increasing amounts of rest toward the end of this period. d. Educate parents about the need for good dental hygiene, since these are the years in which permanent teeth erupt.
ANS: D The permanent teeth erupt during the school-age years. Good dental hygiene and regular attention to dental caries are vital parts of health supervision during this period. Caloric needs are decreased in relation to body size for this age-group. Balanced nutrition is essential to promote growth. Questions about sex should be addressed honestly as the child asks questions. The child usually no longer needs a nap, but most require approximately 11 hours of sleep each night at age 5 and 9 hours at age 12. DIF: Cognitive Level: Application REF: p. 671 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance
21. A nurse observes a toddler playing with sand and water. The nurse appropriately documents this type of play as _____ play. a. skill b. dramatic c. social-affective d. sense-pleasure
ANS: D The toddler playing with sand and water is engaging in sense-pleasure play. This is characterized by nonsocial situations in which the child is stimulated by objects in the environment. Infants engage in skill play when they persistently demonstrate and exercise newly acquired abilities. Dramatic play is the predominant form of play in the preschool period. Children pretend and fantasize. Social-affective play is one of the first types of play in which infants engage. The infant responds to interactions with people.
21. A nurse observes a toddler playing with sand and water. The nurse appropriately documents this type of play as _____ play. a. skill b. dramatic c. social-affective d. sense-pleasure
ANS: D The toddler playing with sand and water is engaging in sense-pleasure play. This is characterized by nonsocial situations in which the child is stimulated by objects in the environment. Infants engage in skill play when they persistently demonstrate and exercise newly acquired abilities. Dramatic play is the predominant form of play in the preschool period. Children pretend and fantasize. Social-affective play is one of the first types of play in which infants engage. The infant responds to interactions with people.
The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse's response should be based on knowledge that this is: a. unacceptable because of the risk of sudden infant death syndrome (SIDS). b. unacceptable because it does not encourage achievement of developmental milestones. c. acceptable to encourage fine motor development. d. acceptable to encourage head control and turning over.
ANS: D These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs and then be placed on their abdomens when awake to enhance development of milestones such as head control.
Austin, age 6 months, has six teeth. The nurse should recognize that this is which of the following? a. Normal tooth eruption b. Delayed tooth eruption c. Unusual and dangerous d. Earlier-than-normal tooth eruption
ANS: D This is earlier than expected. Most infants at age 6 months have two teeth.
16. The school nurse is discussing after-school sports participation with parents of children age 10 years. The nurse's presentation includes which of the following important considerations? a. Teams should be gender specific. b. Organized sports are not appropriate at this age. c. Competition is detrimental to the establishment of a positive self-image. d. Sports participation is encouraged if the type of sport is appropriate to the child's abilities.
ANS: D Virtually every child is suited for some type of sport. The child should be matched to the type of sport appropriate to his or her abilities and physical and emotional makeup. At this age, girls and boys have the same basic structure and similar responses to exercise and training. After puberty, teams should be gender specific because of the increased muscle mass in boys. Organized sports help the child learn teamwork and skill acquisition. The emphasis should be on playing and learning. Children do enjoy appropriate levels of competition. DIF: Cognitive Level: Comprehension REF: p. 669 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance
What is most descriptive of atopic dermatitis (AD) (eczema) in an infant?
Associated with hereditary allergies. (AD is a type of pruritic eczema that usually begins during infancy and is associated with allergy with a hereditary tendency. Approximately 50% of children with AD develop asthma. AD can be controlled but not cured. Manifestations of the disease are worse when environmental humidity is lower. AD is not associated with respiratory tract infections.)
Allergy with a hereditary tendency
Atopy
The nurse is planning care for an infant with eczema. Which interventions should the nurse include in the care plan? (Select all that apply.)
Avoid giving the infant a bubble bath, Avoid overdressing the infant. (Guidelines for care of an infant with eczema include avoiding a bubble bath and harsh soaps and avoiding overdressing the infant to prevent perspiration, which can cause a flare-up. The care plan should include using a humidifier in the infant's room, topical steroids, and wet compresses on the most affected areas.)
Characteristics of bullying include: A. Unintentional harm inflicted upon another person that is part of the socialization process in childhood B. The infliction of repetitive physical, verbal, or emotional abuse upon another person with intent to harm C. An attempt to gain acceptance and be liked by same-sex peers D. An early sign of a severely disturbed personality disorder that escalates in adulthood
B
One of the concerns of the preschool period is adequate nutrition. What can the nurse say to give anticipatory guidance to parents? A. Preschoolers are growing during this period and need to increase their caloric intake to 110 kcal/kg, for an average daily intake of 2200 calories. B. There is some evidence that children self-regulate their caloric intake. If they eat less at one meal, they compensate at another meal or snack. C. To monitor fat intake, dairy and meat should be limited to twice a day. D. For children who do not like milk, consumption of fruit juices is a healthy alternative.
B
One of the primary reasons for monitoring the toddler's activities and intervening to prevent accidental injury is that: A. Toddlers have oppositional defiant behavior and negativism B. Toddlers do not understand the concept of "cause and effect," so explaining that certain actions will result in serious injury is useless C. Toddlers will often listen to reasoning about why an activity should be avoided D. Toddlers enjoy making their parents worry about their safety and like to see the parents' reactions to the behavior
B
The typical play activity in which toddlers engage is called: A. Solitary B. Parallel C. Associative D. Cooperative
B
When her preschool son is in the hospital, the parent tells the nurse, "I think there is something wrong with him because he is so skinny." The most appropriate answer by the nurse is: A. Most preschoolers weigh between 10 and 14 kilograms. B. The legs of a preschooler, rather than the trunk, increase in length, which may make him look slimmer. C. Preschoolers usually keep that pot-bellied appearance until about 4 years old. D. Most preschoolers gain 2 to 3 pounds per year.
B
Which of the following immunization booster vaccines should be considered for a 13-year-old adolescent who has completed all recommended routine childhood vaccinations? Select all that apply. A. DTaP vaccine B. Tdap vaccine C. Meningococcal vaccine D. Pneumococcal vaccine E. Hepatitis B vaccine F. Hib vaccine
B, C
According to Jean Piaget, adolescent cognitive development is represented by the stage of formal operational thought that includes which of the following? Select all that apply. A. Believing that thoughts are all-powerful B. Thinking in abstract terms C. Thinking about hypotheses D. Using a future time perspective E. Thinking in the here and now
B, C, D
Which one of the following strategies might be recommended for an infant with failure to thrive (FTT) to increase caloric intake?
Be persistent through 10 to 15 minutes of food refusal. (Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Children with FTT need a structured routine to help establish rhythmicity in their activities of daily living. Many children with FTT are fed exclusively from a bottle. Solids should be fed first. Stimulation is reduced during mealtimes to maintain the focus on eating.)
The nurse is preparing to feed a 10-month-old child diagnosed with failure to thrive (FTT). Which actions should the nurse plan to implement? (Select all that apply.)
Be persistent, Introduce new foods slowly, Maintain a calm, even temperament. (Feeding strategies for children with FTT should include persistence; introducing new foods slowly; and maintaining a calm, even temperament. The environment should be unstimulating, and a structured routine should be developed with regard to feeding, not just when the infant shows signs of hunger.)
A mother brings her 3-year-old daughter to the well-child clinic and expresses concern that the child's behavior is worrisome and possibly requires therapy or medication at minimum. The mother further explains that the child constantly responds to the mother's simple requests with a "no" answer even though the activity has been a favorite in the recent past. Furthermore, the child has had an increase in the number of temper tantrums at bedtime and refuses to go to bed. The mother is afraid her daughter will hurt herself during a temper tantrum because she holds her breath until the mother picks her up and gives in to her request. The nurse's best response to the mother is that: A. The child probably would benefit from some counseling with a trained therapist B. The mother and father should evaluate their childrearing practices C. The child's behavior is normal for a toddler and may represent frustration with control of her emotions; further exploration of events surrounding temper tantrums and possible interventions should be explored D. The child's behavior is typical of toddlers, and the parents should just wait for the child to finish this phase, since this will end soon as well
C
At an appointment at the pediatrician's office, a patient's mother states, "My son gets rough with some of the neighborhood kids. I am worried that he is becoming a bully." Which statements by the mother need more teaching? Select all that apply. A. When my son becomes aggressive, I feel he needs to be punished. B. I think it is good for him to bond with his dad, so they often watch TV together. C. I am trying to get him to learn to say what he is upset about in words. D. Boys will be boys, so I think this can be considered a normal stage in development. E. I am thinking that a time-out would be a better strategy than spanking when my son shows this behavior.
C, E
The nurse is examining an infant, age 10 months, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions. What is the most likely cause?
Candida albicans infection. (C. albicans infection produces perianal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal folds. Impetigo is a bacterial infection that spreads peripherally in sharply marginated, irregular outlines. Eruptions involving the skin in contact with the diaper but sparing the folds are likely to be caused by chemical irritation, especially urine and feces, and may be related to infrequent diapering.)
Where do eczematous lesions most commonly occur in an infant?
Cheeks and extensor surfaces of the arms and legs. (The lesions of atopic dermatitis are generalized in infants. They are most common on the cheeks, scalp, trunk, and extensor surfaces of the extremities. The abdomen and buttocks are not common sites of lesions. The back and flexor surfaces are not usually involved.)
The community health nurse is reviewing risk factors for vitamin D deficiency. Which children are at high risk for vitamin D deficiency? (Select all that apply.)
Children who are overweight or obese, Children with diets low in sources of vitamin D, Children of families who use milk products not supplemented with vitamin D. (Populations at risk for vitamin D deficiency include overweight or obese children, children with diets low in sources of vitamin D, and children of families who use milk products not supplemented with vitamin D. Children with dark, not fair, pigmentation and children who are exclusively breast fed, not bottle fed, are also at risk.)
An infant has been diagnosed with failure to thrive (FTT) classified according to the pathophysiology of defective utilization. The nurse understands that the reason for the FTT is most likely related to what?
Congenital infection. (FTT classified according to the pathophysiology of defective utilization is related to a genetic anomaly, congenital infection of metabolic storage disease. Cystic fibrosis would be related to the pathophysiology of inadequate absorption, hyperthyroidism would be related to the pathophysiology of increased metabolism, and breastfeeding problems are related to inadequate caloric intake.)
Which term refers to the relative lactase deficiency observed in preterm infants of less than 34 weeks of gestation?
Developmental lactase deficiency. (Developmental lactase deficiency refers to the relative lactase deficiency observed in preterm infants of less than 34 weeks of gestation. Congenital lactase deficiency occurs soon after birth after the newborn has consumed lactose-containing milk. Primary lactase deficiency, sometimes referred to as late-onset lactase deficiency, is the most common type of lactose intolerance and is manifested usually after 4 or 5 years of age. Secondary lactase deficiency may occur secondary to damage of the intestinal lumen, which decreases or destroys the enzyme lactase.)
The nurse is administering an oral antihistamine at bedtime to a child with atopic dermatitis (eczema). Which antihistamine should the nurse expect to be prescribed at bedtime?
Diphenhydramine (Benadryl) (Oral antihistamine drugs such as hydroxyzine or diphenhydramine usually relieve moderate or severe pruritus. Nonsedating antihistamines such as cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra) may be preferred for daytime pruritus relief. Because pruritus increases at night, a mildly sedating antihistamine such as Benadryl is prescribed.)
The parent of an infant with colic tells the nurse, "All this baby does is scream at me; it is a constant worry." What is the nurse's best action?
Encourage the parent to verbalize feelings.(Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathetic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parent's anxiety. The nurse should reassure the parent that he or she is not doing anything wrong. The infant with colic is experiencing spasmodic pain that is manifested by loud crying, in some cases up to 3 hours each day. Telling the parent that it will eventually go away does not help him or her through the current situation.)
The nurse is teaching parents strategies to manage their child's refusal to go to sleep. Which should the nurse include in the teaching session? (Select all that apply.)
Enforce consistent limits, Use a reward system with the child, Have a consistent before bedtime routine.(Strategies to manage a child's refusal to go to sleep include enforcement of consistent limits, using a reward system, and having a consistent before bedtime routine. An evaluation of whether the hour of sleep is too early should be considered because an early bedtime could cause the child to resist sleep if not tired.)
A new parent relates to the nurse that the family has many known food allergies. Which is considered a primary strategy for feeding the infant with many family food allergies?
Exclusive breastfeeding for 4 to 6 months. (Exclusive breastfeeding for 4 to 6 months is now considered a primary strategy for avoiding atopy in families with known food allergies; however, there is no evidence that maternal avoidance (during pregnancy or lactation) of cow's milk protein or other dietary products known to cause food allergy will prevent food allergy in children. Researchers indicate that delaying the introduction of highly allergenic foods past 4 to 6 months of age may not be as protective for food allergy as previously believed. Likewise, studies have shown that soy formula does not prevent allergic disease in infants.)
Rickets is caused by a deficiency in what?
Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent rickets
Specific components of food or ingredients in food that are recognized by allergen-specific immune cells eliciting an immune reaction
Food allergen
An adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food
Food allergy
A food elicits a reproducible adverse reaction but does not have an established immunologic mechanism
Food intolerance
An infant has been diagnosed with failure to thrive (FTT) classified according to the pathophysiology of inadequate caloric intake. The nurse understands that the reason for the FTT is most likely related to what?
Incorrect formula preparation. (FTT classified according to the pathophysiology of inadequate caloric intake is related to incorrect formula preparation, neglect, food fads, excessive juice poverty, breastfeeding problems, behavioral problems affecting eating, parental restriction of caloric intake, or central nervous system problems affecting intake consumption. Cow's milk allergy would be related to the pathophysiology of inadequate absorption, congenital heart disease would be related to the pathophysiology of increased metabolism, and metabolic storage disease is related to defective utilization.)
The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their children. Which is most likely lacking in their particular diet?
Iron and calcium. (Deficiencies can occur when various substances in the diet interact with minerals. For example, iron, zinc, and calcium can form insoluble complexes with phytates or oxalates (substances found in plant proteins), which impair the bioavailability of the mineral. This type of interaction is important in vegetarian diets because plant foods such as soy are high in phytates. Fat and vitamins C and A are readily available from vegetable sources. Plant proteins are available)
Supplements needed
Iron, calcium, phosphorous
What may a clinical manifestations of failure to thrive (FTT) in a 13-month-old include?
Irregularity in activities of daily living. (One of the clinical manifestations of children with FTT is irregularity or low rhythmicity in activities of daily living. Children with FTT often refuse to switch from liquids to solid foods. Weight below the fifth percentile is indicative of FTT. Developmental delays, including social, motor, adaptive, and language, exist.)
The nurse is discussing the management of atopic dermatitis (eczema) with a parent. What should be included?
Keep the infant's fingernails and toenails cut short and clean.(The infant's nails should be kept short and clean and have no sharp edges. Gloves or cotton socks can be placed over the child's hands and pinned to the shirt sleeves. Heat and humidity increase perspiration, which can exacerbate the eczema. The child should be dressed properly for the climate. Synthetic material (not wool) should be used for the child's clothing during cold months. Baths are given as prescribed with tepid water, and emollients such as Aquaphor, Cetaphil, and Eucerin are applied within 3 minutes. Soap (except as indicated), bubble bath oils, and powders are avoided. Fabric softener should be avoided because of the irritant effects of some of its components.)
What are risk factors for sudden infant death syndrome? (Select all that apply.)
Low Apgar scores, Recent viral illness, Native American infants. (Infant risk factors for sudden infant death syndrome include those with low Apgar scores and recent viral illness and Native American infants. Preterm, not postterm, birth and male, not female, gender are other risk factors.)
What is an important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS)?
Make a follow-up home visit to the parents as soon as possible after the child's death. (A competent, qualified professional should visit the family at home as soon as possible after the death. Printed information about SIDS should be provided to the family. Parents should be allowed and encouraged to make a last visit with their child. SIDS cannot always be prevented or predicted, but parents can take steps to reduce the risk (e.g., supine sleeping, removing blankets and pillows from the crib, and not smoking). Discussions about the cause only increase parental guilt. The parents should be asked only factual questions to determine the cause of death.)
Which factors will decrease iron absorption and should not be given at the same time as an iron supplement?
Many foods interfere with iron absorption and should be avoided when iron is consumed. These foods include phosphates found in milk, phytates found in cereals, and oxalates found in many vegetables.
What is marasmus?
Marasmus is a syndrome of emotional and physical deprivation. It is not confined to geographic areas were food supplies are inadequate. Marasmus is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears old, with flabby and wrinkled skin. Marasmus is a deficiency of both protein and calories
A 12-month-old infant has been diagnosed with failure to thrive (FTT). Which assessment findings does the nurse expect to be documented with this infant? (Select all that apply.)
Minimal smiling, Avoidance of eye contact,Wide-eyed gaze and continual scan of the environment. (Signs and symptoms of FTT include minimal smiling, avoidance of eye contact, and a wide-eyed gaze and continual scan of the environment ("radar gaze"). There is no fear of strangers, and there are developmental delays, including social, motor, adaptive, and language.)
An infant has been diagnosed with an allergy to milk. In teaching the parent how to meet the infant's nutritional needs, the nurse states that
Most children will grow out of the allergy. (Approximately 80% of children with cow's milk allergy develop tolerance by the fifth birthday. The child can have eggs. Any food that has milk as a component or filler is eliminated. These foods include processed meats, salad dressings, soups, and milk chocolate. Having the entire family follow the special diet would provide support for the child, but the nutritional needs of other family members must be addressed. Antihistamines are not used for food allergies.)
The nurse has administered a dose of epinephrine to a 12-month-old infant. For which adverse reactions of epinephrine should the nurse monitor? (Select all that apply.)
Nausea,Tremors,Irritability. (Epinephrine increases activation of the sympathetic nervous system. Adverse effects include nausea, tremors, and irritability. Tachycardia would occur, not bradycardia, and hypertension, not hypotension, would occur.)
The nurse is teaching parents about potential causes of colic in infancy. Which should the nurse include in the teaching session? (Select all that apply.)
Overeating, Parental smoking, Swallowing excessive air. (Potential causes of colic include too rapid feeding, overeating, swallowing excessive air, improper feeding technique (especially in positioning and burping), emotional stress or tension between the parent and child, parental smoking, and overstimulation.)
The nurse is teaching parents about foods that are hyperallergenic. Which foods should the nurse include? (Select all that apply.)
Peanuts, Egg noodles, Tomato juice. (Hyperallergenic foods include peanuts, egg noodles, and tomato juice. Bananas and potatoes are not hyperallergenic.)
After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which pediatric issues?
Plagiocephaly. (Plagiocephaly is a misshapen head caused by the prolonged pressure on one side of the skull. If that side becomes misshapen, facial asymmetry may result. SIDS has decreased by more than 40% with the introduction of the Back to Sleep campaign. Apnea of infancy and failure to thrive are unrelated to the Back to Sleep campaign.)
A bottle-fed infant has been diagnosed with cow's milk allergy. Which formula should the nurse expect to be prescribed for the infant?
Pregestimil. (For infants with cow's milk allergy, the formula will be changed to a casein hydrolysate milk formula (Pregestimil, Nutramigen, or Alimentum) in which the protein has been broken down into its amino acids through enzymatic hydrolysis. Similac, Enfamil with iron, and Gerber Good Start are cow's milk-based formulas.)
What is an appropriate action when an infant becomes apneic?
Roll the infant's head to the side.
Initial exposure to an allergen resulting in an immune response; subsequent exposure induces a much stronger response
Sensitization
Will revert to more infantile forms of behavior, such as demanding a bottle, soiling their underpants, clinging for attention, using baby talk, or aggressively acting out toward others
Sibling rivalry
The nurse is interviewing the parents of a 4-month-old boy brought to the hospital emergency department. The infant is dead, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. The nurse might initially suspect his death was caused by what?
Sudden infant death syndrome (SIDS). (The description of how the child was found in the crib is suggestive of SIDS. The nurse is careful to tell the parents that a diagnosis cannot be confirmed until an autopsy is performed.)
The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse's response should be based on remembering what?
This is acceptable to encourage head control and turning over. (These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs to reduce the risk of SIDS and then be placed on their abdomens when awake to enhance achievement of milestones such as head control. These position changes encourage gross motor, not fine motor, development.)
Ritualism
Toddlers like to have the same dish, cup, or spoon every time they eat. They may reject a favorite food simply because it is served in a different dish. If one food touches another, they often refuse to eat it.
A 1-year-old child is on a pure vegetarian (vegan) diet. This diet requires supplementation with what?
Vitamins D and B12. (Pure vegetarian (vegan) diets eliminate any food of animal origin, including milk and eggs. These diets require supplementation with many vitamins, especially vitamin B6, vitamin B12, riboflavin, vitamin D, iron, and zinc)
Regression
When regression does occur, the best approach is to ignore it while praising existing patterns of appropriate behavior. Regression is a child's way of saying, "I can't cope with this present stress and perfect this skill as well, but I will if given patience and understanding." For this reason, it is advisable not to attempt new areas of learning when an additional crisis is present or expected, such as beginning toilet training shortly before a sibling is born or during a brief period of hospitalization.
A new parent asks the nurse, "How can diaper rash be prevented?" What should the nurse recommend?
Wipe stool from the skin using water and a mild cleanser.(Change the diaper as soon as it becomes soiled. Gently wipe stool from the skin with water and mild soap. The skin should be thoroughly dried after washing. Applying oil does not create an effective barrier. Over washing the skin should be avoided, especially with perfumed soaps or commercial wipes, which may be irritating. Baby powder should not be used because of the danger of aspiration.)
Lactose intolerance is diagnosed in an 11-month-old infant. Which should the nurse recommend as a milk substitute?
Yogurt. (Yogurt contains the inactive lactase enzyme, which is activated by the temperature and pH of the duodenum. This lactase activity substitutes for the lack of endogenous lactase. Ice cream and cow's milk-based formula contain lactose, which will probably not be tolerated by the child. Fortified cereal does not have the nutritional equivalents of milk.)
Fluoride needed in toddlers that
are older than the age of 6 months whose drinking water is deficient in fluoride
Rear facing car seat
birth-3 years
Voluntary control of elimination is due to
complete myelination of the spinal cord
Birth weight should be _____ by _______ years old
quadrupled; 2.5 yrs
Ritualism
the need to maintain sameness and reliability, provides a sense of comfort. Toddlers can venture out with security when they know that familiar people, places, and routines still exist.