Peds Success Ch. 2 - Growth

18. Which statement by the mother of an 18-month-old would lead the nurse to believe that the child should be referred for further evaluation for developmental delay?

1. "My child is able to stand but is not yet taking steps independently." - The child should be walking independently by 15 to 18 months. Because this toddler is 18 months & not walking, a referral should be made for a developmental consult.

10. A 3-year-old female is hospitalized for an ASD repair. Her parents have decided to go home for a few hours to spend time with her siblings. The child asks when her mommy and daddy will be back. The nurse's best response is:

1. "Your mommy and daddy will be back after your nap." - Preschoolers understand time in relation to events.

28. A nurse caring for a 5-year-old boy is trying to encourage developmental growth. What can the nurse do to reinforce the child's intellectual initiative when he asks the nurse about his upcoming surgery?

1. Answer the child's questions about his upcoming surgery in simple terms - The child is taking the initiative to ask questions, as all toddlers do, and the nurse should always answer those questions as appropriately and accurately as possible.

48. A 9-year-old boy has been hospitalized following a bicycle injury. What should the nurse recommend to the child's parents to prevent future injury?

1. Safety equipment is essential for bicycling, skateboarding & participating in contact sports. Most injuries occur during school age years, when kids are more active & participate in contact sports.

35. A 13-year-old boy is hospitalized for a femur fracture. He was hit by a car while he & his friends were racing bikes near a major intersection. The parents are concerned about his judgment. What should the nurse understand?

1. The child's behavior is typical of young teens - The brains of young teens are not completely developed, which often leads to poor judgment and low impulse control.

37. The nurse is performing a physical assessment on a 6-month-old baby. Which finding should the nurse understand as abnormal for this child?

1. The child's posterior fontanel is open - The posterior fontanel should close between 6 and 8 weeks of age.

60. A 4-year-old has been hospitalized with FTT. The child has orders for daily weights, strict input and output, and calorie counts as a means of measuring her nutritional ,status. Which action by the nurse would be a concern?

1. The nurse weighs the child every morning before the child eats breakfast - The child should be weighed every day before she eats. Her weight will not be an accurate reflection if she is fed prior to being weighed.

14. The school nurse is planning an educational program centered on abstinence for adolescents. Which method does the nurse recognize as the most effective way to present this program?

1. Use peer-led programs that emphasize the consequences of unprotected sexual contact - Adolescents are most concerned with what their peers think and feel. They are most receptive to information that comes from another adolescent.

16. A first-time mother brings in her 5-day-old baby for a well-child visit. The nurse weighs infant and reports a weight of 7 lb 5 oz to mother. The mother looks concerned and tells nurse that her baby weighed 7 lb 10 oz when she was discharged 4 days ago. The nurse's best response to the mother is:

2. "An initial weight loss of a few ounces is common among newborns, especially for breastfeeding mothers." - Newborns can lose up to 10% of their birth weight without concern but should regain their birth weight by 2 weeks of age.

34. A 3-year-old girl is attending her grandfather's funeral. Her parents have told her that her grandfather is in heaven with God. The child is taken up to open casket with her parents. Which statement by child describes a 3-year-old child's understanding of spirituality?

2. "Grandpa is in heaven. Is this heaven?" - Children 3 years old are literal thinkers. The child's parents told her that Grandpa was in heaven. She sees his body, so she thinks they are all in heaven.

50. An 11-mo-old girl has a diagnosis of iron-deficiency anemia. The child's mother tells the nurse that her daughter is currently taking iron and a multivitamin. Which statement made by mother should be of concern to the nurse?

2. "I give my daughter her iron and her multivitamin in her morning 6-oz bottle." - Meds should never be mixed in a large amount of food or formula because the parent cannot be sure that the child will take the entire feeding. Formula decreases the absorption of iron.

11. A male infant is visiting the pediatrician for his 6-month well child checkup. His mother tells the nurse she wants to advance infant's diet. Which statement by infant's mother leads nurse to believe that she needs further education about nutritional needs of a 6-month-old?

2. "I will start my son on fruits & gradually introduce vegetables." - Infants should be started on vegetables prior to fruits. The sweetness of the fruits may inhibit them from taking vegetables.

36. A 2-day-old girl is being discharged from the hospital. Her mother asks the nurse when she will receive her first hepatitis B immunization. Which is the nurse's best response?

2. "She will receive her first dose of hepatitis B vaccine prior to discharge today." - first dose of Hep B vaccine is recommended between birth and 2 months. Most hospitals give the vaccine prior to discharge home.

32. An 18-year-old boy comes to the ER complaining of a rash and itching in the groin area. He is concerned he has contracted a sexually transmitted disease and worries that his parents will find out. The nurse's best response is:

2. "We will not contact your parents regarding this visit." - An adolescent has every right to privacy as long as the situation is not life-threatening.

17. The nurse is caring for a 12-month-old girl. The child's mother asks if the unit has any toys that her daughter can play with. The nurse goes to the toy area in search of a toy for the child. Which toy is the best choice for this child?

2. A musical rattle - the perfect toy for this child. Infants have short attention spans and enjoy auditory and visual stimulation.

38. A 16-year-old girl is having a discussion with her nurse about her recent diagnosis of lupus. The nurse understands how to best answer the young woman's questions about her prognosis because she understands that cognitively:

2. Adolescents are able to understand and imagine possibilities for the future - Adolescents are becoming abstract thinkers and are able to imagine possibilities for the future.

5. A 17-year-old male is being seen in the ER. In order to obtain the adolescent's health information, his nurse should:

2. Casual Conversation - Frequently adolescents will share more info when it is gathered during a casual conversation.

2. A 16-year-old male is hospitalized for cystic fibrosis. He will be an inpatient for 2 weeks while he receives IV antibiotics. As the nurse caring for this patient, what action can you take that will most enhance his psychosocial development?

2. Encourage teen's friends to visit him in hospital - Teens are most concerned about being like their peers. Having the teen's friends visit will help him feel he is still part of school and social environment.

47. A 3-year-old boy has been hospitalized because he fell down the stairs. His mother is crying & states, "This is all my fault." Which is the nurse's best response to the child's mother?

2. Falls are one of the most common injuries for toddlers - it may make the parent feel better to know that this is common among all toddlers.

30. A 9-year-old girl builds a clubhouse in her backyard. She hangs a sign outside her clubhouse that says "No boys allowed." The parents are concerned she is excluding their neighbor's son, and they are upset. What should the school nurse tell the child's parents?

2. Her behavior is common among school-age children - Girls of 9 and 10 generally prefer friends who are of same gender.

20. A 2-year-old boy has been admitted to the hospital for anemia. His mother asks the nurse what foods to include in his diet to improve his nutritional status. Which of the following should the nurse recommend?

2. Increase the child's intake of meats, eggs, and green vegetables - excellent sources of iron.

61. SATA: Which of the following are stressors common to hospitalized toddlers? 1. Social isolation. 2. Interrupted routine. 3. Sleep disturbances. 4. Self-concept disturbances. 5. Fear of being hurt.

2. Interrupted routine, 3. Sleep disturbances, 5. Fear of being hurt - Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. The stressors of social isolation and self-concept disturbances are stressors of the hospitalized teen.

27. The nurse caring for an 8-year-old boy is trying to encourage developmental growth. What activity can the nurse provide for the child to encourage his sense of industry?

2. Provide the child with the homework his teacher has sent in - The school-age child is focused on academic performance & can achieve a sense of industry by completing homework and staying on track with his classmates.

42. A 5-year-old boy has always been one of the shortest kids in class since pre school. His mother tells school nurse her husband is 6' & she is 5'7". She is concerned about her son's height. Based on her knowledge of a child's physical growth during the school-age years, what should the nurse tell the child's mother?

2. She should expect him to grow about 2 inches every year from ages 6 to 9 years - During the school-age years, a child grows approximately 2 inches per year.

9. The nurse is caring for a 6-month-old in the ER. The physician orders the nurse to give the child a dose of Rocephin IM. The 1.5 mL dose arrives from the pharmacy. The nurse must do which of the following?

2. Split the dose into two injections - A nurse should not deliver more than 1 mL per IM injection to a child of 6 months.

24. A 5-year-old is at the pediatrician's office for his well-child checkup. The nurse will be administering three immunizations to the child. The nurse should expect which reaction from the child when she gives his immunizations?

2. The child will likely cry and tell the nurse that it hurts - The common response of a 5-year-old is to cry and protest during an immunization.

44. A mother requests that her child receive the varicella vaccine at her 9-month well-child checkup. The nurse tells mother that:

2. The nurse cannot give the vaccine - The nurse should not give the vaccine. Varicella vaccine is not usually given prior to 1 year of age.

40. A 13-year-old boy is visiting the peds office for his well-child checkup. The child tells nurse he is worried because his breasts are growing and they hurt. He says he is afraid to take his shirt off in front of other boys during gym class. What should the nurse tell him?

3. " This is a normal condition of puberty that will resolve within a year or two." - Gynecomastia & breast tenderness are common for about a third of boys during middle puberty. Gynecomastia usually resolves in 2 years.

3. A 6-month-old male is at his well-child checkup. The nurse weighs him & mother asks if his weight is normal for his age. The nurse's best response is:

3. "At 6 months his weight should be approximately twice his birth weight." - Children should double their birth weight by 4 to 6 months of age.

15. The nurse is instructing a new breastfeeding mother in the need to provide her premature infant with an adequate source of iron in her diet. Which one of the following statements reflects a need for further education of the new mother?

3. "I will need to add iron supplements to my baby's diet when she is 9 months old." - Premature infants have iron stores from the mother that last approximately 2 months, so it is important to introduce an iron supplement by 2 months. Full-term infants have iron stores that last approximately 4 to 6 months.

55. The nurse caring for a 9-month-old is using the FLACC scale to rate her pain level. The child's parents ask the nurse what the FLACC scale is. Which is the nurse's best response?

3. "It estimates a child's level of pain utilizing behavioral and physical responses - The FLACC scale utilizes behavioral and physical responses of the child to measure the child's level of pain. The scale utilizes facial expression, leg position, activity, intensity of cry, and level of consolability.

29. The mother of 11-year-old fraternal twins tells nurse at their well-child checkup she is concerned because her daughter has gained more weight and height than her twin brother. The mother is concerned there is something wrong with her son. The nurse's best response is:

3. "It is normal for girls to grow a little taller and gain more weight than boys at this age." - This is appropriate response. The nurse understands that it is normal for girls to grow taller and gain more weight than boys near the end of middle childhood.

52. A 5-year-old boy is being screened for developmental delays using Denver Developmental Screening Test. The child's mother is explaining to nurse her understanding of the screening test. The nurse realizes the mother needs further education about the test when she states which of the following?

3. "It screens my son's intelligence level." - The Denver Developmental Test does not test a child's level of intelligence.

57. An 8-week-old male has just had surgery for pyloric stenosis. His nurse is assessing his level of pain. The child's mother asks the nurse what vital sign changes she should expect to see in a child who is experiencing pain. The nurse's best response is:

3. "We expect to see a child's HR & BP increase." - When a child is experiencing pain, the normal physiological response is for the HR, RR & BP to increase.

54. A 3-year-old was admitted to hospital with croup. His nurse just obtained vital signs. The child's HR is 90, his RR is 44, his BP is 100/52, and his temp is 98.8°F (37.1° C). Parents ask the nurse if his vital signs are appropriate for a child his age. The nurse's best response to the parents is:

3. "Your son's respiratory rate is elevated, but the other vital signs are within normal limits." - A normal respiratory rate for a child from 3 to 6 years is 20 to 30 breaths per minute.

1. A 3-year-old female is hospitalized for a femur fracture. As her nurse, what action would help foster child's sense of autonomy?

3. Allow child to administer her own dose of Keflex (cephalexin) via oral syringe - Allowing toddlers to participate in actions of which they are capable is an excellent way to enhance their autonomy.

56. A 12-month-old boy weighed 8 lb 2 oz at birth. Understanding developmental milestones, what should the nurse caring for the child calculate his current weight as?

3. Approximately 24 lb 6 oz - Children should triple their birth weight by 12 months of age.

59. A 4-year-old is visiting peds office for his well-child checkup. The nurse needs to take his blood pressure. Which action by the nurse is a developmentally appropriate method for eliciting the child's cooperation?

3. Ask the child if he feels a squeezing of his arm - Preschool children enjoy games & it is a good way to elicit their assistance and cooperation during a procedure.

46. The parents of a 7-month-old girl are attending a class on child safety. Following the class, what should child's parents understand as one of the most common causes of injury and death for a 7-month-old child?

3. Aspiration - is a common cause of injury and death among children of this age. These children often find small objects lying on the floor and place them in their mouths. Older siblings are often responsible for leaving small objects around.

33. Nurse is working on discharge teaching with parents of a 2-day-old girl. They are asking how to use infant car seat and where it should be placed in their vehicle. What should the nurse do?

3. Contact hospital's car-seat safety officer, and ask the officer to accompany parents to the car for car-seat installation - The car-seat safety officer is the best choice, as that individual would have the needed information and certification to help the family.

53. The mother has brought her 16-year-old daughter to the ER because she is concerned her daughter is anorexic. During child's initial physical assessment, the nurse notes the daughter has signs and symptoms of nutritional deficit. Which assessment item led the nurse to this initial conclusion?

3. Dry and brittle hair and nails - common among people who have a nutritional deficit.

25. An 8-year-old is NPO while he awaits surgery for central line placement later in the afternoon. The nurse is trying to engage child in some form of activity to distract him from thinking about his upcoming surgery. What is best method of distraction for a child of this age in this situation?

3. Encourage the child to play a board game - optimal choice because school-age children enjoy being engaged in an activity with others that will require some skill and challenge.

22. In order to prevent separation anxiety in a hospitalized toddler, which of the following should the nurse do?

3. Establish a routine similar to that of the child's home - It is very important to try to maintain a child's home routine both when parents are present and when they have to leave the hospital. This will increase child's sense of security and decrease anxiety.

39. The mother of a 13-year-old girl tells nurse she is concerned because her daughter has gained 10 lb since she puberty. The child's mother asks the nurse for advice about what to do about her daughter's weight gain. Which of the following should the nurse do?

3. Inform mother that it is common for teen girls to gain weight during puberty - The nurse should tell child's mother that this is a normal finding in teenage girls as they enter puberty.

7. How can the nurse best facilitate the trust relationship between infant and parent while the infant is hospitalized?

3. Nurse should encourage parents to hold their child as much as possible - Having parents hold child while in hospital is an excellent means of building the trust relationship. Infants are most secure when they are being held, patted, and spoken to.

45. A 16-year-old boy has a diagnosis of new onset diabetes. The child is meeting with the nurse educator regarding changes that will need to be made in his diet. What would most influence a teenager's food choices?

3. Peers & their dietary choices - As a teen, the child is most influenced by his peers. Teens long to be like others around them.

4. The nurse caring for a 4-year-old female in the ER is about to start a peripheral IV. The nurse's best method for explaining the procedure to the child is to:

3. Show the child the IV placement equipment, and demonstrate the procedure on a doll - A 4-year-old child understands things in very concrete and simple terms. Therefore, medical play is an excellent method for helping her understand the procedure.

51. The mother of a 15-year-old boy is frustrated because he spends much of his weekend time sleeping. She tells nurse, "My son sleeps longer now than he did when he was in kindergarten." What is nurse's best response to the child's mother's frustration?

3. Teens require more sleep due to the rapid physical growth that occurs during adolescence.

8. The nurse is caring for a 7-year-old female on school-age unit. Her mother is concerned that she may have some developmental delays. Which statement would indicate to the nurse that the child is not developmentally on track for her age:

3. The child has an imaginary friend named Kelly - Most school-age children do not have imaginary friends. This is much more common for children of 3 and 4 years of age.

19. The mother of a child 2 years 6 months has arranged a play date with the neighbor and her 3-year-old daughter. During the play date the two mothers should expect that the children will do which of the following?

3. The children will play alongside one another but not actively with one another - Toddlers engage in parallel play. They often play alongside another child but they rarely engage in activities with the other child.

6. A 7-year-old female is admitted to hospital for a diagnosis of acute lymphocytic leukemia. The nurse wants to gather info from child regarding her feelings about her diagnosis. Which nursing action is most appropriate to gain information about how child is feeling?

3. The nurse should provide the child with some paper to draw a picture of how she is feeling - Often children will include much more detail of their feelings in drawings. They will often express things in pictures they are unable to verbalize.

41. An 8-year-old girl is at peds office for a well-child checkup. Her mother tells the nurse she has been having some difficulty getting her daughter to complete her chores. The child's mother asks the nurse for techniques for gaining the child's cooperation with chores. Which of the following should the nurse suggest the mother do?

3. Use a reward system as a technique - School-age children usually respond very well to a reward system & often enjoy the rewards so much that they will continue chores without continual reminders.

58. A 17-year-old male has had some recent behavioral changes. His mother calls the nurse & says her son has been coming home from school every day, closing his door & having no interaction with his parents. The child's mother does not know what she should do about her son's unsociable behavior. The nurse's best response to the child's mother is:

4. "His behavior is normal. You should listen to him without being judgmental." - The child's behavior is typical of a teen's response to developmental and psychosocial changes of adolescence.

43. A 2-year-old girl has just become a big sister. Her mother has been a stay-at-home mother. Based on the developmental level of a 2-year-old, which comment should the child's mother expect from her toddler about her new baby brother?

4. "Mommy, it is time to put him away so we can play."- This is a typical statement that would be made by a toddler. Toddlers are very egocentric and do not consider needs of other child.

49. An 8-day old female was admitted to hospital with vomiting and dehydration. The nurse did vital signs. The child's HR is 185, her RR is 44, her BP is 85/52, and her temp is 99°F (37.2° C). The child's parents ask the nurse if her vital signs are within normal limits. What is the nurse's best response to the parents?

4. "Your daughter's heart rate is elevated, but the other vital signs are within normal limits." - A normal HR for a child from birth to 1 month is 90 to 160.

31. The school nurse is preparing a discussion on nutrition with the fourth-grade class. Based on childrens' developmental level, what information should she include in her presentation?

4. A review of nutritious foods with basic scientific info about how they affect body organs and systems - Reviewing nutritious choices keeps the lesson on a positive note & school age kids are very interested in how food affects their bodies. They are capable of understanding basic medical terminology.

21. The parents of a 2-year-old boy are concerned about his behavior. Since child's admission to the hospital 2 days ago he has been crying much more than usual and is inconsolable much of the time. The nurse's best response to the child's parents is:

4. The child is in the protest stage of separation anxiety, which is normal for children during hospitalization - During protest stage of separation anxiety, children are often inconsolable & they often cry more than they do when they are at home. These children also frequently ask to go home.

26. According to developmental theories, which important event does the nurse understand is essential to the development of the toddler?

4. The child participates in being potty-trained - Developmental theorists like Erickson and Freud believe that toilet training is the essential event that must be mastered by the toddler.

12. ER nurse is assessing a 12-month-old female. Which statement accurately describes the best method for assessing this child?

4. The nurse should assess the child while she is in her mother's lap - Infants are most secure when in proximity to parent. The parent's lap is an excellent place to assess the child.

13. An 11-year-old male is being evaluated in the ER for an inguinal hernia. Which statement accurately describes how nurse should approach him for his physical assessment?

4. The nurse should explain to the child what the nurse will be doing in basic understandable terms - School-age children are capable of understanding basic functions of body and should be taught about their diagnosis in simple, basic terms.

23. A 5-year-old girl has been brought to the ER for suspected child abuse. What approach should nurse use to gather info from the child?

4. The nurse should tell child that the abuse is not her fault and that she is a good person - Many young children believe abuse or illness is their fault, and they should be reminded they are not to blame. Many children of this age believe they have acquired a disease or have been abused because they are bad people.