peds exam #1

The nurse is providing anticipatory guidance to parents related to promoting healthy nutrition in their young child. She discusses age-appropriate sequencing of feeding behaviors. Place all of the stages listed below in ascending chronologic order from youngest age progressing to oldest age. Use all options. a. One (1) b. Two (2) c. Three (3) d. Four (4) 1. Uses a spoon well to feed self 2. Uses a fork well to feed self 3. Begins to eat the same foods as the rest of the family 4. Uses a "sippy cup"

1. ANS: D NOT: "Sippy cups are introduced before 1 year of age, eating the same foods as the rest of the family at 12 months of age, using a spoon well and holding a cup in one hand by 2 years of age, and using a fork well to feed self by age 3 to 4 years." 2. ANS: C NOT: "Sippy cups are introduced before 1 year of age, eating the same foods as the rest of the family at 12 months of age, using a spoon well and holding a cup in one hand by 2 years of age, and using a fork well to feed self by age 3 to 4 years." 3. ANS: A NOT: "Sippy cups are introduced before 1 year of age, eating the same foods as the rest of the family at 12 months of age, using a spoon well and holding a cup in one hand by 2 years of age, and using a fork well to feed self by age 3 to 4 years." 4. ANS: B NOT: "Sippy cups are introduced before 1 year of age, eating the same foods as the rest of the family at 12 months of age, using a spoon well and holding a cup in one hand by 2 years of age, and using a fork well to feed self by age 3 to 4 years."

Postoperative pain is an example of: A. Acute pain B. Conscious pain C. Chronic pain D. Objective pain

A

The best indicator of pain in a 15 month old toddler is: A. Behavioral changes B. Changes in vital signs C. The child's parents assessment of the childs pain D. The child's verbal response

A

Which assessment should the nurse perform last when examining a 5-year-old child? a. Heart b. Lungs c. Abdomen d. Throat ANS: D

A The nurse may proceed from head to toe with preschool-age children. More invasive procedures should be saved until the end of the examination. Assessment of the heart is considered noninvasive. B For preschool children, invasive procedures should be left to the end of the examination. Assessment of the lungs is not considered to be frightening. C For preschool children, invasive procedures should be left to the end of the examination. Assessment of the abdomen is not considered to be frightening. D Examination of the mouth and throat is considered to be more invasive than other parts of a physical examination. For preschool children, invasive procedures should be left to the end of the examination.

1. A 10-year-old girl is brought to the emergency department manifesting the following physical symptoms: sweating, nausea, headache, abdominal cramps, cool moist skin, and an elevated temperature. The child's mother reports that since this was the first warm day of summer, they spent most of the day at the beach. This patient is experiencing ___________.

ANS: heat exhaustion This child is experiencing a heat-related illness known as heat exhaustion. Treatment includes moving the child to a cool environment and applying cool moist cloths to the skin, removing clothing or changing her to dry clothing, elevating her legs, and offering oral rehydration fluids if no altered mental status or vomiting is evident.

Children have a total of __________ primary (deciduous) teeth that they begin to lose when they are school age.

ANS: 20 twenty

Primary (deciduous) teeth are replaced by permanent teeth. By adulthood the child will have __________ permanent teeth.

ANS: 32 thirty-two

In assessing adolescents using Tanner staging, sexual maturity is rated using _________ distinct stages. (Your answer should appear as a number.)

ANS: 5 Tanner stages of adolescent sexual development describe five distinct stages of sexual maturity rating. There are separate rating scales for males and females, but both use five stages.

A nurse is planning a class for school-age children on obesity. Which percentile does the body mass index (BMI) need to exceed for a child to be assessed as obese?

ANS: 95 95th When intake of food exceeds expenditure, the excess is stored as fat. Obesity is an excessive accumulation of fat in the body and is assessed in children as a BMI that exceeds the 95th percentile for age.

Adolescent sexuality refers to the thoughts, feelings, and behaviors related to the teen's sexual identity. The most recent research (2009) indicates that 46% of all adolescents have been involved in some kind of sexual activity. The only complete protection from pregnancy and sexually transmitted diseases (STDs) is ____________.

ANS: abstinence Adolescents should be encouraged that there is nothing wrong with abstaining from sexual activity. Adolescents who engage in sexual activity at a young age are more likely to participate in other high-risk behaviors such as alcohol and drug use. Adolescents who demonstrate high self-esteem are more likely to delay sexual intercourse.

The nurse has just assisted in the delivery of a female infant to first-time parents. The infant is suctioned, dried, and placed skin-to-skin on her mother's chest. This allows for significant interaction between mother and baby and is known as _____________.

ANS: attachment Parent-infant attachment is one of the most important aspects of infant psychosocial development. Initiated immediately after birth, attachment is strengthened by many mutually satisfying interactions between parents and their infant during the first few months of life. Attachment is a sense of belonging or connection with each other.

A type of play that allows children to act out roles and experiences that may have happened to them, that they fear may happen, or that they have observed in others is known as ______ play.

ANS: dramatic This type of play can be spontaneous or guided and often includes medical or nursing equipment. It is especially valuable for children who have had or will have multiple procedures or hospitalizations.

Adolescents' eyes and ears are fully developed and, with the exception of minor infections, the sensory system remains quite healthy during this period of development. The mother of a 12-year-old complains to the nurse that she is concerned that her daughter frequently needs changes to her corrective lenses. This is a condition known as ___________.

ANS: myopia Myopia (nearsightedness) occurs in early adolescence, between the ages of 11 and 13 and is a normal part of adolescent development

When a child is hospitalized, one component of their plan of care is the use of therapeutic play. This care is often provided by a(n) _____________.

ANS: child life specialist Child life specialists are available in many hospitals to share their expertise in child growth and development, and the use of play. Using a collaborative approach with the nurse, activities are planned to meet both the physical and psychological needs of the child.

After a serious illness or trauma the child's ability to function may change. Once the acute situation has resolved, the child may be transferred to a __________ hospital

ANS: rehabilitation Children with neurologic injuries, such as head injuries and children with serious burns may thrive in the environment of a rehabilitation hospital, which resembles the home setting. In this setting the child is cared for by a multidisciplinary team who focuses on what he or she can do, rather than their limitations.

Which play activity should the nurse implement to enhance deep breathing exercises for a toddler? a. Blowing bubbles b. Throwing a Nerf ball c. Using a spirometer d. Keeping a chart of deep breathing

ANS: A Feedback A Age-appropriate play for a toddler to enhance deep breathing is blowing bubbles. B Throwing a Nerf ball does not enhance deep breathing. C Using a spirometer and keeping a chart of deep breathing are more appropriate for a school-age child. D Using a spirometer and keeping a chart of deep breathing are more appropriate for a school-age child.

The nurse is obtaining vital signs on a 1-year-old child. What is the most appropriate site for assessing the pulse rate? a. Apical b. Radial c. Carotid d. Femoral

ANS: A Feedback A Apical pulse rates are taken in children younger than 2 years. B Radial pulse rates may be taken in children older than 2 years. C It is difficult to palpate the carotid pulse in an infant. D The femoral pulse is palpated when comparing peripheral pulses, but it is not used to measure an infant's pulse rate.

When a child broke her favorite doll during a hospitalization, her primary nurse bought the child a new doll and gave it to her the next day. What is the best interpretation of the nurse's behavior? a. The nurse is displaying signs of overinvolvement. b. The nurse is a kind and generous person. c. The nurse feels a special closeness to the child. d. The nurse wants to make the child happy.

ANS: A Feedback A Buying gifts for individual children is a warning sign of overinvolvement. B Nurses are kind and generous people, but buying gifts for individual children is unprofessional. C Nurses may feel closer to some patients and families. This does not make giving gifts to children or families acceptable from a professional standpoint. D Replacing lost items is not the nurse's responsibility. Becoming overly involved with a child can inhibit a healthy relationship.

A nurse is reviewing pediatric physical assessment techniques. Which statement about performing a pediatric physical assessment is correct? a. Physical examinations proceed systematically from head to toe unless developmental considerations dictate otherwise. b. The physical examination should be done with parents in the examining room for children of any age. c. Measurement of head circumference is done until the child is 5 years old. d. The physical examination is done only when the child is cooperative.

ANS: A Feedback A Physical assessment usually proceeds from head to toe; however, developmental considerations with infants and toddlers dictate that the least threatening assessments be done first to obtain accurate data. B Having parents in the examining room with adolescents is not appropriate. C Head circumference is routinely measured until 36 months of age. D Children will not always be cooperative during the physical examination. The examiner will need to incorporate communication and play techniques to facilitate cooperation.

How should the nurse advise parents whose preschooler used to sleep through the night and now awakens at intervals after a short hospitalization? a. Regressive behavior after a hospitalization is normal and usually short term. b. The child is probably expressing anger. c. Egocentric behavior often manifests itself when the child is left alone to sleep. d. The child is probably feeling pain and needs further evaluation.

ANS: A Feedback A Regression is manifested in a variety of ways, is normal, and usually is short term. B Nighttime waking is not associated with anger. C Egocentric behavior is not an explanation for nighttime waking. D More information is needed before assessment of pain can be made.

The nurse palpated the anterior fontanel of a 14-month-old infant and found that it was closed. What does this finding indicate? a. This is a normal finding. b. This finding indicates premature closure of cranial sutures. c. This is abnormal and the child should have a developmental evaluation. d. This is an abnormal finding and the child should have a neurologic evaluation.

ANS: A Feedback A The anterior fontanel should be completely closed by 12 to 18 months of age. B A closed anterior fontanel at 14 months of age does not indicate premature closure of cranial sutures. C This finding is not abnormal and does not necessitate a developmental evaluation. D This finding is not abnormal and does not indicate the need for a neurologic examination.

A 3-year-old child cries, kicks, and clings to the father when the parents try to leave the hospital room. What is the nurse's best response to the parents about this behavior? a. "Your child is showing a normal response to the stress of hospitalization." b. "Your child is not coping effectively with hospitalization. We'll need to get a consult from the doctor due to this behavioral problem." c. "It is helpful for parents to stay with children during hospitalization." d. "You can avoid this if you leave after your child falls asleep."

ANS: A Feedback A The child is exhibiting a healthy attachment to the father. B The child's behavior represents the protest stage of separation and does not represent maladaptive behavior. C This response places undue stress and guilt on the parents. D This response fosters the child's mistrust.

Which choice includes the components of a complete pediatric history? a. Statistical information, client profile, health history, family history, review of systems, lifestyle and life patterns b. Vital signs, chief complaint, and list of previous problems c. Chief complaint, including body location, quality, quantity, timeframe, and alleviating and aggravating factors d. Pertinent developmental and family information

ANS: A Feedback A The identified items are included in a complete pediatric history. B Vital signs, chief complaint, and list of previous problems do not constitute a complete history. C A problem-oriented history includes specific information about the chief complaint. D Pertinent developmental and family information are part of the complete history.

Which is the most developmentally appropriate intervention when working with the hospitalized adolescent? a. Encourage peers to call and visit when the adolescent's condition allows. b. Encourage the adolescent's friends to continue with their daily activities; the adolescent has concrete thinking and will understand. c. Discourage questions and concerns about the effects of the illness on the adolescent's appearance. d. Ask the parents how the adolescent usually copes in new situations.

ANS: A Feedback A The peer group is important to the adolescent's sense of belonging and identity; therefore separation from friends is a major source of anxiety for the hospitalized adolescent. B Adolescents should have advanced beyond concrete thinking. In addition, hospitalized adolescents may be upset if their friends continue with daily activities without them. Communication, interacting, and meeting with friends will be important. C Questions and concerns should be encouraged regarding the adolescent's appearance and the effects of illness on appearance. D How the adolescent copes should be asked directly of the adolescent.

The nurse has a 2-year-old boy sit in "tailor" position during palpation for the testes. What is the rationale for this position? a. It prevents cremasteric reflex. b. Undescended testes can be palpated. c. This tests the child for an inguinal hernia. d. The child does not yet have a need for privacy.

ANS: A Feedback A The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity. B Undescended testes cannot be predictably palpated. C Inguinal hernias are not detected by this method. This position is used for inhibiting the cremasteric reflex. D Privacy should always be provided for children.

The nurse percussing over an empty stomach expects to hear which sound? a. Tympany b. Resonance c. Flatness d. Dullness

ANS: A Feedback A Tympany is a high-pitched, loud-intensity sound heard over air-filled body parts such as the stomach and bowel. B Resonance is a low-pitched, low-intensity sound elicited over hollow organs such as the lungs. C Flatness is a high-pitched, soft-intensity sound elicited by percussing over solid masses such as bone or muscle. D Dullness is a medium-pitched, medium-intensity sound elicited when percussing over high-density structures such as the liver.

12. You are the nurse working triage in the emergency department. A school-age child is brought in for treatment, carried by her mother. What is part of a primary assessment that should be performed first on this child? a. Determine level of consciousness. b. Obtain a health history. c. Obtain a full set of vital signs. d. Evaluate for pain.

ANS: A Feedback A A primary assessment consists of assessing the child's airway, breathing, circulation, level of consciousness, and exposure (ABCDEs). B Obtaining the child's health history is a component of a secondary assessment. C Vital signs are included in a secondary assessment, after the ABCDEs are assessed. D Assessing for pain is a component of a secondary assessment.

18. Which is the most critical element of pediatric emergency care? a. Airway management b. Prevention of neurologic impairment c. Maintaining adequate circulation d. Supporting the child's family

ANS: A Feedback A Airway management is the most critical element in pediatric emergency care. B Prevention of neurologic impairment is certainly a concern in pediatric emergency care; however, it is not considered the most critical element. C Maintaining adequate circulation is accomplished after a patent airway is established. D The focus of emergency care is stabilizing the child's physiologic status. Supporting the family is important, but it is not considered to be the most critical element in pediatric emergency care.

14. What is the nurse's immediate action when a child comes to the emergency department with sweating, chills, and fang bite marks on the thigh? a. Secure antivenin therapy. b. Apply a tourniquet to the leg. c. Ambulate the child. d. Reassure the child and parent.

ANS: A Feedback A Antivenin therapy is essential to the child's survival because the child is showing signs of envenomation. B The use of a tourniquet is no longer recommended. C When a bite or envenomation is located on an extremity, the extremity should be immobilized. D Envenomation is a potentially life-threatening condition. False reassurance is not helpful for building a trusting relationship.

7. The emergency department nurse notices that the mother of a young child is making a lot of phone calls and getting advice from her friends about what she should do. This behavior is an indication of a. Stress b. Healthy coping skills c. Attention-getting behaviors d. Low self-esteem

ANS: A Feedback A Hyperactive behavior such as making a lot of phone calls and enlisting everyone's opinions is a sign of stress. B The behavior described is not a healthy coping skill. C This may be an attention-getting behavior but is more likely an indicator of stress. D This mother may have low self-esteem, but the immediate provocation is stress.

10. What should be the emergency department nurse's next action when a 6-year-old child has a systolic blood pressure of 58 mm Hg? a. Alert the physician about the systolic blood pressure. b. Comfort the child and assess respiratory rate. c. Assess the child's responsiveness to the environment. d. Alert the physician that the child may need intravenous fluids.

ANS: A Feedback A Hypotension is a late sign of shock in children. The lower limit for systolic blood pressure for a child more than 1 year old is 70 mm Hg plus two times the child's age in years. A systolic blood pressure of 58 mm Hg calls for immediate action. The nurse should be direct in relaying the child's condition to the physician. B This action does not address the problem of shock, which requires immediate intervention. C Assessing the child's responsiveness is included in a neurologic assessment. It does not address the systolic blood pressure of 58 mm Hg. D Although this child most likely requires intravenous fluids, the physician must be apprised of the systolic blood pressure so that appropriate intervention can be initiated.

13. What is the goal of the initial intervention for a child in cardiopulmonary arrest? a. Establishing a patent airway b. Determining a pulse rate c. Removing clothing d. Reassuring the parents

ANS: A Feedback A The first intervention for a child in cardiopulmonary arrest, as for an adult, is to establish a patent airway. B Assessment of pulse follows establishment of a patent airway. C Clothing may be removed from the upper body for chest compressions after a patent airway is established. D The first priority is to establish a patent airway.

23. A 2-year-old child is in the playroom. The nurse observes him picking up a small toy and putting it in his mouth. The child begins to choke. He is unable to speak. Which intervention is appropriate? a. Heimlich maneuver b. Abdominal thrusts c. Five back blows d. Five chest thrusts

ANS: A Feedback A To clear a foreign body from the airway, the American Heart Association recommends the Heimlich maneuver for a conscious child older than 1 year of age. B Abdominal thrusts are indicated when the child is unconscious. C Back blows are indicated for an infant with an obstructed airway. D Chest thrusts follow back blows for the infant with an obstructed airway.

A nurse determines that a child consistently displays predictable behavior and is regular in performing daily habits. Which temperament is the child displaying? a. Easy b. Slow-to-warm-up c. Difficult d. Shy

ANS: A A Children with an easy temperament are even tempered, predictable, and regular in their habits. They react positively to new stimuli. B The slow-to-warm-up temperament type prefers to be inactive and moody. C A high activity level and adapting slowly to new stimuli are characteristics of a difficult temperament. D Shyness is a personality type and not a characteristic of temperament.

The formula used to guide time-out as a disciplinary method is a. 1 minute per each year of the child's age b. To relate the length of the time-out to the severity of the behavior c. Never to use time-out for a child younger than 4 years d. To follow the time-out with a treat

ANS: A A It is important to structure time-out in a time frame that allows the child to understand why he or she has been removed from the environment. B Relating time to a behavior is subjective and is inappropriate when the child is very young. C Time-out can be used with the toddler. D Negative behavior should not be reinforced with a positive action.

Which toy is the most developmentally appropriate for an 18- to 24-month-old child? a. A push-and-pull toy c. A bicycle with training wheels b. Nesting blocks d. A computer

ANS: A A Push-and-pull toys encourage large muscle activity and are appropriate for toddlers. B Nesting blocks are more appropriate for a 12- to 15-month-old child. C A bicycle with training wheels is appropriate for a preschool or young school-age child. D A computer can be appropriate as early as the preschool years.

Which activity is most appropriate for developing fine motor skills in the school-age child? a. Drawing b. Singing c. Soccer d. Swimming

ANS: A Feedback A Activities such as drawing, building models, and playing a musical instrument increase the school-age child's fine motor skills. B Singing is an appropriate activity for the school-age child, but it does not increase fine motor skills. C The school-age child needs to participate in group activities to increase both gross motor skills and social skills, but group activities do not increase fine motor skills. D Swimming is an activity that also increases gross motor skills.

The nurse advises the mother of a 3-month-old exclusively breastfed infant to a. Start giving the infant a vitamin D supplement. b. Start using an infant feeder and add rice cereal to the formula. c. Start feeding the infant rice cereal with a spoon at the evening feeding. d. Continue breastfeeding without any supplements.

ANS: A Feedback A Breast milk does not provide an adequate amount of dietary vitamin D. Infants who are exclusively breastfed need vitamin D supplements to prevent rickets. B An infant feeder is an inappropriate method of providing the infant with caloric intake. Solid foods are not recommended for a 3-month-old infant. C Rice cereal and other solid foods are contraindicated in a 3-month-old infant. Solid feedings do not typically begin before 4 to 6 months of age. D Because breast milk is not an adequate source of fluoride, infants need to be given a fluoride supplement in addition to a vitamin D supplement.

The ability to mentally understand that 1 + 3 = 4 and 4 - 1 = 3 occurs in which stage of cognitive development? a. Concrete operations b. Formal operations c. Intuitive thought d. Preoperations

ANS: A Feedback A By 7 to 8 years of age, the child is able to retrace a process (reversibility) and has the skills necessary for solving mathematical problems. This stage is called concrete operations. B The formal operations stage deals with abstract reasoning and does not occur until adolescence. C Thinking in the intuitive stage is based on immediate perceptions. A child in this stage often solves problems by random guessing. D In preoperational thinking, the child is usually able to add 1 + 3 = 4 but is unable to retrace the process.

In terms of fine motor development, what should the 7-month-old infant be able to do? a. Transfer objects from one hand to the other. b. Use thumb and index finger in crude pincer grasp. c. Hold crayon and make a mark on paper. d. Release cubes into a cup.

ANS: A Feedback A By age 7 months, infants can transfer objects from one hand to the other, crossing the midline. B The crude pincer grasp is apparent at approximately age 9 months. C The child can scribble spontaneously at age 15 months. D At age 12 months, the child can release cubes into a cup.

An 8-year-old girl tells the nurse that she has cancer because God is punishing her for "being bad." She shares her concern that if she dies, she will go to hell. The nurse should interpret this as being a. A belief common at this age b. A belief that forms the basis for most religions c. Suggestive of excessive family pressure d. Suggestive of a failure to develop a conscience

ANS: A Feedback A Children at this age may view illness or injury as a punishment for a real or imagined mystique. B The belief in divine punishment is common at this age. C The belief in divine punishment is common at this age. D The belief in divine punishment is common at this age.

According to Piaget, the adolescent is in the fourth stage of cognitive development, or period of what? a. Formal operations b. Concrete operations c. Conventional thought d. Postconventional thought

ANS: A Feedback A Cognitive thinking culminates with capacity for abstract thinking. This stage, the period of formal operations, is Piaget's fourth and last stage. B Concrete operations usually develops between ages 7 and 11 years. C Conventional and postconventional thought refer to Kohlberg's stages of moral development. D Conventional and postconventional thought refer to Kohlberg's stages of moral development.

Which statement best describes development in infants and children? a. Development, a predictable and orderly process, occurs at varying rates within normal limits. b. Development is primarily related to the growth in the number and size of cells. c. Development occurs in a proximodistal direction with fine muscle development occurring first. d. Development is more easily and accurately measured than growth.

ANS: A Feedback A Development, a continuous and orderly process, provides the basis for increases in the child's function and complexity of behavior. The increases in rate of function and complexity can vary normally within limits for each child. B An increase in the number and size of cells is a definition for growth. C Development proceeds in a proximodistal direction with fine muscle organization occurring as a result of large muscle organization. D Development is a more complex process that is affected by many factors; therefore, it is less easily and accurately measured. Growth is a predictable process with standard measurement methods.

A school nurse is teaching a health class for 5th grade children. The nurse plans to include which statement to best describe growth in the early school-age period? a. Boys grow faster than girls. b. Puberty occurs earlier in boys than in girls. c. Puberty occurs at the same age for all races and ethnicities. d. It is a period of rapid physical growth.

ANS: A Feedback A During the school-age developmental period, boys are approximately 1 inch taller and 2 pounds heavier than girls. B Puberty occurs 1 1/2 to 2 years later in boys, which is developmentally later than puberty in girls (not unusual in 9- or 10-year-old girls). C Puberty occurs approximately 1 year earlier in African-American girls than in white girls. D Physical growth is slow and steady during the school-age years.

The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is a. Erikson b. Freud c. Kohlberg d. Piaget

ANS: A Feedback A Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled. B Sigmund Freud proposed a psychosexual theory of development. He proposed that certain parts of the body assume psychological significance as foci of sexual energy. The foci shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of development. C Lawrence Kohlberg described moral development as having three levels (preconventional, conventional, and postconventional). His theory closely parallels Piaget's. D Jean Piaget's cognitive theory interprets how children learn and think and how this thinking progresses and differs from adult thinking. Stages of his theory include sensorimotor, preoperations, concrete operations, and formal operations.

A 14-year-old male seems to be always eating, although his weight is appropriate for his height. The best explanation for this is that a. This is normal because of increase in body mass. b. This is abnormal and suggestive of future obesity. c. His caloric intake would have to be excessive. d. He is substituting food for unfilled needs

ANS: A Feedback A In adolescence, nutritional needs are closely related to the increase in body mass. The peak requirements occur in the years of maximal growth. The caloric and protein requirements are higher than at almost any other time of life. B This describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern. C This describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern. D This describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern.

The environment, both physical and psychosocial, is a significant determinate of growth and development outcomes before and after birth. Nurses can assist parents in preventing environmental injury for their 2-year-old toddler by teaching them to avoid the most common sources of exposure. This anticipatory guidance includes teaching related to a. Avoiding sun exposure, secondhand smoke, and lead b. Socioeconomic status, primarily poverty c. Maternal smoking and alcohol intake during pregnancy d. The passing of environmental toxins through breast milk

ANS: A Feedback A Lead can be present in the home and in toys made overseas. Environmental injury can also be the result of mercury, pesticides (flea and tick collars), radon, and exposure to the sun and secondhand smoke. It is important for the nurse to provide health teaching related to these factors. B The nurse is unable to influence socioeconomic status. C It is too late for the nurse to instruct the mother regarding smoking or alcohol intake during pregnancy. This should have been included in prenatal teaching. D It is unlikely that a 2-year-old child will still be breastfeeding.

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? a. Roll from abdomen to back. b. Roll from back to abdomen. c. Sit erect without support. d. Move from prone to sitting position.

ANS: A Feedback A Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. B The ability to roll from back to abdomen usually occurs at 6 months old. C Sitting erect without support is a developmental milestone usually achieved by 8 months. D The 10-month-old infant can usually move from a prone to a sitting position.

A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her schoolwork satisfactorily, but lately she has been somewhat aggressive and stubborn in the classroom. The school nurse should recognize this as a. Signs of stress b. Developmental delay c. Physical problem causing emotional stress d. Lack of adjustment to school environment

ANS: A Feedback A Signs of stress include stomach pains or headache, sleep problems, bedwetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. B This child is exhibiting signs of stress. C This child is exhibiting signs of stress. D This child is exhibiting signs of stress.

Which is appropriate play for a 6-month-old infant? a. Pat-a-cake, peek-a-boo b. Ball rolling, hide-and-seek game c. Bright rattles and tactile toys d. Push and pull toys

ANS: A Feedback A Six-month-old children enjoy playing pat-a-cake and peek-a-boo. B Nine-month-old infants enjoy rolling a ball and playing hide-and-seek games. C Four-month-old infants enjoy bright rattles and tactile toys. D Twelve-month-old infants enjoy playing with push and pull toys.

A nurse is teaching adolescent boys about pubertal changes. The first sign of pubertal change seen with boys is a. Testicular enlargement b. Facial hair c. Scrotal enlargement d. Voice deepens

ANS: A Feedback A The first sign of pubertal changes in boys is testicular enlargement in response to testosterone secretion, which usually occurs in Tanner stage 2. Slight pubic hair is present and the smooth skin texture of the scrotum is somewhat altered. B During Tanner stages 4 and 5, facial hair appears at the corners of the upper lip and chin. C As testosterone secretion increases, the penis, testes, and scrotum enlarge. D During Tanner stages 4 and 5, rising levels of testosterone cause the voice to deepen.

The nurse is performing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as a(n) a. Normal finding b. Questionable finding—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 Feedback A This is a normal finding. The anterior fontanel closes between ages 12 and 18 months. The posterior fontanel closes between 2 and 3 months of age. B Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required. C Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required. D Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required.

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 as a result of prematurity d. Suggestive of a neurologic disorder such as cerebral palsy

ANS: A Feedback A This is indicative of normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. B The infant is expected to be able to perform this task by age 3 months. If the child's age is corrected because of being 2 weeks preterm, the child is at the midpoint of the range for this developmental task. C The infant is expected to be able to perform this task by age 3 months. If the child's age is corrected because of being 2 weeks preterm, the child is at the midpoint of the range for this developmental task. D The child is age-appropriate. No evidence of neurologic dysfunction is present.

You are working as the triage nurse in a pediatric emergency room. You receive a telephone call from the mother of an adolescent whose front tooth was completely knocked out of his mouth while he was playing soccer. The mother is seeking advice. Which is the appropriate response? Select all that apply. a. Rinse the tooth in lukewarm tap water. b. Place the tooth in saline, milk, or water. c. Scrub the tooth with a disinfectant, such as mouth wash. d. Bring the child to the emergency room within the next hour for the best prognosis.

ANS: A, B Feedback Correct Rinse the tooth in lukewarm tap water—this is a correct response. Place the tooth in saline, milk, or water—this is a correct response. Incorrect The tooth should not be scrubbed, and cleaning agents and disinfectants should be avoided. The prognosis is best if the injury is treated within 30 minutes.

Which play patterns does a 3-year-old child typically display? (Choose all that apply.) a. Imaginary play c. Cooperative play b. Parallel play d. Structured play

ANS: A, B, C Correct A, B, C. Children between ages 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Imaginary friends are common around age 3 years. Incorrect D. Structured play is typical of school-age children.

Peer victimization is becoming a significant problem for school-age children and adolescents in the United States. Parents should be educated regarding signs that a child is being bullied. These might include (select all that apply) a. The child spends an inordinate amount of time in the nurse's office. b. Belongings frequently go missing or are damaged. c. The child wants to be driven to school. d. School performance improves. e. The child freely talks about his day.

ANS: A, B, C Feedback Correct Signs that may indicate a child is being bullied are similar to signs of other types of stress and include nonspecific illness or complaints, withdrawal, depression, school refusal, and decreased school performance. Children express fear of going to school or riding the school bus. Very often, children will not talk about what is happening to them. Incorrect These are not indications of bullying.

Which demonstrates the school-age child's developing logic in the stage of concrete operations? Select all that apply. a. The school-age child is able to recognize that 1 lb of feathers is equal to 1 lb of metal. b. The school-age child is able to recognize that he can be a son, brother, or nephew at the same time. c. The school-age child understands the principles of adding, subtracting, and reversibility. d. The school-age child has thinking that is characterized by egocentrism, animism, and centration

ANS: A, B, C Feedback Correct The school-age child understands that the properties of objects do not change when their order, form, or appearance does. Conservation occurs in the concrete operations stage. Comprehension of class inclusion occurs as the school-age child's logic increases. The child begins to understand that a person can be in more than one class at the same time. This is characteristic of concrete thinking and logical reasoning. The school-age child is able to understand principles of adding and subtracting, as well as the process of reversibility, which occurs in the stage of concrete operations. Incorrect This type of thinking occurs in the intuitive thought stage, not the concrete operations stage of development.

While developing a care plan for a school-age child with a visual impairment, the nurse knows that which of the following actions are important in working with this special needs child? Select all that apply. a. Obtain a thorough assessment of the child's self-care abilities. b. Orient the child to various sounds in the environment. c. Mandate that the child's parents stay continuously with their child during hospitalization. d. Allow the child to handle equipment as procedures are explained. e. Encourage the child to use a dry erase board to write his needs.

ANS: A, B, D Feedback Correct These are correct responses that can be used for a school-age child with a visual impairment. Incorrect Mandating that the child's parents stay continuously with their child may not be possible and is not usually necessary if the school-age child is at the expected level of growth and development. Encouraging a child to write his needs on a dry erase board would be an appropriate intervention for a child who is aphonic, not for a child with a visual deficit.

The nurse is assessing parental knowledge of temper tantrums. Which are true statements about temper tantrums? (Choose all that apply.) a. Temper tantrums are a common response to anger and frustration in toddlers. b. Temper tantrums often include screaming, kicking, throwing things, and head banging. c. Parents can effectively manage temper tantrums by giving in to the child's demands. d. Children having temper tantrums should be safely isolated and ignored.

ANS: A, B, D Correct A, B, D. Temper tantrums are a common response to anger and frustration in toddlers. They occur more often when toddlers are tired, hungry, bored, or excessively stimulated. Tantrums may include screaming, kicking, throwing things, biting themselves, or banging their head. Effective management of tantrums includes safely isolating and ignoring the child. Incorrect C. The child should learn that nothing is gained by having a temper tantrum. Giving in to the child's demands only increases the behavior.

The traditional areas of school health nursing that are still prevalent in many school systems include (select all that apply) a. Health screening b. Emergency care c. Intensive care d. Communicable disease management e. Health care advice

ANS: A, B, D, E Feedback Correct Health screening such as vision, hearing, and growth checks can provide information about problems that may affect the child's ability to learn. School nurses are often the first to provide care for children experiencing an unintentional injury, either on the playground or in the school building. The nurse must assess children for illnesses that may be transmitted to other children, provide care and isolation until a parent can pick up the child from school. The school nurse can be a source of referral for families in need of health care services. Incorrect Seriously ill hospitalized children may require intensive care. Another role appropriate for the school nurse is supervision of specialized care for children with chronic health needs. School attendance by these children may include the need for catheterization, gastric tube feedings, and suctioning.

What is an age-appropriate nursing intervention to facilitate psychological adjustment for an adolescent expected to have a prolonged hospitalization? Select all that apply. a. Encourage parents to bring in homework and schedule study times. b. Allow the adolescent to wear street clothes. c. Involve the parents in care. d. Follow home routines. e. Encourage parents to bring in favorite foods.

ANS: A, B, E Feedback Correct These are all developmentally appropriate approaches to facilitate adjustment and coping for an adolescent who will be experiencing prolonged hospitalization. Incorrect Involving parents in care and following home routines are important interventions for the preschool child who is in the hospital. Adolescents do not need parents to assist in their care. They are used to performing independent self-care. Adolescents may want their parents to be nearby, or they may enjoy the freedom and independence from parental control and routines.

The nurse is caring for a child from a Middle Eastern family. Which interventions should the nurse include in planning care? Select all that apply. a. Include the father in the decision making. b. Ask for a dietary consult to maintain religious dietary practices. c. Plan for a male nurse to care for a female patient. d. Ask the housekeeping staff to interpret if needed. e. Allow time for prayer.

ANS: A, B, E The man is typically the head of the household in Muslim families. So the father should be included in all decision making. Muslims do not eat pork and do not use alcohol. Many are vegetarians. The dietitian should be consulted for dietary preferences. Compulsory prayer is practiced several times throughout the day. The family should not be interrupted during prayer, and treatments should not be scheduled during this time. Muslim women often prefer a female health care provider because of laws of modesty; therefore, the female patient should not be assigned a male nurse. A housekeeping staff member should not be asked to interpret. When interpreters are used, they should be of the same country and religion, if possible, because of regional differences and hostilities.

Hearing seems to be relatively acute, even at birth, as shown by reflexive generalized reaction to noise. All newborns should undergo hearing screening at birth, before hospital discharge. In addition, assessment for hearing deficits should take place at every well-baby visit. Risk factors for hearing loss include (select all that apply) a. Structural abnormalities of the ear b. Family history of hearing loss c. Alcohol or drug use by the mother during pregnancy d. Gestational diabetes e. Trauma

ANS: A, B, E Feedback Correct Structural abnormalities of the ear, a family history of hearing loss, and trauma are risk factors for hearing loss. Other risk factors include persistent otitis media and developmental delay. The American Academy of Pediatrics suggests that infants who demonstrate hearing loss be eligible for early intervention and specialized hearing and language services. Incorrect Prenatal alcohol or drug intake and gestational diabetes are not risk factors for hearing loss in the infant.

Motor vehicle injuries are a significant threat to young children. Knowing this, the nurse plans a teaching session with a toddler's parents on car safety. Which will she teach? (Choose all that apply.) a. Secure in a forward-facing, upright, car safety seat. b. Place the car safety seat in the rear seat, behind the driver's seat. c. Harness safety straps should be fit snugly. d. Place the car safety seat in the front passenger seat equipped with an airbag.

ANS: A, C Correct A, C. Toddlers should be secured in a forward-facing, upright, approved car safety seat. Harness straps should be adjusted to provide a snug fit. Incorrect B, D. The car safety seat should be placed in the middle of the rear seat. Children younger than 13 years should not ride in a front passenger seat that is equipped with an air bag.

Trust is important in establishing and maintaining a therapeutic relationship. Maintaining the balance between appropriate involvement and professional separation is quite challenging. Which behaviors may indicate professional separation or underinvolvement? Select all that apply. a. Avoiding the child or his or her family b. Revealing personal information c. Calling in sick d. Spending less time with a particular child e. Asking to trade assignments

ANS: A, C, D, E Feedback Correct Whether nurses become too emotionally involved or find themselves at the other end of the spectrum—being underinvolved—they lose effectiveness as objective professional resources. These are all indications of the nurse who is underinvolved in a child's care. Incorrect Revealing personal information to a patient or his or her family is an indication of overinvolvement.

A nurse has completed a teaching session for parents about "baby-proofing" the home. Which statements made by the parents indicate an understanding of the teaching? Select all that apply. a. "We will put plastic fillers in all electrical plugs." b. "We will place poisonous substances in a high cupboard." c. "We will place a gate at the top and bottom of stairways." d. "We will keep our household hot water heater at 130 degrees." e. "We will remove front knobs from the stove."

ANS: A, C, E Feedback Correct By the time babies reach 6 months of age, they begin to become much more active, curious, and mobile. Putting plastic fillers on all electrical plugs can prevent an electrical shock. Putting gates at the top and bottom of stairways will prevent falls. Removing front knobs form the stove can prevent burns. Incorrect Poisonous substances should be stored in a locked cabinet not in a cabinet that children can reach when they begin to climb. The household hot water heater should be turned down to 120 degrees or less.

Which interventions are appropriate for preventing childhood obesity? Select all that apply. a. Establish consistent times for meals and snacks. b. Eliminate all snacks. Eat three nutritious meals a day. c. Teach the family and child how to select foods and prepare foods. d. Encourage schools to provide snack machines with popcorn, cookies, and diet soda. e. Limit computer and television time.

ANS: A, C, E Feedback Correct Preventing obesity includes encouraging families to establish consistent times for meals and snacks and discouraging between-meal eating. Parents and children also need to be taught how to select and prepare healthful foods. Because snacks are an important aspect in childhood nutrition, nutritious snacks should be identified. School-age children usually require a healthful snack after school and in the evening. A child who spends time with social media has less interest in physical activity and going outdoors. Incorrect Snacks are an important aspect in childhood nutrition. Nutritious snacks should be identified, not eliminated. Healthy snack options include fruit, popcorn, nuts, and yogurt, not cookies and diet soda. In schools with snack machines, children may use their lunch money to purchase high-calorie snacks versus a nutritious lunch.

A preschool age child is being admitted for some diagnostic tests and possible surgery. The nurse planning care should use which phrases when explaining procedures to the child? Select all that apply. a. Fluids will be given through tubing connected to a small tiny tube inserted into your arm. b. After surgery we will be doing dressing changes. c. You will get a shot before surgery. d. The doctor will give you medicine that will help you go into a deep sleep. e. We will take you to surgery on a bed on wheels.

ANS: A, D, E Feedback Correct A preschool child needs simple concrete explanations that cannot be misinterpreted. An IV should be explained as fluids going into a tube connected to a small tube in your hand; anesthesia can be explained as a medicine that will help you go into a deep sleep (put to sleep should be avoided); and a stretcher can be described as riding on a bed with wheels. Incorrect The term "dressing changes" is ambiguous and will not be understood by a preschooler. The term "get a shot" should not be used. A preschooler or young child is likely to misinterpret this information.

1. An emergency department nurse is making a general appearance assessment on a preschool child just admitted to the emergency department. Which general assessment findings indicate the child "looks bad"? Select all that apply. a. Color pale b. Capillary refill less than 2 seconds c. Unwilling to separate from parents d. Cold extremities e. Lethargic

ANS: A, D, E Feedback Correct Signs of a child "looking bad" on a general appearance assessment include pale skin, cold extremities, and lethargy. Incorrect A capillary refill of less than 2 seconds is a "good sign" as well as a child who is unwilling to separate from parents (separation anxiety, expected).

Injuries claim many lives during adolescence. Which factors contribute to early adolescents engaging in risk-taking behaviors? Select all that apply. a. Peer pressure b. A desire to master their environment c. Engagement in the process of separation from their parents d. A belief that they are invulnerable e. Impulsivity

ANS: A, D, E Feedback Correct Peer pressure (including impressing peers) is a factor contributing to adolescent injuries. During early to middle adolescence, children feel that they are exempt from the consequences of risk-taking behaviors; they believe that negative consequences only happen to others. Feelings of invulnerability ("It can't happen to me") are evident in adolescence. Impulsivity places adolescents in unsafe situations. Incorrect Mastering the environment is the task of young school-age children. Emancipation is a major issue for the older adolescent. The process is accomplished as the teenager gains an education or vocational training

Why is observation for 24 hours in an acute-care setting often appropriate for children? a. Longer hospital stays are more costly. b. Children become ill quickly and recover quickly. c. Children feel less separation anxiety when hospitalized for 24 hours. d. Families experience less disruption during short hospital stays.

ANS: B Feedback A A child's state of wellness, rather than cost, determines the length of stay. B Children become ill quickly and recover quickly; therefore they can require acute care for a shorter period of time. C Separation anxiety is primarily a factor of the stage of development, not the length of hospital stay. D Family disruption is a secondary outcome of a child's hospitalization; it does not determine length of stay.

In which age-group does the child's active imagination during unfamiliar experiences increase the stress of hospitalization? a. Toddlers b. Preschoolers c. School-age children d. Adolescents

ANS: B Feedback A A toddler's primary response to hospitalization is separation anxiety. B Active imagination is a primary characteristic of preschoolers. C School-age children experience stress with loss of control. D Adolescents experience stress from separation from their peers.

Which situation poses the greatest challenge to the nurse working with a child and family? a. Twenty-four-hour observation b. Emergency hospitalization c. Outpatient admission d. Rehabilitation admission

ANS: B Feedback A Although preparation time may be limited with a 24-hour observation, this situation does not usually involve the acuteness of the situation and the high levels of anxiety associated with emergency admission. B Emergency hospitalization involves (1) limited time for preparation both for the child and family, (2) situations that cause fear for the family that the child may die or be permanently disabled, and (3) a high level of activity, which can foster further anxiety. C Outpatient admission generally involves preparation time for the family and child. Because of the lower level of acuteness in these settings, anxiety levels are not as high. D Rehabilitation admission follows a serious illness or disease. This type of unit may resemble a home environment, which decreases the child's and family's anxiety.

The nurse inspecting the skin of a dark-skinned child notices an area that is a dusky red or violet color. This skin coloration is associated with what? a. Cyanosis b. Erythema c. Vitiligo d. Nevi

ANS: B Feedback A Cyanosis in a dark-skinned child appears as a black coloration of the skin. B In dark-skinned children, erythema appears as dusky red or violet skin coloration. C Vitiligo refers to areas of depigmentation. D Nevi are areas of increased pigmentation.

Kimberly is having a checkup before starting kindergarten. The nurse asks her to do the "finger-to-nose" test. The nurse is testing for a. Deep tendon reflexes b. Cerebellar function c. Sensory discrimination d. Ability to follow directions

ANS: B Feedback A Each deep tendon reflex is tested separately. B The finger-to-nose-test is an indication of cerebellar function. This test checks balance and coordination. C Each sense is tested separately. D Although this test enables the nurse to evaluate the child's ability to follow directions, it is used primarily for cerebellar function.

Which information should the nurse include when preparing a 5-year-old child for a cardiac catheterization? a. A detailed explanation of the procedure b. A description of what the child will feel and see during procedure c. An explanation about the dye that will go directly into his vein d. An assurance to the child that he and the nurse can talk about the procedure when it is over

ANS: B Feedback A Explaining the procedure in detail is probably more than the 5-year-old child can comprehend, and it will likely produce anxiety. B For a preschooler, the provision of sensory information about what to expect during the procedure will enhance the child's ability to cope with the events of the procedure and will decrease anxiety. C Using the word "dye" with a preschooler can be frightening for the child. D The child needs information before the procedure.

What is the most appropriate response for the nurse to make to the parent of a 3-year-old child found in a bed with the side rails down? a. "You must never leave the child in the room alone with the side rails down." b. "I am very concerned about your child's safety when you leave the side rails down. The hospital has guidelines stating that side rails need to be up if the child is in the bed." c. "It is hospital policy that side rails need to be up if the child is in bed." d. "When parents leave side rails down, they might be considered as uncaring."

ANS: B Feedback A Framing the communication in the negative does not facilitate effective communication. B To express concern and then choose words that convey a policy is appropriate. C Stating a policy to parents conveys the attitude that the hospital has authority over parents in matters concerning their children and may be perceived negatively. D This statement conveys blame and judgment to the parent.

Based on concepts related to the normal growth and development of children, which child would have the most difficulty with separation from family during hospitalization? a. A 5-month-old infant b. A 15-month-old toddler c. A 4-year-old child d. A 7-year-old child

ANS: B Feedback A Infants younger than 6 months of age will generally adapt to hospitalization if their basic needs for food, warmth, and comfort are met. B Separation is the major stressor for children hospitalized between ages 6 and 30 months. C Although separation anxiety occurs in hospitalized preschoolers, it is usually less obvious and less serious than that experienced by the toddler. D The school-age child is accustomed to separation from parents. Although hospitalization is a stressor, the 7-year-old child will have less separation anxiety than a 15-month-old toddler.

An important consideration for the nurse who is communicating with a very young child is to a. Speak loudly, clearly, and directly. b. Use transition objects, such as a puppet. c. Disguise own feelings, attitudes, and anxiety. d. Initiate contact with child when parent is not present.

ANS: B Feedback A Speaking in this manner will tend to increase anxiety in very young children. B Using a transition object, such as a puppet or doll, allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This will facilitate communication with a child of this age. C The nurse must be honest with the child. Attempts at deception will lead to a lack of trust. D Whenever possible, the parent should be present for interactions with young children.

Which tool measures body fat most accurately? a. Stadiometer b. Calipers c. Cloth tape measure d. Paper or metal tape measure

ANS: B Feedback A Stadiometers are used to measure height. B Calipers are used to measure skin-fold thickness, which is an indicator of body fat content. C Cloth tape measures should not be used because they can stretch. D Paper or metal tape measures can be used for recumbent lengths and other body measurements that must be made.

Which chart should the nurse use to assess the visual acuity of an 8-year-old child? a. Lea chart b. Snellen chart c. HOTV chart d. Tumbling E chart

ANS: B Feedback A The Lea chart tests vision using four different symbols designed for use with preschool children. B The Snellen chart is used to assess the vision of children older than 6 years of age. C The HOTV chart tests vision by using graduated letters and is designed for use with children ages 3 to 6 years. D The tumbling E chart uses the letter E in various directions and is designed for use with children ages 3 to 6 years.

A preschool-aged child tells the nurse "I was bad, that's why I got sick." What is the best rationale for this child's statement? a. The child has a fear that mutilation will lead to death. b. The child's imagination is very active, and he may believe the illness is a result of something he did. c. The child has a general understanding of body integrity at this age. d. The child will not have fear related to an IV catheter initiation but will have fear of an impending surgery.

ANS: B Feedback A The child has imaginative thoughts at this stage of growth and development. B The child may believe that an illness occurred as a result of some personal deed or thought or perhaps because he touched something or someone. C Preschoolers do not have the cognitive ability to connect mutilation to death and do not have a sound understanding of body integrity. D The preschooler fears all types of intrusive procedures whether undergoing a simple procedure such as an IV start or something more invasive such as surgery.

Which strategy is the best approach when initiating the physical examination of a 9-month-old male infant? a. Undress the infant and do a head-to-toe examination. b. Have the parent hold the child on his or her lap. c. Put the infant on the examination table and begin assessments at the head. d. Ask the parent to leave because the infant will be upset.

ANS: B Feedback A The head-to-toe approach needs to be modified for the infant. Uncomfortable procedures, such as the otoscopic examination, should be left until last. B Infants 6 months and older feel stranger anxiety. It is easier to do most of the examination on the parent's lap to lessen anxiety. C The infant may feel less fearful if placed in the parent's lap or with the parent within visual range if placed on the examining table. The head-to-toe approach is modified for the infant. D There is no reason to ask a parent to leave when an infant is being examined. Having the parent with the infant will make the experience less upsetting for the infant.

Which strategy is not always appropriate for pediatric physical examination? a. Take the history in a quiet, private place. b. Examine the child from head to toe. c. Exhibit sensitivity to cultural needs and differences. d. Perform frightening procedures last.

ANS: B Feedback A The nurse should collect the child's health history in a quiet, private area. B The classic approach to physical examination is to begin at the head and proceed through the entire body to the toes. When examining a child, however, the examiner must tailor the physical assessment to the child's age and developmental level. C The nurse should always be sensitive to cultural needs and differences among children. D When examining children, painful or frightening procedures should be left to the end of the examination.

Which assessment finding is considered a neurologic soft sign in a 7-year-old child? a. Plantar reflex b. Poor muscle coordination c. Stereognostic function d. Graphesthesia

ANS: B Feedback A The plantar reflex is a normal response. When the lateral aspect of the sole of the foot is stroked in a movement curving medially from the heel to the ball, the response will be plantar flexion of the toes. B Poor muscle coordination is a neurologic soft sign. C Stereognostic function refers to the ability to identify familiar objects placed in each hand. D Graphesthesia is the ability to identify letters or numbers traced on the palm or back of the hand with a blunt point.

Which question most likely elicits information about how a family is coping with a child's hospitalization? a. "Was this admission an emergency?" b. "How has your child's hospitalization affected your family?" c. "Who is taking care of your other children while you are here?" d. "Is this the child's first hospitalization?"

ANS: B Feedback A This is a closed-ended question. The nurse needs to ask other questions to gather additional information. B Open-ended questions encourage communication. Ensuring a positive outcome from the hospital experience can be optimized by the nurse addressing the health needs of family members, as well as the needs of the child. C This is a closed-ended question. The parent answers the question with a short response. The nurse must ask additional questions to learn more about the family. D The parent would answer "yes" or "no" to this question and expect the conversation to be over. The nurse must ask additional questions to learn more about the family.

The nurse is assessing a 4-year-old child's visual acuity. He is planning to attend preschool next week. The results indicate a visual acuity of 20/40 in both eyes. The child's father asks the nurse about his son's results. Which response, if made by the nurse, is correct? a. "Your child will need a referral to the ophthalmologist before he can attend preschool next week." b. "Your child's visual acuity is normal for his age." c. "The results of this test indicate your child may be color blind." d. "Your child did not pass the screening test. He will need to return within the next few weeks to be reevaluated."

ANS: B Feedback A This is within the normal range for visual acuity at 4 years of age. The 4-year-old's acuity is usually 20/30 to 20/40. There is no need for evaluation by an ophthalmologist at this time. B This is the correct response. C The child's visual acuity is within normal range for his age. Color vision is evaluated by different methods than visual acuity. D This is within the normal range for visual acuity at 4 years of age. The 4-year-old's acuity is usually 20/30 to 20/40. There is no need for further evaluation at this time.

1. Which nursing action facilitates care being provided to a child in an emergency situation? a. Encourage the family to remain in the waiting room. b. Include parents as partners in providing care for the child. c. Always reassure the child and family. d. Give explanations using professional terminology.

ANS: B Feedback A Allowing the parents to remain with the child may help calm the child. B Include parents as partners in the child's treatments. Parents may need direct guidance in concrete terms to help distract the child. C Telling the truth is the most important thing. False reassurance does not facilitate a trusting relationship. D Professional terminology may not be understood. Speak to the child and family in language that they will understand.

8. A preschool child in the emergency department has a respiratory rate of 10 breaths per minute. How should the nurse interpret this finding? a. The child is relaxed. b. Respiratory failure is likely. c. This child is in respiratory distress. d. The child's condition is improving.

ANS: B Feedback A Although the respiratory rate slows when an individual is relaxed, a rate of 10 breaths per minute in an ill preschool child is not a normal finding and is cause for concern. B Very slow breathing in an ill child is an ominous sign, indicating respiratory failure. C A rapid respiratory rate indicates respiratory distress. Other signs of respiratory distress may include retractions, grunting, and nasal flaring. D A respiratory rate of 10 breaths per minute is not a normal finding for a preschool child. This conclusion is incorrect.

11. You are the nurse caring for a child who is diagnosed with septic shock. He begins to develop an dysrhythmia and hemodynamic instability. Endotracheal intubation is necessary. The physician feels that cardiac arrest may soon develop. What drug do you anticipate the physician will order? a. Atropine sulfate b. Epinephrine c. Sodium bicarbonate d. Inotropic agents

ANS: B Feedback A Atropine sulfate is used to treat symptomatic bradycardia. B Epinephrine is the drug of choice for the management of cardiac arrest, dysrhythmias, and hemodynamic instability. C Sodium bicarbonate is given to treat severe acidosis associated with cardiac arrest. D Inotropic agents are indicated for hypotension or poor peripheral circulation in a child.

17. Assessment of a child with a submersion injury focuses on which system? a. Cardiovascular b. Respiratory c. Neurologic d. Gastrointestinal

ANS: B Feedback A Cardiovascular assessment is secondary to the airway and breathing. B Assessment of the child with a submersion injury focuses on the respiratory system. The airway and breathing are the priorities. C Preventing neurologic impairment is a goal of intervention. Because the primary problem in submersion injuries is hypoxia, the focus of assessment is the respiratory system. D Gastrointestinal assessment is less of a priority than assessment of other body systems.

24. What condition does the nurse recognize as an early sign of distributive shock? a. Hypotension b. Skin warm and flushed c. Oliguria d. Cold, clammy skin

ANS: B Feedback A Hypotension is a late sign of all types of shock. B An early sign of distributive shock is extremities that are warm to the touch. The child with distributive shock may have hypothermia or hyperthermia. C Oliguria is a manifestation of hypovolemic shock. D Cold, clammy skin is a late sign of septic shock, which is a type of distributive shock.

4. Which action should the nurse working in the emergency department implement in order to decrease fear in a 2-year-old child? a. Keep the child physically restrained during nursing care. b. Allow the child to hold a favorite toy or blanket. c. Direct the parents to remain outside the treatment room. d. Let the child decide whether to sit up or lie down for procedures.

ANS: B Feedback A It may be necessary to restrain the toddler for some nursing care or procedures. Because toddlers need autonomy and do not respond well to restrictions, the nurse should remove any restriction or restraint as soon as safety permits. B Allowing a child to hold a favorite toy or blanket is comforting. C Parents should remain with the child as much as possible to calm and reassure her. D The toddler should not be given the overwhelming choice of deciding which position she prefers.

19. Which observations made by an emergency department nurse raises the suspicion that a 3-year-old child has been maltreated? a. The parents are extremely calm in the emergency department. b. The injury is unusual for a child of that age. c. The child does not remember how he got hurt. d. The child was doing something unsafe when the injury occurred.

ANS: B Feedback A The nurse should observe the parents' reaction to the child but must keep in mind that people behave very differently depending on culture, ethnicity, experience, and psychological makeup. B An injury that is rarely found in children or is inconsistent with the age and condition of the child should raise suspicion of child maltreatment. C The child may not remember what happened as a result of the injury itself, for example, sustaining a concussion. Also, a 3-year-old child may not be a reliable historian. D The fact that the child was not supervised might be an area for health teaching. The nurse needs to gather more information to determine whether the parents have been negligent in the care of their child.

15. How should the nurse instruct the mother who calls the emergency department because her 9-year-old child has just fallen on his face and one of his front teeth fell out? a. Put the tooth back in the child's mouth and call the dentist right away. b. Place the tooth in milk or water and go directly to the emergency department. c. Gently place the tooth in a plastic zippered bag until she makes a dental appointment. d. Clean the tooth and call the dentist for an immediate appointment.

ANS: B Feedback A The parent may replace the tooth incorrectly, so it is best not to advise the parent to do this. B The parent should be told to keep the tooth moist by placing it in a saline solution, water, milk, or a commercial tooth-preserving solution and get the child evaluated as soon as possible. C The tooth should be kept moist, not dry. The child should be evaluated as soon as possible. D Cleaning or scrubbing the tooth could damage it. It is essential for the child to have an immediate dental evaluation.

A pictorial tool that can assist the nurse in assessing aspects of family life related to health care is the a. Genogram b. Ecomap c. Life cycle model d. Human development wheel

ANS: B A A genogram (also known as a pedigree) is a diagram that depicts the relationships of family members over generations. B An ecomap is a pictorial representation of the family structures and their relationships with the external environment. C The life cycle model in no way illustrates a family genogram. This model focuses on stages that a person reaches throughout his or her life. D The human development wheel describes various stages of growth and development rather than a family's relationships to each other.

A nurse observes that parents discuss rules with their children when the children do not agree with the rules. Which style of parenting is being displayed? a. Authoritarian b. Authoritative c. Permissive d. Disciplinarian

ANS: B A A parent who expects children to follow rules without questioning is using an authoritarian parenting style. B A parent who discusses the rules with which children do not agree is using an authoritative parenting style. C A parent who does not consistently enforce rules and allows the child to decide whether he or she wishes to follow rules is using a permissive parenting style. D A disciplinarian style would be similar to the authoritarian style.

In caring for a 4-year-old child with a diagnosis of suspected child abuse, which is the best nursing intervention? a. Avoid touching the child. b. Provide the child with play situations that allow for disclosure. c. Discourage the child from remembering the incident. d. Deny the suspected perpetrator visiting rights to the child.

ANS: B A All children need to be touched. What is important is to tell the child in simple, clear terms what you are doing and why you are doing it. Nurses have the opportunity to teach children the normal, healthy boundaries of their bodies and what constitutes inappropriate behavior. B Play allows the child to disclose what happened to him or her without having to talk about the incident. Symbolic play is important for emotional development and it allows the child to work through distressing feelings. C If the child chooses to remember what happened, it is inappropriate to discourage it. It is important to listen to the child in a nonjudgmental way, allowing the child to discuss what happened, to make statements, or to ask questions. D It is not the nurse's role or responsibility to restrict visitors unless child safety is an issue. The child may be negatively affected if a caregiver, who may be the abuser, does not visit.

Which statement best identifies the characteristics of language development in a toddler? a. Language development skills slow during the toddler period. b. The toddler understands more than he can express. c. Most of the toddler's speech is not easily understood. d. The toddler's vocabulary contains approximately 600 words.

ANS: B A Although language development varies in relationship to physical activity, language skills are rapidly accelerating by 15 to 24 months of age. B The toddler's ability to understand language (receptive language) exceeds the child's ability to speak it (expressive language). C By 2 years of age, 60% to 70% of the toddler's speech is understandable. D The toddler's vocabulary contains approximately 300 or more words.

Which family will most likely have the most difficulty coping with an ill child? a. A single-parent mother who has the support of her parents and siblings b. Parents who have just moved to the area and are living in an apartment while they look for a house c. The family of a child who has had multiple hospitalizations related to asthma and has adequate relationships with the nursing staff d. A family in which there is a young child and four older married children who live in the area

ANS: B A Although only one parent is available, she has the support of her extended family, which will assist her in adjusting to the crisis. B Parents in a new environment will have increased stress related to their lack of a support system. They have no previous experiences in the setting from which to draw confidence. C Because this family has had positive experiences in the past, family members can draw from those experiences and feel confident about the setting. D This family has an extensive support system that will assist the parents in adjusting to the crisis.

What characteristic would most likely be found in a Mexican-American family? a. Stoicism b. Close extended family c. Considering docile children weak d. Very interested in health-promoting lifestyles

ANS: B A Although stoicism may be present in any family, Mexican-American families tend to be more expressive. B Most Mexican-American families are very close, and it is not unusual for children to be surrounded by parents, siblings, grandparents, and godparents. It is important to respect this cultural characteristic and to see it as a strength, not a weakness. C Considering docile children weak is a characteristic of Native Americans. D Although everyone tends now to embrace more health-promoting lifestyles, they are more prominent in Anglo-Americans.

Which statement, made by a 4-year-old child's father, is true about the care of the preschooler's teeth? a. "Because the 'baby teeth' are not permanent, they are not important to the child." b. "My son can be encouraged to brush his teeth after I have thoroughly cleaned his teeth." c. "My son's 'permanent teeth' will begin to come in at 4 to 5 years of age." d. "Fluoride supplements can be discontinued when my son's 'permanent teeth' erupt."

ANS: B A Deciduous teeth are important because they maintain spacing and play an important role in the growth and development of the jaws and face and in speech development. B Toddlers and preschoolers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility. C Secondary teeth erupt at about 6 years of age. D If the family does not live in an area where fluoride is included in the water supply, fluoride supplements should be continued.

More than 100 different ethno-cultural groups reside within the United States, and numerous traditional health beliefs are observed among these groups. Traditional beliefs related to the maintenance of health are likely to include a. Avoidance of natural events such as a solar eclipse b. Practicing silence, meditation, and prayer c. Protection of the soul by avoiding envy or jealousy d. Understanding that a hex, spell, or the evil eye may cause illness or injury

ANS: B A Illness can be prevented by avoiding natural events such as a solar eclipse along with environmental factors such as bad air. B Mental and spiritual health is maintained by activities such as silence, meditation, and prayer. Many people view illness as punishment for breaking their religious code and adhere strictly to morals and religious practices to maintain health. C Phenomena such as accidental provocation of envy, jealousy, or hate of a friend or acquaintance may cause illness. D Agent such as hexes, spells, and the evil eye may strike a person (often a child) and causes injury, illness, or misfortunate.

Which statement by a mother of a toddler indicates a correct understanding of the use of discipline? a. "I always include explanations and morals when I am disciplining my toddler." b. "I always try to be consistent when disciplining the children, and I correct my children at the time they are misbehaving." c. "I believe that discipline should only be done by one family member." d. "My rule of thumb is no more than one spanking a day."

ANS: B A The toddler's cognitive level of development precludes the use of explanations and morals as a part of discipline. B Consistent and immediate discipline for toddlers is the most effective approach. Unless disciplined immediately, the toddler will have difficulty connecting the discipline with the behavior. C Discipline for the toddler should be immediate; therefore the family member caring for the child should provide discipline to the toddler when it is necessary. D Discipline is required for unacceptable behavior, and the one-spanking-a-day rule contradicts the concept of a consistent response to inappropriate behavior. Additionally, spanking is an inappropriate method of disciplining a child.

The mother of a 14-month-old child is concerned because the child's appetite has decreased. The best response for the nurse to make to the mother is: a. "It is important for your toddler to eat three meals a day and nothing in between." b. "It is not unusual for toddlers to eat less." c. "Be sure to increase your child's milk consumption, which will improve nutrition." d. "Giving your child a multivitamin supplement daily will increase your toddler's appetite."

ANS: B A Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age-group. B Physiologically, growth slows and appetite decreases during the toddler period. C Milk consumption should not exceed 16 to 24 oz daily. Juice should be limited to 4 to 6 oz per day. Increasing the amount of milk will only further decrease solid food intake. D Supplemental vitamins are important for all children, but they do not increase appetite.

A mother asks when toilet training is most appropriately initiated. What would be the nurse's best response? a. "When your child is 12 to 18 months of age." b. "When your child exhibits signs of physical and psychological readiness." c. "When your child has been walking for 9 months." d. "When your child is able to sit on the 'potty' for 10 to 15 minutes."

ANS: B A Toilet training is not arbitrarily started at 12 to 18 months of age. The child needs to demonstrate signs of bowel or bladder control before attempting toilet training. The average toddler is not ready until 18 to 24 months of age. Waiting until 24 to 30 months of age makes the task easier; toddlers are less negative, more willing to control their sphincters, and want to please their parents. B Neurologic development is completed at approximately 18 months of age. Parents need to know that both physical and psychological readiness are necessary for toilet training to be successful. C One of the physical signs of readiness for toilet training is that the child has been walking for 1 year. D The ability to sit on the "potty" for 10 to 15 minutes may demonstrate parental control rather than being a sign of developmental readiness for toilet training.

A mother of a 2-month-old infant tells the nurse, "My child doesn't sleep as much as his older brother did at the same age." What is the best response for the nurse? a. "Have you tried to feed the baby more often?" b. "Infant sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time." c. "It is helpful to keep a record of your baby's eating, waking, sleeping, and elimination patterns and to come back in a week to discuss them." d. "This infant is difficult. It is important for you to identify what is bothering the baby."

ANS: B Feedback A Infants typically do not need more caloric intake to improve sleep behaviors. B Newborn infants may sleep as much as 17 to 20 hours per day. Sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time. C Keeping intake, output, waking, and sleeping data is not typically helpful to discuss differences among infants' behaviors. D Just because an infant may not sleep as much as a sibling did does not justify labeling the child as being difficult. Identifying an infant as difficult without identifying helpful actions is not a therapeutic response for a parent concerned about sleep.

The mother of a 10-month-old infant tells the nurse that her infant "really likes cow's milk." What is the nurse's best response to this mother? a. "Milk is good for him." b. "It is best to wait until he is a year old before giving him cow's milk." c. "Limit cow's milk to his bedtime bottle." d. "Mix his cereal with cow's milk and give him formula in a bottle."

ANS: B Feedback A Although milk is a good source of calcium and protein for children after the first year of life, it is not the best source of nutrients for children younger than 1 year old. B It is best to wait until the infant is at least 1 year old before giving him cow's milk because of the risk of allergies and intestinal problems. Cow's milk protein intolerance is the most common food allergy during infancy. C Bedtime bottles of formula or milk are contraindicated because of their high sugar content, which leads to dental decay in primary teeth. D Cereal can be mixed with formula.

An important consideration for the school nurse who is planning a class on bicycle safety is a. Most bicycle injuries involve collision with an automobile. b. Head injuries are the major causes of bicycle-related fatalities. c. Children should wear bicycle helmets if they ride on paved streets. d. Children should not ride double unless the bicycle has an extra-large seat.

ANS: B Feedback A Although motor vehicle collisions do cause injuries to bicyclists, most injuries result from falls. 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. C The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission. D Children should not ride double.

Approximately how much would a newborn who weighed 7 pounds 6 ounces at birth weigh at 1 year of age? a. 14 3/4 lb b. 22 1/8 lb c. 29 1/2 lb d. Unable to estimate weigh at 1 year

ANS: B Feedback A An infant doubles birth weight by 6 months of age. B An infant triples birth weight by 1 year of age. C An infant quadruples birth weight by 2 years of age. D Weight at 6 months, 1 year, and 2 years of age can be estimated from the birth weight.

Which statement made by a mother is consistent with a developmental delay? a. "I have noticed that my 9-month-old infant responds consistently to the sound of his name." b. "I have noticed that my 12-month-old child does not get herself to a sitting position or pull to stand." c. "I am so happy when my 1 1/2-month-old infant smiles at me." d. "My 5-month-old infant is not rolling over in both directions yet."

ANS: B Feedback A An infant who responds to his name at 9 months of age is demonstrating abilities to both hear and interpret sound. B Critical developmental milestones for gross motor development in a 12-month-old include standing briefly without support, getting to a sitting position, and pulling to stand. If a 12-month-old child does not perform these activities, it may be indicative of a developmental delay. C A social smile is present by 2 months of age. D Rolling over in both directions is not a critical milestone for gross motor development until the child reaches 6 months of age.

Which behavior by parents or teachers will best assist the child in negotiating the developmental task of industry? a. Identifying failures immediately and asking the child's peers for feedback b. Structuring the environment so that the child can master tasks c. Completing homework for children who are having difficulty in completing assignments d. Decreasing expectations to eliminate potential failures

ANS: B Feedback A Asking peers for feedback reinforces the child's feelings of failure. B The task of the caring teacher or parent is to identify areas in which a child is competent and to build on successful experiences to foster feelings of mastery and success. Structuring the environment to enhance self-confidence and to provide the opportunity to solve increasingly more complex problems will promote a sense of mastery. C When teachers or parents complete children's homework for them, it sends the message that you do not trust them to do a good job. Providing assistance and suggestions and praising their best efforts are more appropriate. D Decreasing expectations to eliminate failures will not promote a sense of achievement or mastery.

Which statement by a mother indicates that her 5-month-old infant is ready for solid food? a. "When I give my baby solid foods, she has difficulty getting it to the back of her throat to swallow." b. "She has just started to sit up without any support." c. "I am surprised that she weighs only 11 pounds. I expected her to have gained some weight." d. "I find that she really has to be encouraged to eat."

ANS: B Feedback A Children who are ready to manage solid foods are able to move food to the back of their throats to swallow. This child's extrusion reflex may still be present. B Sitting is a sign that the child is ready to begin with solid foods. C Infants who weigh less than 13 pounds and demonstrate a lack of interest in eating are not ready to be started on solid foods. D Infants who are difficult feeders and do not demonstrate an interest in solid foods are not ready to be started on them.

A 17-year-old tells the nurse that he is not having sex because it would make his parents very angry. This response indicates that the adolescent has a developmental lag in which area? a. Cognitive development b. Moral development c. Psychosocial development d. Psychosexual development

ANS: B Feedback A Cognitive development is related to moral development, but it is not the pivotal point in determining right and wrong behaviors. B The appropriate moral development for a 17-year-old would include evidence that the teenager has internalized a value system and does not depend on parents to determine right and wrong behaviors. Adolescents who remain concrete thinkers may never advance beyond conformity to please others and avoid punishment. C Identity formation is the psychosocial development task. Energy is focused within the adolescent, who exhibits behavior that is self-absorbed and egocentric. D Although a task during adolescence is the development of a sexual identity, the teenager's dependence on the parents' sanctioning of right or wrong behavior is more appropriately related to moral development.

Which is assessed with Tanner staging? a. Hormone levels b. Secondary sex characteristics c. Response to growth hormone secretion tests d. Hyperthyroidism

ANS: B Feedback A Hormone levels are assessed by their concentration in the blood. B Tanner stages are used to assess staging of secondary sex characteristics at puberty. C Growth hormone secretion tests are not associated with Tanner staging. D Tanner stages are not associated with hyperthyroidism.

According to Erikson, the psychosocial task of adolescence is to develop a. Intimacy b. Identity c. Initiative d. Independence

ANS: B Feedback A Intimacy is the developmental stage for early adulthood. B Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. C Initiative is the developmental stage for early childhood. D Independence is not one of Erikson's developmental stages.

Which expected outcome is developmentally appropriate for a hospitalized 4-year-old child? a. The child will be dressed and fed by the parents. b. The child will independently ask for play materials or other personal needs. c. The child will be able to verbalize an understanding of the reason for the hospitalization. d. The child will have a parent stay in the room at all times.

ANS: B Feedback A Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. B Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrates developmental appropriateness. C A 4-year-old child cannot be expected to cognitively understand the reason for hospitalization. Expecting the child to verbalize an understanding for hospitalization is an inappropriate outcome. D Parents staying with the child throughout a hospitalization is an inappropriate outcome. Although children benefit from parental involvement, parents may not have the support structure to stay in the room with the child at all times.

What predisposes the adolescent to feel an increased need for sleep? a. An inadequate diet b. Rapid physical growth c. Decreased activity that contributes to a feeling of fatigue d. The lack of ambition typical of this age-group

ANS: B Feedback A Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contributes to fatigue. B During growth spurts, the need for sleep is increased. C Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contributes to fatigue. D Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contributes to fatigue.

Which statement is the most appropriate advice to give parents of a 16-year-old who is rebellious? a. "You need to be stricter so that your teen stops trying to test the limits." b. "You need to collaborate with your daughter and set limits that are perceived as being reasonable." c. "Increasing your teen's involvement with her peers will improve her self-esteem." d. "Allow your teenager to choose the type of discipline that is used in your home."

ANS: B Feedback A Setting stricter limits typically does not decrease rebelliousness or decrease testing of parental limits. B Allowing teenagers to choose between realistic options and offering consistent and structured discipline typically enhances cooperation and decreases rebelliousness. Structure helps adolescents to feel more secure and assists them in the decision-making process. C Increasing peer involvement does not typically increase self-esteem. D Allowing teenagers to choose the method of discipline is not realistic and typically does not reduce rebelliousness.

Many adolescents decide to follow a vegetarian diet during their teen years. The nurse can advise the adolescent and his or her parents that a. This diet will not meet the nutritional requirements of growing teens. b. A vegetarian diet is healthy for this population. c. An adolescent on a vegetarian diet is less likely to eat high-fat or low-nutrient foods. d. A vegetarian diet requires little extra meal planning.

ANS: B Feedback A Several dietary organizations have suggested that a vegetarian diet, if correctly followed, is healthy for this population. B A vegetarian diet is healthy for this population, and the low-fat aspect of the diet can prevent future cardiovascular problems. C As with any adolescent, nurses need to advise teens who follow a vegetarian eating plan to avoid low-nutrient, high-fat foods. D The nurse can assist with planning food choices that will provide sufficient calories and necessary nutrients. The focus is on obtaining enough calories for growth and energy from a variety of fruits and vegetables, whole grains, nuts, and soymilk.

A preschool aged child will be receiving immunizations. Which statement identifies an appropriate level of language development for a 4-year-old child? a. The child has a vocabulary of 300 words and uses simple sentences. b. The child uses correct grammar in sentences. c. The child is able to pronounce consonants clearly. d. The child uses language to express abstract thought.

ANS: B Feedback A Simple sentences and a 300-word vocabulary are appropriate for a 2-year-old child. B The 4-year-old child is able to use correct grammar in sentence structure. C The 4-year-old child typically has difficulty in pronouncing consonants. D The use of language to express abstract thought is developmentally appropriate for the adolescent

A nurse is assessing an older school-age child recently admitted to the hospital. Which assessment indicates that the child is in an appropriate stage of cognitive development? a. The child's addition and subtraction ability b. The child's ability to classify c. The child's vocabulary d. The child's play activity

ANS: B Feedback A Subtraction and addition are appropriate cognitive activities for the young school-age child. B The ability to classify things from simple to complex and the ability to identify differences and similarities are cognitive skills of the older school-age child; this demonstrates use of classification and logical thought processes. C Vocabulary is not as valid an assessment of cognitive ability as is the child's ability to classify. D Play activity is not as valid an assessment of cognitive function as is the child's ability to classify.

Which developmental assessment instrument is appropriate to assess a 5-year-old child? a. Brazelton Behavioral Scale b. Denver Developmental Screening Test II (DDST-II) c. Dubowitz Scale d. New Ballard Scale

ANS: B Feedback A The Brazelton Behavioral Scale is used for newborn assessment. B The DDST-II is used for infants and children between birth and 6 years of age. C The Dubowitz Scale is used for estimation of gestational age. D The New Ballard Scale is used for newborn screening.

Which is the preferred site for administration of the Hib vaccine to an infant? a. Deltoid b. Anterolateral thigh c. Upper, outer aspect of the arm d. Dorsal gluteal region

ANS: B Feedback A The deltoid muscle is not used for infants. B The anterolateral thigh is the preferred site for intramuscular administration of vaccines for infants. C Subcutaneous injections can be given in the upper arm. The HIB vaccine is given by the intramuscular route. D The dorsal gluteal site is never used for vaccines.

Which behavior suggests appropriate psychosocial development in the adolescent? a. The adolescent seeks validation for socially acceptable behavior from older adults. b. The adolescent is self-absorbed and self-centered and has sudden mood swings. c. Adolescents move from peers and enjoy spending time with family members. d. Conformity with the peer group increases in late adolescence.

ANS: B Feedback A The peer group validates acceptable behavior during adolescence. B During adolescence, energy is focused within. Adolescents concentrate on themselves in an effort to determine who they are or who they will be. Adolescents are likely to be impulsive and impatient. Parents often describe their teenager as being "self-centered or lazy." C Adolescents move from family and enjoy spending time with peers. Adolescents also spend time alone; they need this time to think and concentrate on themselves. D Conformity becomes less important in late adolescence.

Which is an appropriate disciplinary intervention for the school-age child? a. Using time-out periods b. Using a consequence that is consistent with the inappropriate behavior c. Using physical punishment d. Using lengthy dialog about inappropriate behavior

ANS: B Feedback A Time-out periods are more appropriate for younger children. B A consequence that is related to the inappropriate behavior is the recommended discipline. C Physical intervention is an inappropriate form of discipline. It does not connect the discipline with the child's inappropriate behavior. D Lengthy discussions typically are not helpful.

Which child is most likely to be frightened by hospitalization? a. A 4-month-old infant admitted with a diagnosis of bronchiolitis b. A 2-year-old toddler admitted for cystic fibrosis c. A 9-year-old child hospitalized with a fractured femur d. A 15-year-old adolescent admitted for abdominal pain

ANS: B Feedback A Young infants are not as likely to be as frightened as toddlers by hospitalization because they are not as aware of the environment. B Toddlers are most likely to be frightened by hospitalization because their thought processes are egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange environments. C The 9-year-old child's cognitive ability is sufficient enough for the child to understand the reason for hospitalization. D The 15-year-old adolescent has the cognitive ability to interpret the reason for hospitalization.

2. What may cause hypovolemic shock in children? Select all that apply. a. Hyperthermia b. Burns c. Vomiting or diarrhea d. Hemorrhage e. Skin abscess that cultures positive for methicillin-resistant Staphylococcus aureus (MRSA)

ANS: B, C, D Feedback Correct These are all causes of hypovolemic shock, which is characterized by an overall decrease in circulating blood or fluid volumes. Incorrect Neither of these is a cause of hypovolemic shock.

The consequences technique will assist children to learn the direct result of their behavior. This technique can be used with children from toddler age to adolescence. If children learn to understand consequences, they are less likely to repeat the offending behavior. Consequences fall into which categories? Select all that apply. a. Corporal b. Natural c. Logical d. Unrelated e. Behavioral

ANS: B, C, D Natural consequences are those that occur spontaneously. For example, a child leaves a toy outside and it is lost. Logical consequences are those that are directly related to the misbehavior. If two children are fighting over a toy, the toy is removed and neither child has it. Unrelated consequences are purposely imposed; for example, the child is late for dinner so he or she is not allowed to watch television. Corporal punishment is not part of this behavioral approach and usually takes the approach of spanking the child. Corporal punishment is highly controversial and is strongly discouraged by the American Academy of Pediatrics. Behavior modification is another disciplinary technique that rewards positive behavior and ignores negative behavior.

Tattoos have become increasingly popular among mainstream adolescents. Like clothing and hairstyles, tattoos serve to define one's identity. It is important for nurses to caution adolescents on the health risks of obtaining a tattoo. These include (select all that apply) a. Amateur tattoos are difficult to remove. b. Tattoos pose a risk for bloodborne and skin infections. c. Health care professionals must be notified of the existence of a tattoo before a magnetic resonance imaging (MRI) scan. d. Tattoo dyes may cause allergic reactions. e. Tattoo parlors are well regulated.

ANS: B, C, D Feedback Correct Tattoos carry the risk for contracting bloodborne diseases such as hepatitis B and HIV. Infection, allergic reaction to the dye, scarring, or keloid formation can occur. Should an MRI ever be required, it is important to notify the health care professionals, because the dyes can contain iron and other metals. Incorrect Amateur tattoos are easily removed; however, studio tattoos made with red and green dye are extremely difficult to remove. Very little regulation exists in the tattoo industry; therefore, the cleanliness of each tattoo parlor varies. Teens should be counseled to avoid making an impulsive decision to get a tattoo.

A school nurse is screening children for scoliosis. Which assessment findings should the nurse expect to observe for scoliosis? Select all that apply. a. Pain with deep palpation of the spinal column b. Unequal shoulder heights c. The trouser pant leg length appears shorter on one side d. Inability to bend at the waist e. Unequal waist angles

ANS: B, C, E Feedback Correct The assessment findings associated with scoliosis include unequal shoulder heights, trouser pant leg length appearing shorter on one side meaning unequal leg length, and unequal waist angles. Incorrect Scoliosis is a nonpainful curvature of the spine so pain is not expected and the child is able to bend at the waist adequately.

A nurse is performing an assessment on a newborn. Which vital signs indicate a normal finding for this age group? Select all that apply. a. Pulse of 80-125 a minute b. B/P of systolic 65-95 and diastolic 30-60 c. Temperature of 36.5-37.3 Celsius (axillary) d. Temperature of 36.4-37 Celsius (axillary) e. Respirations of 30-60 a minute

ANS: B, C, E Feedback Correct The normal vital signs for a newborn are temperature 36.5 to 37.3 Celsius (axillary), pulse rate of 120-160 a minute, respiratory rate of 30-60 a minute, systolic B/P of 65-95, and diastolic B/P of 30-62. A temperature of 36.4-37 Celsius is normal for an older child. A pulse rate of 80-125 is normal for a 4-year-old child. Incorrect A pulse rate of 80-125 per minute and temperature of 36.4-37° C are both too low for a well-newborn.

Which strategies can a nurse teach to parents of a child experiencing uncomplicated school refusal? Select all that apply. a. The child should be allowed to stay home until the anxiety about going to school is resolved. b. Parents should be empathetic yet firm in their insistence that the child attends school. c. A modified school attendance may be necessary. d. Parents need to pick the child up at school whenever the child wants to come home. e. Parents need to communicate with the teachers about the situation.

ANS: B, C, E Feedback Correct In uncomplicated cases of school refusal, the parent needs to return the child to school as soon as possible. If symptoms are severe, a limited period of part-time or modified school attendance may be necessary. For example, part of the day may be spent in the counselor's or school nurse's office, with assignments obtained from the teacher. Parents should be empathetic yet firm and consistent in their insistence that the child attend school. Incorrect Parents should not pick the child up at school once the child is there. The principal and teacher should be told about the situation so that they can cooperate with the treatment plan.

In planning care for a preschool-age child, the nurse knows that which open body postures encourage positive communication? Select all that apply. a. Leaning away from the preschooler b. Frequent eye contact c. Hands on hips d. Conversing at eye level e. Asking the parents to stay in the room

ANS: B, D Feedback Correct Frequent eye contact and conversing at eye level are both open body postures that encourage positive communication. Incorrect Leaning away from the child and placing your hands on your hips are both closed body postures that do not facilitate effective communication. Asking the parents to stay in the room while the nurse is talking to the child is helpful but is not an open body posture.

What should the nurse recognize as a possible indicator of child abuse in a 4-year-old child being treated for ear pain at the emergency department on a chilly Christmas Day in New York State? Select all that apply. a. The child extends his arms to be hugged by the nurse. b. The child is wearing clean, baggy shorts, sandals, and an oversized T-shirt. c. The child answers all questions in complete sentences, and smiles afterward. d. The child has dirty, broken teeth. e. The child states "I'm so fat" when the nurse tells his mother he weighs 25 lb.

ANS: B, D, E Feedback Correct These clothes are inappropriate attire for December in New York State. Even though the clothes are clean, dressing inappropriately for the weather is a potential indicator of child abuse. Clothing that is too large or small for the child's size also requires further evaluation. Dirty, broken teeth are an indicator of potential child abuse. A child who is 4 years old and weighs only 25 lb is thin for his age. Body image distortion (being thin but describing self as fat) is a potential indicator of child abuse. A child who is too thin for his height should also be further evaluated. Incorrect Although it may be unusual for this child to want to hugged by the nurse, it is not an indicator of child abuse. Answering questions using complete sentences and smiling is appropriate for a 4-year-old.

Parents of a teenager ask the nurse what signs they should look for if their child is in a gang. The nurse should include which signs when answering? Select all that apply. a. Plans to try out for the debate team at school b. Skipping classes to go to the mall c. Hanging out with friends they have had since childhood d. Unexplained source of money e. Fear of the police

ANS: B, D, E Feedback Correct Signs of gang involvement include skipping classes, unexplained sources of money, and fear of the police. Associating with new friends while ignoring old friends is also a sign. A change in attitude toward participating in activities is another sign of gang involvement. Incorrect Plans to try out for the debate team at school are not a sign of gang involvement. Hanging out with friends he or she has had since childhood is not a sign of gang involvement.

What term should be used in the nurse's documentation to describe auscultation of breath sounds that are short, popping, and discontinuous on inspiration? a. Pleural friction rub b. Bronchovesicular sounds c. Crackles d. Wheeze

ANS: C Feedback A A pleural friction rub has a grating, coarse, low-pitched sound. B Bronchovesicular sounds are auscultated over mainstem bronchi. They are clear, without any adventitious sounds. C Crackles are short, popping, discontinuous sounds heard on inspiration. D Wheezes are musical, high-pitched, predominant sounds heard on expiration.

When is the most appropriate time to inspect the genital area during a well-child examination of a 14-year-old girl? a. It is not necessary to inspect the genital area. b. Examine the genital area first. c. After the abdominal assessment. d. Do the genital inspection last.

ANS: C Feedback A A visual inspection of all areas of the body is included in a physical examination. B Examination of the genital area can be embarrassing. It is not be appropriate to begin the examination of this area. C It is best to incorporate the genital assessment into the middle of the examination. This allows ample time for questions and discussion. If possible, proceed from the abdominal area to the genital area. D Assessing the genital area earlier in the examination allows more time for the adolescent to ask questions and engage in discussion.

Which action is appropriate when the nurse is assessing breath sounds of an 18-month-old crying child? a. Ask the parent to quiet the child so the nurse can listen. b. Auscultate breath sounds and chart that the child was crying. c. Encourage the child to play with the stethoscope to distract and to calm down before auscultating. d. Document that data are not available because of noncompliance.

ANS: C Feedback A Asking a parent to quiet the child may or may not work. B Auscultating while the child is crying typically results in less than optimal data. C Distracting the child with an interesting activity can assist the child to calm down so an accurate assessment can be made. D Documenting that the child is not compliant is not appropriate. An assessment needs to be completed.

When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. This should be considered a. Unnecessary information, because the child is 3 years old b. An important part of the family history c. An important part of the child's past growth and development d. An important part of the child's review of systems

ANS: C Feedback A Developmental milestones provide important information about the child's physical, social, and neurologic health. B The developmental milestones are specific to this child. If pertinent, attainment of milestones by siblings should be included in the family history. C Information about the attainment of developmental milestones is important to obtain. It provides data about the child's growth and development that should be included in the history. D The review of systems does not include the developmental milestones.

Which is the most appropriate question to ask when interviewing an adolescent to encourage conversation? a. "Are you in school?" b. "Are you doing well in school?" c. "How is school going for you?" d. "How do your parents feel about your grades?"

ANS: C Feedback A Direct questions with "yes" or "no" answers do not encourage conversation. B Direct questions that can be interpreted as judgmental do not enhance communication. C Open-ended questions encourage communication. D Asking adolescents about their parents' feelings may block communication.

The nurse is performing a comprehensive physical examination on a young child in the hospital. At what age can the nurse expect a child's head and chest circumferences to be almost equal? a. Birth b. 6 months c. 1 year d. 3 years

ANS: C Feedback A Head circumference is larger than chest circumference until approximately 12 months of age. B Chest circumference is smaller than head circumference until approximately 1 year of age. C Head and chest measurements are almost equal at 1 year of age. D By 3 years of age, the chest circumference exceeds the head circumference.

What is the best explanation for a 2-year-old child who is quiet and withdrawn on the fourth day of a hospital admission? a. The child is protesting her separation from her caregivers. b. The child has adjusted to the hospitalization. c. The child is experiencing the despair stage of separation. d. The child has reached the stage of detachment.

ANS: C Feedback A In the protest stage, the child would be agitated, crying, resistant to caregivers, and inconsolable. B Toddlers do not readily "adjust" to hospitalization and separation from caregivers. C In the despair stage of separation, the child exhibits signs of hopelessness and becomes quiet, withdrawn, and apathetic. D The detachment stage occurs after prolonged separation. During this phase, the child becomes interested in the environment and begins to play.

What is the best action for the nurse to take when a 5-year-old child who requires another 2 days of IV antibiotics cries, screams, and resists having the IV restarted? a. Exit the room and leave the child alone until he stops crying. b. Tell the child big boys and girls "don't cry." c. Let the child decide which color arm board to use with the IV. d. Administer a narcotic analgesic for pain to quiet the child.

ANS: C Feedback A Leaving the child alone robs the child of support when a coping difficulty exists. B Crying is a normal response to stress. C Giving the preschooler some choice and control, while maintaining boundaries of treatment, supports the child's coping skills. D The child needs time to adjust and support to cope with unfamiliar and painful procedures during hospitalization. Although administration of a topical analgesic is indicated before restarting the child's IV, a narcotic analgesic is not indicated.

An effective technique for communicating with toddlers is to a. Have the toddler make up a story from a picture. b. Involve the toddler in dramatic play with dress-up clothing. c. Use picture books. d. Ask the toddler to draw pictures of his fears.

ANS: C Feedback A Most toddlers do not have the vocabulary to make up stories. B Dramatic play is associated with older children. C Activities and procedures should be described as they are about to be done. Use picture books and play for demonstration. Toddlers experience the world through their senses. D Toddlers probably are not capable of drawing or verbally articulating their fears.

When meeting a toddler for the first time, the nurse initiates contact by a. Calling the toddler by name and picking the toddler up b. Asking the toddler for her first name c. Kneeling in front of the toddler and speaking softly to the child d. Telling the toddler that you are her nurse

ANS: C Feedback A Picking a toddler up at an initial meeting is a threatening action and will more likely result in a negative response from the child. B Toddlers are unlikely to respond to direct questions at a first meeting. C More positive interactions occur when the toddler perceives the meeting in a nonthreatening way. Placing yourself at the toddler's level and speaking softly can be less threatening for the child. D Telling the toddler you are the nurse is not likely to facilitate or encourage cooperation. The toddler perceives you as a stranger and will find the action threatening.

What is an appropriate preoperative teaching plan for a school-age child? a. Begin preoperative teaching the morning of surgery. b. Schedule a tour of the hospital a few weeks before surgery. c. Show the child books and pictures 4 days before surgery. d. Limit teaching to 5 minutes and use simple terminology.

ANS: C Feedback A Preoperative teaching a few hours before surgery is more appropriate for the preschool child. Preoperative materials should be introduced 1 to 5 days in advance for school-age children. B Preparation too far in advance of the procedure can be forgotten or cause undue anxiety for an extended period of time. C Preparatory material can be introduced to the school-age child several days (1 to 5) in advance of the event. Books, pictures, charts, and videos are appropriate. D A very short, simple explanation of the surgery is appropriate for a younger child such as a toddler.

Home care is being considered for a young child who is ventilator dependent. Which factor is most important in deciding whether home care is appropriate? a. Level of parents' education b. Presence of two parents in the home c. Preparation and training of family d. Family's ability to assume all health care costs

ANS: C Feedback A The amount of formal education reached by the parents is not the important issue. The determinant is the family's ability to care adequately for the child in the home. B At least two family members should learn and demonstrate all aspects of the child's care in the hospital, but it does not have to be two parents. C One of the essential elements is the training and preparation of the family. The family must be able to demonstrate all aspects of care for the child. In many areas, it cannot be guaranteed that nursing care will be available on a continual basis, and the family will have to care for the child. D Few families can assume all health care costs. Financial planning, including negotiating arrangements with the insurance company and/or public programs, may be required.

Which therapeutic approach will best help a 7-year-old child cope with a lengthy course of intravenous antibiotic therapy? a. Arrange for the child to go to the playroom daily. b. Ask the child to draw you a picture of himself or herself. c. Allow the child to participate in injection play. d. Give the child stickers for cooperative behavior.

ANS: C Feedback A The hospitalized child should have opportunities to go to the playroom each day if the child's condition warrants. This free play does not have any specific therapeutic purpose. B Children can express their thoughts and beliefs through drawing. Asking the child to draw a picture of himself or herself may not elicit the child's feelings about the treatment. C Injection play is an appropriate intervention for the child who has to undergo frequent blood work, injections, intravenous therapy, or any other therapy involving syringes and needles. D Rewards such as stickers may enhance cooperative behavior. They will not address coping with painful treatments.

Which is an appropriate nursing intervention for the hospitalized neonate? a. Assign the neonate to a room with other neonates. b. Provide play activities in the hospital room. c. Offer the neonate a pacifier between feedings. d. Request that parents bring a security object from home.

ANS: C Feedback A The neonate is not aware of other children. The choice of roommate will not affect the neonate socially. It is important for older children to room with similar-age children. B Formal play activities are not relevant for the neonate. C The neonate needs opportunities for nonnutritive sucking and oral stimulation with a pacifier. D Having parents bring a security object from home is applicable to older children.

An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to a. Ask her why she wants to know. b. Determine why she is so anxious. c. Explain in simple terms how it works. d. Tell her she will see how it works as it is used.

ANS: C Feedback A The nurse should respond positively for requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. B The child is not exhibiting anxiety, just requesting clarification of what will be occurring. C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. D The nurse must explain how the blood pressure cuff works so that the child can then observe during the procedure.

What heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? a. S1, S2 b. S3, S4 c. Murmur d. Physiologic splitting

ANS: C Feedback A These are normal heart sounds. S1 is the closure of the tricuspid and mitral valves, and S2 is the closure of the pulmonic and aortic valves. B S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If heard, medical evaluation is required. C Murmurs are the sounds that are produced in the heart chambers or major arteries from the purulence of blood flow. Murmurs create a blowing and swooshing sound. D Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding.

What is the primary disadvantage associated with outpatient and day facility care? a. Increased cost b. Increased risk of infection c. Lack of physical connection to the hospital d. Longer separation of the child from family

ANS: C Feedback A This type of care decreases cost. B This type of care decreases risk of infection. C Outpatient and day facility care do not provide extended care; therefore a child requiring extended care should be transferred to the hospital, causing increased stress to the child and parents. D This type of care minimizes separation of the child from family.

Having explanations for all procedures and selecting their own meals from hospital menus is an important coping mechanism for which age-group? a. Toddlers b. Preschoolers c. School-age children d. Adolescents

ANS: C Feedback A Toddlers need routine and parental involvement for coping. B Preschoolers need simple explanations of procedures. C School-age children are developmentally ready to accept detailed explanations. School-age children can select their own menus and become actively involved in other areas of their care. D Detailed explanations and support of peers help adolescents cope.

9. The nurse observes abdominal breathing in a 2-year-old child. What does this finding indicate? a. Imminent respiratory failure b. Hypoxia c. Normal respiration d. Airway obstruction

ANS: C Feedback A A very slow respiration rate is an indicator of respiratory failure. B Nasal flaring with inspiration and grunting on expiration occurs when hypoxia is present. C Young children normally exhibit abdominal breathing. When measuring respiratory rate, the nurse should observe the rise and fall of the abdomen. D The child with an airway obstruction will use accessory muscles to breathe.

6. Which action should the nurse incorporate into a care plan for a 14-year-old child in the emergency department? a. Limit the number of choices to be made by the adolescent. b. Insist that parents remain with the adolescent. c. Provide clear explanations and encourage questions. d. Give rewards for cooperation with procedures.

ANS: C Feedback A Because adolescents are capable of abstract thinking, they should be allowed to make decisions about their care. B Adolescents should have the choice of whether parents remain with them. They are very modest, and this modesty should be respected. C Adolescents are capable of abstract thinking and can understand explanations. They should be offered the opportunity to ask questions. D Giving rewards such as stickers for cooperation with treatments or procedures is more appropriate for the younger child.

22. A child is brought to the emergency department. When he is called to triage, which vital sign should be measured first? a. Temperature b. Heart rate c. Respiratory rate d. Blood pressure

ANS: C Feedback A Temperature should be measured after other vital signs because it can be upsetting for children. B Heart rate is not the first vital sign measured in children. C When taking children's vital signs, the nurse observes the respiratory rate first. D Blood pressure is taken after other vital signs because it can be upsetting for children.

What is the primary purpose of a transitional object? a. It helps the parents deal with the guilt they feel when they leave the child. b. It keeps the child quiet at bedtime. c. It is effective in decreasing anxiety in the toddler. d. It decreases negativism and tantrums in the toddler.

ANS: C A A decrease in parental guilt (distress) is an indirect benefit of a transitional object. B A transitional object may be part of a bedtime ritual, but it may not keep the child quiet at bedtime. C Decreasing anxiety, particularly separation anxiety, is the function of a transitional object; it provides comfort to the toddler in stressful situations and helps make the transition from dependence to autonomy. D A transitional object does not significantly affect negativity and tantrums, but it can comfort a child after tantrums.

In general, healthy families are able to adapt to changes within the family unit; however, some factors add to the usual stress experienced by any family. The nurse is in a unique position to assess the child for symptoms of neglect. Which high-risk family situation places the child at the greatest risk for being neglected? a. Marital conflict and divorce b. Adolescent parenting c. Substance abuse d. A child with special needs

ANS: C A Although divorce is traumatic to children, research has shown that living in a home filled with conflict is also detrimental. In this situation conflict may arise and young children may be unable to verbalize their distress; however, the child is not likely to be neglected. B Teenage parenting often has a negative effect on the health and social outcomes of the entire family. Adolescent girls are at risk for a number of pregnancy complications, are unlikely to attain a high level of education, and are more likely to be poor. C Parents who abuse drugs or alcohol may neglect their children because obtaining and using the substance(s) may have a stronger pull on the parents than the care of their children. D When a child is born with a birth defect or has an illness that requires special care, the family is under additional stress. These families often suffer financial hardship as health insurance benefits quickly reach their maximum.

While reviewing the dietary-intake documentation of a 7-year-old Asian boy with a fractured femur, the nurse notes that he consistently refuses to eat the food on his tray. What assumption is most likely accurate? a. He is a picky eater. b. He needs less food because he is on bed rest. c. He may have culturally related food preferences. d. He is probably eating between meals and spoiling his appetite.

ANS: C A Although the child may be a picky eater, the key point is that he is from a different culture. The foods he is being served may seem strange to him. B Nutrition plays an important role in healing. Although the energy the child expends has decreased while on bed rest, he has increased needs for good nutrition. C When cultural differences are noted, food preferences should always be obtained. A child will often refuse to eat unfamiliar foods. D Although the nurse should determine whether the child is eating food the family has brought from home, the more important point is to determine whether he has food preferences.

The parent of a child who has had numerous hospitalizations asks the nurse for advice because her child has been having behavior problems at home and in school. In discussing effective discipline, what is an essential component? a. All children display some degree of acting out and this behavior is normal. b. The child is manipulative and should have firmer limits set on her behavior. c. Positive reinforcement and encouragement should be used to promote cooperation and the desired behaviors. d. Underlying reasons for rules should be given and the child should be allowed to decide which rules should be followed.

ANS: C A Behavior problems should not be disregarded as normal. B It would be incorrect to assume the child is being manipulative and should have firmer limits set on her behaviors. C Using positive reinforcement and encouragement to promote cooperation and desired behaviors is one of the three essential components of effective discipline. D Providing the underlying reasons for rules and giving the child a choice concerning which rules to follow constitute a component of permissive parenting and are not considered an essential component of effective discipline.

A nurse is caring for a child with the religion of Christian Science. What intervention should the nurse include in the care plan for this child? a. Offer iced tea to the child who is experiencing deficient fluid volume. b. Inform the spiritual care department that the child has been admitted to the hospital. c. Allow parents to sign a form opting out of routine immunizations. d. Ask parents whether the child has been baptized.

ANS: C A Coffee and tea are declined as a drink. B When a Christian Science believer is hospitalized, a parent or patient may request that a Christian Science practitioner be notified as opposed to the hospital-assigned clergy. C Christian Science believers seek exemption from immunizations but obey legal requirements. D Baptism is not a ceremony for the Christian Science religion.

A traditional family structure in which male and female partners and their children live as an independent unit is known as a(n) _____ family. a. Extended b. Binuclear c. Nuclear d. Blended

ANS: C A Extended families include other blood relatives in addition to the parents. B A binuclear family involves two households. C Approximately two thirds of U.S. households meet the definition of a nuclear family. This is also known as the traditional family. D A blended family is reconstructed after divorce and involves the merger of two families.

Families who deal effectively with stress exhibit which behavior pattern? a. Focus on family problems b. Feel weakened by stress c. Expect that some stress is normal d. Feel guilty when stress exists

ANS: C A Healthy families focus on family strengths rather than on the problems and know that stress is temporary and may be positive. B If families are dealing effectively with stress, then weakening of the family unit should not occur. C Healthy families recognize that some stress is normal in all families. D Because some stress is normal in all families, feeling guilty is not reasonable. Guilt only immobilizes the family and does not lead to resolution of the stress.

In providing anticipatory guidance to parents whose child will soon be entering kindergarten, which is a critical factor in preparing a child for kindergarten entry? a. The child's ability to sit still b. The child's sense of learned helplessness c. The parent's interactions and responsiveness to the child d. Attending a preschool program

ANS: C A The child's ability to sit still is important to learning; however, parental responsiveness and involvement are more important factors. B Learned helplessness is the result of a child feeling that he or she has no effect on the environment and that his or her actions do not matter. Parents who are actively involved in a supportive learning environment will demonstrate a more positive approach to learning. C Interactions between the parent and child are an important factor in the development of academic competence. Parental encouragement and support maximize a child's potential. D Preschool and daycare programs can supplement the developmental opportunities provided by parents at home, but they are not critical in preparing a child for entering kindergarten.

To resolve family conflict, it is necessary to have open communication, accurate perception of the problem, and a(n) a. Intact family structure b. Arbitrator c. Willingness to consider the view of others d. Balance in personality types

ANS: C A The structure of a family may affect family dynamics, but it is still possible to resolve conflict without an intact family structure if all of the ingredients of conflict resolution are present. B Conflicts can be resolved without the assistance of an arbitrator. C Without the willingness of the members of a group to consider the views of others, conflict resolution cannot take place. D Most families have diverse personality types among their members. This diversity may make conflict resolution more difficult but should not impede it as long as the ingredients of conflict resolution are present.

Which comments indicate that the mother of a toddler needs further teaching about dental care? a. "We use well water so I give my toddler fluoride supplements." b. "My toddler brushes his teeth with my help." c. "My child will not need a dental checkup until his permanent teeth come in." d. "I use a small nylon bristle brush for my toddler's teeth."

ANS: C A Toddlers need fluoride supplements when they use a water supply that is not fluorinated. B Toddlers need supervision with dental care. The parent should finish brushing areas not reached by the child. C Children should first see the dentist 6 months after the first primary tooth erupts and no later than age 30 months. D A small nylon bristle brush works best for cleaning toddlers' teeth.

Which milestone is developmentally appropriate for a 2-month-old infant? a. Pulled to a sitting position, head lag is absent. b. Pulled to a sitting position, the infant is able to support the head when the trunk is lifted. c. The infant can lift his or her head from the prone position and briefly hold the head erect. d. In the prone position, the infant is fully able to support and hold the head in a straight line.

ANS: C Feedback A A 2-month-old infant's neck muscles are stronger than those of a newborn; however, head lag is present when pulled to a sitting position. B A 2-month-old infant continues to have some head lag when pulled to a sitting position. C A 2-month-old infant is able to briefly hold the head erect when in a prone position. If a parent were holding the infant against the parent's shoulder, the infant would be able to lift his or her head briefly. D It is not until 4 months of age that the infant can easily lift his or her head and hold it steadily erect when in the prone position.

Which children are at greater risk for not receiving immunizations? a. Children who attend licensed daycare programs b. Children entering school c. Children who are home schooled d. Young adults entering college

ANS: C Feedback A All states require immunizations for children in daycare programs. B All states require immunizations for children entering school. C Home-schooled children are at risk for being underimmunized and need to be monitored. D Most colleges require a record of immunizations as part of a health history.

Which statement is the most accurate about moral development in the 9-year-old school-age child? a. Right and wrong are based on physical consequences of behavior. b. The child obeys parents because of fear of punishment. c. The school-age child conforms to rules to please others. d. Parents are the determiners of right and wrong for the school-age child.

ANS: C Feedback A Children 4 to 7 years of age base right and wrong on consequences. B Consequences are the most important consideration for the child between 4 and 7 years of age. C The 7- to 12-year-old child bases right and wrong on a good-boy or good-girl orientation in which the child conforms to rules to please others and avoid disapproval. D Parents determine right and wrong for the child younger than 4 years of age.

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 Feedback A Cow's milk should not be used in children younger than 12 months. B Cow's milk should not be used in children younger than 12 months. 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. D Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia.

Which factor has the greatest influence on child growth and development? a. Culture b. Environment c. Genetics d. Nutrition

ANS: C Feedback A Culture is a significant factor that influences how children grow toward adulthood. Culture influences both growth and development but does not eliminate inborn genetic influences. B Environment has a significant role in determining growth and development both before and after birth. The environment can influence how and to which extent genetic traits are manifested, but environmental factors cannot eliminate the effect of genetics. C Genetic factors (heredity) determine each individual's growth and developmental rate. Although factors such as environment, culture, nutrition, and family can influence genetic traits, they do not eliminate the effect of the genetic endowment, which is permanent. D Nutrition is critical for growth and plays a significant role throughout childhood.

Why do peer relationships become more important during adolescence? a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents.

ANS: C Feedback A During adolescence, the parent/child relationship changes from one of protection-dependency to one of mutual affection and quality. B Parents continue to play an important role in the personal and health-related decisions. C The peer group serves as a strong support to teenagers, providing them with a sense of belonging and a sense of strength and power. D The peer group forms the transitional world between dependence and autonomy.

At what age is an infant first expected to locate an object hidden from view? a. 4 months of age b. 6 months of age c. 9 months of age d. 20 months of age

ANS: C Feedback A Four-month-old infants are not cognitively capable of searching out objects hidden from their view. Infants at this developmental level do not pursue hidden objects. B Six-month-old infants have not developed the ability to perceive objects as permanent and do not search out objects hidden from their view. C By 9 months of age, an infant will actively search for an object that is out of sight. D Twenty-month-old infants actively pursue objects not in their view and are capable of recalling the location of an object not in their view. They first look for hidden objects around age 9 months.

In general, the earliest age at which puberty begins is ____ years in girls and _____ years in boys. a. 13; 13 b. 11; 11 c. 10; 12 d. 12; 10

ANS: C Feedback A Girls and boys do not usually begin puberty at the same age; girls usually begin earlier than boys. B Girls and boys do not usually begin puberty at the same age; girls usually begin earlier than boys. C Puberty signals the beginning of the development of secondary sex characteristics. This begins in girls earlier than in boys. Usually, there is a 2-year difference in the age at onset. D Girls and boys do not usually begin puberty at the same age; girls usually begin earlier than boys.

Frequent developmental assessments are important for which reason? a. Stable developmental periods during infancy provide an opportunity to identify any delays or deficits. b. Infants need stimulation specific to the stage of development. c. Critical periods of development occur during childhood. d. Child development is unpredictable and needs monitoring.

ANS: C Feedback A Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. B Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage. C Critical periods are blocks of time during which children are ready to master specific developmental tasks. The earlier those delays in development are discovered and intervention initiated, the less dramatic their effect will be. D Normal growth and development is orderly and proceeds in a predictable pattern based on each individual's abilities and potentials.

Which statement by the nurse is most appropriate to a 15-year-old whose friend has mentioned suicide? a. "Tell your friend to come to the clinic immediately." b. "You need to gather details about your friend's suicide plan." c. "Your friend's threat needs to be taken seriously, and immediate help for your friend is important." d. "If your friend mentions suicide a second time, you will want to get your friend some help."

ANS: C Feedback A Instructing a 15-year-old to tell a friend to come to the clinic immediately provides the teen with limited information and does not address the concern. B It is important to determine whether a person threatening suicide has a plan of action; however, the best information for the 15-year-old to have is that all threats of suicide should be taken seriously and immediate help is important. C Suicide is the third most common cause of death among American adolescents. A suicide threat from an adolescent serves as a dramatic message to others and should be taken seriously. Adolescents at risk should be targeted for supportive guidance and counseling before a crisis occurs. D It is imperative that help is provided immediately for a teenager who is talking about suicide. Waiting until the teen discusses it a second time may be too late.

The parents of a newborn infant state, "We will probably not have our baby immunized because we are concerned about the risk of our child being injured." What is the nurse's best response? a. "It is your decision." b. "Have you talked with your parents about this? They can probably help you think about this decision." c. "The risks of not immunizing your baby are greater than the risks from the immunizations." d. "You are making a mistake."

ANS: C Feedback A It is the parents' decision not to immunize the child; however, the nurse has a responsibility to inform parents about the risks to infants who are not immunized. B Grandparents can be supportive but are not the primary decision makers for the infant. C Although immunizations have been documented to have a negative effect in a small number of cases, an unimmunized infant is at greater risk for development of complications from childhood diseases than from the vaccines. D Telling parents that they are making a mistake is an inappropriate response.

A 2-month-old child has not received any immunizations. Which immunizations should the nurse give? a. DTaP, Hib, HepB, MCV, varicella b. DTaP, Hib, HepB, HPV, IPV, Rota c. DTaP, Hib, HepB, PCV, Rota d. DTaP, Hib, HepB, PCV, HepA

ANS: C Feedback A Meningococcal vaccine should be administered to children at 11 to 12 years of age. B Human papillomavirus vaccine is administered to adolescent girls only. C DTaP, Hib, HepB, PCV, IPV, and Rota are appropriate immunizations for an unimmunized 2-month-old child. D HepA is recommended for all children at 1 year of age.

A group of boys ages 9 and 10 years have formed a "boys-only" club that is open to neighborhood and school friends who have skateboards. This should be interpreted as a. Behavior that encourages bullying and sexism b. Behavior that reinforces poor peer relationships c. Characteristic of social development of this age d. Characteristic of children who later are at risk for membership in gangs

ANS: C Feedback A Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. B Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. D A boys-only club does not have a direct correlation with later gang activity.

What does the nurse need to know when observing a chronically ill child at play? a. Play is not important to hospitalized children. b. Children need to have structured play periods. c. Children's play is a form of communication. d. Play is to be discouraged because it tires hospitalized children.

ANS: C Feedback A Play is important to all children in all environments. Play for children is a mechanism for mastering their environment. B Although children's play activities appear to be unorganized and at times chaotic, play has purpose and meaning. Imposing structure on play interferes with the tasks being worked on. C Play for all children is an activity woven with meaning and purpose. For chronically ill children, play can indicate their state of wellness and response to treatment. It is a way to express joy, fear, anxiety, and disappointments. D Children who have fewer energy reserves still require play. For these children, less-active play activities will be important.

The parents of a 14-year-old girl are concerned that their adolescent spends too much time looking in the mirror. Which statement is the most appropriate for the nurse to make? a. "Your teenager needs clearer and stricter limits about her behavior." b. "Your teenager needs more responsibility at home." c. "During adolescence this behavior is not unusual." d. "The behavior is abnormal and needs further investigation."

ANS: C Feedback A Stricter limits are not an appropriate response for a behavior that is part of normal development. B More responsibility at home is not an appropriate response for this situation. C Egocentric and narcissistic behavior is normal during this period of development. The teenager is seeking a personal identity. D The behavior is normal and needs no further investigation.

The nurse is explaining Tanner staging to an adolescent and her mother. Which statement best describes Tanner staging? a. Predictable stages of puberty that are based on chronologic age b. Staging of puberty based on the initiation of menarche and nocturnal emissions c. Predictable stages of puberty that are based on primary and secondary sexual characteristics d. Staging of puberty based on the initiation of primary sexual characteristics

ANS: C Feedback A Tanner stages are not based on chronologic age. The age at which an adolescent enters puberty is variable. B The puberty stage in girls begins with breast development. Puberty stage in boys begins with genital enlargement. C Tanner sexual-maturing ratings are based on the development of stages of primary and secondary sexual characteristics. D Primary sexual characteristics are not the basis of Tanner staging.

Which is a priority in counseling parents of a 6-month-old infant? a. Increased appetite from secondary growth spurt b. Encouraging the infant to smile c. Securing a developmentally safe environment for the infant d. Strategies to teach infants to sit up

ANS: C Feedback A The infant's appetite and growth velocity decrease in the second half of infancy. B Although a social smile should be present by 6 months of age, encouraging this is not of higher priority than ensuring environmental safety. C Safety is a primary concern as an infant becomes increasingly mobile. D Unless the infant has a neuromuscular deficit, strategies for teaching a normally developing infant to sit up are not necessary.

The parent of 2-week-old Sarah asks the nurse whether Sarah needs fluoride supplements, because she is exclusively breastfed. The nurse's best response is 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 Feedback A The recommendation is to begin supplementation at 6 months. B The amount of water that is ingested and the amount of fluoride in the water are considered when supplementation is being considered. 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. D The amount of water that is ingested and the amount of fluoride in the water are considered when supplementation is being considered.

The nurse is planning a teaching session for a young child and her parents. According to Piaget's theory, the period of cognitive development in which the child is able to distinguish between concepts related to fact and fantasy, such as human beings are incapable of flying like birds, is the _______ period of cognitive development. a. Sensorimotor b. Formal operations c. Concrete operations d. Preoperational

ANS: C Feedback A The sensorimotor stage occurs in infancy and is a period of reflexive behavior. During this period, the infant's world becomes more permanent and organized. The stage ends with the infant demonstrating some evidence of reasoning. B Formal operations is a period in development in which new ideas are created through previous thoughts. Analytic reason and abstract thought emerge in this period. C Concrete operations is the period of cognitive development in which children's thinking is shifted from egocentric to being able to see another's point of view. They develop the ability to distinguish fact from fantasy. D The preoperational stage is a period of egocentrism in which the child's judgments are illogical and dominated by magical thinking and animism.

According to Piaget, the 6-month-old infant is in what stage of the sensorimotor phase? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata

ANS: C Feedback A The use of reflexes is primarily during the first month of life. B Primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from age 1 month to 4 months. C Infants are usually in the secondary circular reaction stage from age 4 months to 8 months. This stage is characterized by a continuation of the primary circular reaction because of the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. D The fourth sensorimotor stage is coordination of secondary schemata. This is a transitional stage in which increasing motor skills enable greater exploration of the environment.

What should the nurse evaluate before administering the Denver Developmental Screening Test II (DDST-II)? Select all that apply. a. The child's height and weight b. The parent's ability to comprehend the results c. The child's mood d. The parent-child interaction e. The child's chronologic age

ANS: C, E Feedback Correct: The results of the screening test are valid if the child acted in a normal and expected manner. The child's chronologic age in years, months, and days must be calculated in order to draw the age line. This is necessary in order to perform an accurate DDST-II. Reliability and validity of the test can be altered if the child is not feeling well or is under the influence of medications. Incorrect: The child's height and weight are not relevant to the DDST-II screening process. The parent's ability to understand the results of the screening is not relevant to the validity of the test. The parent-child interaction is not significantly relevant to the test results.

Which behavior is most likely to encourage open communication? a. Avoiding eye contact b. Folding arms across chest c. Standing with head bowed d. Soft stance with arms loose at the side

ANS: D Feedback A Avoiding eye contact does not facilitate communication. B Folding arms across the chest is a closed body posture, which does not facilitate communication. C Standing with head bowed is a closed body posture, which does not facilitate communication. D An open body stance and positioning such as loose arms at the side invite communication and interaction.

Which measurement is not indicated for a 4-year-old well-child examination? a. Blood pressure b. Weight c. Height d. Head circumference

ANS: D Feedback A Blood pressure measurements are taken on all children at every ambulatory visit. B Weight is measured at every well-child examination. C Height is measured at every well-child examination. D Head circumference is measured on all children from birth to 3 years. Children older than 3 years of age with questionable head size or a history of megalocephaly, hydrocephalus, or microcephaly should have their head circumference assessed at every visit. A 4-year-old without a history of these problems does not need his or her head circumference measured.

You are the nurse admitting a toddler to the pediatric infectious disease unit. What is the single most important component of the child's physical examination? a. Assessment of heart and lungs b. Measurement of height and weight c. Documentation of parental concerns d. Obtaining an accurate history

ANS: D Feedback A Heart and lung assessment is not as important as an accurate history. B A single measurement of height and weight is not as significant as determining growth over time. The child's growth pattern can be elicited from the history. C Documentation of parental concerns is not as relevant to the physical examination as an accurate history. D An accurate history is most helpful in identifying problems and potential problems.

The home health nurse outlines short- and long-term goals for a 10-year-old child with many complex health problems. Who should agree on these goals? a. Family and nurse b. Child, family, and nurse c. All professionals involved d. Child, family, and all professionals involved

ANS: D Feedback A Involvement of the individuals who are essential to the child's care is necessary during this very important stage. The elimination of any one of these groups can potentially create a plan of care that does not meet the needs of the child and family. B Involvement of the individuals who are essential to the child's care is necessary during this very important stage. The elimination of any one of these groups can potentially create a plan of care that does not meet the needs of the child and family. C Involvement of the individuals who are essential to the child's care is necessary during this very important stage. The elimination of any one of these groups can potentially create a plan of care that does not meet the needs of the child and family. D In the home, the family is a partner in each step of the nursing process. The family priorities should guide the planning process. Both short-term and long-term goals should be outlined and agreed on by the child, family, and professionals involved.

Communication entails much more than words going from one person's mouth to another person's ears. A positive, supportive technique that is effective from birth throughout adulthood is a. Listening b. Physical proximity c. Environment d. Touch

ANS: D Feedback A Listening is an essential component of the communication process. By practicing active listening skills, nurses can be effective listeners. Listening is a component of verbal communication. B Individuals have different comfort zones for physical distance. The nurse should be aware of these differences and move cautiously when meeting new children and families. C It is important to create a supportive and friendly environment for children including the use of child-sized furniture, posters, developmentally appropriate toys, and art displayed at a child's eye level. D Touch can convey warmth, comfort, reassurance, security, caring, and support. In infancy, messages of security and comfort are conveyed when they are being held. Toddlers and preschoolers find it soothing and comforting to be held and rocked. School-aged children and adolescents appreciate receiving a hug or pat on the back (with permission).

Examination of the abdomen is performed correctly by the nurse in which order? a. Inspection, palpation, and auscultation b. Palpation, inspection, and auscultation c. Palpation, auscultation, and inspection d. Inspection, auscultation, and palpation

ANS: D Feedback A Palpation is always performed last because it may distort the normal abdominal sounds. B Palpation is always performed last because it may distort the normal abdominal sounds. C Palpation is always performed last because it may distort the normal abdominal sounds. D The correct order of abdominal examination is inspection, auscultation, and palpation.

Which strategy is most likely to encourage a child to express his feelings about the hospital experience? a. Avoiding periods of silence b. Asking direct questions c. Sharing personal experiences d. Using open-ended questions

ANS: D Feedback A Periods of silence can serve to facilitate communication. B Direct questions can threaten and block communication. C Talking about yourself shifts the focus of the conversation away from the child. D Open-ended questions encourage conversation.

Which intervention helps a hospitalized toddler feel a sense of control? a. Assign the same nurses to care for the child. b. Put a cover over the child's crib. c. Require parents to stay with the child. d. Follow the child's usual routines for feeding and bedtime.

ANS: D Feedback A Providing consistent caregivers is most applicable for the very young child, such as the neonate and infant. B Placing a cover over the child's crib may increase feelings of loss of control. C Parents are encouraged, rather than expected, to stay with the child during hospitalization. D Familiar rituals and routines are important to toddlers and give the child a sense of control. Following the child's usual routines during hospitalization minimizes feelings of loss of control.

What is the best nursing response to the mother of a 4-year-old child who asks what she can do to help the child cope with a sibling's repeated hospitalizations? a. Recommend that the child be sent to visit the grandmother until the sibling returns home. b. Inform the parent that the child is too young to visit the hospital. c. Assume the child understands that the sibling will soon be discharged because the child asks no questions. d. Help the mother give the child a simple explanation of the treatment, and encourage the mother to have the child visit the hospitalized sibling.

ANS: D Feedback A Separation from family and home may intensify fear and anxiety. B Parents are experts on their children and need to determine when their child can visit a hospital. C Children may have difficulty expressing questions and fears and need the support of parents and other caregivers. D Needs of a sibling will be better met with factual information and contact with the ill child.

A 3 1/2-year-old child who is toilet trained has had several "accidents" since hospital admission. What is the nurse's best action in this situation? a. Find out how long the child has been toilet trained at home. b. Encourage the parents to scold the child. c. Explain how to use a bedpan and place it close to the child. d. Follow home routines of elimination.

ANS: D Feedback A Some regression to previous behaviors is normal during hospitalization, even when the child has been practicing the skill for some time. B Hospitalization is a stressful experience. If the incontinence is caused by anxiety, scolding is not indicated and may increase the anxiety. C Developmentally, the 3 1/2-year-old child cannot use a bedpan independently. D Cooperation will increase and anxiety will decrease if the child's normal routine and rituals are maintained.

What should the nurse advise the mother of a 4-year-old child to bring with her child to the outpatient surgery center on the day of surgery? a. Snacks b. Fruit juice boxes c. All of the child's medications d. One of the child's favorite toys

ANS: D Feedback A The child will be NPO before surgery; therefore including snacks for the child is contraindicated. B The child will be NPO before surgery. Unnecessary stress will result when the child is denied the juice. C It is not necessary to bring all medications on the day of surgery. The medication the child has been receiving should have been noted during the preoperative workup. The parent should be knowledgeable of which medications the child has been taking if further information is necessary. D A familiar toy can be effective in decreasing a child's stress in an unfamiliar environment.

What is the most important consideration for effectively communicating with a child? a. The child's chronologic age b. The parent-child interaction c. The child's receptiveness d. The child's developmental level

ANS: D Feedback A The child's age may not correspond with the child's developmental level; therefore it is not the most important consideration for communicating with children. B Parent-child interaction is useful in planning communication with children, but it is not the primary factor in establishing effective communication. C The child's receptiveness is a consideration in evaluating the effectiveness of communication. D The child's developmental level is the basis for selecting the terminology and structure of the message most likely to be understood by the child.

During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is a. Abnormal, requiring further investigation b. Abnormal unless it occurs in conjunction with knock-knee c. Normal if the condition is unilateral or asymmetric d. Normal, because the lower back and leg muscles are not yet well developed

ANS: D Feedback A This is an expected finding in toddlers. B This is an expected finding in toddlers. C Further evaluation is needed if it persists beyond age 2 to 3 years, especially in African-American children. D Genu varum (bowlegged) is common in toddlers when they begin to walk. It usually persists until all of their lower back and leg muscles are well developed.

Which cranial nerve is assessed when the child is asked to imitate the examiner's wrinkled frown, wrinkled forehead, smile, and raised eyebrow? a. Accessory b. Hypoglossal c. Trigeminal d. Facial

ANS: D Feedback A To assess the accessory nerve, the examiner palpates and notes the strength of the trapezius and sternocleidomastoid muscles against resistance. B To assess the hypoglossal nerve, the examiner asks the child to stick out the tongue. C To assess the trigeminal nerve, the child is asked to identify a wisp of cotton on the face. The corneal reflex and temporal and masseter muscle strength are evaluated. D The facial nerve is assessed as described in the question.

The nurse is discussing toddler development with the mother of a 2 1/2-year-old child. Which statement by the mother indicates she has an understanding of how to help her daughter succeed in a developmental task while hospitalized? a. "I always help my daughter complete tasks to help her achieve a sense of accomplishment." b. "I provide many opportunities for my daughter to play with other children her age." c. "I consistently stress the difference between right and wrong to my daughter." d. "I encourage my daughter to do things for herself when she can."

ANS: D Feedback A Toddlers should be encouraged to do what they can for themselves. B Toddlers participate in parallel play. They play next to rather than with age mates. C Excessive stress on the differences between right and wrong can stifle autonomy in the toddler and foster shame and doubt. D The toddler's developmental task is to achieve autonomy. Encouraging toddlers to do things for themselves assists with this developmental task (i.e. feeding self, putting on own socks.)

Which parameter correlates best with measurements of the body's total muscle-mass to fat ratio? a. Height b. Weight c. Skin-fold thickness d. Mid arm circumference

ANS: D Feedback A Height is reflective of past nutritional status. B Weight is indicative of current nutritional status. C Skin-fold thickness is a measurement of the body's fat content. D Mid arm circumference is correlated with measurements of total muscle mass. Muscle serves as the body's major protein reserve and is considered an index of the body's protein stores.

When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm. What is the best explanation for this? a. Some form of cancer b. Local scalp infection common in children c. Infection or inflammation distal to the site d. Infection or inflammation close to the site

ANS: D Feedback A Tender lymph nodes are not usually indicative of cancer. B A scalp infection usually does not cause inflamed lymph nodes. C The lymph nodes close to the site of inflammation or infection would be inflamed. D Small nontender nodes are normal. Tender, enlarged, and warm lymph nodes may indicate infection or inflammation close to their location.

16. A 3-year-old is brought to the emergency department by ambulance after her body was found submerged in the family pool. The child has altered mental status and shallow respirations. She did not require resuscitative interventions. Which condition should the nurse monitor first in this child? a. Neurologic status b. Hypothermia c. Hypoglycemia d. Hypoxia

ANS: D Feedback A Although a neurologic assessment will be required, it is not the area of primary assessment. The airway is always assessed first. B Hypothermia offers protection to the brain. It is a concern, but not the area of primary concern. C Although the child may have electrolyte imbalances, this is not the primary assessment area. D Hypoxia is responsible for the injury to organ systems during submersion injuries. Hypoxia can progress to cardiopulmonary arrest. Monitoring the airway is always the number one concern.

3. What is an appropriate nursing intervention for a 6-month-old infant in the emergency department? a. Distract the infant with noise or bright lights. b. Avoid warming the infant. c. Remove any pacifiers from the baby. d. Encourage the parent to hold the infant.

ANS: D Feedback A Distraction with noise or bright lights is most appropriate for a preschool-age child. B In an emergency health care facility, it is important to keep infants warm. C Infants use pacifiers to comfort themselves; therefore the pacifier should not be taken away. D Parents should be encouraged to hold the infant as much as possible while in the emergency department. Having the parent hold the infant may help to calm the child.

25. What is the leading cause of unintentional death in children younger than 19 years of age in the United States? a. Drowning b. Airway obstruction c. Pedestrian injury d. Motor vehicle injuries

ANS: D Feedback A Drowning is the second leading cause of unintentional death for children under 19 years of age. B Airway obstruction is the third leading cause of unintentional death for children under 19 years of age. C Pedestrian injuries are not the leading cause of unintentional death in children. It is a significant problem, with most injuries occurring in children between 1 and 4 years. D The Centers for Disease Control and Prevention (CDC) has consistently found that motor vehicle injuries are the leading cause of unintentional death in children younger than 19 years of age in the United States.

20. In which situation is the administration of milk or water indicated after ingestion? a. The child is suspected of ingesting lead paint chips. b. The child ingested approximately 15 tablets of baby aspirin. c. The child ingested an over-the-counter product containing acetaminophen. d. The child ingested an acid or alkali.

ANS: D Feedback A Ingestion of leaded paint chips does not indicate treatment with administration of water or milk. B Ingestion of aspirin is not treated with administration of water or milk. The treatment may involve gastric lavage with activated charcoal, IV fluids with various additives to decrease absorption, treatment of electrolyte imbalances, and vitamin K for bleeding tendencies. C Ingestion of acetaminophen is not treated with administration of milk or water. Gastric lavage within 1 hour and administration of the antidote N-acetylcysteine (Mucomyst) is indicated. D Administering water or milk can dilute the toxic effects of acid or alkali ingestion.

21. Which initial assessment made by the triage nurse suggests that a child requires immediate intervention? a. The child has thick yellow rhinorrhea. b. The child has a frequent nonproductive cough. c. The child's oxygen saturation is 95% by pulse oximeter. d. The child is grunting.

ANS: D Feedback A Nasal discharge indicates that the child has a respiratory condition but does not mean the child needs immediate attention. B A productive cough is not a finding that indicates that the child requires immediate attention. C An oxygen saturation of 95% is a normal finding. D One of the initial observations for triage is respiratory rate and effort. Grunting is a sign of hypoxemia and represents the body's attempt to improve oxygenation by generating positive end-expiratory pressure.

5. Which nursing action is most appropriate to assist a preschool-age child in coping with the emergency department experience? a. Explain procedures and give the child at least 1 hour to prepare. b. Remind the child that she is a big girl. c. Avoid the use of bandages. d. Use positive terms and avoid terms such as "shot" and "cut."

ANS: D Feedback A Preschool-age children should be told about procedures immediately before they are done. Allowing 1 hour of time to prepare only allows time for fantasies and increased anxiety. B Children should not be shamed into cooperation. C Bandages are important to preschool-age children. Children in this age-group believe that their insides can leak out and that bandages stop this from happening. D Using positive terms and avoiding words that have frightening connotations assist the child in coping.

2. The father of a child in the emergency department is yelling at the physician and nurses. Which action is contraindicated in this situation? a. Provide a nondefensive response. b. Encourage the father to talk about his feelings. c. Speak in simple, short sentences. d. Tell the father he must wait in the waiting room.

ANS: D Feedback A When dealing with parents who are upset, it is important not to be defensive or attempt to justify anyone's actions. B Encouraging the father to talk about his feelings may assist him to acknowledge his emotions and may defuse his angry reaction. C People who are upset need to be spoken to with simple words (no longer than five letters) and short sentences (no more than five words). D Because a parent who is upset may be aggravated by observers, he should be directed to a quiet area.

What is helpful to tell a mother who is concerned about preventing sleep problems in her 2-year-old child? a. Have the child always sleep in a quiet, darkened room. b. Provide high-carbohydrate snacks before bedtime. c. Communicate with the child's daytime caretaker about eliminating the afternoon nap. d. Use a nightlight in the child's room.

ANS: D A A dark, quiet room may be scary to a preschooler. B High-carbohydrate snacks increase energy and do not promote relaxation. C Most 2-year-olds take one nap each day. Many give up the habit by age 3. Insufficient rest during the day can lead to irritability and difficulty sleeping at night. D The preschooler has a great imagination. Sounds and shadows can have a negative effect on sleeping behavior. Nightlights provide the child with the ability to visualize the environment and decrease the fear felt in a dark room.

Which assessment finding in a preschooler would suggest the need for further investigation? a. The child is able to dress independently. b. The child rides a tricycle. c. The child has an imaginary friend. d. The child has a 2-lb weight gain in 12 months.

ANS: D A A preschool child should be able to dress independently. B A preschool child should be able to ride a tricycle. C Imaginary friends are common for preschoolers. D Preschool children gain an average of 5 pounds a year. A gain of only 2 pounds is less than half of the expected weight gain and should be investigated.

Which is the priority concern in developing a teaching plan for the parents of a 15-month-old child? a. Toilet training guidelines b. Guidelines for weaning children from bottles c. Instructions on preschool readiness d. Instructions on a home safety assessment

ANS: D A Although it is appropriate to give parents of a 15-month-old child toilet training guidelines, the child is not usually ready for toilet training, so it is not the priority teaching intervention. B Parents of a 15-month-old child should have been advised to beginning weaning from the breast or bottle at 6 to 12 months of age. C Educating a parent about preschool readiness is important and can occur later in the parents' educational process. The priority teaching intervention for the parents of a 15-month-old child is the importance of a safe environment. D Accidents are the major cause of death in children, including deaths caused by ingestion of poisonous materials. Home and environmental safety assessments are priorities in this age-group because of toddlers' increased motor skills and independence, which puts them at greater risk in an unsafe environment.

The nurse observes that when an 8-year-old boy enters the playroom, he often causes disruption by taking toys from other children. The nurse's best approach for this behavior is to a. Ban the child from the playroom. b. Explain to the children in the playroom that he is very ill and should be allowed to have the toys. c. Approach the child in his room and ask, "Would you like it if the other children took your toys from you?" d. Approach the child in his room and state, "I am concerned that you are taking the other children's toys. It upsets them and me."

ANS: D A Banning the child from the playroom will not solve the problem. The problem is his behavior, not the place where he exhibits it. B Illness is not a reason for a child to be undisciplined. When the child recovers, the parents will have to deal with a child who is undisciplined and unruly. C Children should not be made to feel guilty and to have their self-esteem attacked. D By the nurse's using "I" rather than the "you" message, the child can focus on the behavior. The child and the nurse can begin to explore why the behavior occurs.

What should the nurse expect to be problematic for a family whose religious affiliation is Jehovah's Witness? a. Immunizations b. Autopsy c. Organ donation d. Blood transfusion

ANS: D A Christian Science believers may seek exemption from immunizations. B Believers in Islam are opposed to organ donation. C Jehovah's Witness believers can make individual decisions about autopsy. D Jehovah's Witness believers are opposed to blood transfusions. They may accept alternatives to transfusions, such as non-blood plasma expanders.

What do parents of preschool children need to understand about discipline? a. Both parents and the child should agree on the method of discipline. b. Discipline should involve some physical restriction. c. The method of discipline should be consistent with the discipline methods of the child's peers. d. Discipline should include positive reinforcement of desired behaviors.

ANS: D A Discipline does not need to be agreed on by the child. Preschoolers feel secure with limits and appropriate, consistent discipline. Both parents should be in agreement so that the discipline is consistently applied. B Discipline does not necessarily need to include physical restriction. C Discipline does not need to be consistent with that of the child's peers. D Effective discipline strategies should involve a comprehensive approach that includes consideration of the parent-child relationship, reinforcement of desired behaviors, and consequences for negative behaviors

Which statement is true about the characteristics of a healthy family? a. The parents and children have rigid assignments for all the family tasks. b. Young families assume the total responsibility for the parenting tasks, refusing any assistance. c. The family is overwhelmed by the significant changes that occur as a result of childbirth. d. Adults agree on the majority of basic parenting principles.

ANS: D A Healthy families remain flexible in their role assignments. B Members of a healthy family accept assistance without feeling guilty. C Healthy families can tolerate irregular sleep and meal schedules, which are common during the months after childbirth. D Adults in a healthy family communicate with each other so that minimal discord occurs in areas such as discipline and sleep schedules.

Which is the most appropriate action for the nurse to take when telling a preschool child about an upcoming procedure? a. Explain all the information in detail to the child. b. Speak loudly and clearly to the child. c. Inform the parents of the procedure and ask them to tell the child. d. Allow the child to play with medical supplies that may be used during the procedure.

ANS: D A It is inappropriate to give a preschooler all the information in detail. The child needs to understand what is going to happen to him or her without explicit details of the procedure. B Speaking in clear sentences with simple words is important, but the conversation should be conducted at a nonthreatening, normal sound level. C The nurse has the most knowledge and best ability for explaining the procedure to the child; however, the parents can be an important resource when explaining the procedure. D Symbolic play is important for emotional development because it allows the child to work through distressing feelings and can be therapeutic.

According to Friedman's classifications, providing such physical necessities as food, clothing, and shelter is the _____ family function. a. Economic b. Socialization c. Reproductive d. Health care

ANS: D A The economic function provides resources but is not concerned with health care and other basic necessities. B The socialization function teaches the child cultural values. C The reproductive function is concerned with ensuring family continuity. D Physical necessities such as food, clothing, and shelter are considered part of health care.

A mother asks the nurse, "When should I begin to clean my baby's teeth?" What is the best response for the nurse to make? a. "You can begin when all her baby teeth are in." b. "You can easily begin now. Just put some toothpaste on a gauze pad to clean the teeth." c. "I don't think you have to worry about that until she can handle a toothbrush." d. "You can begin as soon as your child has a tooth. The easiest way is to take cotton swabs or a face cloth and just wipe the teeth. Toothpaste is not necessary."

ANS: D Feedback A An infant's teeth need to be cleaned as soon as they erupt. Waiting until all the baby teeth are in is inappropriate and prolongs cleaning until 2 years of age. B Because toothpaste contains fluoride and infants will swallow the toothpaste, parents should avoid its use. C The infant's teeth need to be cleaned by the parent as soon as they erupt. Even when a child has the ability to hold a toothbrush, the parent should continue cleaning the child's teeth. D An infant's teeth need to be cleaned as soon as they erupt. Cleaning the teeth with cotton swabs or a face cloth is appropriate.

When counseling parents and children about the importance of increased physical activity, the nurse can emphasize a. Anaerobic exercise should comprise a major component of the child's daily exercise. b. All children should be physically active for at least 2 hours per day. c. It is not necessary to participate in physical education classes at school if a student is taking part in other activities. d. Making exercise fun and a habitual activity.

ANS: D Feedback A Aerobic exercise should comprise a major component of children's daily exercise; however, physical activity should also include muscle and bone strengthening activities. B Children and adolescents should be physically active for at least 1 hour daily. C Encourage all student to participate fully in any physical education classes. D It is important to make exercise a fun and a habitual activity. Encourage parents to investigate their community's different activity programs. This includes recreation centers, parks, and the YMCA.

A school nurse is conducting a class on safety for a group of school-age children. Which statement indicates that the children may need further teaching? a. "My sister and I know two different ways to get out of the house." b. "I can dial 911 if there is a fire or a burglar in the house." c. "My mother has told us that if we have a fire, we have to meet at the neighbor's house." d. "If there is a fire I will have to go back in for my cat Fluffy because she will be scared."

ANS: D Feedback A All children should know two different escape routes from the house, in case one is blocked. B It is important for children to be taught how to call 911 in an emergency. C All families should have a predetermined meeting place away from the house. D Children should be taught never to return to a burning house, not even for a pet.

The mother of a 9-month-old infant is concerned because the infant cries when approached by an unknown shopper at the grocery store. What is the best response for the nurse to make to the mother? a. "You could consider leaving the infant more often with other people so he can adjust." b. "You might consider taking him to the doctor because he may be ill." c. "Have you noticed whether the baby is teething?" d. "This is a sign of stranger anxiety and demonstrates healthy attachment."

ANS: D Feedback A An infant who manifests stranger anxiety is showing a normal sign of healthy attachment. This behavior peaks at 7 to 9 months and is developmentally appropriate. The mother leaving the child more often will not change this developmental response to new strangers. B Assessing developmental needs is appropriate before taking an infant to a physician. C Pain from teething expressed by the infant's cries would not occur only when the mother left the room. D The nurse can reassure parents that healthy attachment is manifested by stranger anxiety in late infancy.

What is the best response a nurse can make to a 15-year-old girl who has verbalized a desire to have a baby? a. "Have you talked with your parents about this?" b. "Do you have plans to continue school?" c. "Will you be able to support the baby?" d. "Can you tell me how your life will be if you have an infant?"

ANS: D Feedback A Asking the teenager whether she has talked to her parents is not particularly helpful to the teen or the nurse and may terminate the communication. B A direct question about continuing school will not facilitate communication. Open-ended questions encourage communication. C Asking the teenager about how she will support the child will not facilitate communication. Open-ended questions encourage communication. D Having the teenager describe how the infant will affect her life will allow the teen to think more realistically. Her description will allow the nurse to assess the teen's perception and reality orientation.

The mother of a 10-month-old infant asks the nurse about beginning to wean her child from his bottle. Which statement by the mother suggests that the child is not ready to be weaned? a. "My son is frequently throwing his bottle down." b. "The baby takes a few ounces of formula from the bottle." c. "He is constantly chewing on the nipple. It concerns me." d. "He consistently is sucking."

ANS: D Feedback A Decreased interest in the bottle starts between 6 and 12 months. Throwing the bottle down is a sign of a decreased interest in the bottle. B When the child is taking more fluids from a cup and decreasing amounts from the bottle, the child is demonstrating a readiness for weaning. C Chewing on the nipple is another sign that the infant is ready to be weaned. D Consistent sucking is a sign that the child is not ready to be weaned.

The most common cause of death in the adolescent age-group involves a. Drownings b. Firearms c. Drug overdoses d. Motor vehicles

ANS: D Feedback A Drownings are major concerns in adolescence but do not cause the majority of deaths. B Firearms are major concerns in adolescence but do not cause the majority of deaths. C Drug overdoses are major concerns in adolescence but do not cause the majority of deaths. D Risk taking behaviors play a major role in the high incidence of motor vehicle injuries and death among teenagers i.e. alcohol use, failure to wear a seatbelt, and inexperience.

The school nurse has been asked to begin teaching sex education in the 5th grade. The nurse should recognize that a. Children in 5th grade are too young for sex education. b. Children should be discouraged from asking too many questions. c. Correct terminology should be reserved for children who are older. d. Sex can be presented as a normal part of growth and development.

ANS: D Feedback A Fifth graders are usually 10 to 11 years old. This age is not too young to speak about physiologic changes in their bodies. B They should be encouraged to ask questions. C Preadolescents need precise and concrete information. D When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development.

Which immunizations should be used with caution in children with an allergy to eggs? a. HepB b. DTaP c. Hib d. MMR

ANS: D Feedback A HepB is safe for children with an egg allergy. B DTaP is safe for children with an egg allergy. C Hib is safe for children with an egg allergy. D Live measles vaccine is produced by using chick embryo cell culture, so there is a remote possibility of anaphylactic hypersensitivity in children with egg allergies. Most reactions are actually the result of other components in the vaccine.

Which comment is most developmentally typical of a 7-year-old boy? a. "I am a Power Ranger, so don't make me angry." b. "I don't know whether I like Mary or Joan better." c. "My mom is my favorite person in the world." d. "Jimmy is my best friend."

ANS: D Feedback A Magical thinking is developmentally appropriate for the preschooler. B Opposite-sex friendships are not typical for the 7-year-old child. C Seven-year-old children socialize with their peers, not their parents. D School-age children form friendships with peers of the same sex, those who live nearby, and other children who have toys that they enjoy.

Which behavior is not demonstrated in the 8-year-old child? a. Understands that his or her point of view is not the only one b. Enjoys telling riddles and silly jokes c. Understands that pouring liquid from a small to large container does not change the amount d. Engages in fantasy and magical thinking

ANS: D Feedback A School-age children enter the stage of concrete operations. They learn that their point of view is not the only one. B The school-age child has a sense of humor. The child's increased language mastery and increased logic allow for appreciation of plays on words, jokes, and incongruities. C The school-age child understands that properties of objects do not change when their order, form, or appearance does. D The preschool-age child engages in fantasy and magical thinking. The school-age child moves away from this type of thinking and becomes more skeptical and logical. Belief in Santa Claus or the Easter Bunny ends in this period of development.

Which statement made by a mother of a school-age boy indicates a need for further teaching? a. "My child is playing soccer this year." b. "He is always busy with his friends playing games. He is very active." c. "I limit his television watching to about 2 hours a day." d. "I am glad his coach is a good role model. He emphasizes the importance of winning in today's society. The kids really are disciplined."

ANS: D Feedback A Team sports such as soccer are appropriate for exercise and refinement of motor skills. B School-age children need to participate in physical activities, which contribute to their physical fitness skills and well-being. C Limiting television to 2 hours a day is an appropriate restriction. School-age children should be encouraged to participate in physical activities. D Team sports are important for the development of sportsmanship and teamwork and for exercise and refinement of motor skills. A coach who emphasizes winning and strict discipline is not appropriate for children in this age-group.

When planning care for adolescents, the nurse should a. Teach parents first, and they, in turn, will teach the teenager. b. Provide information for their long-term health needs because teenagers respond best to long-range planning. c. Maintain the parents' role by providing explanations for treatment and procedures to the parents only. d. Give information privately to adolescents about how they can manage the specific problems that they identify.

ANS: D Feedback A Teenagers are socially and cognitively at the developmental stage where the health care provider can teach them. B Teenagers are more interested in immediate health care needs than in long-term needs. C Teenagers are at the developmental level that allows them to receive explanations about health care directly from the nurse. D Problems that teenagers identify and are interested in are typically the problems that they are the most willing to address. Confidentiality is important to adolescents. Adolescents prefer to confer privately (without parents) with the nurse and health care provider.

In providing anticipatory guidance to parents, which parental behavior is the most important in fostering moral development? a. Telling the child what is right and wrong b. Vigilantly monitoring the child and her peers c. Weekly family meetings to discuss behavior d. Living as the parents say they believe

ANS: D Feedback A Telling the child what is right and wrong is not effective unless the child has experienced what she hears. Parents need to live according to the values they are teaching to their children. B Vigilant monitoring of the child and her peers is an inappropriate action for the parent to initiate. It does not foster moral development and reasoning in the child. C Weekly family meetings to discuss behaviors may or may not be helpful in the development of moral reasoning. D Parents living what they believe gives nonambivalent messages and fosters the child's moral development and reasoning.

Which statement concerning physiologic factors is true? a. The infant has a slower metabolic rate than an adult. b. An infant has an inability to digest protein and lactase. c. Infants have a slower circulatory response than adults do. d. The kidneys of an infant are less efficient in concentrating urine than an adult's kidneys.

ANS: D Feedback A The infant's metabolic rate is faster, not slower, than an adult's. B Although the newborn infant's gastrointestinal system is immature, it is capable of digesting protein and lactase, but the ability to digest and absorb fat does not reach adult levels until approximately 6 to 9 months of age. C Circulation is faster in infants than in adults. D The infant's kidneys are not as effective at concentrating urine compared with an adult's because of immaturity of the renal system and slower glomerular filtration rates. This puts the infant at greater risk for fluid and electrolyte imbalance.

In girls, the initial indication of puberty is a. Menarche b. Growth spurt c. Growth of pubic hair d. Breast development

ANS: D Feedback A The usual sequence of secondary sexual characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth. B The usual sequence of secondary sexual characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth. C The usual sequence of secondary sexual characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth. D In most girls, the initial indication of puberty is the appearance of breast buds, an event known as thelarche.

You are preparing immunizations for a 12-month-old child who is immunocompromised. Which immunizations cannot be given? Select all that apply. a. DTaP b. HepA c. IPV d. Varicella e. MMR

ANS: D, E Feedback Correct: Children who are immunologically compromised should not receive live viral vaccines. Varicella is a live vaccine and should not be given except in special circumstances. MMR is a live vaccine and should not be given to immunologically compromised children. Incorrect: DTaP, HepA, and IPV can be given safely.

A designated safe place can enhance the child's security while in the hospital. For example, intrusive procedures that may cause discomfort or anxiety are best done in the child's room. Is this statement true or false?

ANS: F Any invasive procedures should be performed in the treatment room, not the child's room. The playroom should also be a place for play, not treatments or medication administration. The nurse should consider the child's age and developmental level when deciding where to perform procedures that might be painful or distressing.

2. Automatic external defibrillators (AEDs) are becoming increasingly more available in community settings. They are very effective for correcting serious rhythm disturbances in adults; however, they are not recommended for use in children.

ANS: F It is now recommended that AEDs be used for infants and children as well. AEDs with high specificity in recognizing pediatric shockable rhythms and a system to decrease or attenuate delivery of shock are best used in children under 8 years of age.

For the child who speaks another language, the nurse must identify an interpreter who is proficient in both languages. The patient's 12-year-old brother has accompanied him to the hospital and would be an ideal candidate to interpret before any treatment or surgical procedure. Is this statement true or false?

ANS: F Other children should not be used as interpreters under any circumstances. An adult family member, a friend of the family, or an interpreter service should be used whenever possible. This is necessary in order to explain procedures, teach new skills, and assess patient needs.

The CDC recommends that all health care providers use the World Health Organization (WHO) growth standards to monitor growth for infants and children aged 0-2 years. For children ages 2 and older the CDC growth chart should be used. These charts are standardized and appropriate for all children. Is this statement true or false?

ANS: F There are special growth charts available for premature or very low birth weight infants, and children with specific conditions that may affect size and growth (i.e., Down syndrome).

The number of hours spent sleeping decreases as the child grows older. Children ages 6 and 7 years require approximately 9 or 10 hours of sleep per night. Is this statement true or false?

ANS: F Children ages 6 and 7 actually need approximately 12 hours of sleep per night. Some children also continue to need an afternoon nap or quiet time to restore energy levels. The 12-year-old needs approximately 9 to 10 hours of sleep at night. Adequate sleep is important for school performance and physical growth. Inadequate sleep can cause irritability, inability to concentrate, and poor school performance.

The rate of Sudden Infant Death Syndrome (SIDS), now the third leading cause of death in infants, has increased despite international efforts and the Back to Sleep campaign. Is this statement true or false?

ANS: F This statement is incorrect. SIDS, which for a long time was the second leading cause of infant deaths, has decreased in part because of the Back to Sleep program. It is important for both hospital and clinic nurses to educate parents on safe sleep strategies for their infant.

Parents of children with special needs often require specialized care and experience frequent hospitalizations. When caring for these families, the nurse should be aware that they may experience financial hardship due to their child's condition and require assistance in obtaining referrals to resources. Is this statement true or false?

ANS: T These families often suffer financial hardship, which can lead to issues related to coping and other strains on the family. Health insurance benefits may quickly reach their maximum. Even if the child is on special assistance for health care, one parent may have to remain home with the child rather than work outside of the home. Social work and financial or prescription assistance may all be necessary and appropriate sources of support.

1. Regardless of the cause of traumatic injury, most children do well unless the injuries are extremely severe. Even children with traumatic brain injuries (TBI) have far more favorable chances of recovery than most adults. Is this statement true or false?

ANS: T Children up to 4 years old sustain TBIs 30% more often than any other age-group, but make up the lowest number of TBI hospitalizations and deaths.

An important part of the physical exam is the otoscopic examination of the ear. The ear canal should be straightened prior to visualization. If the child is younger than 3, this is accomplished when the nurse pulls the pinna of the ear down and back. Is this the correct procedure?

ANS: T If the child is older than 3, the pinna is pulled up and back. As much of the ear canal as possible should be visible before the speculum is inserted into the auditory meatus.

The use of electronic or digital media for communication has had a negative effect on the language development of adolescents. Is this statement true or false?

ANS: T Text messaging, instant messaging, blogs, and Twitter all contribute to abbreviated communication techniques, which eliminate not only grammar and sentence construction, but also word development (e.g., using ur, for you are).

Breastfeeding is the ideal method for providing nutrition to the human infant and is recommended by the American Heart Association, the American Academy of Pediatrics, and the World Health Organization. Infants should be exclusively breastfed for a minimum of 4 months and preferably 6 months. Is this statement true or false?

ANS: T This statement is correct. Solid food should not be introduced until 4 to 6 months of age. Breastfeeding should accompany solid food introduction until 1 year of age.

____________________ is the leading cause of death in children of every age-group beyond 1 year of age.

ANS: Unintentional injury

It is time to give 3-year-old boy his oral liquid medication. Which approach is most likely to receive a positive response? A. "It's time for your medication now. Would you like water or apple juice afterward?" B. "You must take your medicine, because the doctor says it will make you better." C. "See how nicely your roommate took his medicine? Now take yours." D. "Wouldn't you like to take your medicine now?"

Answer: A Rationale: A. This choice provides the patient with a structured choice with two acceptable options. B. This option can elicit negative behavior from the child; the nurse is abdicating responsibility to the physician. C. Encouraging competition is not appropriate for this age group. D. This question allows the child the option to say "no."

The units pediatric nurse educator is explaining the physiological differences in infants and young children related to absorption of medications. Which information should the educator present? (SELECT ALL THAT APPLY.) A. Because of the greater fluid volume per weight in infants and young children, patients in this age range need a higher dose per kilogram of water-soluble medication to achieve the desired distribution effects B. The immaturity of infants skin creates a decreased absorption of topical medications C. Blood flow to muscle tissue can be erratic in young children, and this can increase or decrease the absorption of IM medications D. Infants up to 8 months of age tend to have increased gastric motility which is generally predictable E. The blood-brain barrier does not fully mature until a child is about 18 months old F. Since pancreatic enzyme activity also is variable in infants for the first 3 months of life as the GI system matures, medications that require specific enzymes for dissolution and absorption might not be converted to a suitable form for intestinal action.

Answer: A, C, F

For which medications should the nurse verify dosage and the drug container with another nurse? (SELECT ALL THAT APPLY.) A. Insulin B. 0.9% sodium chloride C. 5% Dextrose in water D. Digoxin (Lanoxin) E. Warfarin (Coumadin) F. 0.45% sodium chloride

Answer: A, D, E

A toddler was severely dehydrated when first admitted three days ago. Since then, a rehydration regimen has been constantly delivered. What is the most important assessment by the nurse prior to giving the next dose of medication? A. Check the toddler's vital signs B. Determine if the toddler's weight is accurate C. Assess the toddler's skin turgor D. Check his intake and output record

Answer: B Rationale: A. Be sure the child's weight is accurately recorded and is current, especially since his weight upon admission would most likely be less than at the current time. The vital signs change late and would not be a priority nursing action. B. Be sure the child's weight is accurately recorded and is current, especially since his weight upon admission would most likely be less than at the current time. Medication calculations are weight-based, and there the weight must be checked frequently. C. The skin turgor will provide an estimate of the toddler's hydration, but has nothing to do with medication administration safety. D. The intake and output record is important but has nothing to do with the medication administration.

The nurse is preparing to administer an intramuscular injection to a toddler in the vastus lateralis muscle and there is not time for EMLA cream to be used. Which approach by the nurse is best in this situation? A. Ask the parents to help hold the toddler's legs still B. Ask another staff member to help hold the toddler's legs still C. Distract the toddler while giving the injection alone D. Promise the toddler a surprise if there is cooperation

Answer: B Rationale: A. The parents should be in a comforting role, not holding their toddler still. B. Asking another staff member to help hold the toddler's legs still is best. C. Distracting the toddler while giving the injection alone is not safe. The toddler could move and the needle could cause harm to the leg. D. Promising the toddler a surprise if there is cooperation is not realistic for a potentially painful procedure.

A child weighs 18 kg and is to receive a medication which is 6 mg/kg/day in two divided doses. How much medication should the nurse administer per dose? A. 6 mg B. 36 mg C. 54 mg D. 108 mg

Answer: C Rationale: 18 mg x 6 mg/kg/day =108 mg per day. Since it is in 2 divided doses, each dose would contain half of the daily medication dose which would be 54 mg per dose.

A child needs medication administered through his gastrostomy tube. Which form of the medication should the nurse use? A. A crushed chewable tablet B. A time-release capsule C. A suspension D. A crushed enteric coated tablet

Answer: C Rationale: A. A crushed chewable tablet is not a good choice. It can clog the tube. B. A time-release capsule is exactly that: medication which is to be released after a certain period of time. C. A suspension is a liquid which must be shaken before given in the tube. The tube should also be flushed before and afterward if tube feeding is currently being given. D. An enteric coated tablet should never be crushed and administered through a gastrostomy tube, because the coated which protects it from gastric juices is destroyed and the child will not get the entire dose.

A child with terminal bone cancer is in severe pain. Based on the nurse's knowledge of terminal cancer and pain control, what action should the nurse take? A. Try to distract the child since children tend to be overmedicated for pain B. Give large doses of opioids regardless of the side effects C. Give small amounts of pain medication, since narcotic addiction is common in terminally ill children D. Administer large doses of opioids when there are no other treatment options

Answer: D Rationale: A. Distraction doesn't work for severe pain. Continuing studies report that children are consistently undermedicated for pain. B. The dose is titrated to relieve pain. C. Addiction refers to a psychological dependence on the medication, which does not happen in terminal care. D. Large doses may be needed, because the child has become physiologically tolerant to the drug, requiring higher doses to achieve the same degree of pain control.

The nurse is doing preoperative teaching with a child and his parents. The parents say that their child is "dreading the shot" for premedication. What information should the nurse take into consideration when responding to the parent's concern? A. Preanesthetic medication can only be given IM B. The IM route is safer than the IV route in children C. The child will have no memory of the injection because of amnesia D. Preanesthetic medication should be non-traumatic and other routes can be explored

Answer: D Rationale: A. Preanesthetic medicines can be given in a variety of routes other than intramuscular. B. The IV route is preferable. C. The muscle may be sore after an injection. D. The necessity of premedication is being investigated. If necessary, numerous drug regimens and routes exist.

The nurse suspects a child is having an adverse reaction to a blood transfusion. What is the first action by the nurse? A. Notify the physician B. Recheck the vital signs C. Increase the flow of normal saline D. Stop the transfusion

Answer: D Rationale: A. The nurse should notify the physician after the blood transfusion is stopped and infusion of normal saline solution has begun. B. The nurse should take vital signs and compare them with the baseline after the blood transfusion is stopped and infusion of normal saline solution has begun. C. The blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred, and first-voided urine and a new blood sample drawn from the patient for typing should be sent to the laboratory. D. It is the priority nursing action to stop the transfusion, then obtain new tubing, and maintain a patent IV line with normal saline solution. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused.

A 12 year old had abdominal surgery at 10 am she last received a dose of morphine at 5pm. At 8pm the nurse enters her room and finds her playing video games. When asked about her pain, the child rates it as 1 on a 0-5 scale. In this situation, playing the video game is an example of: A. Imagery B. Distraction C. Play therapy D. Obsession

B

Respiratory depression is a side effect of: A. Acetaminophen B. Fentanyl C. Ketorolac D. Naloxone

B

Which drug is classified as an NSAID? A. Acetaminophen B. Codeine C. Ibuprofen D. Midazolam

C

Which statement about children and pain and its management is true? A. Children can easily become addicted B. Children who are playing are not in pain C. Past pain experiences can affect how a child experiences pain D. Child are more likely than adults to experience respiratory depression from narcotics

C

A child's perception of pain is influenced by the: A. Parental response to the child's pain B. Child's ethnic background C. Child's developmental stage D. All of the above

D

IV fentanyl is prescribed for a child who is about to have a chest tube placed. Fentanyl is an appropriate analgesic choice for this procedure because: A. It is more potent than meperidine B. It releases less histamine than other analgesics C. It is shorter acting than morphine D. All of these reasons apply

D

The drug Narcan: A. Causes respiratory depression at high doses B. Is used as an antidote to ibuprofen overdose C. Is a topical anesthetic D. Is used to reverse the sedative effects of morphine

D

The side effect of opioid analgesics include: A. Constipation B. Nausea C. Sedation D. All of the above

D

___________ refers to the view that one's own culture's way of doing things is always the best.

Ethnocentrism Rationale: Although the United States is a culturally diverse nation, the prevailing practice of health care is based on the beliefs held by members of the dominant culture, primarily Caucasians of European descent. Cultural relativism is the opposite of ethnocentrism. It refers to learning about and applying the standards of another's culture.

T/F A child with arthritis typically experiences acute pain

False

T/F Children are at greater risk for respiratory depression from narcotics than are adults

False

T/F Eutectic mixture of local anesthetics (EMLA) cream is effective within 10 minutes if application

False

T/F Guidelines for managing pain in sickle cell disease were developed by the World Health Organization

False

T/F Meperidine (Demerol) is more effective than morphine in children

False

T/F Neuropathic pain is usually easier to manage than acute pain

False

T/F Premature infants lack the neuralgic structures required for pain perception

False

T/F Rubbing a sprained ankle makes the pain worse

False

T/F There are no long term consequences of pain experiences in the newborn period

False

. In which section of the health history should the nurse record that the parent brought the infant to the clinic today because of frequent diarrhea? a. Review of systems b. Chief complaint c. Lifestyle and life patterns d. Health history

Feedback A The review of systems includes past health functions of body systems. B The chief complaint is documented using the child's or parent's words for the reason the child was brought to the health care center. C Lifestyle and life patterns include the child's interaction with the social, psychological, physical, and cultural environment. D Health history includes birth history, growth and development, common childhood illnesses, immunizations, hospitalizations, injuries, and allergies.

Which statement about performing a pediatric physical assessment is correct for a school-age child? Select all that apply. a. Physical examinations proceed systematically from head to toe. b. The physical examination should be done with parents in the waiting room. c. Measurement of head circumference is obtained. d. The physical examination is done only when the child is cooperative. e. Remove clothing and have the child put on an examination gown.

Feedback Correct Physical assessment usually proceeds from head to toe; however if developmental delays exist, considerations dictate that the least threatening assessments be done first to obtain accurate data. School-age children are at a developmental stage when they should be cooperative for the physical examination. Children of this age are usually modest, and an examination gown should be provided. Incorrect Having parents in the examining room with adolescents is not appropriate, but is appropriate for children of other age-groups. Parents usually are not kept in the waiting room. Measurement of head circumference is obtained on children 36 months of age or less.

T/F Acetaminophen does not inhibit prostaglandin

True

T/F Acute pain experienced by hospitalized children is often procedural pain

True

T/F Emotional factors contribute to the pain experience

True

T/F Epidural opioid analgesia has fewer side effects than intravenous (IV) opioid analgesia

True

T/F How present pain experiences are managed will influence future pain experiences

True

T/F Midazolam (Versed) is used for conscious sedation

True

T/F Myelinization is not necessary for pain perception

True

T/F Narcan may need to be repeated after 30 to 60 mins because of its short half life

True

T/F Nonsteroidal anti-inflammatory drugs (NASIDs) reduce pain and inflammation

True

T/F Opioid analgesics can cause sedation and respiratory depression

True

T/F The gate control theory supports the use of physiologic and psychological interventions in pain management

True

A _________ family is one formed when single, divorced, or widowed parents bring children from a previous union into the new relationship.

blended These families must overcome differences in parenting styles and values to form a cohesive blended family. Often they wish to have children with each other in the new relationship. Differing expectations of the children's development and beliefs regarding discipline may lead to conflict. Older children often resent the introduction of a stepmother or stepfather.

The parents of a preschool child ask the nurse why their child needs to have her "eyes tested." The nurse explains that although evaluating the visual acuity in a young child can be difficult, the American Academy of Pediatric recommends that visual acuity testing be assessed on all children beginning no later than age _________ years.

three The American Academy of Pediatric recommends that visual acuity testing be assessed on all children beginning no later than age 3 years. Tools available for testing the visual acuity of preschool children include Lea cards, tumbling Es, and the HOTV chart.