Peds Test 1

A follow-up visit for a newborn client is scheduled with the pediatric nurse practitioner 3 days after discharge. What will the nurse include in the assessment during the scheduled visit for this newborn? Standard Text: Select all that apply. 1. Feeding pattern 2. Jaundice 3. Length 4. Vision screen 5. Sleep pattern

1,2,5 Feeding pattern, sleep pattern, and jaundice assessment would be appropriate 3 days after discharge. It would not be necessary to do a length or vision screen at this age.

Which of these aspects of developmental health supervision should be included in each healthcare visit of young children? Standard Text: Select all that apply. 1. Assessment 2. Discipline 3. Education 4. Intervention 5. Toilet training

1,3,4 The main recommendations for developmental health supervision of young children include assessment, education, intervention, and care coordination. This standard framework should be used as guidelines for each healthcare visit. Discipline and toilet training, while important to the care of children, are age specific and not part of the main developmental plans.

7-year-old child presents to the clinic with an exacerbation of asthma symptoms. On physical examination, the nurse would expect which assessment findings? Standard Text: Select all that apply. 1. Wheezing 2. Increased tactile fremitus 3. Decreased vocal resonance 4. Decreased tactile fremitus 5. Bronchophony

1,3,5 Wheezing is caused by air passing through mucus or fluids in a narrowed lower airway, which is a condition present in asthma exacerbations. The air trapping in the lungs that occurs in asthma causes a decrease in the sensation of vibrations felt, not an increase in tactile fremitus, which is indicative of pneumonia. Bronchophony is an increase in the intensity and clarity of transmitted sounds. This is also indicative of pneumonia but not asthma, which causes a decrease in vocal resonance.

The nurse in a pediatric acute-care unit is assigned the following tasks. Which task is not appropriate for the registered to nurse complete? 1. Diagnose an 8-year-old with acute otitis media and prescribe an antibiotic. 2. Listen to the concerns of an adolescent about being out of school for a lengthy surgical recovery. 3. Provide information to a mother of a newly diagnosed 4-year-old diabetic about local support-group options. 4. Diagnose a 6-year-old with Diversional Activity Deficit related to placement in isolation.

1. Diagnose an 8-year-old with acute otitis media and prescribe an antibiotic The role of the pediatric nurse includes providing nursing assessment, directing nursing care interventions, and educating client and family at developmentally appropriate levels; client advocacy, case management, minimization of distress, and enhancement of coping. Advanced practice nurse practitioners perform assessment, diagnosis, and management of health conditions.

Which of these measures used by a nurse will help relieve parental anxiety related to the changing appetite in the toddler who is gaining weight along the 50th percentile? 1. Discussing the growth of the toddler as compared to the growth chart 2. Suggesting ways to have the toddler eat higher calorie foods 3. Instructing the mother to feed the toddler alone without any distractions such as TV or music 4. Teaching the mother to avoid disciplining the toddler within one-half hour of eating

1. Discussing the growth of the toddler as compared to the growth chart Showing the parents the growth pattern of the child as compared to the normal growth chart will help relieve parental anxiety related to eating less food during the toddler years. Toddlers who are at the 50th percentile do not need additional high-calorie foods. Toddlers eat to their personal needs and there is no reason to restrict watching TV or other environmental stimuli during meals. There is no reason to relate timing of discipline and eating.

Which would be an acceptable community-health diagnosis? 1. Risk for Injury Related to Lack of Safe Bicycle Paths in High-Traffic Areas 2. Ineffective Family Coping Related to Lack of Time Together 3. Alterations in Nutrition Related to Use of Fast Food Restaurants 4. Ineffective Communication Related to Lack of Community Newsletter

1. Risk for injury related to lack of safe bicycle paths in high-traffic areas The lack of safe bicycle paths in high-traffic areas is a community hazard affecting a large population of people. Ineffective family coping is appropriate for one family; alterations in nutrition and ineffective communication are not appropriate for the community as a whole.

A school-age client tells you that Grandpa, Mommy, Daddy, and my brother live at my house. Which type of family will the nurse identify in the medical record based on this description? 1. Binuclear family 2. Extended family 3. Gay or lesbian family 4. Traditional nuclear family

2, extended family n extended family contains a parent or a couple who share the house with their children and another adult relative. A binuclear family includes the divorced parents who have joint custody of their biologic children, while the children alternate spending varying amounts of time in the home of each parent. A gay or lesbian family is comprised of two same-sex domestic partners; they may or may not have children. The traditional nuclear family consists of an employed provider parent, a homemaking parent, and the biologic children of this union.

A nurse who is the manager of an ambulatory pediatric healthcare center is planning protocols for the routine healthcare visits of the children. Children at this care center have a high incidence of obesity. At which age should the nurses at this clinic calculate the body mass index (BMI) for all pediatric clients? 1. 12 months 2. 24 months 3. 36 months 4. 4 years

2. 24 months The body mass index is first calculated at 2 years of age and gives information about the relationship between the height and weight of the child. With this information, the nurse would be able to develop strategies that may reduce the incidence of obesity.

The community-health nurse is planning an education session for recently hired teachers at a child-care center. Which item is priority for the community-health nurse to include in the educational session? 1. The schedule for immunizations 2. Principles of infection control 3. How to interpret healthcare records 4. How to take a temperature

2. Principles of infection control While all of the information is nice to know, it is most essential that teachers know principles of infection control to decrease the spread of germs that can cause disease in young children.

A 9-year-old child who has been followed in the same pediatric home since birth is at the healthcare center for a well-child visit. A nurse who measures the height and weight of the child documents 35th percentile for height and 90th percentile for weight. How should the nurse interpret these data? 1. The child is beginning a growth spurt. 2. The child is obese and needs dietary counseling. 3. The parents are most likely below the 50th percentile for height and weight. 4. As soon as the child begins the adolescent growth spurt, the height and weight measurements will normalize.

2. The child is obese and needs dietary counseling These data show that the child is disproportionate in height and weight. This childs weight is very high in comparison to height. The child would appear obese. Dietary history and counseling are the first steps. This child may also need an endocrine evaluation. This is not a growth spurt since height is what is referred to as a growth spurt. No assumptions about the parents can be made from the data presented. The statement about the adolescent growth spurt is incorrect for a child of this age.

The nurse is assessing an infant client and parents during a routine health supervision visit at 2 months of age. Which items will the nurse assess to determine if the infants mental health needs are being addressed? Standard Text: Select all that apply. 1. Immunization record 2. Newborn screen results 3. Temperament during the visit 4. Feeding schedule 5. Sleep-wake patterns

3,4,5, When addressing mental health issues, the nurse would assess the infants temperament during the visit, feeding schedule, and sleep-wake patterns. The infants mental health is related to early experiences, inborn characteristics such as temperament and resilience, and relationships with caregivers. The first year of life provides many opportunities for the infant to develop positive mental health; interventions during this important period can enhance the childs future mental status. The immunization record and the newborn screen results will not provide the needed information for the nurse in terms of whether the infants mental health needs are being addressed.

A new mother is worried about a soft spot on the top of her newborn infants head. The nurse informs her that this is a normal physical finding called the anterior fontanel. At what age will the nurse educate the mother that the soft spot will close? 1. 2 to 3 months of age 2. 6 to 9 months of age 3. 12 to 18 months of age 4. Approximately 2 years of age

3. 12 to 18 months of age The anterior fontanel is located at the top of the head and is the opening at the intersection of the suture lines. As the infant grows, the suture lines begin to fuse, and the anterior fontanel closes at 12 to 18 months of age.

A nurse is assessing language development in all the infants presenting at the doctors office for well-child visits. At which age range would the nurse expect a child to verbalize the words dada and mama? 1. 3 and 5 months 2. 6 and 8 months 3. 9 and 12 months 4. 13 and 18 months

3. 9 and 12 months Children should be able to verbalize mama or dada to identify their parents by 1 year of age.

The nurse is working on parenting skills with a mother of three children. The nurse demonstrates a strategy that uses reward to increase positive behavior. Which strategy will the nurse document in the medical record based on this description? 1. Time out 2. Reasoning 3. Behavior modification 4. Experiencing consequences of misbehavior

3. Behavior modification Behavior modification identifies and gives rewards for desired behaviors. Time out and experiencing consequences of misbehavior show the child that unacceptable behavior brings undesirable outcomes. Reasoning attempts to use explanation to end misbehavior.

A 12-year-old child is admitted to the unit for a surgical procedure. The child is accompanied by two parents and a younger sibling. What is the level of involvement in treatment decision making for this child? 1. That of an emancipated minor. 2. That of a mature minor. 3. That of assent. 4. None.

3. That of assent Assent requires the ability to generally understand what procedure and treatments are planned, to understand what participation is required, and to make a statement of agreement or disagreement with the plan. Usually, in Piagets stage of formal operations, 11- to 13-year-olds should be able to problem solve using abstract concepts and are able to give valid assent when parents sign the informed consent. An emancipated minor is a self-supporting adolescent who is not subject to the control of a parent or guardian. A mature minor is a 14- or 15-year-old whom the state law designates as being able to understand medical risks and who is thus permitted to give informed consent for treatment.

At a routine healthcare visit, a nurse measures a toddler and plots the height and weight on the growth charts. The nurse documents that the toddler is above the 95th percentile for weight and is at the 5th percentile for height. How should the nurse interpret these data? 1. The toddler is proportionate for the age. 2. The toddler needs to eat more at each feeding. 3. The height and weight are disproportionate, and the toddler needs further evaluation. 4. The family is most likely short.

3. The height and weight are disproportionate, and the toddler needs further evaluation Usually height and weight are at approximately the same percentile. When the weight of a child is found to be at the 95th percentile, the childs height is also greater than the 50th percentile. The height and weight for the child described in this question are a concern, and the child may need further endocrine testing.

The community-health nurse is assessing several families for various strengths and needs in regard to after-school and backup child-care arrangements. Which family type will benefit the most from this assessment and subsequent interventions? 1. The binuclear family 2. The extended family 3. The single-parent family 4. The traditional nuclear family

3. The single-parent family The single-parent family most typically lacks social, emotional, and financial resources. Nursing considerations for such families should include referrals to options that will enable the parent to fulfill work commitments while providing the child with access to resources that can support the childs growth and development. The binuclear family, the extended family, and the traditional nuclear family generally have at least two adults who can share in the care and the nurturing of its children.

A mother asks which developmental milestones she can expect when her baby is 6 months old. Which response by the nurse is the most appropriate? 1. Lifts head momentarily when prone 2. Has well-developed pincer grasp 3. Transfers objects from one hand to the other 4. Rolls from front to back

3. Transfers objects from one hand to the other Lifting head when prone is a milestone at 1 month. A well-developed pincer grasp is a milestone at 12 months. Transferring objects from one hand to the other is a milestone at 6 months. Rolling from front to back is a milestone at 4 months.

A father is a known carrier of an X-linked condition, and asks when he will know whether his newborn son has the condition he carries. Which response by the nurse is the most appropriate? 1. Genetic studies have been ordered, and they will take about a week to determine the results. 2. We plan to run additional tests this afternoon, and should have results by the end of the day. 3. Your son cannot have the condition because the condition is X-linked and cannot be passed on to him. 4. There is a 50% chance you passed it on, but further tests are not recommended until he is a month old.

3. Your son cannot have the condition because the condition is X-linked and cannot be passed on to him. A male child does not inherit any X chromosome from the father; therefore, the male child will not have the condition.

Some nursing students are discussing job options. One of the students states that a position as a school nurse sounds interesting. What is an important role of the school nurse? 1. Screening for congenital heart disease 2. Prescribing antibiotics for streptococcal pharyngitis 3. Developing a plan for emergency care of injured children 4. Diagnosing an ear infection

3. developing a plan for emergency care of injured children Screening of students for certain conditions; educating students, teachers, and staff; and developing emergency plans are all roles of the school nurse. Diagnosing acute illness and prescribing medication for a new illness are beyond the scope of practice for the school nurse unless the nurse is licensed as an advance-practice nurse.

Two 3-year-olds are playing in a hospital playroom together. One is working on a puzzle while the other is stacking blocks. Which type of play are these children exhibiting? 1. Cooperative play 2. Associative play 3. Parallel play 4. Solitary play

3. parallel play Parallel play describes when two or more children play together, each engaging in their own activities. Cooperative play happens when children demonstrate the ability to cooperate with others and play a part in order to contribute to a unified whole. Associative play is characterized by children interacting in groups and participating in similar activities. In solitary play, a child plays alone.

Injury prevention is an important aspect of parent teaching. Which injury prevention strategy would reduce the risk of suffocation? 1. Measure crib slat spacing at 2-3/8 inches or less. 2. Never leave an infant alone in a bath. 3. Position the infant on her back to sleep. 4. Use only approved restraint systems.

3. position the infant on her back to sleep Measuring crib slats will reduce strangulation. Not leaving an infant alone in a bath will reduce drowning. Positioning an infant on her back will reduce suffocation. Using approved restraint systems will reduce motor vehicle injury.

Which aspect of an Emergency Medical Services (EMS) system is most indicative that EMS providers are prepared to provide emergency care to children? 1. Placement of small stretchers in emergency vehicles 2. Lists of hospitals in the area that treat children 3. Staff education related to assessment and treatment of children of all ages 4. Pediatric-sized equipment and supplies

3. staff education related to assessment and treatment of children of all ages While size-appropriate equipment and lists of hospitals that treat children are essential parts of an EMS system, the aspect that is most indicative that EMS providers are actually prepared to take care of children is evidence of education related to assessment and emergency treatment.

A preschool-age client is seen in the clinic for a sore throat. In this childs mind, what is the most likely causative agent for the sore throat? 1. Was exposed to someone else with a sore throat. 2. Did not eat the right foods. 3. Yelled at his brother. 4. Did not take his vitamins.

3. yelled at his brother Preschoolers understand some concepts of being sick but not the cause of illness. They are likely to think that they are sick as a result of something that they have done. They will frequently view illness as punishment. A child of this age does not yet understand that he can become sick from exposure to someone else who is sick. The other two answers, while not causes of sore throat, can be factors in some illnesses but are beyond the thinking of a 4-year-old.

A nurse is planning an education session on genetic testing. What would not concern the nurse when planning the session? 1. Cultural beliefs 2. Religious beliefs 3. Family values 4. Insurance reimbursement

4. Insurance reimbursement Cultural and religious beliefs and family values are all considerations when planning a teaching session on genetic testing. Insurance plays a factor in determining whether the test is done, but is not a consideration in the teaching session itself.

An adolescent female presents at a nurse practitioners office and requests a signature for working papers. The nurse reviews her chart and notes that the last physical examination was two years ago. In addition to providing the signature for the working papers, what else should the nurse use this visit? 1. An opportunity to discuss birth-control measures 2. A time to discuss exercise and sports participation 3. A health-supervision opportunity 4. A chance to discuss the importance of pursuing post secondary education

A health-supervision opportunity All visits should be used as health-promotion and health-supervision visits. While discussing birth control, exercise, and future plans is important, these can be included in the overall health-supervision protocols.

The school health nurse recognizes that children who display certain characteristics are at risk for poor school performance. The nurse will, therefore, observe each school-age child for which characteristics? Standard Text: Select all that apply. 1. Decreased ability to perform visual tracking. 2. Decreased auditory stimulation. 3. Decreased muscle tone. 4. Multiple dental caries. 5. Chronic tonsillitis.

1,2,3 Children with vision, hearing, and muscle tone problems are at risk for poor school performance, since most school activities involve listening, seeing, and kinetic activity. School performance most likely would not be affected by dental caries and chronic tonsillitis.

The nurse is planning care for a preschool-age child and family. In order to assess the family, what should the nurse plan to do during each health supervision visit? Standard Text: Select all that apply. 1. Discuss of the childs developmental status 2. Observe interactions among the family members 3. Discuss concerns with the parents 4. Administer age appropriate vaccinations 5. Record height and weight

1,2,3 In order to assess the child and family, the nurse would plan to discuss the childs developmental status, observe interactions among the family members, and discuss any concerns with the parents. Administering age appropriate vaccinations and recording height and weight are appropriate interventions, but are not included during the family assessment process.

The school nurse performs screenings on all students in the middle school. In addition, the nurse will perform selected screenings on individual school-age children. When planning the screenings for the year, which screenings will the nurse include for all school-age children? Standard Text: Select all that apply. 1. Hearing 2. Height and weight 3. Blood-pressure measurement 4. Hepatitis B profile serology 5. Chest x-ray

1,2,3 Routine screening for school-age children include hearing, checking for height and weight, and blood-pressure measurements. The hepatitis B profile is only needed once, prior to administration of hepatitis B vaccine; however, this is not a required screening for all school-age children. A chest x-ray is not a routine screening test for school-age children.

The school nurse is teaching a class about safety. The nurse will teach the children that they should wear protective athletic gear when participating in selected activities. Which of these activities require protective athletic gear? 1. Skateboarding 2. Playing football 3. Swimming 4. Playing lacrosse 5. Performing acrobatic tricks

1,2,4 Any sport that includes body contact requires a child to wear protective equipment. These include skateboarding, football, and lacrosse. Swimming and acrobatics do not have any requirements for protective equipment.

An adolescent is accompanied by the mother for an annual physical examination. The nurse is aware of privacy issues related to the adolescent. While the mother is in the room, the nurse should avoid which questions? Standard Text: Select all that apply. 1. Sexual activity 2. Cigarette smoking 3. School performance 4. Use of alcohol 5. Car seatbelt use

1,2,4 The nurse must maintain the nurse client relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes. The nurse can ask general questions about seatbelt use and academic performance without breaching confidentiality.

The nurse is asked to teach injury prevention measures to a classroom of 4-year-old preschoolers. Which teaching points are most appropriate at this age? Standard Text: Select all that apply. 1. Stop, drop and roll if clothes catch fire 2. Never go into the road alone. 3. Acceptable places for climbing 4. Safe meeting place outside the house in case of fire 5. Car seat safety

1,2,4,5 Acceptable places to climb should be introduced in the toddler years when children are learning to walk, climb, and explore. It is not a topic for a preschool class. All the other topics are appropriate for this age.

The nurse is preparing to complete a health surveillance appointment with a school-age client and parents. Which observations would necessitate the need for further assessment by the nurse? Standard Text: Select all that apply. 1. Client who does not make eye contact 2. Client with visible bruises in various stages of healing 3. Client holding a video game talking with parent 4. Client playing a card game with sibling 5. Client who appears red in the face while walking to exam room

1,2,5 Nursing assessment begins with the first encounter with the client and the family. The nurse would want to further explore a client who does not make eye contact, who has bruises in various stages of healing, and a client who appears red in the face while walking to the exam room. All of these items may be clues to emotional issues, physical violence, and health related issues, such as hypertension. A client who is holding a video game and talking to the parent and a client who is playing a card game with a sibling are not observations that are abnormal for the school-age client.

The nurse working with a family has observed that the older children have a large number of dental caries and plans to provide the mother with information to prevent the development of dental caries in her new infant. Which interventions will prevent the development of dental caries in the infant? Standard Text: Select all that apply. 1. Avoiding nursing or giving the infant a bottle at bedtime 2. Giving foods high in sugar only at breakfast time 3. Using a soft moist gauze for cleaning 4. Using a topical anesthetic daily beginning as soon as the first tooth begins to erupt

1,3 The only interventions that will assist in the prevention of dental caries listed in this question are wiping the gums with a soft, moist gauze and avoiding putting the infant to bed with a bottle. Foods high in sugar should be avoided in the infant period. Topical anesthetic should not be applied daily.

The nurse is providing care to a preschool-age client who was admitted to the medicalsurgical unit after an acute asthma attack. Which interventions foster a family-centered focus to client care? Standard Text: Select all that apply. 1. Discussing rooming in with the parents of the client 2. Allowing the client to cry it out after the parents leave for the evening 3. Providing comfort items from home, such as a blanket 4. Maintaining strict visitation for the family 5. Discussing what to expect during the hospital stay

1,3,5 family-centered care principles that are used in the hospital setting include rooming in, providing comfort items from home, and discussing what to expect. Allowing the child to cry it out and maintaining strict visitation for the family are not family-centered principles.

A mother of an 18-month old asks the nurse whether she can begin to introduce low-fat milk like the rest of the family drinks. The nurse answers the mother based on the knowledge that low-fat milk can safely be introduced at what age? 1. 18 months 2. 24 months 3. 3 years 4. 4 years

1. 18 months Health promotion for the toddler includes whole milk until age 2. Age 1 is too early for low-fat milk; and it can safely be introduced before ages 3 and 4.

A nurse is assessing an 11-month-old infant and notes that the infants height and weight are at the 5th percentile on the growth chart. Family history reveals that the infants two siblings are at the 50th percentile for height and at the 75th percentile for weight. Psychosocial history reveals that the parents are separated and are planning to divorce. Which of these nursing diagnoses takes priority? 1. Alteration in Growth Pattern Related to Parental Anxiety 2. Alteration in Growth Pattern Secondary to Familial Short Stature 3. Nutritional Intake: Excessive Secondary to Maternal Feeding Patterns 4. At Risk for Constitutional Growth Delay Related to Decreased Appetite

1. Alteration in Growth Pattern Related to Parental Anxiety The scenario reveals parental anxiety due to marital problems. The most appropriate nursing diagnosis is alteration in growth patterns related to parental anxiety. There is no data that indicates familial short stature. Since height and weight are at the 5th percentile, there is no indication of increased nutritional intake. This infant is not at risk for constitutional growth delay.

The nurse is teaching a new mother developmental expectations. Which activity should the nurse expect a newborn to do within the first month of life? 1. Bring hands to eyes and mouth. 2. Push up with hands, moving chest up. 3. Keep hands in a relaxed position. 4. Roll over from back to abdomen.

1. Bring hands to eyes and mouth Newborns at one month of age can bring hands to their eyes and mouths, move their heads from side to side when lying on their abdomens, and attempt to lift their heads only when prone. Newborn hands are kept in tight fist position, and the newborn cannot roll over until 4 months of age.

An adolescent client has a long leg cast secondary to a fractured femur. Which action by the nurse would effectively facilitate the adolescents return to school? 1. Meet with teachers and administrators at the school to make sure entrances and classrooms are wheelchair accessible. 2. Develop an individualized health plan (IHP) that focuses on long-term needs of the adolescent. 3. Prior to the students return to school, meet with all of the other students to emphasize the special needs of the injured teen. 4. Meet with parents of the injured student to encourage homebound schooling until a short leg cast is applied.

1. Meet with teachers and administrators at the school to make sure entrances and classrooms are wheelchair accessible An adolescent with a long leg cast secondary to a fractured femur will be dependent on a wheelchair for mobility. It is essential that the environment be wheelchair accessible prior to the adolescents return to school. While an IHP might be developed, short-term needs would be the focus. It is not necessary to meet all of the students to discuss the adolescents needs. There is no reason to encourage the adolescent to stay at home for schooling if he is ready to return.

The nurse is working with a hospitalized preschool-age child. The nurse is planning activities to reduce anxiety in this child. Which action by the nurse is the most appropriate? 1. Provide the child with a doll and safe medical equipment. 2. Read a story to the child. 3. Use an anatomically correct doll to teach the child about the illness. 4. Talk to the child about the hospitalization.

1. Provide the child with a doll and safe medical equipment Therapeutic play is a means of anxiety reduction in the hospitalized child. Allowing the child to play with safe medical equipment is an age-appropriate method through which the child can express her feelings, thereby reducing anxiety. Anatomically correct dolls are not age appropriate. Reading a story to the child does not allow for expression of feelings. Talking to the child may be beneficial, but it does not allow for active release of frustration and anxiety as active play does.

A parent questions how her toddler plays with other toddlers. Which response by the nurse displays the best description of the differences in play between the toddler and the preschooler? 1. Toddlers play side by side, while preschoolers play cooperatively. 2. Toddlers play house and imitate adult roles, while preschoolers become the Mom or Dad while playing house. 3. Toddlers play cooperatively, while preschoolers play interactive games. 4. There are no differences between toddlers and preschoolers since both groups play cooperatively.

1. Toddlers play side by side, while preschoolers play cooperatively Toddlers will play side by side with another child, but they do not interact with the child during play. Preschoolers play cooperatively with other children.

A mother who is bottle feeding her newborn asks to be discharged 24 hours post delivery, because she also has twin 2-year-old children at home. When should the nurse schedule the first office visit for this newborn? 1. Within 48 hours of discharge 2. Within one week of discharge 3. Within two weeks of discharge 4. When the infant is 1 month old

1. Within 48 hours of discharge Newborns discharged before 48 hours old should be seen within 48 hours of discharge. Waiting one week and/or two weeks after discharge of a 24-hour-old infant increases the chance that several common newborn conditions can go undiagnosed (e.g., jaundice, failure to gain weight). Waiting one month is too long for any infant who is discharged at 24 hours old.

a child who is dependent on a ventilator is being discharged from the hospital. Prior to discharge, the home-health nurse discusses development of an emergency plan of care with the family. Which is the most essential part of the plan? 1. Acquisition of a backup generator 2. Designation of an emergency shelter site 3. Provision for an alternate heating source if power is lost 4. Notifying the power company that the child is on life support

1. acquisition of a backup generator Prior to discharge to home, it is essential that the family acquire a generator so that the childs life support will continue to function effectively should power be lost. While all other actions are very important, it is most essential that the ventilator has power to continue to function at all times.

The nurse is working with an adolescent client who will be admitted to the hospital in two days. Which nursing approach is most appropriate to prepare this client for hospitalization? 1. Have teens who have had similar experiences talk to the adolescent about hospitalization. 2. Provide an opportunity for the child to talk with an adult who has had a similar experience. 3. Teach parents what to expect so the information can be shared with the adolescent. 4. Provide an opportunity for the teen to try on surgical attire.

1. have teens who have had similar experiences talk to the adolescent about hospitalization Adolescents benefit from a different approach than younger children when being prepared for hospitalization. Written materials, anatomically correct dolls, and talking to peers who have had similar experiences are all appropriate for the adolescent. The adolescent should be taught first-hand what to expect during the hospitalization. Dressing up in surgical attire is appropriate for the younger child.

An adolescent reports the following: I get up at 6 am, I attend early-morning band classes three times each week, I play sports for two hours each day after school, and homework takes me three hours each night. I always feel tired. Which question by the nurse is most appropriate based on this information? 1. How many hours of sleep do you get each night? 2. Do you consume foods high in iron? 3. Do you think you are doing too much? 4. Have you considered talking with your teachers about decreasing your homework, since you have so many extracurricular activities?

1. how many hours of sleep do you get each night? The data in this scenario reveals very little time for sleep; therefore, the history should focus on sleep patterns.

The nurse working in the clinic includes an adolescent history in every client intake interview. Which issue should the nurse address when the parents are not present? 1. Possible domestic violence 2. Teen job responsibilities 3. Activities that are done as a family 4. The adolescents role in the family

1. possible domestic violence If domestic violence is suspected, it would only be appropriate to ask these questions when the teenager is alone with the nurse or healthcare provider

The charge nurse on a hospital unit is developing plans of care related to separation anxiety. The charge nurse recognizes that which hospitalized child at highest risk to experience separation anxiety when parents cannot stay? 1. 6-month-old 2. 18-month-old 3. 3-year-old 4. 4-year-old

18 month old While all of these children can experience separation anxiety, the young toddler is at highest risk. Toddlers are the group most at risk for a stressful experience when hospitalized. Separation from parents increases this risk greatly.

The nurse is performing a well-child exam on a child who turned 4 years old 3 months ago. What can the nurse ask the child to do to assess appropriate milestones for this age? 1. Jump up and down 2. Throw a ball 3. Stack three or more blocks 4. Draw lines on paper

2. Throw a ball Jumping up and down, stacking three or more blocks, and drawing lines on paper are activities that represent milestones for young children. Throwing a ball and observing how it is thrown would assess a milestone for this age. By 45 years, a child begins to throw a ball overhand.

Which of these developmental milestones should the nurse expect to find in children who are between 2 and 3 years old? Standard Text: Select all that apply. 1. Always feeds self 2. Scribbles and draws on paper 3. Kicks a ball 4. Throws ball overhand 5. Goes up and down stairs

2,3,5 Children between the ages of 2 and 3 years can scribble and draw on paper, kick a ball, and go up and down the stairs. Children who are between the ages of 3 and 4 years can feed themselves. Children between the ages of 4 and 5 years can throw a ball overhand.

Which health promotion activities can the nurse recommend to the parents of a preschool-age child in order to enhance the childs self-concept? Standard Text: Select all that apply. 1. Encourage a play date with a school-age child. 2. Praise the child for staying dry at night. 3. Tell the child there will be a punishment for bathroom accidents. 4. Set aside time for the child each day. 5. Discuss appropriate activities to engage in with the daycare provider.

2,4,5 Health promotion activities focus on development of a healthy self-concept in the toddler and young child by helping parents to set up successful play experiences, to praise the child for successes, to use effective limit-setting techniques, and to realize and appreciate the childs unique characteristics. Health maintenance seeks to avoid the poor self-image that can occur with constant criticism or expectations not in alignment with the toddlers or preschoolers developmental capabilities.

A nurse is preparing to perform a physical assessment on a toddler. Which action is most appropriate for the nurse to take? 1. Perform the assessment from head to toe. 2. Leave intrusive procedures such as ear and eye examinations until the end. 3. Explain each part of the examination to the child before performing it. 4. Ask the mother to tell the child not to be afraid.

2. leave intrusive procedures such as ear and eye examinations until the end Intrusive procedures such as examination of the ears, throat, eye, and genital areas should be done last to decrease the anxiety of the child during the initial phases of the examination, which includes the heart and lungs.

A nurse assesses the height and weight measurements on an infant and documents these measurements at the 75th percentile. The nurse notes that the previous measurements two months ago were at the 25th percentile. Which interpretation by the nurse is the most accurate? 1. The infant is not gaining enough weight. 2. The infant has gained a significant amount of weight. 3. The previous measurements were most likely inaccurate. 4. These measurements are most likely inaccurate.

2. The infant has gained a significant amount of weight A comparison of these two sets of measurements shows that the infant has crossed two percentiles going from the 25th to the 75th percentile and therefore has gained a significant amount of weight. There is neither indication that the previous measurements are inaccurate nor that the current measurement is inaccurate.

Parents of a preschool child report that they find it necessary to spank the child at least once a day. Which response should the nurse make to the parents? 1. Spanking is one form of discipline; however, you want to be certain that you do not leave any marks on the child. 2. Lets talk about other forms of discipline that have a more positive effect on the child. 3. Can you try only spanking the child every other day for one week and see how that affects the childs behavior? 4. I think you are not parenting your child properly, so lets talk about ways to improve your parenting skills.

2. Lets talk about other forms of discipline that have a more positive effect The behavior reported by the parent was excessive. The only response that is appropriate is to find a more positive way of influencing behavior in this age child. The nurses response needs to reflect these feelings. To suggest spanking as an appropriate form of discipline is inappropriate, especially when the parent is describing daily spanking of the child.

An school-age client who recently moved to a new school in a different town presents to an ambulatory care center and describes the following: I have no friends in my new school, and I no longer want to go to play soccer. I know I will be lonely there, too. Which of these takes priority when speaking with the school-age client? 1. Helping the school-age client realize the value of soccer 2. Promoting healthy mental-health outcomes 3. Acknowledging the fact that it takes several months to make new friends at a new school 4. Stressing the importance of remaining in a close parentchild relationship during these stressful times

2. Promoting healthy mental-health outcomes The school-age client is obviously lonely with the move to the new school. The nurse should focus on appropriate coping skills, which will enhance good mental-health outcomes for the child. It would not be appropriate to discuss the importance of soccer at this time, since the school-age client must deal with the loss of friends and developing new friendships first. The parentchild relationship should not be used as a substitute for the development of new peer relationships.

A mother reports that her adolescent is always late. The mother states, She was born late and has been late every day of her life. Which response should the nurse make to this mother? 1. You need to establish specific time frames for your adolescent and be certain she adheres to them. 2. You should not expect your adolescent to be an on-time individual unless you set specific alarms and then reinforce the value of being on-time. 3. You should not expect your adolescent to be on time. Teenagers are always late. 4. You have a major problem. There must be a lot of screaming in your home.

2. You should not expect your adolescent to be an on-time individual unless you set specific alarms and then reinforce the value of being on-time The best response is to help the mother find a way to help the teen deal with the problem of lateness. The other responses will either create parentchild conflict and/or make assumptions about household communication.

The telephone triage nurse receives a call from a parent who states that her 18-month-old is making a crowing sound when he breathes and is hard to wake up. Which action by the nurse is the most appropriate? 1. Obtain the history of the illness from the parent. 2. Advise the parent to hang up and call 911. 3. Make an appointment for the child to see the healthcare provider. 4. Reassure the parent and provide instructions on home care for the child.

2. advise the parent to hang up and call 911 The nurse should immediately recognize the symptoms of severe upper respiratory distress and advise the parent to call 911. Crowing is heard when there is severe narrowing of the airway. The other actions would be appropriate in nonemergency situations.

The parents of a critically injured child wish to stay in the room while the child is receiving emergency care. Which action by the nurse is the most appropriate? 1. Escort the parents to the waiting room and assure them that they can see their child soon. 2. Allow the parents to stay with the child. 3. Ask the physician if the parents can stay with the child. 4. Tell the parents that they do not need to stay with the child.

2. allow the parents to stay with the child Parents should be allowed to stay with their child if they wish to do so. This position is supported by the Emergency Nurses Association and is a key aspect of family-centered care.

A 27-month-old toddler who is in the pediatric office for a well-child visit begins to cry the moment he is placed on the examination table. The parent attempts to comfort the toddler; however, nothing is effective. Which of these actions by the nurse takes priority? 1. Instruct the father to hold the toddler down tightly to complete the examination. 2. Allow the toddler to sit on the parents lap and begin the assessment. 3. Allow the toddler to stand on the floor until he stops crying. 4. Ask another nurse in the office to hold the toddler, since the parent is not able to control the toddlers behavior.

2. allow the toddler to sit on the parents lap and begin the assessment Toddlers are most comfortable when sitting with the parents. Much of the examination can be completed in this way. Allowing the toddler to stand on the floor is inappropriate. A nurse can assist if the parent is unable to hold the child during the examination of the throat and ears to prevent injury from movement.

The nurse is providing care for several pediatric clients. Which client would require an Individualized Health Plan (IHP) prior to returning to school? 1. A school-age client who has recently developed a penicillin allergy. 2. An adolescent client newly diagnosed with insulin-dependent diabetes mellitus. 3. A school-age client who has been treated for head lice. 4. An adolescent client who has missed two weeks of school due to mononucleosis.

2. an adolescent client newly diagnosed with insulin-dependent diabetes An IHP that ensures appropriate management of the childs healthcare needs must be developed for a child newly diagnosed with a chronic illness such as diabetes. A child who is allergic to penicillin will not receive this medication any longer and therefore should not encounter any problems related to it at school. A child who has been treated for head lice can return to school and does not need an IHP. While a child who has missed two weeks of school will need to make arrangements for makeup work, an IHP is not needed.

During a clinic visit, the parents of a 15-month-old ask what disease and injury prevention topics would be appropriate to discuss at this age. Which response by the nurse is the most appropriate? 1. Its never too early to teach a child to wear a helmet when riding a bicycle. 2. Teaching simple handwashing is a good topic at this age. 3. Tell the child over and over to stay away from water unless you are with him. 4. Tell him firmly no when he tries to cross the street.

2. teaching simple handwashing is a good topic at this age Disease and injury prevention are ongoing topics at all ages. Simple handwashing is appropriate for a 15-month-old child. A 15-month-old is too young for bicycle riding, so this can be delayed. A 15-month-old is too young to understand water safety and crossing the street, and should never be left unattended in these situations.

An adolescent reports participating in an exercise program at school each Wednesday throughout the school year. Further history reveals that the adolescent does not participate in any other physical activities. Which outcome is most appropriate for this adolescent? 1. The adolescent is reporting information consistent with what 60 percent of adolescents report as participation in physical activities. 2. The adolescent is not meeting the recommendations of the Healthy People 2020 initiative. 3. The adolescent should be encouraged to continue this program of exercise, since something is better than nothing. 4. The adolescent should be encouraged to vigorously exercise for at least five minutes each day.

2. the adolescent is reporting information consistent with what 60 percent of adolescents report as participation in physical activities In this scenario, the adolescent is not receiving the recommended amount of exercise to support good health habits. Encouraging the adolescent to continue as is or to exercise vigorously for five minutes each day also is not consistent with current recommendations. Suggesting that something is better than nothing is not good practice.

The nurse is providing care to a school-age client and family. The family, which consists of two parents and 4 children, live in a one-bedroom apartment. The father recently lost his job and the mother stays at home with the children. Which community resources would most benefit this family? Standard Text: Select all that apply. 1. Play groups 2. Parenting programs 3. Social services programs 4. Job skills training 5. Respite care

3,4 This family is currently living in a one-bedroom apartment and the sole income earner recently lost his job. This family would most benefit from social services programs for monetary assistance and job skills training which would allow the parents to learn a trade and become employed. Play groups, parenting programs, and respite care are not applicable to this familys situation.

The nurse is providing care to a school-age client who is admitted to the hospital after a motor vehicle accident. Which interventions are appropriate to prepare this client and family for their hospital stay? Standard Text: Select all that apply. 1. A hospital tour 2. A health fair brochure 3. An orientation to the unit 4. An age-appropriate explanation of procedures 5. A child life program consultation

3,4,5 Interventions that are appropriate for this client and family are those that occur as the result of an unplanned hospital admission. The nurse would orient the client and family to the unit and provide age-appropriate explanation for all procedures. It is also appropriate for the nurse to consult with the child life program. A hospital tour and a health fair brochure are appropriate interventions for a planned hospitalization.

The nurse is evaluating the car seat of a 3-year-old who weighs 42 pounds. Which recommendation should the nurse make about the car seat to the parents? 1. Convertible, rear-facing seat 2. Belt-positioning booster seat 3. A car seat with a harness approved for higher weights and heights 4. A regular seat with lap and shoulder strap

3. A car seat with a harness approved for higher weights and heights The American Academy of Pediatrics and the National Highway Safety Administration recommend booster seats for children over 40 pounds and 4 years of age. A 3-year-old should be in a regular car seat with approved harness for higherweight/height children so that she is protected from injury. Rear-facing seats and regular seat with lap and shoulder strap are not appropriate for a 3-year-old.

The community-health nurse visits the child-care center. Which finding indicates the need for staff education? 1. A group of 2-year-olds are eating a snack of Cheerios. 2. Several 4-year-olds are outside playing on a slide. 3. An 18-month-old is pushing a toy truck. 4. A 2-month-old is sleeping in a crib on his stomach.

4. A 2-month-old is sleeping in a crib on his stomach To decrease the incidence of sudden infant death syndrome (SIDS), infants should be placed on their backs to sleep. All of the other examples are developmentally appropriate activities for the specified age group.

The school nurse is preparing a plan of care specific to several children in the school who have asthma. What is the initial action on the plan of care? 1. Call 911 to request emergency medical assistance. 2. Call the childs parents to come and pick up the child. 3. Have the child use his or her metered-dose inhaler. 4. Have the child lie down to see if the symptoms subside.

3. Have the child use his or her metered-dose inhaler A child with a history of asthma may have episodes of wheezing that can be controlled by prompt use of the childs rescue inhaler. An inhaler should be readily available in the school setting for a child previously diagnosed with asthma. This should be tried first. Emergency personnel should be notified if the inhaler does not provide relief and the child is in respiratory distress. Parents may be notified if the child does not feel well, but this is not the initial action. Having the child lie down will likely worsen his condition.

A nurse asks the mother of a 4-month-old infant to undress the infant. The nurse observes the mother taking off several layers of clothing and knows that the outdoor temperature is 70 degrees Fahrenheit. Which statement by the nurse is most appropriate in this situation? 1. My, you are dressing your infant warmly today. 2. Did you think it was cold when you left your home this morning? 3. I see that you have many layers of clothing on your baby. This may cause your babys temperature to rise. 4. When you leave the office, only put one layer of clothing on your baby.

3. I see that you have many layers of clothing on your baby. This may cause your babys temperature to rise In this scenario, the mother has overdressed the infant. The nurse needs to gently inform the mother of this problem and to provide information to the mother on why it is a problem. Just making a statement on how warmly the child is dressed will not accomplish this goal or just telling the mother to only put one layer of clothing on the child does not provide a rationale for the mother to make a better decision the next time, so this statement also is not helpful to the mother.

An obese adolescent who adamantly denies sexual activity has a positive pregnancy test, which was performed in the adolescent clinic. Which statement by the nurse is the most appropriate in this situation? 1. Tell me how you feel about your body image. 2. When was your last menstrual period (LMP)? 3. Lets discuss some activities that you have done within the past few months that could possibly lead to pregnancy. 4. Were you involved in a date rape and are you hesitant to speak about it?

3. Lets discuss some activities that you have done within the past few months that could possibly lead to pregnancy The nurse must help the adolescent realize that previous behaviors have led to a positive pregnancy test. The only response by the nurse that will accomplish this goal is for the nurse to ask a direct question in which the nurse and client search for an answer.

A nurse observes the parent/child interaction during the 4-year-old well-child checkup and notes that the parent speaks harshly to the child and uses negative remarks when speaking with the nurse. Which statement by the nurse would be most beneficial? 1. Perhaps you should leave the room so that I can speak with your child privately. 2. I am going to refer you for counseling since your interactions with your child seem so negative. 3. Lets talk privately. Lets discuss the way you speak with your child and possible ways to be more positive. 4. Addressing the child, the nurse says, Are you unhappy when Mommy talks to you like this?

3. Lets talk privately. Lets discuss the way you speak with your child and possible ways to be more positive The best approach to this encounter would be for the nurse to discuss concerns with the parent privately, since the nurse wants to help the parent develop a good relationship with the child. The child should not be a part of this conversation. Since the child is only 6 years old, it would be difficult to ask the parent to leave the room. If the nurse also wants to speak alone with the child, the nurse perhaps would escort the child to another area and speak briefly with the child. Referring to counseling without a discussion with the parent is not appropriate. The nurse should not ask the child if she is unhappy with the parent.

The nurse is caring for a client in the pediatric intensive-care unit (PICU). The parents have expressed anger over the nursing care their child is receiving. Which nursing intervention is most appropriate based on the situation? 1. Ask the physician to talk with the family. 2. Explain to the parents that their anger is affecting their child so they will not be allowed to visit the child until they calm down. 3. Acknowledge the parents concerns and collaborate with them regarding the care of their child. 4. Call the chaplain to sit with the family.

3. acknowledge the parents concerns and collaborate with them regarding the care of their child Hospitalization of the child in a pediatric intensive-care unit is a great stressor for parents. If the parents feel that they are not informed or involved in the care of their child, they may become angry and upset. Calling the physician or chaplain may be appropriate at some point, but the nurse must assume the role of supporter in this situation to promote a sense of trust. Telling the parents that they cannot visit their child will only increase their anger.

Which nursing intervention is most appropriate when providing education to the pediatric client and family? 1. Giving primary care for high-risk children who are in hospital settings 2. Giving primary care for healthy children 3. Working toward the goal of informed choices with the family 4. Obtaining a physician consultation for any technical procedures at delivery

3. working toward the goal of informed choices with the family The educator works with the family toward the goal of making informed choices through education and explanation.

Which assessment question would get the most accurate response when a nurse is assessing learning/reading skills in the early childhood years? 1. What rewards do you use when your child does something good? 2. What is your childs language like now? 3. Does your child get along well with others? 4. Do you keep books for your child readily available?

4. Do you keep books for your child readily available? Keeping books readily available will stimulate reading skills. This is the question that will provide the most information about learning/reading skills. Language and getting along with others are more communication skills. Rewards are more closely related to discipline.

The number of serious injuries in children has doubled in the past year. Based on this information, which is the most appropriate community nursing diagnosis? 1. Noncompliance Related to Inappropriate Use of Child Safety Seats 2. Risk for Injury Related to Inadequate Use of Bicycle Helmets 3. Altered Family Processes Related to Hospitalization of an Injured Child 4. Knowledge Deficit Related to Injury Prevention in Children

4. Knowledge Deficit related to injury prevention in children All of these diagnoses might be appropriate in specific situations, but Knowledge Deficit Related to Injury Prevention in Children is the only one that is general to the problem as a whole and is therefore the most appropriate community nursing diagnosis.

A school nurse is performing annual height and weight screening. The nurse notes that three females who are close friends each lost 15 pounds over the past year. What is the priority nursing action in this situation? 1. Call the respective parents to discuss the eating patterns of each adolescent. 2. Speak with the girls in a group to discuss the problems associated with anorexia nervosa. 3. Refer these adolescents to the school psychologist. 4. Obtain a nutritional history for each of these adolescents.

4. Obtain a nutritional history for each of these adolescents The school nurse must evaluate why these three friends have all lost 15 pounds in one year. The best way to begin this assessment is to obtain a nutritional history for each client. Speaking with the parents would not be appropriate at this time. Discussing anorexia nervosa is too extreme, as is referring the adolescents to a school psychologist without performing a complete nursing assessment.

The nurse is providing anticipatory guidance instructions to the parents of a newborn. Which instruction should the nurse give as a strategy for illness/disease prevention? 1. Dont allow visitors for the first month. 2. Smoke outside only. 3. Take the newborn to weekly child-stimulation classes. 4. SIDS risk-reduction measures

4. SIDS risk-reduction measures Several disease-prevention strategies are used during anticipatory guidance for the parents of newborns. Not allowing visitors is unreasonable but screening for illness is appropriate. Smoking outside will not prevent disease. Attending weekly stimulation classes is not a disease prevention strategy. SIDS risk-reduction measures can reduce the risk of sudden infant death syndrome.

The nurse must perform a procedure on a toddler. Which technique is the most appropriate when performing the procedure? 1. Ask the mother to restrain the child during the procedure. 2. Ask the child if it is okay to start the procedure. 3. Perform the procedure in the childs hospital bed. 4. Allow the child to cry or scream.

4. allow the child to cry or scream While the toddler will need to be restrained, the parent should not be the one to do this. The nurse should avoid giving the child a choice if there is no choice. The treatment room should be utilized for the procedure so that the hospital bed remains a safe place. The child should be allowed to cry or scream during the procedure.

The charge nurse is concerned with reducing the stressors of hospitalization. Which nursing intervention is most helpful in decreasing the stressors for the toddler-age client? 1. Assign the same nurse to the toddler as much as possible. 2. Let the child listen to an audiotape of the mothers voice. 3. Place a picture of the family at the bedside. 4. Encourage a parent to stay with the child.

4. encourage the parent to stay with the child While all of the interventions are appropriate for the hospitalized toddler, presence of a parent is most important. Separation from parents is the major stressor for the hospitalized toddler.

A group of children on one hospital unit are all suffering separation anxiety. Which child is experiencing the despair stage of separation anxiety? 1. Does not cry if parents return and leave again 2. Screams and cries when parents leave 3. Appears to be happy and content with staff 4. Lies quietly in bed

4. lies quietly in bed Children in the despair stage appear sad, depressed, or withdrawn. A child who is lying in bed might be exhibiting any of these. Screaming and crying are components of the protest stage. The young child who appears to be happy and content with everyone is in the denial stage, as is the child who does not cry if parents return and leave again.

The nurse is reviewing the immunization record of an adolescent who will be seen later in the day. Which item in the clients history makes heptatis B status a priority? 1. Chronic acne 2. Overuse injuries from playing varsity sports 3. Chronic asthma 4. Plans to get a tattoo

4. plans to get a tattoo The adolescent who is most at-risk in the scenario presented is the teen who is planning on getting a tattoo. Adolescents with chronic acne or asthma do not have an increased risk for hepatitis B, since transmission has nothing to do with a diagnosis of acne. Overuse of muscles while playing sports is not related to development of hepatitis B.

A young school-age client who has had a tracheostomy for several years is scheduled to begin school in the fall. The teacher is concerned about this childs being in her class and consults the school nurse. Which action by the nurse is the most appropriate? 1. Make arrangements for the child to go to a special school. 2. Ask the parents of the child to provide a caregiver during school hours. 3. Recommend that the child be home schooled. 4. Teach the teacher how to care for the child in the classroom.

4. teach the teacher how to care for the child in the classroom Section 504 of the Rehabilitation Act of 1973 guarantees access for children with disabilities to federally funded programs, including public schools. The child may need little extra attention while in the school setting, since he has had the tracheostomy for several years. The teacher should be taught how to care for the child if needed and the signs of distress. If needed, a health aide may be assigned to the child, but this is not the responsibility of the parents.

What must a home-health nurse realize prior to accepting an assignment? 1. All decisions will be made by the healthcare provider. 2. The family will adapt their lifestyle to the needs of the nurse. 3. Independent decisions regarding emergency care of the child will be made by the nurse. 4. The family is in charge.

4. the family is in charge The home-health nurse must realize that the family is in charge. The nurse must be flexible and adaptable to the lifestyle of the family. The family must provide informed consent for emergency care.

While teaching parents of a newborn about normal growth and development, which statement is most appropriate for the nurse to include in the session? 1. Weight should triple by 6 months of age. 2. Weight should double by 1 year of age. 3. Weight should double by 4 months of age. 4. Weight should triple by 1 year of age.

4. weight should triple by 1 year of age

When examining a 7-year-old, which action by the nurse would be most appropriate? 1. Allow the child to participate in the exam. 2. Ask the parent what kind of food the child likes to eat. 3. Ask the child whether he plays outside for at least 30 minutes a day. 4. Allow the child to decide whether he is ready for his next immunization.

Allow the child to participate in the exam At this age, children have logical thought, and are learning about their bodies. Participating in the physical exam is appropriate for this age. The child can answer the question about food intake himself. Asking whether he plays outside for 30 minutes is fine, but children at this age need at least 60 minutes of activity, so the question will not gather appropriate information. It is not the childs decision whether he is ready for immunization, so do not ask this question.

A young school-age client is in the playroom when the respiratory therapist arrives on the pediatric unit to give the child a scheduled breathing treatment. Which action by the nurse is the most appropriate? 1. Reschedule the treatment for a later time. 2. Show the respiratory therapist to the playroom so the treatment may be performed. 3. Escort the child to his room and ask the child-life specialist to bring toys to the bedside. 4. Assist the child back to his room for the treatment but reassure the child that he may return when the procedure is completed.

Assist the child back to his room for the treatment but reassure the child that he may return when the procedure is completed Procedures should not be performed in the playroom. Scheduled respiratory treatments should be performed on time; however, the child should be allowed to return to the playroom as soon as the procedure is completed.

An infant has been NPO for surgery for 4 hours and does not have an intravenous line. The nurse receives a call from the operating room with the information that the surgery has been postponed due to an emergency. Which action by the nurse is the most appropriate? 1. Feed the infant 4 ounces of formula. 2. Reassure the parents that it will not be much longer before surgery. 3. Allow the parents to feed the infant an ounce of oral rehydration solution. 4. Call the physician to see if the infant needs to have an intravenous line started.

Call the physician to see if the infant needs to have an IV line started The infant who is NPO is at high risk for dehydration. The nurse does not know how much longer it will be before surgery. The nurse cannot independently make the decision to feed the infant. Feeding the infant could further postpone the surgery, should an operating room become available sooner than expected. It is best to keep the infant NPO and consult the physician to see if an intravenous line is needed.

The nurse needs to administer a medication to a preschool-age child. The medication is only available in tablet form. Which action by the nurse is the most appropriate? 1. Place the tablet on the childs tongue and give the child a drink of water. 2. Break the tablet in small pieces and ask the child to swallow the pieces one by one. 3. Crush the tablet and mix it in a teaspoon of applesauce. 4. Crush the table and mix it in a cup of juice.

Crush the tablet and mix it in a teaspoon of applesauce A 4-year-old is not mature enough to swallow a pill or pieces of a pill. The medication should be crushed and mixed with a very small amount of food, not juice.

A nurse obtains a nutritional health history from a 10-year-old child. Which of these food selections, if consumed on a regular basis, should lead the nurse to become concerned about the need for improving oral hygiene? 1. Peanuts and crackers 2. Sorbet and yogurt 3. Gummy bears and licorice 4. Fluoridated water

Gummy bears and licorice Food items that stick to the teeth lead to dental caries. Items such as gummy bears and licorice all stick to the teeth and lead to dental caries. Foods such as peanut butter, crackers, sorbet, and yogurt do not stick to the teeth and are not considered foods that increase dental caries. Fluoridated water has been shown to decrease the incidence of dental caries.

A child is being discharged from the hospital after a 3-week stay following a motor vehicle accident. The mother expresses concern about caring for the childs wounds at home. She has demonstrated appropriate technique with medication administration and wound care. Which nursing diagnosis is the priority in this situation? 1. Knowledge Deficit of Home Care 2. Altered Family Processes Related to Hospitalization 3. Parental Anxiety Related to Care of the Child at Home 4. Risk for Infection Related to Presence of Healing Wounds

Parental Anxiety related to care of the child at home While all of the diagnoses might have been appropriate at some point, the current focus is the mothers anxiety about caring for the child at home. The priority of the nurse is relieving this anxiety.

A 2-month-old infant with bronchopulmonary dysplasia (BPD) is being prepared for discharge from the neonatal intensive-care unit (NICU). The infant will continue to receive oxygen via nasal cannula at home. Prior to discharge, the home-health nurse assesses the home. Which finding poses the greatest risk to this infant? 1. Small toys strewn on the floor 2. A woodstove used for heating 3. A sibling who has an ear infection 4. Paint peeling on the walls

a woodstove used for heating Assessment of the home environment is essential prior to discharge of a medically fragile infant. The use of a woodstove poses great risk to the infant who already has fragile lungs. Oxygen and woodstove heat will produce a flammable reaction. Small toy pieces and paint peeling from the wall will pose a choking risk to the older infant who is crawling. Ear infections are not contagious.

The nurse is working with a school-age child who is hospitalized. Which action by the nurse will promote a sense of industry in this child? 1. Allow the child to assist with her care. 2. Encourage parents to participate in the childs care. 3. Give the child a detailed scientific explanation of the illness. 4. Speak to the child in a high-pitched voice.

allow the child to assist with her care Allowing the child to participate in her care will decrease the sense of loss of control and increase a sense of industry. While parents can certainly participate in their childs care, it does not increase the childs sense of control. School-age children in general will not understand detailed scientific explanations. Change in voice tone is appropriate when talking to very young children.

A toddler recently diagnosed with a seizure disorder will be discharged home on an anticonvulsant. Which action by the mother best demonstrates understanding of how to give the medication? 1. Verbalizing how to give the medication 2. Acknowledging understanding of written instructions 3. Drawing up the medication correctly in an oral syringe and administering it to the child 4. Observing the nurse draw up the medication and administering it to the child.

drawing up the medication correctly in an oral syringe and administering it to the child Verbalization of how to give the medication and acknowledging understanding of written instructions are methods that might be used, but they do not actually demonstrate understanding. Observing the nurse draw up and administer the medication may be used in the teaching process. The best way for the mother to demonstrate understanding is to actually draw up and give the medication.

The school health nurse is evaluating the home environment of several children as it relates to child safety. The nurse visits the home of each child and gathers the following data. Which activity places a child at greatest risk for bodily harm? 1. The parents are in a methadone program. 2. The parents consume alcohol on a daily basis. 3. The child is permitted to target practice with a revolver, unsupervised. 4. The child is a latchkey child.

the child is permitted to target practice with a revolver, unsupervised Of all the activities mentioned, the child who is playing with guns is most at risk for injury. The inappropriate behaviors, such as drug and alcohol use or past use, also place the child at risk, but the use of firearms is more risky. A latchkey child needs special attention but in regard to the situations given is not at the greatest risk of injury.

When conducting a health history on a late school-age client, what would the nurse document as a dysmorphic feature? 1. A repaired cleft palate 2. A 10% burn to the face 3. A severed finger 4. A flat anterior fontanel

1. A repaired cleft palate A dysmorphic feature was present at birth. A cleft palate, even though repaired, would be included in a health history as a dysmorphic feature. The burns and a severed digit were not present at birth, and would not be considered dysmorphic. A soft fontanel would be considered normal.

The clinic administrator has asked each nurse to classify the nursing activities as a beginning step of clinic reorganization. Which of these strategies can be identified as health promotion and health maintenance? Standard Text: Select all that apply. 1. Administration of the flu vaccine for infants from 6 months to 23 months old. 2. Daily feeding schedules for infants. 3. Instruction to adolescents on how to use dental floss. 4. Treatment for a child with a diagnosis of acute otitis media.

1, 2, 3 Administering flu vaccines, discussion of feeding schedules, and instructions to adolescents are all health-promotion and/or health-maintenance topics. Treatment of an acute ear infection (otitis media) would not be a topic for health promotion and health maintenance since it is an acute illness.

The nurse is assessing an infant client during a health supervision visit. Which assessment findings are considered normal variations for this client? Standard Text: Select all that apply. 1. Sucking pads in the mouth 2. A rounded chest 3. Hearing breath sounds over the entire chest 4. Pubertal development 5. Knock-knees

1, 2, 3 Normal variations for the infant client include sucking pads in the mouth, a rounded chest, and hearing breath sounds over the entire chest. Pubertal development and knock-knees are not normal variations for the infant client.

Which nursing assessment activities should be included for the child and family at each health-supervision visit? Standard Text: Select all that apply. 1. Interview to obtain an updated health history. 2. Performing an age-appropriate development assessment. 3. Monitoring parents ability to pay for services. 4. Performing age-appropriate screening examinations. 5. Physical assessment for genetic abnormalities.

1, 2, 4 The interview, the developmental assessment, and age-appropriate screenings are all included in the nursing assessment of a child and family during each health-supervision visit. A nurse would not assess the parents financial status at each health-supervision visit. Physical assessments for genetic abnormalities would be done based on history and/or physical findings, not at each routine visit.

A family with a child who had a cleft lip and palate at birth are planning another pregnancy. What intervention should be recommended prior to conception? 1. A genetic family history 2. A family pedigree 3. A genetic physical assessment 4. A maternal health history

1. A genetic family history A genetic family history is recommended when there is history of a congenital anomaly, such as cleft lip and palate. A pedigree is a more comprehensive family history, and could follow a genetic family history if needed. The previous anomaly is already known, so a genetic history would be recommended over a genetic physical assessment. A maternal health history is not comprehensive enough for this case.

The nurse is conducting a health surveillance visit with a 6-month-old infant. Which methods are appropriate to monitor the infants growth pattern since birth? Standard Text: Select all that apply. 1. Weight the infant twice and average together 2. Measure the infants height 3. Measure the infants head circumference 4. Determine the infants body mass index 5. Plot the infants growth on appropriate chart

1, 3, 5 In order to determine the infants growth pattern the nurse will obtain two weights and average them together, measure the infants head circumference, and obtain the infants length, not height. After the measurements have been obtained the nurse will plot the measurements on the appropriate growth chart and monitor the infants growth pattern. Body mass index is not determined during infancy.

the nurse educator is teaching a group of students about the key concepts of a medical home during the developmental years of the pediatric client. Which items should the educator include in the teaching session? Standard Text: Select all that apply. 1. Financial accessibility 2. Consistent, ongoing care 3. Coordination of care 4. No individualization of care 5. A paternalistic view of care

1,2,3 All children need a medical home, where accessible, continuous, and coordinated health supervision is provided during the developmental years. Accessibility refers to both financial and geographic access; continuous indicates that the care is ongoing with consistent care providers; coordination refers to the need for communication among health professionals to provide for the needs of the child. Care is individualized and is not paternalistic.

A nursery nurse is planning care for the newborns currently in the newborn nursery. Which activities does the nurse plan for the first 48 hours of life? Standard Text: Select all that apply. 1. Monitor feeding behaviors. 2. Perform a hearing screening. 3. Perform a heel stick to obtain blood for the newborn screen. 4. Monitor the mother as she performs the first newborn bath to remove blood and amniotic fluids. 5. Administer folic-acid injection to the infant to prevent bleeding.

1,2,3 The nurse should assess feeding behaviors of the infant whether the infant is breast-fed or bottle-fed. A hearing screening is performed on all newborn infants prior to discharge. The newborn screen is performed prior to infant discharge from the newborn unit. The nurse, not the mother, performs the first bath to remove blood and amniotic fluids. Vitamin K is administered, not folic acid.

The nurse in the newborn nursery is admitting a neonate. To determine the health and development of the newborn, what will the nurse include in the assessment? Standard Text: Select all that apply. 1. Head circumference 2. Body length 3. Weight 4. Length of pregnancy 5. Hearing screens

1,2,3,4 The nurse should assess almost all of these parameters to determine the health of the newborn. However, hearing screens are typically done after the first 12 hours after birth and are not part of newborn assessment.

A new parent group inquires about the stages through which their children will progress as they grow older. The nurse is discussing Piagets developmental stages. In what order would the nurse expect the child to progress through Piagets stages of development? Standard Text: Click and drag the options below to move them up or down. Choice 1. Sensorimotor Choice 2. Formal operational Choice 3. Preoperational Choice 4. Concrete operational

1,3,4,2 Sensorimotor (birth to 2 years), preoperational (2 to 7 years), concrete operational (7 to 11 years), formal operational (11 years to adulthood).

While in the pediatricians office for their childs 12-month well-child exam, the parents ask the nurse for advice on age-appropriate toys for their child. Based on the childs developmental level, which types of toys would the nurse suggest? Standard Text: Select all that apply. 1. Soft toys that can be manipulated 2. Small toys that can pop apart and go back together 3. Jack-in-the-box toys 4. Toys with black and white patterns 5. Push-and-pull toys

1,3,5 Both gross and fine motor skills are becoming more developed, and children at this age enjoy toys that can help them refine these skills. They tend to enjoy more colorful toys at this age and are more mobile and thus have less interest in placing toys in their mouths and more interest in toys that can be manipulated.

The nurse is performing an assessment of the ecological systems of childhood. What will the nurse include when assessing mesosystems? Standard Text: Select all that apply. 1. Parental involvement in school 2. Local political influences 3. Libraries in the community 4. Influences of the religious community 5. Age of each family member

1,4 When assessing a childs mesosystem, the nurse will assess parental involvement in school and the influences of the religious community on the child and family. Local political influences and the libraries in the community are assessed in a exosystem assessment. The age of each family member is assessed during chronosystem assessment.

A supervisor is reviewing the documentation of the nurses in the unit. Which client documentation is the most accurate and contains all the required part for a narrative entry? 1. 2/2/05 1630 Catheterized using an 8 French catheter, 45 mL clear yellow urine obtained, specimen sent to lab, squirmed and cried softly during insertion of catheter. Quiet in mothers arms following catheter removal. M. May RN 2. 1/9/05 2 pm NG tube placement confirmed and irrigated with 30 ml sterile water. Suction set at low, intermittent. Oxygen via nasal canal at 2 L/min. Nares patent, pink, and nonirritated. K. Earnst RN 3. 4:00 Trach dressing removed with dime-size stain of dry serous exudate. Site cleansed with normal saline. Dried with sterile gauze. New sterile trach sponge and trach ties applied. Respirations regular and even throughout the procedure. F. Luck RN 4. Feb. 05 Port-A-Cath assessed with Huber needle. Blood return present. Flushed with NaCl sol., IV gamma globins hung and infusing at 30cc/hr. Child smiling and playful throughout the procedure. P. Potter, RN

1. 2/2/05 1630 Catheterized using an 8 French catheter, 45 mL clear yellow urine obtained, specimen sent to lab, squirmed and cried softly during insertion of catheter. Quiet in mothers arms following catheter removal. M. May RN The client record should include the date and time of entry, nursing care provided, assessments, an objective report of the clients physiologic response, exact quotes, and the nurses signature and title.

The telephone triage nurse at a pediatric clinic knows each call is important. Which call would require extra attentiveness from the registered nurse because of an increased risk of mortality? 1. A 3-week-old infant born at 35 weeks gestation with gastroenteritis 2. A term 2-week-old infant of American Indian descent with an upper respiratory infection 3. A post term 4-week-old infant non-Hispanic black descent with moderate emesis after feeding 4. A 1-week-old infant born at 40 weeks gestation with symptoms of colic

1. A 3-week-old infant born at 35 weeks gestation with gastroenteritis The leading causes of death in the neonatal period (birth to 28 days of age) are short gestation, low birth weight, and congenital malformations. The preterm infant experiencing gastroenteritis at 3 weeks of age is at the greatest risk for mortality; therefore, would require extra attentiveness from the registered nurse.

Which legal or ethical offense would be committed if a nurse tells family members the condition of a newborn baby without first consulting the parents? 1. A breach of privacy 2. Negligence 3. Malpractice 4. A breach of ethics

1. A breach of privacy A breach of privacy would have been committed in this situation, because it violates the right to privacy of this family. The right to privacy is the right of a person to keep his or her person and property free from public scrutiny, including other family members. Negligence and malpractice are punishable legal offenses and are more serious. A breach of ethics would not apply to this situation.

A student nurse asks, What is carrier testing? Which response by the nurse educator is most appropriate to answer the student nurses question? 1. Carrier testing involves testing an asymptomatic individual for carrier status for a genetic condition. 2. Carrier testing is used to establish a diagnosis of a genetic disorder in an individual who is symptomatic or has had a positive screening test. 3. Carrier testing is testing to identify a fetus with a genetic disease or condition. Some prenatal testing is offered routinely; other testing may be initiated due to family history or maternal factors. 4. Carrier testing follows in vitro fertilization (IVF) testing to identify embryos with a particular genetic condition.

1. Carrier testing involves testing an asymptomatic individual for carrier status for a genetic condition Carrier testing involves testing an asymptomatic individual for carrier status for a genetic condition. Diagnostic testing is testing to identify a fetus with a genetic disease or condition. Some prenatal testing is offered routinely; other testing may be initiated due to family history or maternal factors. Prenatal testing is testing to identify a fetus with a genetic disease or condition. Some prenatal testing is offered routinely; other testing may be initiated due to family history or maternal factors. Pre-implantation testing follows in vitro fertilization (IVF) testing to identify embryos with a particular genetic condition.

The nurse is assigned to a child in a spica cast for a fractured femur suffered in an automobile accident. The childs teenage brother was driving the car, which was totaled. The nurse learns that the father lost his job three weeks ago and the mother has just accepted a temporary waitress job. Which nursing diagnosis will the nurse use when planning care for this child and family? 1. Compromised Family Coping Related to the Effects of Multiple Simultaneous Stressors 2. Impaired Social Interaction (Parent and Child) Related to the Lack of Family or Respite Support 3. Interrupted Family Processes Related to Child with Significant Disability Requiring Alteration in Family Functioning 4. Risk for Caregiver Role Strain Related to Child with a Newly Acquired Disability and the Associated Financial Burden

1. Compromised Family Coping Related to the Effects of Multiple Simultaneous Stressors Compromised Family Coping Related to the Effects of Multiple Simultaneous Stressors best fits the multiple crises to which this family is responding. The spica cast may require alteration in family functioning; however, fractures are generally not considered a significant long-term disability. Lack of family members and lack of respite support was not mentioned in the scenario.

A nurse is working with the family of a pediatric client. When planning to obtain an accurate family assessment, which initial step is the most appropriate? 1. Establish a trusting relationship with the family. 2. Select the most relevant family-assessment tool. 3. Focus primarily upon the mother, while learning her greatest concern. 4. Observe the family in the home setting, since this step always proves indispensable.

1. Establish a trusting relationship with the family Establishment of a trusting relationship between the family and the nurse is the essential preliminary step in obtaining an accurate family assessment. There is benefit when the tool used matches the familys strengths and resources; however, selecting the most relevant family-assessment tool is not indispensable to accuracy in the assessment. Focusing primarily upon the mother while learning her greatest concern is counterproductive and prevents the nurse from acknowledging multiple perceptions held by the familys members. Observing the family in the home setting is only recommended in some cases.

The nurse is assessing a familys effective coping strategies and ineffective defensive strategies. Which family-social-system theory is the nurse using in this assessment of the family? 1. Family-stress theory 2. Family-development theory 3. Family-systems theory 4. Family life-cycle theory

1. Family-stress theory Family-stress theory indicates an array of coping strategies that effectively help reduce stress, in contrast with the defensive strategies of dysfunctional families. Family-development theory suggests developmental tasks for families in each stage. Family-systems theory looks at the relationships among and between family members and the environment. The family life cycle is not a family social system theory.

The nurse is measuring an abdominal girth on a child with abdominal distension. Identify the area on the childs abdomen where the tape measure should be placed for an accurate abdominal girth. 1. Just above the umbilicus, around the largest circumference of the abdomen 2. Below the umbilicus 3. Just below the sternum 4. Just above the pubic bone

1. Just above the umbilicus, around the largest circumference of the abdomen An abdominal girth should be taken around the largest circumference of the abdomen, in this case, just above the umbilicus. The circumference below the umbilicus or just below the sternum would not be an accurate abdominal girth.

While assessing the development of a 9-month-old infant, the nurse asks the mother if the child actively looks for toys when they are placed out of sight. Which developmental task is the nurse assessing this infant for? 1. Object permanence 2. Centration 3. Transductive reasoning 4. Conservation

1. Object permanence A child who has developed object permanence has the ability to understand that even though something is out of sight, it still exists. In centration, a child focuses only on a particular aspect of a situation. Transductive reasoning happens when a child connects two events in a cause-effect relationship because they have occurred at the same time. Conservation describes when a child knows that matter is not changed when its form is altered.

The nurse is counseling the parents of a 6-1/2-month-old infant. Which age-appropriate toy is most appropriate for the nurse to suggest to these parents? 1. Soft, fluid-filled ring that can be chilled in the refrigerator 2. Colorful rattle 3. Jack-in-the-box toy 4. Push-and-pull toy

1. soft, fluid-filled ring that can be chilled in the refrigerator Teething toys would be appropriate for this age. The rattle might be better enjoyed by a 3- to 6-month-old infant, and the jack-in-the-box and push-and-pull toys are better suited for a 9- to 12-month-old child.

A parent says to a nurse, How do you know when my child needs these screening tests the doctor just mentioned? Which response by the nurse is the most appropriate? 1. Screening tests are administered at the ages when a child is most likely to develop a condition. 2. Screening tests are done in the newborn nursery and from these results, additional screening tests are ordered throughout the first two years of life. 3. Screening tests are most often done when the doctor suspects something is wrong with the child. 4. Screening tests are done at each office visit.

1. Screening tests are administered at the ages when a child is more likely to develop a condition Screening tests administered at ages when a child is most likely to develop a condition provide a good basis for health promotion. The remaining answers all provide incorrect information to the parent. Abnormal newborn screening tests require immediate follow-up. Screening tests are done to detect the possibility of problems, not when a problem is suspected; at that point, a child needs diagnostic testing. Screening tests are not done at each office visit.

Which of these strategies would be most effective for a teachable moment during a routine office visit for the parents of a 6-year-old child? 1. Select one topic and present a brief amount of information on the topic. 2. Review all 6-year-old anticipatory guidelines with the parents. 3. Review 7-year-old anticipatory guidelines with the parents. 4. Discuss signs of malnutrition with the parents.

1. Select one topic and present a brief amount of information on the topic Children and families often learn best when presented with small bits of information. Do not give too much information to the parents at one time; therefore, selecting one topic and presenting information is appropriate. It is not appropriate to discuss malnutrition with these parents, since nothing in the stem of the question indicates that the child has a problem with nutrition.

While inspecting a 5-year-old childs ears, the nurse notes that the right pinna protrudes outward and that there is a mass behind the right ear. In light of these findings, which vital-sign parameter would the nurse assess on priority? 1. Temperature 2. Heart rate 3. Respirations 4. Blood pressure

1. Temperature Swelling behind an ear could indicate mastoiditis, and the presence of a fever would indicate a higher index of suspicion for this. There could also be changes in other vital-sign parameters, but they would not be specific for the presence of infection.

Several children arrived at the emergency department accompanied only by their fathers. Which father may legally sign emergency medical consent for treatment? 1. The divorced one from the binuclear family 2. The stepfather from the blended or reconstituted family 3. The divorced one when the single-parent mother has custody 4. The nonbiologic one from the heterosexual cohabitating family

1. The divorced one from the binuclear family The divorced father from the binuclear family may sign informed consent because he has equal legal rights with the mother under joint-custody arrangements. The nonbiologic stepfather from the blended or reconstituted family, the divorced biologic father when the single-parent mother has custody, and the nonbiologic father from the heterosexual cohabitating family are without legal authority to seek emergency medical care for the child.

Personalized health care for health promotion and maintenance can be based on environmental factors and which other item? 1. The genes a person inherited 2. Common conditions with known treatment strategies 3. Teaching strategies 4. The health of the person

1. The genes a person inherited Personalized health care is based on environmental factors and the genes the person inherited. Common conditions and the current health of the person are not part of personalized health care. Teaching strategies are not part of personalized health care.

A three-generation pedigree is constructed around the designated index patient. Based on this knowledge which explanation of the term proband is the most accurate? 1. The index patient has the disorder of interest 2. One parent of the index patient has the disorder of interest 3. The index patient does not have the disorder of interest 4. Siblings of the index patient do not have the disorder of interest

1. The index patient has the disorder of interest The proband indicates that the index patient has the disorder of interest. A consultant is an index patient seeking genetic counseling for a disorder she is not affected by at present.

A mother of a 2-year-old child becomes very anxious when the child has a temper tantrum in the medical office. Which response by the nurse is the most appropriate? 1. What do you usually do or say during a temper tantrum? 2. Lets ignore this behavior; it will stop sooner or later. 3. Pick up and cuddle your child now, please. 4. This is definitely a temper tantrum; I know exactly what you are feeling right now.

1. What do you usually do or say during a temper tantrum? Asking the mother to describe her usual behavior via an open-ended question will encourage the mother to talk about home management and will lead the nurse to assist the mother in making a plan of care for temper tantrums. Ignoring the behavior, instructing the mother to cuddle the child, or sympathizing with the mother (I know exactly what you are feeling) are not effective ways to problem solve for temper tantrums.

A neonatal nurse who encourages parents to hold their baby and provides opportunities for Kangaroo Care most likely is demonstrating concern for which aspect of the infants psychosocial development? 1. Attachment 2. Assimilation 3. Centration 4. Resilience

1. attachment Attachment is a strong emotional bond between a parent and child that forms the foundation for the fulfillment of the basic need of trust in the infant. Assimilation describes the childs incorporation of new experiences, centration is the ability to consider only one aspect of a situation at a time, and resilience is the ability to maintain healthy function even under significant stress and adversity.

The nurse is planning care for an adolescent client who will be hospitalized for several weeks following a traumatic brain injury. Which interventions will enhance family-centered care for this client and family? Standard Text: Select all that apply. 1. Making all ADL decisions for the adolescent and family 2. Asking the adolescent what foods to include during meal time 3. Allowing the family time to pray each day with the adolescent 4. Encouraging the adolescents friends to visit during visiting hours 5. Leaving all questions for the healthcare provider

2,3,4 Interventions that will enhance family-centered care for this client and family include asking the adolescent to be an active member of care by making food choices, allowing the family to pray each day with the adolescent, and encouraging the adolescents friends to visit during visiting hours. These interventions each promote the concepts of family-centered care. Making all decisions for the adolescent and family and leaving all questions for the healthcare provider do not promote the concepts of family-centered care.

The nurse is planning care for a school-age client and family who have expressed wanting to use complementary and alternative modalities (CAM) in the treatment plan. Which interventions can the nurse safely implement into the plan of care? Standard Text: Select all that apply. 1. Substituting an herbal remedy for a prescribed medication 2. Encouraging the parents to share which modalities they would like to implement 3. Educating on the benefits and risks for each modality 4. Using essential oils to decrease nausea 5. Discouraging the use of faith-based therapies

2,3,4 ppropriate interventions for this client and family include encouraging the parents to share which modalities they want to implement, educating about the risks and benefits of each modality, and using modalities that are safe, such the use of essential oils to decrease nausea. An herbal remedy should not be substituted for a prescribed medication, but can be used if deemed safe with the prescribed medication. Discouraging the use of faith-based therapies does not support the client and family who want to use CAM in the treatment plan.

A nurse is working with pediatric clients in a research facility. The nurse recognizes that federal guidelines are in place that delineate which pediatric clients must give assent for participation in research trials. Based upon the clients age, the nurse would seek assent from which children? 1. The precocious 4-year-old starting as a cystic fibrosis research-study participant. 2. The 7-year-old leukemia client electing to receive a newly developed medication, now being researched. 3. The 10-year-old starting in an investigative study for clients with precocious puberty. 4. The 13-year-old client beginning participation in a research program for ADHD treatments.

2,3,4 Federal guidelines mandate that research participants 7 years old and older must receive developmentally appropriate information about healthcare procedures and treatments and give assent.

When completing a pedigree, which factors should be included? Standard Text: Select all that apply. 1. Full siblings only 2. Begin with the proband 3. Mark each generation with a Roman numeral 4. Include at least three generations 5. Use only standard pedigree symbols

2,3,4,5 It is important to include half-siblings in addition to full siblings, as half-siblings have half the genetic history that the full siblings do. The other answers are all important to include in a pedigree.

The nurse is preparing to assessment a toddler client. Which activities would gain cooperation from the toddler? Standard Text: Select all that apply. 1. Asking the parents to wait outside 2. Allowing the client to sit in the parents lap 3. Administering vaccinations prior to the assessment 4. Handing the client a stethoscope while taking the health history 5. Making a game out of the assessment process

2,4 Allowing the client to stay on the parents lap and allowing the client to play with instruments that will be used in the assessment process are activities the nurse can implement to gain the toddlers cooperation during the assessment process. Asking the parents to wait outside may cause the toddler to become fearful. Vaccinations should be administered at the end of the visit. While making a game out of the assessment process may be appropriate for older children, this is not an appropriate strategy for a toddler client.

An infant weighs 9 pounds, 3 ounces at birth. The nurse plans to make a home visit to the mother and infant when the infant is 7 days old. What is the lowest acceptable weight the infant should be at this age? 1. 7 pounds, 12 ounces 2. 8 pounds, 2 ounces 3. 8 pounds, 12 ounces 4. 9 pounds

2. 8 pounds, 2 ounces In the first week of life, most infants lose about one-tenth of their birth weight; therefore, this infants weight should be 8 pounds, 2 ounces at 7 days of age. A weight loss to 7 pounds, 12 ounces would be too much for this infant. A decline to 8 pounds, 12 ounces is less than the expected one-tenth weight loss after birth, and an infant would not be expected to lose only 3 ounces during the first week of life.

The nurse must assess each of the 2-year-olds listed below. Which one should be evaluated first? 1. A child with a temperature of 101 degrees F 2. A child who has stridor 3. A child who has absent Babinski sign 4. A child who has a pot belly appearance

2. A child who has stridor A child with stridor is at risk for airway compromise; a child with a temperature of 101 degrees F, while sick, is not as ill as the child with stridor; and the child with an absent Babinski sign and the pot-bellied child are normal.

Pediatric nurses have foundational knowledge obtained in nursing school and add specific competencies related to the pediatric client. Which would be considered an additional specific expected competency of the pediatric nurse? 1. Physical assessment 2. Anatomical and developmental differences 3. Nursing process 4. Management of healthcare conditions

2. Anatomical and developmental Assessing anatomical and developmental differences would be a specific expected competency for the pediatric nurse that would not be learned in nursing school. Physical assessment, nursing process, and management of health conditions are all foundational knowledge learned in nursing school.

When assessing the cognitive development, which technique would be appropriate to test the remote memory of a 5-year-old? 1. Say the name of an object and after 5 minutes ask the child to tell you what you said the object was. 2. Ask the child to repeat his address. 3. Ask the child to say a poem and listen to the childs speech articulation. 4. Have the child point to various parts of the body as you name them.

2. Ask the child to repeat his address. Repeating the name of an object after 510 minutes is assessing recent memory. Asking the child to repeat his address is assessing remote memory. Listening to speech articulation and pointing to body parts both assess communication skills.

The nurse is planning care for clients seen in a newborn clinic. Which is the priority for a newborn client during the first clinic visit? 1. Providing pamphlets to reinforce information provided at the visit 2. Assessing the newborn-and-family interactions 3. Modeling infant-nurturing behaviors 4. Informing the parents of the infants gains in height and weight

2. Assessing the newborn-and-family interactions The first step in the nursing process is assessment; therefore, the nurse should assess the interactions of the parents with the newborn. Providing pamphlets to help educate the parents should be done at each appropriate office visit; however, the pamphlets would be distributed after assessment of parent needs. While the nurse should be a role model for nurturing behaviors during the office visit, this would not be the first thing the nurse performs at the office visit. While parents are informed of the infants gains in height and weight, this activity does not take priority.

Which assessment would not be included with a 17-year-olds screening during a routine health supervision visit? 1. STI evaluation 2. Autism screening 3. Hemoglobin test 4. Vision screening

2. Autism screening Autism screening would not be appropriate at this age. If autism were present, it would have presented before this age. STI evaluation, hemoglobin test, and vision screening are all appropriate for a 17-year-old.

The nurse, talking with the parents of a toddler who is struggling with toilet training, reassures them that their child is demonstrating a typical developmental stage. According to Erikson, which developmental stage will the nurse document in the medical record for this toddler? 1. Trust versus mistrust 2. Autonomy versus shame and doubt 3. Initiative versus guilt 4. Industry versus inferiority

2. Autonomy versus shame and doubt Eriksons stage of autonomy versus shame and doubt marks a period of time when the toddler is trying to gain some independence while still wanting to please adults.

A 7-year-old child is admitted for acute appendicitis. The parents are questioning the nurse about expectations during the childs recovery. Which information tool would be most useful in answering a parents questions about the timing of key events? 1. Healthy People 2020 2. Clinical pathways 3. Child mortality statistics 4. National clinical practice guidelines

2. Clinical pathways Clinical pathways are interdisciplinary documents provided by a hospital to suggest ideal sequencing and timing of events and interventions for specific diseases to improve efficiency of care and enhance recovery. This pathway serves as a model outlining the typical hospital stay for individuals with specified conditions. Healthy People 2020 contains objectives set by the U.S. government to improve the health and reduce the incidence of death in the twenty-first century. Child mortality statistics can be compared with those from other decades for the evaluation of achievement toward health-care goals. National clinical practice guidelines promote uniformity in care for specific disease conditions by suggesting expected outcomes from specific interventions.

The nurse is assessing an adolescent client whose weight is in the 5th percentile. Based on this information, which question is most appropriate for the nurse to ask the adolescent client? 1. Do you eat the school lunches? 2. Do you have any concerns about your weight? 3. Do you eat fruits, vegetables, and drink milk? 4. How many meals do you eat each day?

2. Do you have any concerns about your weight? The only question that addresses the adolescents weight, which is below the expected norm, is Do you have any concerns about your weight? Asking about school lunches, eating fruits and vegetables, and how many meals eaten each day should be used to obtain a nutritional history; however, those questions do not address the underweight status of the adolescent.

When discussing inheritance with parents of a child with a genetic disorder, which statement by the parents indicates they understand inheritance risk? 1. This child has a genetic disorder, so future children will not have it. 2. Each pregnancy carries the same percent risk of inheritance. 3. I cannot have any more children, because they will all have the disorder. 4. There is a good chance future children will be normal.

2. Each pregnancy carries the same percent risk of inheritance Each pregnancy carries the same percent risk of having a child with the disorder in question. The other statements indicate the need for further education regarding inheritance risk.

The nurse recognizes that the pediatric client is from a cultural background different from that of the hospital staff. Which goal is most appropriate for this client when planning nursing care? 1. Overlook or minimize the differences that exist. 2. Facilitate the familys ability to comply with the care needed. 3. Avoid inadvertently offending the family by imposing the nurses perspective. 4. Encourage complementary beneficial cultural practices as primary therapies.

2. Facilitate the familys ability to comply with the care needed The incorporation of the familys cultural perspective into the care plan is most likely to result in the familys ability to accept medical care and comply with the regimen prescribed. Since culture develops from social learning, attempts to ignore or minimize cultural consideration will result in mistrust, suspicion, or offenses that can have negative effects upon the health of children by reducing the resources available to promote health and prevent illness. Complementary therapy may be used later if other primary therapies prove to be ineffective.

A nurse is helping the parents of 2-year-old twins cope with the daily demands of life in an active household. Which strategy is most appropriate for the nurse to use? 1. Health maintenance 2. Health promotion 3. Health protection 4. Health supervision

2. Health promotion In health promotion, nurses partner with families to promote family strategies in the areas of lifestyle and coping. The definition of health maintenance and health supervision makes the other answers incorrect. Health protection is another term for health maintenance.

In the pediatric well-child clinic, the nurse explains the reason for an immunization series to the childs mother. This action represents which item? 1. Health assessment 2. Health promotion 3. Health maintenance 4. Health screening

2. Health promotion The explanation to the mother by the nurse provides an understanding of the immunization series to the mother and enables the mother to make an intelligent choice. While administering immunizations is considered health maintenance, the activity described in the question is clearly health promotion. A health assessment would be completed to determine what immunizations are needed. Health maintenance is the actual administration of the immunization and health screening involves looking at the immunization record to determine which immunizations are needed.

A nurse is planning care for a family who is undergoing genetic screening. Which expected outcome will the nurse include in the plan of care for this family? 1. Decide whether social issues outweigh genetic issues. 2. Make a voluntary decision related to genetic health issues. 3. Not consider the influence of genetics on health promotion. 4. Look closely at the present before considering the future as it relates to genetic screening.

2. Make a voluntary decisions related to genetic health issues The goal of nursing care is to allow informed, voluntary decisions when it comes to genetic screening.

There are several tools that help with obtaining a cultural assessment of a client and his family. Which tool would be appropriate to gather 12 major concepts of cultural assessment? 1. Sunrise enabler 2. Model for cultural competence 3. Transcultural assessment model 4. Health traditions model

2. Model for cultural competence The sunrise enabler examines influences on care and culture. The model for cultural competence will gather information on 12 major concepts. The transcultural assessment model is based on 6 phenomena. The health traditions model is predicated on holistic health.

A 12-year-old pediatric client is in need of surgery. Which member of the health care team is legally responsible for obtaining informed consent for an invasive procedure? 1. Nurse 2. Physician 3. Unit secretary 4. Social worker

2. Physician Informed consent is legal preauthorization for an invasive procedure. It is the physicians legal responsibility to obtain this, because it consists of an explanation about the medical condition, a detailed description of treatment plans, the expected benefits and risks related to the proposed treatment plan, alternative treatment options, the clients questions, and the guardians right to refuse treatment.

A mother brings a child to the pediatric office for a sick visit. Which action by the nurse is the most appropriate? 1. Focus exclusively on the reported illness. 2. Review health-promotion and health-maintenance activities. 3. Ask the mother to leave the room after obtaining the history. 4. Obtain a comprehensive history, including sociodemographic data.

2. Review health-promotion and health-maintenance activities A nurse should use every opportunity during an office visit to review health-promotion and health-maintenance activities. Focusing exclusively on the reported illnesses ignores the opportunity to use health-promotion strategies. There is not enough data in this scenario to determine whether the mother should be asked to leave the room. There is not enough information to indicate that a comprehensive history should be taken at this visit.

Parents of a child with a congenital heart defect ask what the chances are of recurrence in future pregnancies. Which response by the nurse is the most appropriate? 1. There is a 50% chance of recurrence in a future pregnancy. 2. There is a very low chance of recurrence. 3. It should not happen again with a future pregnancy. 4. There is a strong chance of recurrence.

2. There is a very low chance of recurrence There is a very low rate of recurrence with congenital heart defects. The other statements are not appropriate for the nurse to make in this situation.

A nurse caring for a school-age client notices some swelling in the childs ankles. The nurse presses against the ankle bone for five seconds, then releases the pressure and notices a markedly slow disappearance of the indentation. Which priority nursing assessment is appropriate? 1. Skin integrity, especially in the lower extremities 2. Urine output 3. Level of consciousness 4. Range of motion and ankle mobility

2. Urine Output Dependent, pitting edema, especially in the lower extremities, can be a symptom of both kidney and cardiac disorders. Decreases in urine output can also indicate compromise in both the renal and cardiac systems. Changes in level of consciousness, if present, would more than likely be a later effect in this situation. While ankle edema could lead to both decreased ankle mobility and compromise in skin integrity, diagnosing and treating the underlying cause of the edema is most important.

The nurse is working on parenting skills with a group of mothers. Which mother would need the fewest discipline-related suggestions? 1. Authoritarian one 2. Authoritative one 3. Indifferent one 4. Permissive one

2. authoritative one The parenting style that results in positive outcomes for the behavior and learning of its children is the authoritative style. Nurses have observed that children from homes using this parental style more frequently have personalities manifesting self-reliance, self-control, and social competence. These parents should be praised for using the preferred approach. Children in the authoritarian parenting family are denied opportunity to develop some skills in the areas of self-direction, communication, and negotiation. Under the permissive parenting style, children do not learn the socially acceptable limits of behaviors. The indifferent parenting style results in children who often exhibit destructive behaviors and delinquency

The nurse notes a history of a grade III heart murmur in a small infant. When assessing the heart, the nurse would expect to: 1. hear a quiet but easily heard murmur. 2. hear a moderately loud murmur without a palpable thrill. 3. hear a very loud murmur with easily palpable thrill. 4. listen without a stethoscope and hear a murmur at chest wall.

2. hear a moderately loud murmur without a palpable thrill A quiet but easily heard murmur is a grade II. A moderately loud murmur without palpable thrill is a grade III. A very loud murmur with easily palpable thrill is a grade V. A murmur heard at the chest wall without the aid of a stethoscope is a grade VI.

What is the pediatric nurses best defense against an accusation of malpractice or negligence? 1. Following the physicians written orders 2. Meeting the scope and standards of practice for pediatric nursing 3. Being a nurse practitioner or clinical nurse specialist 4. Acting on the advice of the nurse manager

2. meeting the scope and standards of practice for pediatric nursing Meeting the scope and standards of practice for pediatric nursing would cover the pediatric nurse against an accusation of malpractice or negligence because the standards are rigorous and cover all bases of excellent nursing practice. Following the physicians written orders or acting on the advice of the nurse manager are not enough to defend the nurse from accusations because the orders and/or advice may be wrong or unethical. Being a clinical nurse specialist or nurse practitioner does not defend the nurse against these accusations if he or she does not follow the Society of Pediatric Nurses standards of practice.

during an examination, a nurse asks a 5-year-old child to repeat his address. What is the nurse evaluating with this action? 1. Recent memory 2. Language development 3. Remote memory 4. Social-skill development

3 Asking children to remember addresses, phone numbers, and dates assesses remote-memory development. To evaluate recent memory the nurse would have the child name something and then ask him to name it again in 10 to 15 minutes. Listening to how the child talks and his sentence structure evaluates the childs language development, and assessing how he interacts with others evaluates social-skill development.

The nurse educator is presenting a lecture about risks to developmental progression. Which items will the educator include in the lecture? Standard Text: Select all that apply. 1. Family support 2. Access to the Internet 3. Recent loss of employment 4. Terminal illness of a family member 5. Hazards within the home environment

3,4,5 Risk factors that can inhibit developmental progression include financial problems, stresses and worries, family and job instability, neighborhood and home hazards, and lack of resources. Family support and access to the Internet are both considered protective factors.

A nurse in the outpatient pediatric clinic is reviewing the records of a preschool-age child and notes that because the parents often miss routine healthcare visits the child has not received the second measles, mumps, and rubella (MMR) vaccine. Which action by the nurse is most appropriate in this situation? 1. Speak firmly with the parents about the importance of being compliant. 2. Notify the physician that the childs immunizations are no longer up to date. 3. Call the parents and encourage them to bring the child for recommended care. 4. Plan to discuss the principles of health supervision at the next scheduled visit.

3. Call the parents and encourage them to bring the child for recommended care The nurse in the pediatric healthcare setting is responsible for reviewing the health supervision of the child. Partnering with the parents and encouraging the parents to follow health-supervision guidelines are the best strategies to use. Speaking firmly with the parents about compliance will alienate the parents at this time. A discussion of the principles of health supervision without an intervention at this visit would mean a delay in needed health care for the child in this example. Discussing with the physician that the immunizations are not up to date is not necessary in an outpatient clinic. Immunizations are given per schedule.

The camp nurse is assessing a group of children attending summer camp. The nurse will expect which children to most likely have problems perceiving a sense of belonging? 1. Children whose parents divorced recently 2. Children who gained a stepparent recently 3. Children recently placed into foster care 4. Children adopted as infants

3. Children recently placed into foster care Children in foster care are more likely to have problems perceiving a sense of belonging. Children whose parents divorce often fear abandonment. Children who gain a stepparent may have problems trusting the new parent. Infants who are adopted at birth can have minimal problems with acceptance when parents follow preadoption counseling about disclosure.

Cultures have many different childrearing practices. Which culture is known to value the male child more than the female child, and often teaches children to avoid displaying emotion? 1. Mexican 2. Amish 3. Chinese 4. Navajo

3. Chinese The Chinese culture values the male child more than the female child, and often teaches children to avoid showing emotion. The other cultures do not have this component.

The nurse is caring for a newly-admitted infant diagnosed with failure to thrive. The nurse begins to implement the healthcare provider prescribed orders by taking blood pressures in all four extremities. Which congenital cardiac defect does the nurse anticipate based on the prescribed order? 1. Tetralogy of Fallot 2. Pulmonary atresia 3. Coarctation of the aorta 4. Ventricular septal defect

3. Coarctation of the aorta Normally, blood pressures in the lower extremities are the same as or higher than upper-extremity blood pressures. But in coarctation of the aorta, the narrowing of the aorta causes decreased blood flow to the lower extremities and thus lower-extremity blood-pressure readings are significantly lower than upper-extremity readings. There are minimal differences between upper and lower blood-pressure readings in tetralogy of Fallot, pulmonary atresia, and ventricular septal defect.

Which genetic test would be best for the prospective father who recently had a positive screen for a genetic condition? 1. Carrier testing 2. Predictive testing 3. Diagnostic testing 4. Prenatal testing

3. Diagnostic testing Diagnostic testing is best for an individual who has a positive screen for a genetic disorder. Prenatal testing would be done with a pregnancy. Carrier testing is done with an asymptomatic individual who wishes to know whether he or she is a carrier of a condition. Predictive testing predicts the likelihood of a condition later in life.

While assessing a 10-month-old African American infant, the nurse notices that the sclerae have a yellowish tint. Which organ system should the nurse further evaluate to determine an ongoing disease process? 1. Cardiac 2. Respiratory 3. Gastrointestinal 4. Genitourinary

3. Gastrointestinal This infants sclerae are showing signs of jaundice, which most likely is secondary to a failure or malfunction of the liver in the gastrointestinal system. Cyanosis of the skin and mucous membranes is generally a sign of problems with the cardiac and/or respiratory system. Tenting of the skin and dry mucous membranes could be a sign of dehydration, and edema could be a sign of fluid overload. Both of these conditions could be secondary to problems with functioning of the genitourinary system.

The nurse in the pediatric clinic observes a parental lack of warmth and interest toward the child. Which family style will the nurse most likely document in this situation? 1. Authoritarian 2. Authoritative 3. Indifferent 4. Permissive

3. Indifferent Parents displaying the indifferent parenting style fail to demonstrate consistent warmth and interest in their children. Parents who favor the authoritarian style may exhibit a punitive attitude toward the child who is misbehaving but are not disinterested. Parents employing the authoritative style and the permissive style have children who report that my parent loves me and shows affection regularly.

The parents of an 8-year-old state that their son seems very interested in trying new activities. When the parents ask for suggested activities for this age child, the nurse recommends scouts as an activity that will foster growth and development. In which stage of Eriksons psychosocial stages of development is this child? 1. Trust versus mistrust 2. Initiative versus guilt 3. Industry versus inferiority 4. Identity versus role confusion

3. Industry verses inferiority Trust versus mistrust (birth to 1 year)The task of the first year of life is to establish trust in the people providing care. Trust is fostered by provision of food, clean clothing, touch, and comfort. If basic needs are not met, the infant will eventually learn to mistrust others. Initiative versus guilt (3 to 6 years)The young child initiates new activities and considers new ideas. This interest in exploring the world creates a child who is involved and busy. Constant criticism, on the other hand, leads to feelings of guilt and a lack of purpose. Identity versus role confusion (12 to 18 years)In adolescence, as the body matures and thought processes become more complex, a new sense of identity or self is established. The self, family, peer group, and community are all examined and redefined. The adolescent who is unable to establish a meaningful definition of self will experience confusion in one or more roles of life. Industry versus inferiority (6 to 12 years)The middle years of childhood are characterized by development of new interests and by involvement in activities. The child takes pride in accomplishments in sports, school, home, and community. If the child cannot accomplish what is expected, however, the result will be a sense of inferiority.

Which statement by the nurse is most appropriate prior to giving an intramuscular injection to a 2-1/2-year-old child? 1. We will give you your shot when your mommy comes back. 2. This is medicine that will make you better. First we will hold your leg, then I will wipe it off with this magic cloth that kills the germs on your leg right here, then I will hold the needle like this and say one, two, three . . . go and give you your shot. Are you ready? 3. It is all right to cry, I know that this hurts. After we are done you can go to the box and pick out your favorite sticker. 4. This is a magic sword that will give you your medicine and make you all better.

3. It is alright to cry, I know that this hurts. After we are done you can go to the box and pick out your favorite sticker The most appropriate response would be to acknowledge the childs feelings and give her something to look forward to (picking out a sticker). Waiting for the mother to come back would be inappropriate because toddlers do not have an understanding of time. Giving elaborate descriptions and using colorful language are inappropriate. The instructions should not end with a are you ready statement because the toddler will say no. You also dont want to frighten and/or confuse the child by using statements such as use of a magic sword.

A family desires genetic testing for their adolescent. What response by the clinic nurse is appropriate? 1. The child is a minor and cannot give consent. 2. It is not advisable because insurance does not pay for this test. 3. Let me discuss this with the adolescent and then we can discuss it more fully. 4. There is a chance the adolescent might be discriminated against because of the test.

3. Let me discuss this with the adolescent and then we can discuss it more fully The adolescent is old enough to understand the pros and cons of testing. It would be advisable to discuss the matter with the adolescent and then more fully with the parents. That the minor is not able to give consent is true, but this answer cuts off discussion and is not appropriate. Insurance and discrimination can play a role in the decision, but still are not the appropriate answers because they do not address the issue of the request for testing.

A mother of a school-age client who recently had surgery for the removal of tonsils and adenoids complains that the child has begun sucking his thumb again. Which coping mechanisms is the child using to cope with the surgery and hospitalization? 1. Repression 2. Rationalization 3. Regression 4. Fantasy

3. Regression The correct answer is regression, which is a return to an earlier behavior. Repression is the involuntary forgetting of uncomfortable situations, rationalization is an attempt to make unacceptable feelings acceptable, and fantasy is a creation of the mind to help deal with an unacceptable fear.

An adolescent client with cystic fibrosis suddenly becomes non-compliant with the medication regime. Which intervention by the nurse will most likely improve compliance for this client? 1. Give the child a computer-animated game that presents information on the management of cystic fibrosis. 2. Arrange for the physician to sit down and talk to the child about the risks related to non-compliance with medications. 3. Set up a meeting with some older teens with cystic fibrosis who have been managing their disease effectively. 4. Discuss with the childs parents the privileges that can be taken away, such as cell phone, if compliance fails to improve.

3. Set up a meeting with some older teens with cystic fibrosis who have been managing their disease effectively Providing an adolescent with positive role models who are in his peer group is the intervention most likely to improve compliance. Interest in games may begin to wane, adults opinions may be viewed negatively and challenged, and threatening punishment may further incite rebellion.

The nurse is taking a health history from a family of a 3-year-old child. Which statement by the nurse would most likely establish rapport and elicit an accurate response from the family? 1. Does any member of your family have a history of asthma, heart disease, or diabetes? 2. Hello, I would like to talk with you and get some information on you and your child. 3. Tell me about the concerns that brought you to the clinic today. 4. You will need to fill out these forms; make sure that the information is as complete as possible.

3. Tell me about the concerns that brought you to the clinic today. Asking the parents to talk about their concerns is an open-ended question and one which is more likely to establish rapport and an understanding of the parents perceptions. Giving the family a list of items to answer at once may be confusing to the parents. Giving an introduction before asking the parents for information is likely to establish rapport, but giving an explanation of why the information would be needed would be even more effective at establishing rapport and also for getting more accurate, pertinent information. Simply asking the parents to fill out forms is very impersonal, and more information is likely to be obtained and clarified if the nurse is directing the interview.

The nurse notes some dysmorphic facial features when examining a toddler in the well child clinic. Which measurement taken by the nurse would not be considered when looking at dysmorphic facial features? 1. Interpupillary distance 2. Intercanthal distance 3. The distance from the outer canthus to the pinna 4. Outer cantus distance

3. The distance from the outer canthus to the pinna The distance from the outer canthus to the pinna does not apply to the face. The other measurements would be necessary when evaluating facial dysmorphic features.

Despite the availability of Childrens Health Insurance Programs (CHIP), many eligible children are not enrolled. Which nursing intervention would be the most appropriate to help children become enrolled in CHIP? 1. Assessment of the details of the familys income and expenditures 2. Case management to limit costly, unnecessary duplication of services 3. To advocate for the child by encouraging the family to investigate its SCHIP eligibility 4. To educate the family about the need for keeping regular well-childvisit appointments

3. to advocate for the child by encouraging the family to investigate its SCHIP eligibility In the role of an advocate, a nurse will advance the interests of another; by suggesting the family investigate its CHIP eligibility, the nurse is directing their action toward the childs best interest. Financial assessment is more commonly the function of a social worker. The case-management activity mentioned will not provide a source of funding nor will the educational effort described.

The parents of a 1-year-old infant are concerned that this baby seems more shy and scared of new situations than their other child and ask the nurse if this is normal. The nurse knows that the infant is exhibiting a characteristic of the slow-to-warm-up. Which statement to the parents is most appropriate by the nurse? 1. Your infant is showing a regularity in patterns of eating. 2. Your infant displays a predominately negative mood. 3. Your infant initially reacts to new situations by withdrawing. 4. Your infant has intense reactions to the environment.

3. your infant initially reacts to new situations by withdrawing Slow-to-warm-up children adapt slowly to new situations and initially will withdraw. Showing regularity in patterns of eating is a characteristic of an easy child, and displaying a predominately negative mood and commonly having intense reactions to the environment are characteristics of difficult children.

During the newborn examination, the nurse assesses the infant for signs of developmental dysplasia of the hip. A finding that would strongly indicate this disorder would be: 1. soles are flat with prominent fat pads. 2. positive Babinski reflex. 3. metatarsus varus. 4. asymmetric thigh and gluteal folds.

4 asymmetric thigh and gluteal folds A positive Babinski reflex and flat soles are normal newborn findings. Metatarsus varus is an in-toeing of the feet that usually occurs secondary to intra-uterine positioning and frequently resolves on its own, but approximately 10 percent of infants with metatarsus varus also have developmental dysplasia of the hip. Asymmetric thigh and gluteal folds are a positive finding for developmental dysplasia of the hip requiring follow-up with ultrasound.

Place the nursing assessments of a toddler in the best order. Standard Text: Click and drag the options below to move them up or down. Choice 1. Examination of eyes, ears, and throat Choice 2. Auscultation of chest Choice 3. Palpation of abdomen Choice 4. Developmental assessment

4,2,3,1 In examining a toddler, it is usually best to go from least invasive to most invasive examination in order to build her trust and cooperation. Developmental assessment involves visual inspection and activities that the toddler may view as games and will likely cooperate with. Auscultation is usually less threatening to the toddler than palpation, especially if the nurse were to use the stethoscope on a parent or a toy. The most uncomfortable, invasive exam for the toddler is most likely to be the examination of the eyes, ears, and throat, so that should be performed last.

A nurse is discussing health promotion activities with parents of a 4-year-old client. What health-promotion activity is most appropriate for this family? 1. Make arrangements to tour the kindergarten in which the child will enroll next year. 2. Plan a movie afternoon with the childs big brother. 3. Maintain appropriate immunizations. 4. Teach the child the proper method for brushing the teeth.

4. Teach the child the proper method for brushing the teeth Teaching proper oral hygiene through proper teeth brushing is a health-promotion activity. Touring the kindergarten might alleviate anxiety, but is not health promotion. A movie afternoon with the big brother is sedentary, and also not a health-promotion activity. Maintaining immunizations is a health-maintenance, not health-promotion, activity.

The nurse is performing an assessment of a childs biologic family history. Which situation would necessitate the nurses asking the mother for information should use the term childs father instead of your husband? 1. Traditional nuclear family 2. Traditional extended family 3. Two-income nuclear family 4. Cohabitating informal stepfamily

4. Cohabitation informal stepfamily The mother from the cohabitating informal stepfamily does not have a husband; the nurse should be asking about the childs father. In the traditional nuclear family, the traditional extended family, and the two-income nuclear family, the childs father is the same person as the mothers husband.

A nurse says to the mother of a 6-month-old infant, Does the baby sit without assistance, and is the baby crawling? Which process is the nurse using in this interaction? 1. Health promotion 2. Health maintenance 3. Disease surveillance 4. Developmental surveillance

4. Developmental surveillance The question asked by the nurse is seeking information about developmental milestones; therefore, the nurse is involved in developmental surveillance. While health-promotion and health-maintenance activities are related to developmental surveillance, this question is looking specifically at the milestones; therefore, the answers health promotion and health maintenance are incorrect. The questions asked in the stem are not classified as disease-surveillance questions.

The nurse is preparing a three-generation family pedigree. A student asks the nurse the significance of the darkened circles. Which response by the nurse is the most appropriate? 1. Males unaffected by the disease. 2. Males affected by the disease. 3. Females unaffected by the disease. 4. Females affected by the disease.

4. Females affected by the disease A circle is the standard symbol for a female, and darkening the circle represents a female affected by a disease. A male is represented by a square.

A pediatric nurse who is employed in a busy ambulatory clinic setting is informed by the nurse manager that average nursing time allocated for each child and family is being reduced to 10 minutes to more efficiently manage the clinic. The nursing activities must include a nursing assessment and discussion on anticipatory guidance. Which of these strategies should the nurse utilize in the plan of care delivery? 1. Attempt to complete the assessment and education in 10 minutes, but extend the time whenever the nurse deems necessary. 2. Plan to do the anticipatory guidance first since either the nurse practitioner or the physician can perform the assessment of the child. 3. Encourage the parent to ask for specific time to talk with the nurse privately at each office visit. 4. Focus anticipatory guidance strategies on topics that the parent or child have expressed as an area of interest.

4. Focus anticipatory guidance strategies on topics that the parent or child have expressed as an area of interest With limited time for each visit, the nurse should focus on anticipatory guidance strategies that will most benefit the parent and child during that office visit.

While being comforted in the emergency department, a young school-age sibling of a pediatric trauma victim blurts out to the nurse, Its all my fault! When we were fighting yesterday, I told him I wished he was dead! Which response is most appropriate by the nurse? 1. Asking the child if she would like to sit down and drink some water 2. Sitting the child down in an empty room with markers and paper so that she can draw a picture 3. Calmly discussing the catheters, tubes, and equipment that the patient requires and explaining to the sibling why the patient needs them 4. Reassuring the child that it is normal to get angry and say things that we do not mean but that we have no control over whether or not an accident happens

4. Reassuring the child that it is normal to get angry and say things that we do not mean but that we have no control over whether or not an accident happens Magical thinking is the belief that events occur because of ones thoughts or actions, and the most therapeutic way to respond to this is to correct any misconceptions that children may have and reassure them that they are not to blame for any accidents or illness.

The nurse of an outpatient clinic is sitting with the parents while their adolescent goes for a test. The parents are complaining about their childs behavior. Which statement by the nurse fosters family-centered communication? 1. I agree with you, discipline is an important part of parenting. 2. I know just how you feel. I had the same experience with my children. 3. You are so right. Adolescents function in the me-first mode all the time. 4. Tell me what concerns you about your childs behavior.

4. Tell me what concerns you about your childs behavior Using an open-ended question allows the parents to discuss a family concern. All the other questions or statements are blocking statements and would not foster family-centered communication.

While trying to inform a young school-age client about what will occur during an upcoming CT scan, the nurse notices that the child is engaged in a collective monologue, talking about a new puppy. Which response by the nurse is the most appropriate in this situation? 1. Please stop talking about your puppy. I need to tell you about your CT scan. 2. Ignore the childs responses and continue discussing the procedure. 3. Ill come back when you are ready to talk with me more about your CT scan. 4. You must be so excited to have a new puppy! They are so much fun. Now, let me tell you again about going downstairs in a wheelchair to a special room.

4. You must be so excited to have a new puppy! They are so much fun. Now, let me tell you again about going downstairs in a wheelchair to a special room. When a child becomes engaged in a collective monologue, it is best to respond to the content of his or her conversation and then attempt to reinsert facts about the content that needs to be covered.

A child is being prepared for an invasive procedure. The mother of the child has legal custody but is not present. After details of the procedure are explained, who can provide legal consent on behalf of a minor child for treatment? 1. The divorced parent without custody 2. A cohabitating unmarried boyfriend of the childs mother 3. A grandparent who lives in the home with the child 4. A babysitter with written proxy consent

4. a babysitter with written proxy consent A parent may grant proxy consent in writing to another adult so that children are not denied necessary health care. In the case of divorced parents, the parent with custody may be the only parent allowed by some states to give informed consent. Residence in the same household with a child does not authorize an adult to sign consent for treatment.

A new pediatric hospital will open soon. While planning nursing care, the hospital administration is considering two models of providing health care: family-focused care and family-centered care. Which action best implements family-centered care? 1. Telling the family what must be done for the familys health 2. Assuming the role of an expert professional to direct the health care 3. Intervening for the child and family as a unit 4. Conferring with the family in deciding which healthcare option will be chosen

4. conferring with the family in deciding which healthcare option will be chosen The benefit of employing the family-centered-care philosophy is that the priorities and needs as seen by the family are addressed as a partnership between a family and a nurse develops. In family-focused care, the healthcare worker assumes the role of professional expert while missing the multiple contributions the family brings to the healthcare meeting.

Which nursing role is not directly involved when providing family-centered approach to the pediatric population? 1.advocacy 2. case management 3. Patient education 4. researcher

4. researcher a researcher is not involved in the family centered approach to patient care of children and their families. Advocacy, case management, and patient education are all roles directly involved in the care of children and their families.