Peds Test 1

In planning sex education and contraceptive teaching for adolescents, the nurse should consider which of the following? A.Both sexual activity and contraception require planning. B. Teenagers frequently lack a fundamental understanding of fertility. C. Most teenagers today are knowledgeable about reproductive anatomy and physiology. D. Most teenagers who become pregnant do so as an act of hostility, especially toward their parents.

B. Teenagers frequently lack a fundamental understanding of fertility.

Sleep problems in school-age children are often demonstrated by A. night terrors that awaken them. B. delaying tactics because they do not wish to go to bed. C. somatic illness that awakens them. D. increasing need for sleep time as they get older.

B. delaying tactics because they do not wish to go to bed.

The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. The nurse's suggestions regarding participation in sports at this age should include which of the following? A. Organized sports such as soccer are not appropriate at this age. B. Competition is detrimental to the establishment of a positive self-image. C. Sports participation is encouraged if the type of sport is appropriate to the child's abilities. D. Girls should compete only against girls because at this age boys are larger and have more muscle mass.

C. Sports participation is encouraged if the type of sport is appropriate to the child's abilities.

HEADSSSS

H- Home E- education, eating, exercise A- activities D- drugs and ETOH S- sexuality S- Suicide/depression S- safety S- spirituality, music

The nurse is explaining strategy of consequences to a parent he is working with. Which response by the parent indicates more teaching is needed when he describes the types of consequences? a. natural: those that occur without any intervention b. Logical: Those that are directly related to the rule c. Transforming: allowing the child to come to the conclusion on his or her own D. unrelated: Those that are imposed deliberately

c. Transforming: allowing the child to come to the conclusion on his or her own

amenorrhea is the a. menstrual back pain b. a condition developed from excessive menstruation c. excessive diarrhea caused by abdominal pain from menses d. absence of menses

d. absence of menses

Match the cranial syndrome or sequence with its facial features. a. Crouzon syndrome b. Apert syndrome c. Treacher Collins syndrome d. Pierre Robin sequence 1. Craniosynostosis resulting in a prominent forehead 2. Shallow orbits and underdevelopment of the middle third of the face 3. Asymmetric facial deformity, including absent cheekbones 4. Displacement of the chin as a result of micrognathia

1. ANS: B 2. ANS: A 3. ANS: C 4. ANS: D

Match each neurologic reflex that appears in infancy to its description. a. Labyrinth righting b. Body righting c. Otolith righting d. Landau e. Parachute 1. When the body of an erect infant is tilted, the head is returned to an upright, erect position. 2. An infant in the prone or supine position is able to raise his or her head. 3. Turning the hips and shoulders to one side causes all the other body parts to follow. 4. When the infant is suspended in a horizontal prone position and suddenly thrust downward, the hands and fingers extend forward as if to protect against falling. 5. When the infant is suspended in a horizontal prone position, the head is raised and the legs and spine are extended.

1. ANS: C 2. ANS: A 3. ANS: B 4. ANS: E 5. ANS: D

Match the following terms related to food sensitivities to the accurate descriptions. a. Food allergy b. Food allergen c. Food intolerance d. Sensitization e. Atopy 1. A food elicits a reproducible adverse reaction but does not have an established immunologic mechanism 2. An adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food 3. Specific components of food or ingredients in food that are recognized by allergen-specific immune cells eliciting an immune reaction 4. Allergy with a hereditary tendency 5. Initial exposure to an allergen resulting in an immune response; subsequent exposure induces a much stronger response

1. ANS: C 2. ANS: A 3. ANS: B 4. ANS: E 5. ANS: D

Children are taught the values of their culture through observation and feedback on their own behavior. A nurse teaching a class on cultural awareness-competence should be aware of which factor(s) that may be culturally determined? (Select all that apply.) A) Social roles B) Racial variation C) Degree of competition D) Determination of status E) Geographic

A) Social roles C) Degree of competition D) Determination of status Rationale: Social roles are influenced by culture. Cultures that value individual resourcefulness/competition of status is acceptable. Determination of status is culturally determined and varies according to each culture. Racial variation refers to transmissible traits. Culture is composed of beliefs, values, practices, and social relationships that are learned. Cultural development may be limited by geography. The geographic boundaries are not culturally determined.

The practice of cultural humility is continual and an important concept in the nursing process. Nurses can facilitate this process by: (Select all that apply.) A) integrating cultural knowledge. B) recognizing cultural differences. C) acting in a culturally appropriate manner. D) being aware of their own beliefs and practices. E) helping the family adapt to the health care practices.

A) integrating cultural knowledge. B) recognizing cultural differences. C) acting in a culturally appropriate manner. D) being aware of their own beliefs and practices. Rationale: Integrating cultural knowledge is essential to providing care to families and the community. Recognizing cultural difference is a component of cultural awareness, humility, and competence. Acting culturally appropriate is essential in understanding and being able to deal effectively with families in a multicultural community. Nurses must be aware of their own beliefs and practices before they can begin to understand the varied and numerous cultural influences on the life of children and family. It is essential that nurses make an effort to adapt health care practices to the family's health needs rather the attempting to change longstanding beliefs.

The recommendation for calcium for children 1 to 3 years of age is _____ milligrams. (Record your answer in a whole number.)

ANS: 500 While limiting fat consumption, it is important to ensure diets contain adequate nutrients such as calcium. The recommendation for daily calcium intake for children 1 to 3 years of age is 500 mg, and the recommendation for children 4 to 8 years of age is 800 mg.

The nurse is teaching parents about instilling a positive body image for the preschool age. What statement made by the parents indicates the teaching is understood? a. We will make sure our child is praised about his or her looks. b. We will help our child compare his or her size with other children. c. We understand our child will have well-defined body boundaries. d. We will be sure our child understands about being little for his or her age.

ANS: A Because these are formative years for both boys and girls, parents should make efforts to instill positive principles regarding body image. Children at this age are aware of the meaning of words such as pretty or ugly, and they reflect the opinions of others regarding their own appearance. Despite the advances in body image development, preschoolers have poorly defined body boundaries. By 5 years of age, children compare their size with that of their peers and can become conscious of being large or short, especially if others refer to them as so big or so little for their age. Parents should not suggest their child compare him- or herself with other children in regard to size, and parents should not focus on their childs size as being little.

What is a function of brown adipose tissue (BAT) in newborns? a.Generates heat for distribution to other parts of body b.Provides ready source of calories in the newborn period c.Protects newborns from injury during the birth process d.Insulates the body against lowered environmental temperature

ANS: A Brown fat is a unique source of heat for newborns. It has a larger content of mitochondrial cytochromes and a greater capacity for heat production through intensified metabolic activity than does ordinary adipose tissue. Heat generated in brown fat is distributed to other parts of the body by the blood. It is effective only in heat production. Brown fat is located in superficial areas such as between the scapulae, around the neck, in the axillae, and behind the sternum. These areas should not protect the newborn from injury during the birth process. The newborn has a thin layer of subcutaneous fat, which does not provide for conservation of heat.

Which is most important in the immediate care of the newborn? a.Maintain a patent airway. b.Administer prophylactic eye care. c.Maintain a stable body temperature. d.Establish identification of the mother and baby.

ANS: A Maintaining a patent airway is the primary objective in the care of the newborn. First, the pharynx is cleared with a bulb syringe followed by the nasal passages. Administering prophylactic eye care and establishing identification of the mother and baby are important functions, but physiologic stability is the first priority in the immediate care of the newborn. Conserving the newborn's body heat and maintaining a stable body temperature are important, but a patent airway must be established first.

What is descriptive of the nutritional requirements of preschool children? a. The quality of the food consumed is more important than the quantity. b. The average daily intake of preschoolers should be about 3000 calories. c. Nutritional requirements for preschoolers are very different from requirements for toddlers. d. Requirements for calories per unit of body weight increase slightly during the preschool period.

ANS: A Parents need to be reassured that the quality of food eaten is more important than the quantity. Children are able to self-regulate their intake when offered foods high in nutritional value. The average daily caloric intake should be approximately 1800 calories. Toddlers and preschoolers have similar nutritional requirements. There is an overall slight decrease in needed calories and fluids during the preschool period.

What should nursing interventions to maintain a patent airway in a newborn include? a.Positioning the newborn supine after feedings. b.Wrapping the newborn as snugly as possible. c.Placing the newborn to sleep in the prone (on abdomen) position. d.Using a bulb syringe to suction as needed, suctioning the nose first and then the pharynx.

ANS: A Positioning the newborn supine after feedings is recommended by the American Academy of Pediatrics to prevent sudden newborn death syndrome. The child can be wrapped snugly but should be placed on the side or back. Placing a newborn to sleep in the prone (on abdomen) position is not advised because of the possible link between sleeping in the prone position and sudden newborn death syndrome. A bulb syringe should be kept by the bedside if necessary, but the pharynx should be suctioned before the nose.

A boy age 4 1/2 years has been having increasingly frequent angry outbursts in preschool. He is aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8 to 10 weeks. His parent asks the nurse for advice. What is the most appropriate intervention? a. Refer the child for a professional psychosocial assessment. b. Explain that this is normal in preschoolers, especially boys. c. Encourage the parent to try more consistent and firm discipline. d. Talk to the preschool teacher to obtain validation for behavior parent reports.

ANS: A The preschool years are a time when children learn socially acceptable behavior. The difference between normal and problematic behavior is not the behavior but the severity, frequency, and duration. This childs behavior meets the definition requiring professional evaluation. Some aggressive behavior is within normal limits, but at 8 to 10 weeks, this behavior has persisted too long. There is no indication that the parent is using inconsistent discipline. A part of the evaluation is to obtain validation for behavior parent reports.

What information should be given to the parents of a 12-month-old child regarding appropriate play activities for this age? a. Give large push-pull toys for kinetic stimulation. b. Place a cradle gym across the crib to help develop fine motor skills. c. Provide the child with finger paints to enhance fine motor skills. d. Provide a stick horse to develop gross motor coordination.

ANS: A A 12-month-old child is able to pull to a stand and walk holding on or independently. Appropriate toys for this age child include large push-pull toys for kinetic stimulation. A cradle gym should not be placed across the crib. Finger paints are appropriate for older children. A 12-month-old child does not have the stability to use a stick horse.

A nurse is assessing a family's structure. Which describes a family in which a mother, her children, and a stepfather live together? a. Blended b. Nuclear c. Binuclear d. Extended

ANS: A A blended family contains at least one stepparent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling.

The nurse is caring for a breastfed full-term infant who was born after an uneventful pregnancy and delivery. The infant's blood glucose level is 36 mg/dL. Which action should the nurse implement? a. Bring the infant to the mother and initiate breastfeeding. b. Place a nasogastric tube and administer 5% dextrose water. c. Start a peripheral intravenous line and administer 10% dextrose. d. Monitor the infant in the nursery and obtain a blood glucose level in 4 hours.

ANS: A A full-term infant born after an uncomplicated pregnancy and delivery who is borderline hypoglycemic, as indicated by a blood glucose level of 36 mg/dL, and who is clinically asymptomatic should probably reestablish normoglycemia with early institution of breast or bottle feeding. The newborn does not require a nasogastric tube and 5% dextrose water or a peripheral intravenous line with 10% dextrose because the blood glucose level is only borderline. The infant does need to be monitored, but breastfeeding should be started and the blood glucose level checked in 1 to 2 hours.

In teaching parents about appropriate pacifier selection, the nurse should recommend which characteristic? a. Easily grasped handle b. Detachable shield for cleaning c. Soft, pliable material d. Ribbon or string to secure to clothing

ANS: A A good pacifier should be easily grasped by the infant. One-piece construction is necessary to avoid having the nipple and guard separate, posing a risk for aspiration. The material should be sturdy and flexible. If the pacifier is too pliable, it may be aspirated. No ribbon or string should be attached. This poses additional risks.

Preschoolers' fears can best be dealt with by which intervention? a. Actively involving them in finding practical methods to deal with the frightening experience b. Forcing them to confront the frightening object or experience in the presence of their parents c. Using logical persuasion to explain away their fears and help them recognize how unrealistic the fears are d. Ridiculing their fears so that they understand that there is no need to be afraid

ANS: A Actively involving them in finding practical methods to deal with the frightening experience is the best way to deal with fears. Forcing a child to confront fears may make the child more afraid. Preconceptual thought prevents logical understanding. Ridiculing fears does not make them go away.

Which aspect of cognition develops during adolescence? a. Capability to use a future time perspective b. Ability to place things in a sensible and logical order c. Ability to see things from the point of view of another d. Progress from making judgments based on what they see to making judgments based on what they reason

ANS: A Adolescents are no longer restricted to the real and actual. They also are concerned with the possible; they think beyond the present. During concrete operations (between ages 7 and 11 years), children exhibit these characteristic thought processes.

The nurse is caring for an adolescent hospitalized for asthma. The adolescent belongs to a large family. The nurse recognizes that the adolescent is likely to relate to which group? a. Peers b. Parents c. Siblings d. Teachers

ANS: A Adolescents from a large family are more peer oriented than family oriented. Adolescents in small families identify more strongly with their parents and rely more on them for advice.

The nurse is collecting a stool sample from an infant with lactose intolerance. Which fecal pH should the nurse expect as the result? a. 5.5 b. 7.0 c. 7.5 d. 8

ANS: A An acidic pH (5-5.5) indicates malabsorption, which occurs with lactose intolerance. The normal pH of the stool is 7.0 to 7.5. A finding of 8 would be alkaline.

Steven, 16 months old, falls down a few stairs. He gets up and "scolds" the stairs as if they caused him to fall. This is an example of which of the following? a. Animism b. Ritualism c. Irreversibility d. Delayed cognitive development

ANS: A Animism is the attribution of lifelike qualities to inanimate objects. By scolding the stairs, the toddler is attributing human characteristics to them. Ritualism is the need to maintain the sameness and reliability. It provides a sense of comfort to the toddler. Irreversibility is the inability to reverse or undo actions initiated physically. Steven is acting in an age-appropriate manner.

An infant has been diagnosed with an allergy to milk. In teaching the parent how to meet the infant's nutritional needs, the nurse states that a. Most children will grow out of the allergy. b. All dairy products must be eliminated from the child's diet. c. It is important to have the entire family follow the special diet. d. Antihistamines can be used so the child can have milk products.

ANS: A Approximately 80% of children with cow's milk allergy develop tolerance by the fifth birthday. The child can have eggs. Any food that has milk as a component or filler is eliminated. These foods include processed meats, salad dressings, soups, and milk chocolate. Having the entire family follow the special diet would provide support for the child, but the nutritional needs of other family members must be addressed. Antihistamines are not used for food allergies.

An infant, age 5 months, is brought to the clinic by his parents for a well-baby checkup. What is the best advice that the nurse should include at this time about injury prevention? a. "Keep buttons, beads, and other small objects out of his reach." b. "Do not permit him to chew paint from window ledges because he might absorb too much lead." c. "When he learns to roll over, you must supervise him whenever he is on a surface from which he might fall." d. "Lock the crib sides securely because he may stand and lean against them and fall out of bed."

ANS: A Aspiration of foreign objects is a great risk at this age. Parents are instructed to keep small objects out of the infant's reach. At this age, the child is not mobile enough to reach window sills. If window sills have cracked or chipped paint, it needs to be removed before he is a toddler. This child should already be rolling over. This information is reinforced but should have been taught earlier. Pulling to a stand occurs between 8 and 12 months of age

What is an appropriate play activity for a 7-month-old infant to encourage visual stimulation? a. Playing peek-a-boo b. Playing pat-a-cake c. Imitating animal sounds d. Showing how to clap hands

ANS: A Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation. Playing pat-a-cake and showing how to clap hands help with kinetic stimulation. Imitating animal sounds helps with auditory stimulation.

The nurse is teaching a parent with a 2-month-old infant who has been diagnosed with colic about ways to relieve colic. Which statement by the parent indicates the need for additional teaching? a. "I should let my infant cry for at least 30 minutes before I respond." b. "I will swaddle my infant tightly with a soft blanket." c. "I should massage my infant's abdomen whenever possible." d. "I will place my infant in an upright seat after feeding."

ANS: A Because the infant has been diagnosed with colic, the parent should respond to the infant immediately or any type of interventions to relieve colic may not be effective. Also, the infant may develop a mistrust of the world if his or her needs are not met. The parent should swaddle the baby tightly with a soft blanket, massage the baby's abdomen, and place the infant in an upright seat after a feeding to help relieve colic.

A nurse is planning a teaching session for a group of adolescents. The nurse understands that by adolescence the individual is in which stage of cognitive development? a. Formal operations b. Concrete operations c. Conventional thought d. Post-conventional thought

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

The parent of an infant with colic tells the nurse, "All this baby does is scream at me; it is a constant worry." What is the nurse's best action? a. Encourage the parent to verbalize feelings. b. Encourage the parent not to worry so much. c. Assess the parent for other signs of inadequate parenting. d. Reassure the parent that colic rarely lasts past age 9 months.

ANS: A Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathetic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parent's anxiety. The nurse should reassure the parent that he or she is not doing anything wrong. The infant with colic is experiencing spasmodic pain that is manifested by loud crying, in some cases up to 3 hours each day. Telling the parent that it will eventually go away does not help him or her through the current situation.

The neonatal intensive care nurse is planning care for an infant in an incubator. Which interventions should the nurse plan to assure therapeutic visual stimulation for the neonate? a. Use an incubator cover. b. Keep lights bright in the unit. c. Place a cloth over the infant's face. d. Leave a visual stimulus at the head of the infant's bed.

ANS: A Decrease ambient light levels by using an incubator cover and by dimming lights, not keeping them bright. Avoid placing a cloth over the face because it will cause tactile irritation. Avoid leaving visual stimuli in the beds of infants who cannot escape from it

What is an important nursing intervention for a full-term infant receiving phototherapy? a. Observing for signs of dehydration b. Using sunscreen to protect the infant's skin c. Keeping the infant diapered to collect frequent stools d. Informing the mother why breastfeeding must be discontinued

ANS: A Dehydration is a potential risk of phototherapy. The nurse monitors hydration status to be alert for the need for more frequent feedings and supplemental fluid administration. Lotions are not used; they may contribute to a "frying" effect. The infant should be placed nude under the lights and should be repositioned frequently to expose all body surfaces to the lights. Breastfeeding is encouraged. Intermittent phototherapy may be as effective as continuous therapy. The advantage to the mother and father of being able to hold their infant outweighs the concerns related to clearance.

Which accurately describes the speech of the preschool child? a. Dysfluency in speech patterns is normal. b. Sentence structure and grammatic usage are limited. c. By age 5 years, child can be expected to have a vocabulary of about 1000 words. d. Rate of vocabulary acquisition keeps pace with the degree of comprehension of speech.

ANS: A Dysfluency includes stuttering and stammering, a normal characteristic of language development. Children speak in sentences of three or four words at age 3 to 4 years and eight words by age 5 years. At 5 years, children have a vocabulary of 2100 words. Children often gain vocabulary beyond degree of comprehension

The most fatal type of burn in the toddler age group is: a. flame burn from playing with matches. b. scald burn from high-temperature tap water. c. hot object burn from cigarettes or irons. d. electric burn from electric outlets.

ANS: A Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age group. High-temperature tap water, hot objects, and electrical outlets are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use.

When discussing discipline with the mother of a 4-year-old child, which should the nurse include? a. Parental control should be consistent. b. Withdrawal of love and approval is effective at this age. c. Children as young as 4 years rarely need to be disciplined. d. One should expect rules to be followed rigidly and unquestioningly.

ANS: A For effective discipline, parents must be consistent and must follow through with agreed-on actions. Withdrawal of love and approval is never appropriate or effective. The 4-year-old child will test limits and may misbehave. Children of this age do not respond to verbal reasoning. Realistic goals should be set for this age group. Discipline is necessary to reinforce these goals. Discipline strategies should be appropriate to the child's age and temperament and the severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old child.

A young adolescent boy tells the nurse he "feels gawky." The nurse should explain that this occurs in adolescents because of: a. growth of the extremities and neck precedes growth in other areas. b. growth is in the trunk and chest. c. the hip and chest breadth increases. d. the growth spurt occurs earlier in boys than it does in girls.

ANS: A Growth in length of the extremities and neck precedes growth in other areas, and, because these parts are the first to reach adult length, the hands and feet appear larger than normal during adolescence. Increases in hip and chest breadth take place in a few months followed several months later by an increase in shoulder width. These changes are followed by increases in length of the trunk and depth of the chest. This sequence of changes is responsible for the characteristic long-legged, gawky appearance of early adolescent children. The growth spurt occurs earlier in girls than in boys.

The nurse is teaching a group of new parents about the experience of role transition. Which statement by a parent would indicate a correct understanding of the teaching? a. "My marital relationship can have a positive or negative effect on the role transition." b. "If an infant has special care needs, the parents' sense of confidence in their new role is strengthened." c. "Young parents can adjust to the new role easier than older parents." d. "A parent's previous experience with children makes the role transition more difficult."

ANS: A If parents are supportive of each other, they can serve as positive influences on establishing satisfying parental roles. When marital tensions alter caregiving routines and interfere with the enjoyment of the infant, then the marital relationship has a negative effect. Infants with special care needs can be a significant source of added stress. Older parents are usually more able to cope with the greater financial responsibilities, changes in sleeping habits, and reduced time for each other and other children. Parents who have previous experience with parenting appear more relaxed, have less conflict in disciplinary relationships, and are more aware of normal growth and development.

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

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

The mother of a 3-month-old breastfed infant asks about giving her baby water because it is summer and very warm. What should the nurse tell her? a. Fluids in addition to breast milk are not needed. b. Water should be given if the infant seems to nurse longer than usual. c. Clear juices are better than water to promote adequate fluid intake. d. Water once or twice a day will make up for losses resulting from environmental temperature.

ANS: A Infants who are breastfed or bottle fed do not need additional water during the first 4 months of life. Excessive intake of water can create problems such as water intoxication, hyponatremia, or failure to thrive. Juices provide empty calories for infants.

What does the nursing care for infants with fetal alcohol syndrome (FAS) include? a. Nutritional guidance b. An intensive stimulation program c. Facilitation of improvement in cardiovascular status d. An individualized program based on maternal alcohol consumption

ANS: A Infants with FAS have characteristic poor feeding behaviors that persist throughout childhood. The nurse assists in devising strategies to improve nutrition. The infant is protected from overstimulation. FAS does not include cardiovascular problems. The effects of FAS do not depend on the quantity of maternal alcohol consumption.

Which is the leading cause of death during the toddler period? a. Injuries b. Infectious diseases c. Congenital disorders d. Childhood diseases

ANS: A Injuries are the single most common cause of death in children ages 1 through 4 years. This represents the highest rate of death from injuries of any childhood age group except adolescence. Infectious diseases and childhood diseases are less common causes of deaths in this age group. Congenital disorders are the second leading cause of death in this age group.

A 3-year-old girl was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guidelines concerning adoption should the nurse use in planning a response? a. Telling the child is an important aspect of their parental responsibilities. b. The best time to tell the child is between ages 7 and 10 years. c. It is not necessary to tell the child who was adopted so young. d. It is best to wait until the child asks about it.

ANS: A It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the child's identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to keep third parties from telling the children before the parents have had the opportunity.

Which factors will decrease iron absorption and should not be given at the same time as an iron supplement? a. Milk b. Fruit juice c. Multivitamin d. Meat, fish, poultry

ANS: A Many foods interfere with iron absorption and should be avoided when iron is consumed. These foods include phosphates found in milk, phytates found in cereals, and oxalates found in many vegetables. Vitamin C-containing juices enhance the absorption of iron. Multivitamins may contain iron; no contraindication exists to taking the two together. Meat, fish, and poultry do not affect absorption.

Parents tell the nurse that their toddler daughter eats little at mealtime, only sits at the table with the family briefly, and wants snacks "all the time." Which intervention should the nurse recommend? a. Give her nutritious snacks. b. Offer rewards for eating at mealtimes. c. Avoid snacks so she is hungry at mealtimes. d. Explain to her in a firm manner what is expected of her.

ANS: A Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirement associated with the slower growth rate. Parents should help the child develop healthy eating habits. The toddler is often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should be not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat nonnutritious foods in response.

What may a clinical manifestations of failure to thrive (FTT) in a 13-month-old include? a. Irregularity in activities of daily living b. Preferring solid food to milk or formula c. Weight that is at or below the 10th percentile d. Appropriate achievement of developmental landmarks

ANS: A One of the clinical manifestations of children with FTT is irregularity or low rhythmicity in activities of daily living. Children with FTT often refuse to switch from liquids to solid foods. Weight below the fifth percentile is indicative of FTT. Developmental delays, including social, motor, adaptive, and language, exist.

What are possible premature infant complications from oxygen therapy and mechanical ventilation? a. Bronchopulmonary dysplasia and retinopathy of prematurity b. Anemia and necrotizing enterocolitis c. Cerebral palsy and persistent patent ductus arteriosus d. Congestive heart failure and cerebral edema

ANS: A Oxygen therapy, although lifesaving, is not without hazards. The positive pressure created by mechanical ventilation creates an increase in the number of ruptured alveoli and subsequent pneumothorax and bronchopulmonary dysplasia. Oxygen therapy puts the infant at risk for retinopathy of prematurity. Anemia, necrotizing enterocolitis, cerebral palsy, persistent patent ductus, congestive heart failure, and cerebral edema are not primarily caused by oxygen therapy and mechanical ventilation.

When assessing a family, the nurse determines that the parents exert little or no control over their children. This style of parenting is called which? a. Permissive b. Dictatorial c. Democratic d. Authoritarian

ANS: A Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their children's actions. Dictatorial or authoritarian parents attempt to control their children's behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their children's behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect their children's individual natures.

Which intervention may decrease the incidence of physiologic jaundice in a healthy full-term infant? a. Institute early and frequent feedings. b. Bathe newborn when the axillary temperature is 36.3° C (97.5° F). c. Place the newborn's crib near a window for exposure to sunlight. d. Suggest that the mother initiate breastfeeding when the danger of jaundice has passed.

ANS: A Physiologic jaundice is caused by the immature hepatic function of the newborn's liver coupled with the increased load from red blood cell hemolysis. The excess bilirubin from the destroyed red blood cells cannot be excreted from the body. Feeding stimulates peristalsis and produces more rapid passage of meconium. Bathing does not affect physiologic jaundice. Placing the newborn's crib near a window for exposure to sunlight is not a treatment of physiologic jaundice. Colostrum is a natural cathartic that facilitates meconium excavation

The nurse is caring for a preterm neonate who requires mechanical ventilation for treatment of respiratory distress syndrome. Because of the mechanical ventilation, the nurse should recognize an increased risk of what? a. Pneumothorax b. Transient tachypnea c. Meconium aspiration d. Retractions and nasal flaring

ANS: A Positive pressure introduced by mechanical apparatus has created an increase in the incidence of ruptured alveoli and subsequent pneumothorax and bronchopulmonary dysplasia. Tachypnea may be an indication of a pneumothorax, but it should not be transient. Meconium aspiration is not associated with mechanical ventilation. Retractions and nasal flaring are indications of the use of accessory muscles when the infant cannot obtain sufficient oxygen. The use of mechanical ventilation bypasses the infant's need to use these muscles

The parents of a newborn ask the nurse what caused the baby's facial nerve paralysis. The nurse's response is based on remembering that this is caused by what? a. Birth injury b. Genetic defect c. Spinal cord injury d. Inborn error of metabolism

ANS: A Pressure on the facial nerve (cranial nerve VII) during delivery may result in injury to the nerve. Genetic defects, spinal cord injuries, and inborn errors of metabolism did not cause the facial nerve paralysis. The paralysis usually disappears in a few days but may take as long as several months.

The nurse knows that during deep sleep the neonate should not be disturbed if possible. Characteristics of deep sleep include what? a. Regular breathing b. Occasional smiling c. Rapid eye movements d. Apneic pauses of less than 20 seconds

ANS: A Regular breathing is characteristic of deep sleep. During active sleep, irregular breathing may be present. Occasional smiling, rapid eye movements, and apneic pauses of less than 20 seconds are characteristic of active sleep.

At a well-child check-up, the nurse notes that an infant with a previous diagnosis of failure to thrive (FTT) is now steadily gaining weight. The nurse should recommend that fruit juice intake be limited to no more than how much? a. 4 oz/day b. 6 oz/day c. 8 oz/day d. 12 oz/day

ANS: A Restrict juice intake in children with FTT until adequate weight gain has been achieved with appropriate milk sources; thereafter, give no more than 4 oz/day of juice.

A breastfed infant is being seen in the clinic for a 6-month checkup. The mother tells the nurse that the infant recently began to suck her thumb. Which is the best nursing intervention? a. Reassure the mother that this is normal at this age. b. Recommend the mother substitute a pacifier for her thumb. c. Assess the infant for other signs of sensory deprivation. d. Suggest the mother breastfeed the infant more often to satisfy her sucking needs.

ANS: A Sucking is an infant's chief pleasure, and the infant may not be satisfied by bottle-feeding or breastfeeding alone. During infancy and early childhood, there is no need to restrict nonnutritive sucking. The nurse should explore with the mother her feelings about a pacifier versus the thumb. No data support that the child has sensory deprivation.

The nurse is caring for a neonate with respiratory distress syndrome. The infant has an endotracheal tube. What should nursing considerations related to suctioning include? a. Suctioning should not be carried out routinely. b. The infant should be in the Trendelenburg position for suctioning. c. Routine suctioning, usually every 15 minutes, is necessary. d. Frequent suctioning is necessary to maintain the patency of the bronchi.

ANS: A Suctioning is not an innocuous procedure and can cause bronchospasm, bradycardia, hypoxia, and increased intracranial pressure (ICP). It should never be carried out routinely. The Trendelenburg position should be avoided because it can contribute to increased ICP and reduced lung capacity from gravity pushing the organs against the diaphragm

Teasing can be common during the school-age years. The nurse should recognize that which applies to teasing? a. Can have a lasting effect on children b. Is not a significant threat to self-concept c. Is rarely based on anything that is concrete d. Is usually ignored by the child who is being teased

ANS: A Teasing in this age group is common and can have a long-lasting effect. Increasing awareness of differences, especially when accompanied by unkind comments and taunts from others, may make a child feel inferior and undesirable. Physical impairments such as hearing or visual defects, ears that "stick out," or birth marks assume great importance.

Parents are concerned that their child is showing aggressive behaviors. Which suggestion should the nurse make to the parents? a. Supervise television viewing. b. Ignore the behavior. c. Punish the child for the behavior. d. Accept the behavior if the child is male.

ANS: A Television is also a significant source for modeling at this impressionable age. Research indicates there is a direct correlation between media exposure, both violent and educational media, and preschoolers exhibiting physical and relational aggression (Ostrov, Gentile, and Crick, 2006). Therefore, parents should be encouraged to supervise television viewing. The behavior should not be ignored because it can escalate to hyperaggression. The child should not be punished because it may reinforce the behavior if the child is seeking attention. For example, children who are ignored by a parent until they hit a sibling or the parent learn that this act garners attention. The behavior should not be accepted from a male child, this is using a "double standard" and aggression should not be equated with masculinity.

The parents of a 2-year-old tell the nurse that they are concerned because the toddler has started to use "baby talk" since the arrival of their new baby. The nurse should recommend which intervention? a. Ignore the "baby talk." b. Explain to the toddler that "baby talk" is for babies. c. Tell the toddler frequently, "You are a big kid now." d. Encourage the toddler to practice more advanced patterns of speech.

ANS: A The baby talk is a sign of regression in the toddler. It should be ignored, while praising the child for developmentally appropriate behaviors. Regression is children's way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism.

Which technique is best for dealing with the negativism of the toddler? a. Offer the child choices. b. Remain serious and intent. c. Provide few or no choices for child. d. Quietly and calmly ask the child to comply.

ANS: A The child should have few opportunities to respond in a negative manner. Questions and requests should provide choices. This allows the child to be in control and reduces opportunities for negativism. The child will continue trying to assert control. The toddler is too young for verbal explanations. The negativism is the child testing limits. These should be clearly defined by structured choices.

Which statement is true concerning the nutritional needs of preterm infants? a. The secretion of lactase is low. b. Carbohydrates and fats are better tolerated than protein. c. The demand for nutrients is less than in full-term infants. d. Breast milk lacks the proper concentration of nutrients.

ANS: A The enzyme lactase is not readily available in an infant's body until after 34 weeks of gestation. Formulas containing lactose are not well tolerated. Carbohydrates and fats are less well tolerated than protein. Preterm infants require significantly higher intake of calories and other nutrients than full-term infants. The American Academy of Pediatrics recommends 105 to 130 kcal/kg/day. Breast milk from the infant's mother is considered the ideal enteral nutrition for the infant. Several commercial formulas are designed for preterm infants.

The parent of a 16-month-old toddler asks, "What is the best way to keep our son from getting into our medicines at home?" The nurse's best advice is: a. "All medicines should be locked securely away." b. "The medicines should be placed in high cabinets." c. "The child just needs to be taught not to touch medicines." d. "Medicines should not be kept in the homes of small children."

ANS: A The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. Toddlers can climb by using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize as dangerous all the different forms of medications that may be available in the home. It is not feasible to not keep medicines in the homes of small children. Many parents require medications for chronic illnesses. Parents must be taught safe storage for their home and when they visit other homes.

What is the most common cause of iatrogenic anemia in preterm infants? a. Frequent blood sampling b. Respiratory distress syndrome c. Meconium aspiration syndrome d. Persistent pulmonary hypertension

ANS: A The most common cause of anemia in preterm infants is frequent blood-sample withdrawal and inadequate erythropoiesis in acutely ill infants. Microsamples should be used for blood tests, and the amount of blood drawn should be monitored. Respiratory distress syndrome, meconium aspiration syndrome, and persistent pulmonary hypertension are not causes of anemia. They may require frequent blood sampling, which contributes to the problem of decreased erythropoiesis and anemia.

A nurse places some x-ray contrast the toddler is to drink in a small cup instead of a large cup. Which concept of a toddler's preoperational thinking is the nurse using? a. Inability to conserve b. Magical thinking c. Centration d. Irreversibility

ANS: A The nurse is using the toddler's inability to conserve. This is when the toddler is unable to understand the idea that a mass can be changed in size, shape, volume, or length without losing or adding to the original mass. Instead, toddlers judge what they see by the immediate perceptual clues given to them. A small glass means less amount of contrast. Magical thinking is believing that thoughts are all-powerful and can cause events. Centration is focusing on one aspect rather than considering all possible alternatives. Irreversibility is the inability to undo or reverse the actions initiated, such as being unable to stop doing an action when told.

The nurse is caring for a 3-week-old boy born at 29 weeks of gestation. While taking vital signs and changing his diaper after stooling, the nurse observes his color is pink but slightly mottled, his arms and legs are limp and extended, he has the hiccups, his respirations are deep and rapid, and his heart rate is regular and rapid. The nurse should recognize these behaviors as signs of what? a. Stress b. Subtle seizures c. Preterm behaviors d. Onset of respiratory distress

ANS: A These are signs of stress or fatigue in a newborn. Neonatal seizures usually have some type of repetitive movement, from twitching to rhythmic jerking movements. The behavior of a preterm infant may be inactive and listless. Respiratory distress is exhibited by retractions and nasal flaring.

A preterm infant who is being fed commercial formula by gavage has had an increase in gastric residuals, abdominal distention, and apneic episodes. Which is the most appropriate nursing action? a. Notify the practitioner. b. Reduce the amount fed by gavage. c. Feed human milk by gavage. d. Feed only a glucose solution until the infant stabilizes.

ANS: A These are signs that may indicate early necrotizing enterocolitis. The practitioner is notified for further evaluation. Enteral feedings are usually stopped until the cause of increased residuals is identified.

The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse's response should be based on remembering what? a. This is acceptable to encourage head control and turning over. b. This is acceptable to encourage fine motor development. c. This is unacceptable because of the risk of sudden infant death syndrome (SIDS). d. This is unacceptable because it does not encourage achievement of developmental milestones.

ANS: A These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs to reduce the risk of SIDS and then be placed on their abdomens when awake to enhance achievement of milestones such as head control. These position changes encourage gross motor, not fine motor, development.

A parent of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurse's best interpretation of this behavior is included in which statement? a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention.

ANS: A Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and the use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old. Having a rapid mood swing is an expected behavior for a toddler.

Which is a useful skill that the nurse should expect a 5-year-old child to be able to master? a. Tie shoelaces. b. Use knife to cut meat. c. Hammer a nail. d. Make change out of a quarter.

ANS: A Tying shoelaces is a fine motor task of 5-year-olds. Using a knife to cut meat is a fine motor task of a 7-year-old. Hammering a nail and making change out of a quarter are fine motor and cognitive tasks of an 8- to 9-year-old

What is an infant with severe jaundice at risk for developing? a. Encephalopathy b. Bullous impetigo c. Respiratory distress d. Blood incompatibility

ANS: A Unconjugated bilirubin, which can cross the blood-brain barrier, is highly toxic to neurons. An infant with severe jaundice is at risk for developing kernicterus or bilirubin encephalopathy. Bullous impetigo is a highly infectious bacterial infection of the skin. It has no relation to severe jaundice. A blood incompatibility may be the causative factor for the severe jaundice.

The nurse is checking reflexes on a 7-month-old infant. When the infant is suspended in a horizontal prone position, the head is raised and the legs and spine are extended. Which reflex is this? a. Landau b. Parachute c. Body righting d. Labyrinth righting

ANS: A When the infant is suspended in a horizontal prone position, the head is raised and the legs and spine are extended; this describes the Landau reflex. It appears at 6 to 8 months and persists until 12 to 24 months. The parachute reflex occurs when the infant is suspended in a horizontal prone position and suddenly thrust downward; the infant extends the hands and fingers forward as if to protect against falling. This appears at age 7 to 9 months and lasts indefinitely. Body righting occurs when turning the hips and shoulders to one side causes all other body parts to follow. It appears at 6 months of age and persists until 24 to 36 months. The labyrinth-righting reflex appears at 2 months and is strongest at 10 months. This reflex involves holding infants in the prone or supine position. They are able to raise their heads

The nurse is planning care for a patient with a different ethnic background. Which should be an appropriate goal? a. Adapt, as necessary, ethnic practices to health needs. b. Attempt, in a nonjudgmental way, to change ethnic beliefs. c. Encourage continuation of ethnic practices in the hospital setting. d. Strive to keep ethnic background from influencing health needs.

ANS: A Whenever possible, nurses should facilitate the integration of ethnic practices into health care provision. The ethnic background is part of the individual; it should be difficult to eliminate the influence of ethnic background. The ethnic practices need to be evaluated within the context of the health care setting to determine whether they are conflicting.

Lactose intolerance is diagnosed in an 11-month-old infant. Which should the nurse recommend as a milk substitute? a. Yogurt b. Ice cream c. Fortified cereal d. Cow's milk-based formula

ANS: A Yogurt contains the inactive lactase enzyme, which is activated by the temperature and pH of the duodenum. This lactase activity substitutes for the lack of endogenous lactase. Ice cream and cow's milk-based formula contain lactose, which will probably not be tolerated by the child. Fortified cereal does not have the nutritional equivalents of milk.

When doing the first assessment of a male neonate, the nurse notes that the scrotum is large, edematous, and pendulous. This should be interpreted as: a. a normal finding. b. a hydrocele. c. an absence of testes. d. an inguinal hernia.

ANS: A a. A large, edematous, and pendulous scrotum in a term infant, especially in those born in a breech position, is a normal finding. b. A hydrocele is fluid in the scrotum, usually unilateral, which usually resolves within a few months. c. The presence or absence of testes would be determined on palpation of the scrotum and inguinal canal. Absence of testes may be an indication of ambiguous genitalia. d. An inguinal hernia may be present at birth. It is more easily detected when the child is crying.

The parents of a newborn plan to have him circumcised. They ask the nurse about pain associated with this procedure. The nurse's response should be based on the knowledge that newborns: a. experience pain with circumcision. b. do not experience pain with circumcision. c. quickly forget about the pain of circumcision. d. are too young for anesthesia or analgesia.

ANS: A a. Circumcision is a surgical procedure. The American Academy of Pediatrics has recommended that, when circumcision is performed, procedural analgesia be provided. b. Pain is associated with surgical procedures. c. The infant experiences pain, which can be alleviated with analgesia. d. Topical and injected analgesia are available for this procedure.

Where would nonpathologic cyanosis normally be present in the infant shortly after birth? a. Feet and hands b. Bridge of nose c. Circumoral area d. Mucous membranes

ANS: A a. Cyanosis of the feet and hands is termed acrocyanosis and is a usual finding in newborns. b, c, and d. These are signs of general cyanosis, which is a potential sign of distress or major abnormality.

Which of the following characteristics is representative of the neonate's gastrointestinal tract? a. Stomach capacity is approximately 90 ml. b. Peristaltic waves are relatively slow. c. Overproduction of pancreatic amylase occurs. d. Intestines are shorter in relation to body size.

ANS: A a. Infants require frequent small feedings because their stomach capacity is approximately 90 ml. b. Peristaltic waves are rapid. c. A deficiency of pancreatic lipase limits the absorption of fats. d. Infant's intestines are longer in relation to body size than those of an adult.

The nurse is careful to place the incubator away from cold windows or air- conditioning units. This is to conserve the neonate's body heat by preventing heat loss through which of the following methods? a. Radiation b. Conduction c. Convection d. Evaporation

ANS: A a. Radiation is the loss of heat to a cooler solid object. The cold air from either the window or the air conditioner will cool the incubator walls and subsequently the newborn's body. b. Conduction involves the loss of heat from the body because of direct contact of the skin with a cooler object. c. Convection is the loss of heat similar to conduction, but aided by air currents. d. Evaporation is the loss of heat through moisture. The infant should be quickly dried of the amniotic fluid.

Early this morning, a baby boy was circumcised by using the Plastibell method. The nurse should tell the mother that the baby can be discharged after: a. the infant voids. b. receiving vitamin K. c. yellow exudate forms over glans. d. the Plastibell rim falls off.

ANS: A a. The circumcision site is evaluated for excessive bleeding every 30 minutes for at least 2 hours. After these observations and voiding, the infant can be discharged. b. The infant should have received vitamin K soon after delivery. c. This normal yellow exudate will usually form on the second day after the circumcision. Discharge can occur earlier. d. The Plastibell rim will separate and fall off within 5 to 8 days. The infant should be discharged before this.

Which of the following describes the respirations of a newborn? a. Irregular, abdominal, 30 to 60 breaths/min b. Regular, abdominal, 25 to 35 breaths/min c. Regular, noisy, 35 to 45 breaths/min d. Irregular, quiet, 45 to 55 breaths/min

ANS: A a. The respirations of a normal newborn are irregular and abdominal, with a rate of 30 to 60 breaths/min. b and c. Newborn respirations are irregular. Pauses in respiration less than 20 seconds in duration are considered normal. d. The newborn is an abdominal breather with a wider range of respiratory rates.

Which of the following are distended sebaceous glands that appear as tiny white papules on cheeks, chin, and nose in the newborn period? a. Milia b. Lanugo c. Mongolian spots d. Cutis marmorata

ANS: A a. This describes milia, which are common variations found in newborns. b. Lanugo is fine downy hair. c. Mongolian spots are irregular areas of deep blue pigmentation, usually in the sacral and gluteal areas. d. Cutis marmorata is transient mottling when the infant is exposed to decreased body temperatures.

Recommendations for hepatitis B (HBV) vaccine include which of the following? a. First dose is given between birth and age 2 days. b. First dose is given between ages 12 and 15 months. c. It is not recommended for neonates who are at low risk for hepatitis B. d. It is not recommended for neonates whose mothers are positive for HBV surface antigen.

ANS: A a. To reduce the incidence of HBV in children and its serious consequences in adulthood, the first of three doses is recommended soon after birth and before hospital discharge. b. This is too late. The recommendation is for the first dose to be given soon after birth. c. It is recommended for all infants. d. Infants born to mothers who are HBV surface antigen positive should be given the vaccine within 12 hours of birth. They also should be given hepatitis B immune globulin.

Parents ask the nurse, Should we be concerned our preschooler has an imaginary friend, and how should we react? Which responses should the nurse give to the parents? (Select all that apply.) a. The imaginary playmate is a sign of health. b. You can acknowledge the presence of the imaginary companion. c. It is normal for a preschool-aged child to have an imaginary friend. d. If your child wants a place setting at the table for the child, it is best to refuse. e. It is OK to allow the child to blame the imaginary playmate to avoid punishment.

ANS: A, B, C Parents should be reassured that the childs fantasy is a sign of health that helps differentiate between make-believe and reality. Parents can acknowledge the presence of the imaginary companion by calling him or her by name and even agreeing to simple requests such as setting an extra place at the table, but they should not allow the child to use the playmate to avoid punishment or responsibility.

What is the reason pedestrian motor vehicle injuries increase in the preschool age? (Select all that apply.) a. Riding tricycles b. Running after balls c. Playing in the street d. Crossing streets at the crosswalk e. Crossing streets with an adult

ANS: A, B, C Pedestrian motor vehicle injuries increase because of activities such as playing in the street, riding tricycles, running after balls, and forgetting safety regulations when crossing streets. Crossing streets at the crosswalk or with an adult are safety measures.

The nurse suspects a newborn has a fractured clavicle. What are signs of a fractured clavicle? (Select all that apply.) a. An asymmetric Moro reflex b. Limited use of the affected arm c. Crying when the arm is moved d. Muscles of the hand are paralyzed e. The arm hangs limp alongside the body

ANS: A, B, C A newborn with a fractured clavicle may have no signs, but the nurse should suspect a fracture if an infant has limited use of the affected arm, malpositioning of the arm, an asymmetric Moro reflex, or focal swelling or tenderness or cries when the arm is moved. Paralyzed hand muscles and an arm that hangs limp alongside the body are signs of Erb palsy.

The nurse is teaching parents about the effects of media on childhood obesity. The nurse realizes the parents understand the teaching if they make which statements? (Select all that apply.) a. "Advertising of unhealthy food can increase snacking." b. "Increased screen time may be related to unhealthy sleep." c. "There is a link between the amount of screen time and obesity." d. "Increased screen time can lead to better knowledge of nutrition." e. "Physical activity increases when children increase the amount of screen time."

ANS: A, B, C A number of studies have demonstrated a link between the amount of screen time and obesity. Advertising of unhealthy food to children is a long-standing marketing practice, which may increase snacking in the face of decreased activity. In addition, both increased screen time and unhealthy eating may also be related to unhealthy sleep. Increased screen time does not lead to a better knowledge of nutrition or increased physical activity.

The nurse is monitoring an infant's temperature to avoid cold stress. The nurse understands that cold stress in the infant can cause which complications? (Select all that apply.) a. Hypoxia b. Hypoglycemia c. Metabolic acidosis d. Respiratory alkalosis e. Increased shivering response

ANS: A, B, C Cold stress poses hazards to the neonate through hypoxia, metabolic acidosis, and hypoglycemia. Cold stress does not cause respiratory alkalosis. The infant lacks a shivering response, so it is not a complication of cold stress.

The nurse has administered a dose of epinephrine to a 12-month-old infant. For which adverse reactions of epinephrine should the nurse monitor? (Select all that apply.) a. Nausea b. Tremors c. Irritability d. Bradycardia e. Hypotension

ANS: A, B, C Epinephrine increases activation of the sympathetic nervous system. Adverse effects include nausea, tremors, and irritability. Tachycardia would occur, not bradycardia, and hypertension, not hypotension, would occur.

The nurse is admitting a drug-exposed newborn to the neonatal intensive care unit. The nurse should assess the newborn for which signs of withdrawal? (Select all that apply.) a. Tremors b. Nasal stuffiness c. Loose, watery stools d. Hypoactive Moro reflex e. Decrease in respiratory rate

ANS: A, B, C Signs of withdrawal in a drug-exposed newborn include increased tone; increased respiratory rate; disturbed sleep; fever; excessive sucking; and loose, watery stools. Other signs observed included projectile vomiting, mottling, crying, nasal stuffiness, hyperactive Moro reflex, and tremors.

Which describe the feelings and behaviors of adolescents related to divorce? (Select all that apply.) a. Disturbed concept of sexuality b. May withdraw from family and friends c. Worry about themselves, parents, or siblings d. Expression of anger, sadness, shame, or embarrassment e. Engage in fantasy to seek understanding of the divorce

ANS: A, B, C, D Feelings and behaviors of adolescents related to divorce include a disturbed concept of sexuality; withdrawing from family and friends; worrying about themselves, parents, and siblings; and expressions of anger, sadness, shame, and embarrassment. Engaging in fantasy to seek understanding of the divorce is a reaction by a child who has preconceptual cognitive processes, not the formal thinking processes adolescents have.

An infant with an isolated cleft lip is being bottle fed. Which actions should the nurse plan to implement to assist with the feeding? (Select all that apply.) a. Use an NUK nipple. b. Use cheek support. c. Enlarge the nipple opening. d. Position the infant upright. e. Thicken the formula with rice cereal.

ANS: A, B, D A bottle-fed infant with an isolated cleft lip should be fed with cheek support (squeezing the cheeks together to decrease the width of the cleft), which may help the infant achieve an adequate anterior lip seal during feeding. Systems that have a wider base, such as an NUK (orthodontic) nipple or a Playtex nurser, allow the infant with a cleft lip to feed more successfully. The infant should be positioned upright with the head supported. This position helps gravity to direct the flow of liquid so that it is swallowed rather than entering into the nasal cavity. Enlarging the nipple opening would allow too much milk too fast for an infant with a cleft palate. Thickening the formula with rice cereal is done for infants with gastroesophageal reflux, not cleft lip.

Which interventions should the nurse implement for a newborn with a subgaleal hemorrhage? (Select all that apply.) a. Monitor bilirubin levels. b. Monitor hematocrit levels. c. Prepare the newborn for skull radiography. d. Monitor the newborn's level of consciousness. e. Place a warm compress on the affected area.

ANS: A, B, D An increase in serum bilirubin levels may occur as a result of the degrading red blood cells within the hematoma. Monitoring the newborn for changes in level of consciousness and a decrease in the hematocrit are keys to early recognition and management. Computed tomography or magnetic resonance imaging, not skull radiography, is useful in confirming the diagnosis. A warm compress would be contraindicated because it may dilate blood vessels and increase bleeding.

The nurse is planning play activities for a 2-month-old hospitalized infant to stimulate the auditory sense. Which activities should the nurse implement? (Select all that apply.) a. Talk to the infant. b. Play a music box. c. Place a squeaky doll in the crib. d. Give the infant a small-handled clear rattle.

ANS: A, B, D Auditory stimulation appropriate for a 2-month-old infant includes talking to the infant, playing a music box, and giving the infant a small-handled clear rattle. Placing a squeaky doll in the crib is appropriate for an infant 6 months of age or older.

The nurse is preparing to feed a 10-month-old child diagnosed with failure to thrive (FTT). Which actions should the nurse plan to implement? (Select all that apply.) a. Be persistent. b. Introduce new foods slowly. c. Provide a stimulating atmosphere. d. Maintain a calm, even temperament. e. Feed the infant only when signs of hunger are exhibited.

ANS: A, B, D Feeding strategies for children with FTT should include persistence; introducing new foods slowly; and maintaining a calm, even temperament. The environment should be unstimulating, and a structured routine should be developed with regard to feeding, not just when the infant shows signs of hunger.

The parents of a 5-year-old child ask the nurse how they can minimize misbehavior. Which responses should the nurse give? (Select all that apply.) a. Set clear and reasonable goals. b. Praise your child for desirable behavior. c. Don't call attention to unacceptable behavior. d. Teach desirable behavior through your own example. e. Don't provide an opportunity for your child to have any control.

ANS: A, B, D To minimize misbehavior, parents should (1) set clear and reasonable rules and expect the same behavior regardless of the circumstances, (2) praise children for desirable behavior with attention and verbal approval, and (3) teach desirable behavior through their own example. Parents should call attention to unacceptable behavior as soon as it begins and provide children with opportunities for power and control.

Which toys should a nurse provide to promote imaginative play for a 3-year-old hospitalized child? (Select all that apply.) a. Plastic telephone b. Hand puppets c. Jigsaw puzzle (100 pieces) d. Farm animals and equipment e. Jump rope

ANS: A, B, D To promote imaginative play for a 3-year-old child, the nurse should provide: dress-up clothes, dolls, housekeeping toys, dollhouses, play-store toys, telephones, farm animals and equipment, village sets, trains, trucks, cars, planes, hand puppets, or medical kits. A 100-piece jigsaw puzzle and a jump rope would be appropriate for a young, school-age child but not a 3-year-old child.

Divorced parents of a preschool child are asking whether their child will display any feelings or behaviors related to the effect of the divorce. The nurse is correct when explaining that the parents should be prepared for which types of behaviors? (Select all that apply.) a. Displaying fears of abandonment b. Verbalizing that he or she "is the reason for the divorce" c. Displaying fear regarding the future d. Ability to disengage from the divorce proceedings e. Engaging in fantasy to understand the divorce

ANS: A, B, E A child 3 to 5 years of age (preschool) may display fears of abandonment, verbalize feelings that he or she is the reason for the divorce, and engage in fantasy to understand the divorce. He or she would not be displaying fear regarding the future until school age, and the ability to disengage from the divorce proceedings would be characteristic of an adolescent.

Parents are worried that their preschool-aged child is showing hyperaggressive behavior. What are signs of hyperaggresive behavior? (Select all that apply.) a. Disrespect b. Noncompliance c. Infrequent impulsivity d. Occasional temper tantrums e. Unprovoked physical attacks on other children

ANS: A, B, E Hyperaggressive behavior in preschoolers is characterized by unprovoked physical attacks on other children and adults, destruction of others property, frequent intense temper tantrums, extreme impulsivity, disrespect, and noncompliance.

The nurse is completing a respiratory assessment on a newborn. What are normal findings of the assessment the nurse should document? (Select all that apply.) a.Periodic breathing b.Respiratory rate of 40 breaths/min c.Wheezes on auscultation d.Apnea lasting 25 seconds e.Slight intercostal retractions

ANS: A, B, E Periodic breathing is common in full-term newborns and consists of rapid, nonlabored respirations followed by pauses of less than 20 seconds. The newborn's respiratory rate is between 30 and 60 breaths/min. The ribs are flexible, and slight intercostal retractions are normal on inspiration. Periods of apnea lasting more than 20 seconds are abnormal, and wheezes should be reported.

Which assessments are included in the Apgar scoring system? (Select all that apply.) a.Heart rate b.Muscle tone c.Blood pressure d.Blood glucose e.Reflex irritability

ANS: A, B, E The Apgar score is based on observation of heart rate, respiratory effort, muscle tone, reflex irritability, and color. Blood pressure and blood glucose are not part of the Apgar scoring system.

The nurse is teaching parents of a 4-year-old child about socialization developmental milestones. What milestones should the nurse include in the teaching session? (Select all that apply.) a. Very independent b. Has mood swings c. Has better manners d. Eager to do things right e. Tends to be selfish and impatient

ANS: A, B, E The socialization milestones of a 4-year-old child include being very independent, having moods swings, and tending to be selfish and impatient. Having better manners and being eager to do things right are socialization milestones seen at the age of 5 years.

The nurse is evaluating a 7-month-old infant's cognitive development. Which behaviors should the nurse anticipate evaluating? (Select all that apply.) a. Imitates sounds b. Shows interest in a mirror image c. Comprehends simple commands d. Actively searches for a hidden object e. Attracts attention by methods other than crying

ANS: A, B, E A 7-month-old infant is in the secondary circular reactions (4-8 months) stage of cognitive development. Behaviors in this stage include imitating sounds, showing interest in a mirror image, and attracting attention by methods other than crying. Comprehending simple commands and actively searching for a hidden object are behaviors seen in the coordination of secondary schemas (9-12 months).

The nurse is providing anticipatory guidance to parents of a 4-month-old infant on preventing an aspiration injury. What should the nurse include in the teaching? (Select all that apply.) a. Keep baby powder out of reach. b. Inspect toys for removable parts. c. Allow the infant to take a bottle to bed. d. Teething biscuits can be used for teething discomfort. e. The infant should not be fed hard candy, nuts, or foods with pits.

ANS: A, B, E Anticipatory guidance to prevent aspiration for a 4-month-old infant takes into account that the infant will begin to be more active and place objects in the mouth. Toys should be checked for removable parts; baby powder should be kept out of reach; and hard candy, nuts, and foods with pits should be avoided. The infant should not go to bed with a bottle. Teething biscuits should be used with caution because large chunks may be broken off and aspirated

The nurse is caring for a neonate on positive-pressure ventilation. The nurse monitors for which complications of positive-pressure ventilation? (Select all that apply.) a. Pneumothorax b. Pneumomediastinum c. Respiratory distress syndrome d. Meconium aspiration syndrome e. Pulmonary interstitial emphysema

ANS: A, B, E Positive-pressure introduced by mechanical apparatus increases complications such as pulmonary interstitial emphysema, pneumothorax, and pneumomediastinum. Respiratory distress syndrome and meconium aspiration syndrome are not complications of positive-pressure ventilation.

The nursery nurse is aware that which are risk factors for hyperbilirubinemia? (Select all that apply.) a. An infant born prematurely b. An infant born to a mother with diabetes c. An infant born to a white mother d. An infant fed exclusively with formula e. An infant born with a metabolic disease

ANS: A, B, E Prematurity increases the risk of hyperbilirubinemia. An infant born to a mother with diabetes is also at risk for hyperbilirubinemia. Infants with metabolic disorders such as galactosemia or hypothyroidism may also develop hyperbilirubinemia. Neonates of East Asian ethnicity (China, Taiwan, Macao, Hong Kong, Japan, and Korea) are at higher risk for high mean serum bilirubin levels than neonates of any different ethnic origin. Exclusive breastfeeding is another risk factor for neonatal hyperbilirubinemia, not feeding exclusively with formula.

A nurse is planning care for a 7-year-old child hospitalized with osteomyelitis. Which activities should the nurse plan to bring from the playroom for the child? (Select all that apply.) a. Paper and some paints b. Board games c. Jack-in-the-box d. Stuffed animals e. Computer games

ANS: A, B, E School-age children become fascinated with complex board, card, or computer games that they can play alone, with a best friend, or with a group. They also enjoy sewing, cooking, carpentry, gardening, and creative activities such as painting. Jack-in-the-box and stuffed animals would be appropriate for a toddler or preschool child.

The nurse is preparing to administer a topical application of 1 ml of nystatin (Mycostatin) to an infant with oral thrush. Which actions should the nurse plan to implement? (Select all that apply.) a. Administer after a feeding. b. Use a sponge applicator to swab the oral mucosa and tongue. c. Administer after warming the medication under running warm water. d. If white patches are no longer present, hold the medication. e. Deposit the remainder of the dose in the mouth with a syringe so the infant swallows a small amount.

ANS: A, B, E To administer a topical application of nystatin for oral thrush, the medication should be distributed over the surface of the oral mucosa and tongue with an applicator or syringe. The remainder of the dose is deposited in the mouth to be swallowed by the infant to treat any gastrointestinal lesions. The nystatin should be administered after feedings. The medication should not be warmed before administration, and the medication should continue to be administered until discontinued by the health care provider.

The nurse is completing a physical and gestational age assessment on an infant who is 12 hours old. Which components are included in the gestational age assessment? (Select all that apply.) a.Arm recoil b.Popliteal angle c.Motor performance d.Primitive reflexes e.Square window f.Scarf sign

ANS: A, B, E, F The components of the typical gestational age assessment include posture, square window, arm recoil, popliteal angle, scarf sign, and heel to ear. Motor performance and reflexes are parts of the behaviors in the Brazelton Neonatal Behavioral Assessment Scale.

The nurse is teaching a new nurse about types of physical injuries that can occur at birth. Which soft tissue injuries should the nurse include in the teaching? (Select all that apply.) a. Petechiae b. Retinal hemorrhage c. Facial paralysis d. Cephalhematoma e. Subdural hematoma f. Subconjunctival hemorrhage

ANS: A, B, F Soft tissue injuries that can occur at birth include petechiae, retinal hemorrhage, and subconjunctival hemorrhage. Facial paralysis and cephalhematoma are head injuries that occur at birth, and a subdural hematoma is considered a neurologic injury related to the birthing process.

The nurse is planning care for an infant with eczema. Which interventions should the nurse include in the care plan? (Select all that apply.) a. Avoid giving the infant a bubble bath. b. Avoid the use of a humidifier in the infant's room. c. Avoid overdressing the infant. d. Avoid the use of topical steroids on the infant's skin. e. Avoid wet compresses on the infant's most affected areas.

ANS: A, C Guidelines for care of an infant with eczema include avoiding a bubble bath and harsh soaps and avoiding overdressing the infant to prevent perspiration, which can cause a flare-up. The care plan should include using a humidifier in the infant's room, topical steroids, and wet compresses on the most affected areas.

What are common causes of speech problems? (Select all that apply.) a. Autism b. Prematurity c. Hearing loss d. Developmental delay e. Overstimulated environment

ANS: A, C, D Common causes of speech problems are hearing loss, developmental delay, autism, lack of environmental stimulation, and physical conditions that impede normal speech production. Prematurity and an overstimulated environment are not causes of speech problems.

The nurse is teaching parents of a 3-year-old child about gross motor developmental milestones. What milestones should the nurse include in the teaching session? (Select all that apply.) a. Rides a tricycle b. Catches a ball reliably c. Jumps off the bottom step d. Stands on one foot for a few seconds e. Walks downstairs using alternate footing

ANS: A, C, D The gross motor milestones of a 3-year-old child include riding a tricycle, jumping off the bottom step, and standing on one foot for a few seconds. Catching a ball reliably and walking downstairs using alternate footing are gross motor milestones seen at the age of 4 years.

The nurse is teaching parents of a 3-year-old child about language developmental milestones. What milestones should the nurse include in the teaching session? (Select all that apply.) a. Asks many questions b. Names one or more colors c. Repeats sentence of six syllables d. Uses primarily telegraphic speech e. Has a vocabulary of 1500 words or more

ANS: A, C, D The language milestones of a 3-year-old child include asking many questions, repeating a sentence of six syllables, and using primarily telegraphic speech. Naming one or more colors and having a vocabulary of 1500 words or more footing are language milestones seen at the age of 4 years.

The nurse is teaching parents about the visual ability of their newborn. Which should the nurse include in the teaching session? (Select all that apply.) a.Visual acuity is between 20/100 and 20/400. b.Tear glands do not begin to function until 8 to 12 weeks of age. c.Infants can momentarily fixate on a bright object that is within 8 inches. d.The infant demonstrates visual preferences of black-and-white contrasting patterns. e.The infant prefers bright colors (red, orange, blue) over medium colors (yellow, green, pink).

ANS: A, C, D Visual acuity is reported to be between 20/100 and 20/400, depending on the vision measurement techniques. The infant has the ability to momentarily fixate on a bright or moving object that is within 20 cm (8 inches) and in the midline of the visual field. The infant demonstrates visual preferences of black-and-white contrasting patterns. The visual preference is for medium colors (yellow, green, pink) over dim or bright colors (red, orange, blue). Tear glands begin to function until 2 to 4 weeks of age.

Which gross motor milestones should the nurse assess in an 18-month-old child? (Select all that apply.) a. Jumps in place with both feet b. Takes a few steps on tiptoe c. Throws ball overhand without falling d. Pulls and pushes toys e. Stands on one foot momentarily

ANS: A, C, D An 18-month-old child can jump in place with both feet, throw a ball overhand without falling, and pull and push toys. Taking a few steps on tiptoe and standing on one foot momentarily is not acquired until 30 months of age.

The nurse is presenting a staff development program about understanding culture in the health care encounter. Which components should the nurse include in the program? (Select all that apply.) a. Cultural humility b. Cultural research c. Cultural sensitivity d. Cultural competency

ANS: A, C, D There are several different ways health care providers can best attend to all the different facets that make up an individual's culture. Cultural competence tends to promote building information about a specific culture. Cultural sensitivity, a second way of understanding culture in the context of the clinical encounter, may be understood as a way of using one's knowledge, consideration, understanding, respect, and tailoring after realizing awareness of self and others and encountering a diverse group or individual. Cultural humility, the third component, is a commitment and active engagement in a lifelong process that individuals enter into for an ongoing basis with patients, communities, colleagues, and themselves. Cultural research is not a component of understanding culture in the health care encounter.

The nurse is providing anticipatory guidance to parents of an 8-month-old infant on preventing a drowning injury. Which should the nurse include in the teaching? (Select all that apply.) a. Fence swimming pools. b. Keep bathroom doors open. c. Eliminate unnecessary pools of water. d. Keep one hand on the child while in the tub. e. Supervise the child when near any source of water.

ANS: A, C, D, E Anticipatory guidance to prevent drowning for an 8-month-old infant takes into account that the child will begin to crawl, cruise around furniture, walk, and climb. Fences should be placed around swimming pools, unnecessary pools of water should be eliminated, one hand should be kept on the child when bathing, and the child should be supervised when near any source of water. The bathroom doors should be kept closed.

The nurse is providing anticipatory guidance to the parents of a 1-month-old infant on preventing a suffocation injury. Which should the nurse include in the teaching? (Select all that apply.) a. Do not place pillows in the infant's crib. b. Crib slats should be 4 inches or less apart. c. Keep all plastic bags stored out of the infant's reach. d. Plastic over the mattress is acceptable if it is covered with a sheet. e. A pacifier should not be tied on a string around the infant's neck.

ANS: A, C, E Anticipatory guidance for a 1-month-old infant to prevent a suffocation injury takes into account that the infant will have increased eye-hand coordination and a voluntary grasp reflex as well as a crawling reflex that may propel the infant forward or backward. Pillows should not be placed in the infant's crib, plastic bags should be kept out of reach, and a pacifier should not be tied on a string around the neck. Crib slats should be 2.4 inches apart (4 inches is too wide), and the mattress should not be covered with plastic even if a sheet is used to cover it.

The nurse should teach the adolescent that the long-term effects of tanning can cause which conditions? (Select all that apply.) a. Phototoxic reactions b. Increased number of moles c. Premature aging d. Striae e. Increased risk of skin cancer

ANS: A, C, E Long-term effects of tanning include premature aging of the skin, increased risk of skin cancer, and, in susceptible individuals, phototoxic reactions. There has been no correlation to an increase in moles or striae (streaks or stripes on the skin, usually on the abdomen) development.

The home care nurse is visiting a 6-month-old infant with bronchopulmonary dysplasia (BPD). The nurse assesses the child for which signs of overhydration? (Select all that apply.) a. Edema b. Serum sodium of 140 mEq/L c. Urine specific gravity of 1.008 d. Weight gain of 1 lb in 1 week

ANS: A, D Nurses must be alert to signs of overhydration in an infant with BPD such as changes in weight, electrolytes, output measurements, and urine specific gravity and signs of edema. Six-month-old infants gain around 4 to 5 oz a week. One pound in 1 week would indicate fluid retention. Serum sodium of 140 mEq/L and urine specific gravity of 1.008 are normal values and indicate adequate fluid balance.

The nurse is caring for a neonate with an intraventricular hemorrhage. What interventions should the nurse avoid to prevent any increase in intracranial pressure? (Select all that apply.) a. Keeping the head of the bed flat b. Keeping the environment quiet c. Handling the neonate minimally d. Suctioning the endotracheal tube frequently e. Maintaining the neonate's head in a midline position

ANS: A, D Some nursing procedures increase intracranial pressure (ICP). For example, blood pressure increases significantly during endotracheal suctioning in preterm infants, and head positioning produces measurable changes in ICP. ICP is highest when infants are in the dependent (flat) position and decreases when the head is in a midline position and elevated 30 degrees. Keeping the environment quiet, handling the neonate minimally, and maintaining the neonate's head in a midline position are measures to keep the ICP down.

The nurse is teaching a class on breastfeeding to expectant parents. Select all of the following that are contraindications for breastfeeding. a. Human immunodeficiency virus (HIV) in mother b. Mastitis c. Inverted nipples d. Maternal cancer therapy e. Twin births

ANS: A, D a and d. Both of these conditions place the infant at risk. HIV can be transmitted through breast milk, as can be the metabolites of chemotherapy. b, c, and e. These are not contraindications.

The nurse is teaching parents about foods that are hyperallergenic. Which foods should the nurse include? (Select all that apply.) a. Peanuts b. Bananas c. Potatoes d. Egg noodles e. Tomato juice

ANS: A, D, E Hyperallergenic foods include peanuts, egg noodles, and tomato juice. Bananas and potatoes are not hyperallergenic.

The nurse is teaching parents about potential causes of colic in infancy. Which should the nurse include in the teaching session? (Select all that apply.) a. Overeating b. Understimulation c. Frequent burping d. Parental smoking e. Swallowing excessive air

ANS: A, D, E Potential causes of colic include too rapid feeding, overeating, swallowing excessive air, improper feeding technique (especially in positioning and burping), emotional stress or tension between the parent and child, parental smoking, and overstimulation.

A 13-year-old is being seen in the clinic for a routine health check. The adolescent has not been in the clinic for 3 years but was up to date on immunizations at that time. Which immunizations should the adolescent receive? (Select all that apply.) a. DTaP (tetanus, diphtheria, acellular pertussis) b. MMR (measles, mumps, rubella) c. Hepatitis B d. Influenza e. MCV4 (meningococcal)

ANS: A, D, E The DTaP (tetanus, diphtheria, acellular pertussis) vaccine is recommended for adolescents 11 to 18 years old who have not received a tetanus booster (Td) or DTaP dose and have completed the childhood DTaP/DTP series. Meningococcal vaccine (MCV4) should be given to adolescents 11 to 12 years of age with a booster dose at age 16 years. Annual influenza vaccination with either the live attenuated influenza vaccine or trivalent influenza vaccine is recommended for all children and adolescents. The adolescent, previously up to date on vaccinations, would have received the MMR and hepatitis B as a child.

The nurse is caring for a hospitalized 4-year-old boy. His parents tell the nurse they will be back to visit at 6 PM. When he asks the nurse when his parents are coming, what would the nurses best response be? a. They will be here soon. b. They will come after dinner. c. Let me show you on the clock when 6 PM is. d. I will tell you every time I see you how much longer it will be.

ANS: B A 4-year-old child understands time in relation to events such as meals. Children perceive soon as a very short time. The nurse may lose the childs trust if his parents do not return in the time he perceives as soon. Children cannot read or use a clock for practical purposes until age 7 years. I will tell you every time I see you how much longer it will be assumes the child understands the concepts of hours and minutes, which does not occur until age 5 or 6 years.

Which statement best represents the first stage or the first period of reactivity in the infant? a.Begins when the newborn awakes from a deep sleep b.Is an excellent time to acquaint the parents with the newborn c.Ends when the amounts of respiratory mucus have decreased d.Provides time for the mother to recover from the childbirth process

ANS: B During the first period of reactivity, the infant is alert, cries vigorously, may suck his or her fist greedily, and appears interested in the environment. The infant's eyes are usually wide open, suggesting that this is an excellent opportunity for mother, father, and infant to see each other. The second period of reactivity begins when the infant awakes from a deep sleep and ends when the amounts of respiratory mucus have decreased. The mother should sleep and recover during the second stage, when the infant is sleeping.

Which statement reflects accurate information about patterns of sleep and wakefulness in the newborn? a.States of sleep are independent of environmental stimuli. b.The quiet alert stage is the best stage for newborn stimulation. c.Cycles of sleep states are uniform in newborns of the same age. d.Muscle twitches and irregular breathing are common during deep sleep.

ANS: B During the quiet alert stage, the newborn's eyes are wide open and bright. The newborn responds to the environment by active body movement and staring at close-range objects. Newborns' ability to control their own cycles depend on their neurobehavioral development. Each newborn has an individual cycle. Muscle twitches and irregular breathing are common during light sleep

The nurse is caring for a patient who has chosen to breastfeed her infant. Which statement should the nurse include when teaching the mother about breastfeeding problems that may occur? a."If you experience painful nipples, cleanse your nipples with soap two times per day and keep your nipples covered as much as possible." b."If you experience plugged ducts, continue to breastfeed every 2 to 3 hours and alternate feeding positions." c."If mastitis occurs, discontinue breastfeeding while taking prescribed antibiotics and apply warm compresses." d."If engorgement occurs, use cold compresses before a feeding and wear a well-fitting bra at night."

ANS: B If a woman experiences plugged ducts, the best interventions are to continue breastfeeding every 2 to 3 hours and alternate feeding positions while pointing the infant's chin toward the obstructed area. Other interventions include massaging breasts and applying warm compresses before feeding or pumping. If painful nipples occur, the woman should avoid soaps, oils, and lotions and air the nipples as much as possible. If mastitis occurs, the woman should continue breastfeeding to keep the breast well drained. If engorgement occurs, the woman should use a warm compress before feedings and wear a well-fitting bra 24 hours a day.

In terms of cognitive development, a 5-year-old child should be expected to do which? a. Think abstractly. b. Use magical thinking. c. Understand conservation of matter. d. Understand another persons perspective.

ANS: B Magical thinking is believing that thoughts can cause events. An example is thinking of the death of a parent might cause it to happen. Abstract thought does not develop until the school-age years. The concept of conservation is the cognitive task of school-age children, ages 5 to 7 years. A 5-year-old child cannot understand another persons perspective.

The nurse observes flaring of nares in a newborn. What should this be interpreted as? a.Nasal occlusion b.Sign of respiratory distress c.Snuffles of congenital syphilis d.Appropriate newborn breathing

ANS: B Nasal flaring is an indication of respiratory distress. A nasal occlusion should prevent the child from breathing through the nose. Because newborns are obligatory nose breathers, this should require immediate referral. Snuffles are indicated by a thick, bloody nasal discharge without sneezing. Sneezing and thin, white mucus drainage are common in newborns and are not related to nasal flaring.

Which finding in the newborn is considered abnormal? a.Nystagmus b.Profuse drooling c.Dark green or black stools d.Slight vaginal reddish discharge

ANS: B Profuse drooling and salivation are potential signs of a major abnormality. Newborns with esophageal atresia cannot swallow their oral secretions, resulting in excessive drooling. Nystagmus is an involuntary movement of the eyes. This is a common variation in newborns. Meconium, the first stool of newborns, is dark green or black. A pseudomenstruation may be present in normal newborns. This is a blood-tinged or mucoid vaginal discharge.

The nurse is explaining average weight gain during the preschool years to a group of parents. Which average weight gain should the nurse suggest to the parents? a. 1 to 2 kg b. 2 to 3 kg c. 3 to 4 kg d. 4 to 5 kg

ANS: B The average weight gain remains approximately 2 to 3 kg (4.56.5 lb) per year during the preschool period.

Which is the name of the suture separating the parietal bones at the top of a newborn's head? a.Frontal b.Sagittal c.Coronal d.Occipital

ANS: B The sagittal suture separates the parietal bones at the top of the newborn's head. The frontal suture separates the frontal bones. The coronal suture is said to "crown the head." The lambdoid suture is at the margin of the parietal and occipital.

A child age 4 1/2 years sometimes wakes her parents up at night screaming, thrashing, sweating, and apparently frightened, yet she is not aware of her parents presence when they check on her. She lies down and sleeps without any parental intervention. This is most likely what? a. Nightmare b. Sleep terror c. Sleep apnea d. Seizure activity

ANS: B This is a description of a sleep terror. The child is observed during the episode and not disturbed unless there is a possibility of injury. A child who awakes from a nightmare is distressed. She is aware of and reassured by the parents presence. This is not the case with sleep apnea. This behavior is not indicative of seizure activity.

Which type of family should the nurse recognize when a mother, her children, and a stepfather live together? a. Traditional nuclear b. Blended c. Extended d. Binuclear

ANS: B A blended family contains at least one stepparent, stepsibling, or half-sibling. A traditional nuclear family consists of a married couple and their biologic children. No other relatives or nonrelatives are present in the household. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

The nurse is teaching a group of new nursing graduates about identifiable qualities of strong families that help them function effectively. Which quality should be included in the teaching? a. Lack of congruence among family members b. Clear set of family values, rules, and beliefs c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events d. Sense of commitment toward growth of individual family members as opposed to that of the family unit

ANS: B A clear set of family rules, values, and beliefs that establish expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Varied coping strategies are used by strong families. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit.

What is an important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS)? a. Discourage the parents from making a last visit with the infant. b. Make a follow-up home visit to the parents as soon as possible after the child's death. c. Explain how SIDS could have been predicted and prevented. d. Interview the parents in depth concerning the circumstances surrounding the child's death.

ANS: B A competent, qualified professional should visit the family at home as soon as possible after the death. Printed information about SIDS should be provided to the family. Parents should be allowed and encouraged to make a last visit with their child. SIDS cannot always be prevented or predicted, but parents can take steps to reduce the risk (e.g., supine sleeping, removing blankets and pillows from the crib, and not smoking). Discussions about the cause only increase parental guilt. The parents should be asked only factual questions to determine the cause of death.

Which finding on a newborn assessment should the nurse recognize as suggestive of a clavicle fracture? a. Positive scarf sign b. Asymmetric Moro reflex c. Swelling of fingers on affected side d. Paralysis of affected extremity and muscles

ANS: B A newborn with a broken clavicle may have no signs. The Moro reflex, which results in sudden extension and abduction of the extremities followed by flexion and adduction of the extremities, will most likely be asymmetric. The scarf sign that is used to determine gestational age should not be performed if a broken clavicle is suspected. Swelling of the fingers on the affected side and paralysis of the affected extremity and muscles are not signs of a fractured clavicle.

The parent of a 4-year-old boy tells the nurse that the child believes that monsters and boogeymen are in his bedroom at night. The nurse's best suggestion for coping with this problem is to: a. let the child sleep with his parents. b. keep a night-light on in the child's bedroom. c. help the child understand that these fears are illogical. d. tell the child frequently that monsters and boogeymen do not exist.

ANS: B A night-light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with parents will not get rid of the fears. A 4-year-old child is in the preconceptual age and cannot understand logical thought.

The parent of an 8.2-kg (18-lb) 9-month-old infant is borrowing a federally approved car seat from the clinic. The nurse should explain that the safest way to put in the car seat is what? a. Front facing in back seat b. Rear facing in back seat c. Front facing in front seat with air bag on passenger side d. Rear facing in front seat if an air bag is on the passenger side

ANS: B A rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck. The middle of the back seat is the safest position for the child. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat.

A 14-year-old adolescent never had chickenpox as a child. Which should the nurse recommend? a. One dose of the varicella vaccination b. Two doses of the varicella vaccination 4 weeks apart c. One dose of the varicella immune globulin d. No vaccinations—the child is past the age to receive it

ANS: B All adolescents should also be assessed for previous history of varicella infection or vaccination. Vaccination with the varicella vaccine is recommended for those with no previous history; for those with no previous infection or history, the varicella vaccine may be given in two doses 4 or more weeks apart to adolescents 13 years or older. The varicella immune globulin is given to immunosuppressed children exposed to chickenpox to boost immunity; it is only temporary. The varicella vaccination should be given to adolescents, no matter the age, who have not had chickenpox as a child.

At which age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: B At age 2 months, the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. A 3-month-old infant can recognize familiar faces. At age 4 months, infants can enjoy social interactions.

Which is descriptive of a toddler's cognitive development at age 20 months? a. Searches for an object only if he or she sees it being hidden b. Realizes that "out of sight" is not out of reach c. Puts objects into a container but cannot take them out d. Understands the passage of time, such as "just a minute" and "in an hour"

ANS: B At this age, the child is in the final sensorimotor stage. Children will now search for an object in several potential places, even though they saw only the original hiding place. Children have a more developed sense of objective permanence. They will search for objects even if they have not seen them hidden. When a child puts objects into a container but cannot take them out, this is indicative of tertiary circular reactions. An embryonic sense of time exists, although the children may behave appropriately to time-oriented phrases, their sense of timing is exaggerated.

The nurse is interviewing the father of a 10-month-old girl. The child is playing on the floor when she notices an electrical outlet and reaches up to touch it. Her father says "no" firmly and moves her away from the outlet. The nurse should use this opportunity to teach the father what? a. That the child should be given a time-out b. That the child is old enough to understand the word "no" c. That the child will learn safety issues better if she is spanked d. That the child should already know that electrical outlets are dangerous

ANS: B By age 10 months, children are able to associate meaning with words. The father is using both verbal and physical cues to alert the child to dangerous situations. A time-out is not appropriate. The child is just learning about the environment. Physical discipline should be avoided. The 10-month-old child is too young to understand the purpose of an electrical outlet.

Which one of the following strategies might be recommended for an infant with failure to thrive (FTT) to increase caloric intake? a. Vary the schedule for routine activities on a daily basis. b. Be persistent through 10 to 15 minutes of food refusal. c. Avoid solids until after the bottle is well accepted. d. Use developmental stimulation by a specialist during feedings.

ANS: B Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Children with FTT need a structured routine to help establish rhythmicity in their activities of daily living. Many children with FTT are fed exclusively from a bottle. Solids should be fed first. Stimulation is reduced during mealtimes to maintain the focus on eating.

The nurse is explaining different parenting styles to a group of parents. The nurse explains that an authoritative parenting style can lead to which child behavior? a. Shyness b. Self-reliance c. Submissiveness d. Self-consciousness

ANS: B Children raised by parents with an authoritative parenting style tend to have high self-esteem and are self-reliant, assertive, inquisitive, content, and highly interactive with other children. Children raised by parents with an authoritarian parenting style tend to be sensitive, shy, self-conscious, retiring, and submissive.

A foster parent is talking to the nurse about the health care needs for the child who has been placed in the parent's care. Which statement best describes the health care needs of foster children? a. Foster children always come from abusive households and are emotionally fragile. b. Foster children tend to have a higher than normal incidence of acute and chronic health problems. c. Foster children are usually born prematurely and require technologically advanced health care. d. Foster children will not stay in the home for an extended period, so health care needs are not as important as emotional fulfillment.

ANS: B Children who are placed in foster care have a higher incidence of acute and chronic health problems and may experience feelings of isolation and confusion; therefore, they should be monitored closely. Foster children do not always come from abusive households and may or may not be emotionally fragile; not all foster children are born prematurely or require technically advanced health care; and foster children may stay in the home for extended periods, so their health care needs require attention.

The nurse is reviewing the importance of role learning for children. The nurse understands that children's roles are primarily shaped by which members? a. Peers b. Parents c. Siblings d. Grandparents

ANS: B Children's roles are shaped primarily by the parents, who apply direct or indirect pressures to induce or force children into the desired patterns of behavior or direct their efforts toward modification of the role responses of the child on a mutually acceptable basis.

Which term best describes a group of people who share a set of values, beliefs, practices, social relationships, law, politics, economics, and norms of behavior? a. Race b. Culture c. Ethnicity d. Social group

ANS: B Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perceptions and judgments. Race is defined as a division of humankind possessing traits that are transmissible by descent and are sufficient to characterize it as a distinct human type. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. A social group consists of systems of roles carried out in groups. Examples of primary social groups include the family and peer groups.

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

ANS: B During growth spurts, the need for sleep increases. Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contribute to fatigue.

Which statement best describes fear in the school-age child? a. They are increasingly fearful for body safety. b. Most of the new fears that trouble them are related to school and family. c. They should be encouraged to hide their fears to prevent ridicule by peers. d. Those who have numerous fears need continuous protective behavior by parents to eliminate these fears.

ANS: B During the school-age years, children experience a wide variety of fears, but new fears relate predominantly to school and family. During the middle-school years, children become less fearful for body safety than they were as preschoolers. Parents and other persons involved with children should discuss children's fears with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding their fears does not end them and may lead to phobias.

Which should the nurse expect for a toddler's language development at age 18 months? a. Vocabulary of 25 words b. Increasing level of comprehension c. Use of holophrases d. Approximately one third of speech understandable

ANS: B During the second year of life, level of comprehension and understanding of speech increases and is far greater than the child's vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages. The 18-month-old child has a vocabulary of 10 or more words. At this age, the child does not use the one-word sentences that are characteristic of the 1-year-old child. The child has a limited vocabulary of single words that are comprehensible.

A mother is upset because her newborn has erythema toxicum neonatorum. The nurse should reassure her that this is what? a. Easily treated b. Benign and transient c. Usually not contagious d. Usually not disfiguring

ANS: B Erythema toxicum neonatorum, or newborn rash, is a benign, self-limiting eruption of unknown cause that usually appears within the first 2 days of life. The rash usually lasts about 5 to 7 days. No treatment is indicated. Erythema toxicum neonatorum is not contagious. Successive crops of lesions heal without pigmentation.

The nurse is aware that if patients' different cultures are implied to be inferior, the emotional attitude the nurse is displaying is what? a. Acculturation b. Ethnocentrism c. Cultural shock d. Cultural sensitivity

ANS: B Ethnocentrism is the belief that one's way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of one's ethnic group are superior to those of others. Acculturation is the gradual changes that are produced in a culture by the influence of another culture that cause one or both cultures to become more similar. The minority culture is forced to learn the majority culture to survive. Cultural shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. Cultural sensitivity, a component of culturally competent care, is an awareness of cultural similarities and differences.

Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Interactional theory b. Family stress theory c. Erikson's psychosocial theory d. Developmental systems theory

ANS: B Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction. Interactional theory is not a family theory. Interactions are the basis of general systems theory. Erikson's theory applies to individual growth and development, not families. Developmental systems theory is an outgrowth of Duvall's theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others.

The clinic nurse is teaching parents about physiologic anemia that occurs in infants. What statement should the nurse include about the cause of physiologic anemia? a. Maternally derived iron stores are depleted in the first 2 months. b. Fetal hemoglobin results in a shortened survival of red blood cells. c. The production of adult hemoglobin decreases in the first year of life. d. Low levels of fetal hemoglobin depress the production of erythropoietin.

ANS: B Fetal hemoglobin results in a shortened survival of red blood cells (RBCs) and thus a decreased number of RBCs. Maternally derived iron stores are present for the first 5 to 6 months results in a shortened survival of RBCs and thus a decreased number of RBCs. High levels of fetal hemoglobin depress the production of erythropoietin, a hormone released by the kidney that stimulates RBC production.

Parents of a firstborn child are asking whether it is normal for their child to be extremely competitive. The nurse should respond to the parents that studies about the ordinal position of children suggest that firstborn children tend to: a. be praised less often. b. be more achievement oriented. c. be more popular with the peer group. d. identify with peer group more than parents.

ANS: B Firstborn children, like only children, tend to be more achievement oriented. Being praised less often, being more popular with the peer group, and identifying with peer groups more than parents are characteristics of later-born children.

A bottle-fed infant has been diagnosed with cow's milk allergy. Which formula should the nurse expect to be prescribed for the infant? a. Similac b. Pregestimil c. Enfamil with iron d. Gerber Good Start

ANS: B For infants with cow's milk allergy, the formula will be changed to a casein hydrolysate milk formula (Pregestimil, Nutramigen, or Alimentum) in which the protein has been broken down into its amino acids through enzymatic hydrolysis. Similac, Enfamil with iron, and Gerber Good Start are cow's milk-based formulas

The most effective way to clean a toddler's teeth is for the: a. child to brush regularly with a toothpaste of his or her choice. b. parent to stabilize the chin with one hand and brush with the other. c. parent to brush the mandibular occlusive surfaces, leaving the rest for the child. d. parent to brush the front labial surfaces, leaving the rest for the child.

ANS: B For young children, the most effective cleaning of teeth is by the parents. Different positions can be used if the child's back is to the adult. The adult should use one hand to stabilize the chin and the other to brush the child's teeth. The child can participate in brushing, but for a thorough cleaning, adult intervention is necessary.

Rh hemolytic disease is suspected in a mother's second baby, a son. Which factor is important in understanding how this could develop? a. The first child was a girl. b. The first child was Rh positive. c. Both parents have type O blood. d. She was not immunized against hemolysis.

ANS: B Hemolytic disease of the newborn results from an abnormally rapid rate of red blood cell (RBC) destruction. The major causes of this are maternal-fetal Rh and ABO incompatibility. If an Rh-negative mother has previously been exposed to Rh-positive blood through pregnancy or blood transfusion, antibodies to this blood group antigen may develop so that she is isoimmunized. With further exposure to Rh-positive blood, the maternal antibodies agglutinate with the RBCs of the fetus that has the antigen and destroy the cells. Hemolytic disease caused by ABO incompatibilities can be present with the first pregnancy. The gender of the first child is not a concern. Blood type is the important consideration. If both parents have type O blood, ABO incompatibility should not be a possibility.

A nurse, instructing parents of a hospitalized preschool child, explains that which is descriptive of the preschooler's understanding of time? a. Has no understanding of time b. Associates time with events c. Can tell time on a clock d. Uses terms like "yesterday" appropriately

ANS: B In a preschooler's understanding, time has a relation with events such as "We'll go outside after lunch." Preschoolers develop an abstract sense of time at age 3 years. Children can tell time on a clock at age 7 years. Children do not fully understand use of time-oriented words until age 6 years.

Which family theory is described as a series of tasks for the family throughout its life span? a. Exchange theory b. Developmental theory c. Structural-functional theory d. Symbolic interactional theory

ANS: B In developmental systems theory, the family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. Exchange theory assumes that humans, families, and groups seek rewarding statuses so that rewards are maximized while costs are minimized. Structural-functional theory states that the family performs at least one societal function while also meeting family needs. Symbolic interactional theory describes the family as a unit of interacting persons with each occupying a position within the family.

When should the nurse expect jaundice to be present in a full-term infant with hemolytic disease? a. At birth b. Within 24 hours after birth c. 25 to 48 hours after birth d. 49 to 72 hours after birth

ANS: B In hemolytic disease of the infant, jaundice is usually evident within the first 24 hours of life. Infants with hemolytic disease are usually not jaundiced at birth, although some degree of hepatosplenomegaly, pallor, and hypovolemic shock may occur when the most severe form, hydrops fetalis, is present. Twenty-five to 72 hours after birth is too late for hemolytic disease of the infant. Jaundice at these ages is most likely caused by physiologic or early-onset breastfeeding jaundice.

The nurse is discussing issues that are important with parents considering a cross-racial adoption. Which statement made by the parents indicates further teaching is needed? a. "We will try to preserve the adopted child's racial heritage." b. "We are glad we will be getting full medical information when we adopt our child." c. "We will make sure to have everyone realize this is our child and a member of the family." d. "We understand strangers may make thoughtless comments about our child being different from us."

ANS: B In international adoptions, the medical information the parents receive may be incomplete or sketchy; weight, height, and head circumference are often the only objective information present in the child's medical record. Further teaching is needed if the parents expect full medical information. It is advised that parents who adopt children with different ethnic backgrounds do everything to preserve the adopted children's racial heritage. Strangers may make thoughtless comments and talk about the children as though they were not members of the family. It is vital that family members declare to others that this is their child and a cherished member of the family.

A mother has just given birth to a newborn with a cleft lip. Sensing that something is wrong, she starts to cry and asks the nurse, "What is wrong with my baby?" What is the most appropriate nursing action? a. Encourage the mother to express her feelings. b. Explain in simple language that the baby has a cleft lip. c. Provide emotional support until the practitioner can talk to the mother. d. Tell the mother a pediatrician will talk to her as soon as the baby is examined.

ANS: B It is best to explain in simple terms the nature of the defect and to reinforce and help clarify information given by the practitioner before the newborn is shown to the parents. Parents may not be ready to talk about their feelings during the first few days after birth. The nurse should provide information about the child's condition while waiting for the practitioner to speak with the family after the examination. The mother needs simple explanations of her child's condition during this period of waiting.

An infant requires surgery for repair of a cleft lip. An important priority of the preoperative nursing care is which? a. Initiating discharge teaching b. Performing baseline physical and behavioral assessment c. Observing for allergic reactions to preoperative antibiotics d. Determining whether this defect exists in other family members `

ANS: B It is essential to assess the infant before surgery to obtain a baseline. Postoperative changes can be identified and a determination can be made regarding pain or change in status. The parents are not ready for discharge teaching. Their focus is on the congenital defect and surgery. Although a remote possibility, allergic reactions rarely occur on the first dose. Determining whether this defect exists in other family members is an important part of the history but is not a priority before surgery.

Kimberly's parents have been using a rearward-facing, convertible car seat since she was born. Most car seats can be safely switched to the forward-facing position when the child reaches which age? a. 1 b. 2 c. 3 d. 4

ANS: B It is now recommended that all infants and toddlers ride in rear-facing car safety seats until they reach the age of 2 years or height recommended by the car seat manufacturer. Children 2 years old and older who have outgrown the rear-facing height or weight limit for their car safety seat should use a forward-facing car safety seat with a harness up to the maximum height or weight recommended by the manufacturer. One year is too young to switch to a forward-facing position.

The nurse is caring for a newborn who was born at 35 weeks of gestation and is considered a late preterm infant. What intervention should be included in the infant's care plan? a. Feed the infant dextrose water as the first feeding after 12 hours. b. Promote skin-to-skin care in the immediate postpartum period. c. Avoid administration of the hepatitis B vaccine until after discharge. d. Delay the newborn screening and hearing test until the infant is at 40 weeks' corrected age.

ANS: B Late preterm infants can usually tolerate skin-to-skin care in the immediate postpartum period, which enhances the bonding process with the parents. A late preterm infant should be given an early feeding of human milk or formula; dextrose water is not required for the first feeding. The hepatitis B vaccine and all newborn screening, including the hearing test, should be done before discharge, with no limitation on corrected age.

The nurse is discussing development and play activities with the parent of a 2-month-old boy. Which statement by the parent would indicate a correct understanding of the teaching? a. "I can give my baby a ball of yarn to pull apart or different textured fabrics to feel." b. "I can use a music box and soft mobiles as appropriate play activities for my baby." c. "I should introduce a cup and spoon or push-pull toys for my baby at this age." d. "I do not have to worry about appropriate play activities at this age."

ANS: B Music boxes and soft mobiles are appropriate play activities for a 2-month-old infant. A ball of yarn to pull apart or different textured fabrics are appropriate for an infant at 6 to 9 months. A cup and spoon or push-pull toys are appropriate for an older infant. Infants of all ages should be exposed to appropriate types of stimulation.

A parent of a school-age child tells the school nurse that the parents are going through a divorce. The child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as what? a. Indicative of maladjustment b. A common reaction to divorce c. Suggestive of a lack of adequate parenting d. An unusual response that indicates a need for referral

ANS: B Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. The child's responses are common reactions of school-age children to parental divorce.

The parents of a 2-month-old boy are concerned about spoiling their son by picking him up when he cries. What is the nurse's best response? a. "Allow him to cry for no longer than 15 minutes and then pick him up." b. "Babies need comforting and cuddling. Meeting these needs will not spoil him." c. "Babies this young cry when they are hungry. Try feeding him when he cries." d. "If he isn't soiled or wet, leave him, and he'll cry himself to sleep."

ANS: B Parents need to learn that a "spoiled child" is a response to inconsistent discipline and limit setting. It is important to meet the infant's developmental needs, including comforting and cuddling. The data suggest that responding to a child's crying can actually decrease the overall crying time. Allowing him to cry for no longer than 15 minutes and then picking him up will reinforce prolonged crying. Infants at this age have other needs besides feeding. The parents should be taught to identify their infant's cues. Counseling parents on letting the baby cry himself to sleep when not soiled or wet refers to sleep issues, not general infant behavior.

A nurse is conducting parenting classes for parents of adolescents. Which parenting style should the nurse recommend? a. Laissez-faire b. Authoritative c. Disciplinarian d. Confrontational

ANS: B Parents should be guided toward an authoritative style of parenting in which authority is used to guide the adolescent while allowing developmentally appropriate levels of freedom and providing clear, consistent messages regarding expectations. The authoritative style of parenting has been shown to have both immediate and long-term protective effects toward adolescent risk reduction. The laissez-faire method would not give adolescents enough structure. The disciplinarian and confrontational styles would not allow any autonomy or independence.

After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which pediatric issues? a. Sudden infant death syndrome (SIDS) b. Plagiocephaly c. Failure to thrive d. Apnea of infancy

ANS: B Plagiocephaly is a misshapen head caused by the prolonged pressure on one side of the skull. If that side becomes misshapen, facial asymmetry may result. SIDS has decreased by more than 40% with the introduction of the Back to Sleep campaign. Apnea of infancy and failure to thrive are unrelated to the Back to Sleep campaign.

Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. Which is the best interpretation of this behavior? a. This is typical behavior because toddlers are aggressive. b. This is typical behavior because toddlers are egocentric. c. Toddlers should know that sharing toys is expected of them. d. Toddlers should have the cognitive ability to know right from wrong.

ANS: B Play develops from the solitary play of infancy to the parallel play of toddlers. The toddler plays alongside other children, not with them. This typical behavior of the toddler is not intentionally aggressive. Shared play is not within their cognitive development. Toddlers do not conceptualize shared play. Because the toddler cannot view the situation from the perspective of the other child, it is okay to take the toy. Therefore, no right or wrong is associated with taking a toy.

Which play item should the nurse bring from the playroom to a hospitalized toddler in isolation? a. Small plastic Lego b. Set of large plastic building blocks c. Brightly colored balloon d. Coloring book and crayons

ANS: B Play objects for toddlers must still be chosen with an awareness of danger from small parts. Large, sturdy toys without sharp edges or removable parts are safest. Large plastic blocks are appropriate for a toddler in isolation. Small plastic toys such as Lego can cause choking or can be aspirated. Balloons can cause significant harm if swallowed or aspirated. Coloring book and crayons would be too advanced for a toddler.

Children may believe that they are responsible for their parents' divorce and interpret the separation as punishment. At which age is this most likely to occur? a. 1 year b. 4 years c. 8 years d. 13 years

ANS: B Preschool-age children are most likely to blame themselves for the divorce. A 4-year-old child will fear abandonment and express bewilderment regarding all human relationships. A 4-year-old child has magical thinking and believes his or her actions cause consequences, such as divorce. For infants, divorce may increase their irritability and interfere with the attachment process, but they are too young to feel responsibility. School-age children will have feelings of deprivation, including the loss of a parent, attention, money, and a secure future. Adolescents are able to disengage themselves from the parental conflict.

A 4-year-old child is hospitalized with a serious bacterial infection. The child tells the nurse that he is sick because he was "bad." Which is the nurse's best interpretation of this comment? a. Sign of stress b. Common at this age c. Suggestive of maladaptation d. Suggestive of excessive discipline at home

ANS: B Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think they are directly responsible for events, making them feel guilty for things outside their control. Children of this age show stress by regressing developmentally or acting out. Maladaptation is unlikely. Telling the nurse that he is sick because he was "bad" does not imply excessive discipline at home.

Which is an appropriate recommendation for preventing tooth decay in young children? a. Substitute raisins for candy. b. Substitute sugarless gum for regular gum. c. Use honey or molasses instead of refined sugar. d. When sweets are to be eaten, select a time not during meals.

ANS: B Regular gum has high sugar content. When the child chews gum, the sugar is in prolonged contact with the teeth. Sugarless gum is less cariogenic than regular gum. Raisins, honey, and molasses are highly cariogenic and should be avoided. Sweets should be consumed with meals so that the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth.

A mother planned to breastfeed her infant before giving birth at 33 weeks of gestation. The infant is stable and receiving oxygen. What is the most appropriate nursing action related to this? a. Assist the mother in expressing breast milk. b. Assess the infant's readiness to breastfeed. c. Explain to the mother that the infant is too small to receive breast milk. d. Reassure the mother that infant formula is a good alternative to breastfeeding.

ANS: B Research confirms that human milk is the best source of nutrition for term and preterm infants. Preterm infants should be breastfed as soon as they have adequate sucking and swallowing reflexes and no other complications such as respiratory complications or concurrent illnesses. If the infant has adequate sucking and swallowing, the infant should breastfeed for some of the feedings. The mother can express milk to be used in her absence.

After the family, which has the greatest influence on providing continuity between generations? a. Race b. School c. Social class d. Government

ANS: B Schools convey a tremendous amount of culture from the older members to the younger members of society. They prepare children to carry out the traditional social roles that will be expected of them as adults. Race is defined as a division of humankind possessing traits that are transmissible by descent and are sufficient to characterize race as a distinct human type; although race may have an influence on childrearing practices, its role is not as significant as that of schools. Social class refers to the family's economic and educational levels. The social class of a family may change between generations. The government establishes parameters for children, including amount of schooling, but this is usually at a local level. The school culture has the most significant influence on continuity besides family.

In about 1 week, a stable preterm infant will be discharged. The nurse should teach the parents to place the infant in which position for sleep? a. Prone b. Supine c. Position of comfort d. Abdomen with head elevated

ANS: B The American Academy of Pediatrics recommends that healthy infants be placed to sleep in a nonprone position. The prone position is associated with sudden infant death syndrome but can be used for supervised play

A parent brings a 12-month-old infant into the emergency department and tells the nurse that the infant is allergic to peanuts and was accidentally given a cookie with peanuts in it. The infant is dyspneic, wheezing, and cyanotic. The health care provider has prescribed a dose of epinephrine to be administered. The infant weighs 24 lb. How many milligrams of epinephrine should be administered? a. 0.11 to 0.33 mg b. 0.011 to 0.3 mg c. 1.1 to 3.3 mg d. 11 to 33 mg

ANS: B The correct dose of epinephrine to use in the emergency management of an anaphylactic reaction is 0.001 mg/kg up to a maximum of 0.3 mg, giving a range of 0.011 to 0.3 mg using a weight of 11 kg (24 lb).

The nurse is discussing the management of atopic dermatitis (eczema) with a parent. What should be included? a. Dress infant warmly to prevent chilling. b. Keep the infant's fingernails and toenails cut short and clean. c. Give bubble baths instead of washing lesions with soap. d. Launder clothes in mild detergent; use fabric softener in the rinse.

ANS: B The infant's nails should be kept short and clean and have no sharp edges. Gloves or cotton socks can be placed over the child's hands and pinned to the shirt sleeves. Heat and humidity increase perspiration, which can exacerbate the eczema. The child should be dressed properly for the climate. Synthetic material (not wool) should be used for the child's clothing during cold months. Baths are given as prescribed with tepid water, and emollients such as Aquaphor, Cetaphil, and Eucerin are applied within 3 minutes. Soap (except as indicated), bubble bath oils, and powders are avoided. Fabric softener should be avoided because of the irritant effects of some of its components.

What should nursing care of an infant with oral candidiasis (thrush) include? a. Avoid use of a pacifier. b. Continue medication for the prescribed number of days. c. Remove the characteristic white patches with a soft cloth. d. Apply medication to the oral mucosa, being careful that none is ingested.

ANS: B The medication must be continued for the prescribed number of days. To prevent relapse, therapy should continue for at least 2 days after the lesions disappear. Pacifiers can be used. The pacifier should be replaced with a new one or boiled for 20 minutes once daily. One of the characteristics of thrush is that the white patches cannot be removed. The medication is applied to the oral mucosa and then swallowed to treat Candida albicans infection in the gastrointestinal tract.

A preterm infant of 33 weeks of gestation is admitted to the neonatal intensive care unit. Approximately 2 hours after birth, the neonate begins having difficulty breathing, with grunting, tachypnea, and nasal flaring. What should the nurse recognize? a. This is a normal finding. b. Further evaluation is needed. c. Improvement should occur within 24 hours. d. This is not significant unless cyanosis is present.

ANS: B These are signs of respiratory distress syndrome and require further evaluation. There is no way to predict the infant's clinical course based on the available data. Cyanosis may be present, but these are significant findings indicative of respiratory distress even without cyanosis.

The nurse discovers welts on the back of a Vietnamese child during a home health visit. The child's mother says she has rubbed the edge of a coin on her child's oiled skin. The nurse should recognize this as what? a. Child abuse b. Cultural practice to rid the body of disease c. Cultural practice to treat enuresis or temper tantrums d. Child discipline measure common in the Vietnamese culture

ANS: B This is descriptive of coining. The welts are created by repeatedly rubbing a coin on the child's oiled skin. The mother is attempting to rid the child's body of disease. Coining is a cultural healing practice. Coining is not specific for enuresis or temper tantrums. This is not child abuse or discipline.

Parents tell the nurse that they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. Which is the most appropriate recommendation the nurse should make? a. Punish children so this behavior stops. b. Neither condone nor condemn the curiosity. c. Allow children unrestricted permission to satisfy this curiosity. d. Get counseling for this unusual and dangerous behavior.

ANS: B Three-year-olds become aware of anatomic differences and are concerned about how the other "works." Such exploration should not be condoned or condemned. Children should not be punished for this normal exploration. Encouraging the children to ask questions of the parents and redirecting their activity are more appropriate than giving permission. Exploration is age-appropriate and not dangerous behavior

According to Erikson, the psychosocial task of adolescence is developing: a. intimacy. b. identity. c. initiative. d. independence.

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

The mother of a 6-month-old infant has returned to work and is expressing breast milk to be frozen. She asks for directions on how to safely thaw the breast milk in the microwave. What should the nurse recommend? a. Heat only 10 oz or more. b. Do not thaw or heat breast milk in a microwave oven. c. Always leave the bottle top uncovered to allow heat to escape. d. Shake the bottle vigorously for at least 30 seconds after heating.

ANS: B Using a microwave oven to thaw or heat breast milk decreases the anti-infective properties of the breast milk, lowers the vitamin C content, and changes the fat content. Breast milk should be thawed overnight in a refrigerator or in a warm water bath. A microwave should not be used. If steam is created, the milk is too hot. The bottle should be inverted several times after defrosting or warming.

Which statement is correct about toilet training? a. Bladder training is usually accomplished before bowel training? b. Wanting to please the parent helps motivate the child to use the toilet. c. Watching older siblings use the toilet confuses the child. d. Children must be forced to sit on the toilet when first learning

ANS: B Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please parent by holding on rather than pleasing self by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

Which is an important nursing action related to the use of tape or adhesives on premature neonates? a. Avoid using tape and adhesives until skin is more mature. b. Remove adhesives with water, mineral oil, or petrolatum. c. Use scissors carefully to remove tape instead of pulling off the tape. d. Use solvents to remove tape and adhesives instead of pulling on the skin.

ANS: B Warm water, mineral oil, or petrolatum can facilitate the removal of adhesive. In a premature neonate, often it is impossible to avoid using adhesives and tape. The smallest amount of adhesive necessary should be used. Scissors should not be used to remove dressings or tape from very small and immature infants because it is easy to snip off tiny extremities or nick loosely attached skin. Solvents should be avoided because they tend to dry and burn the delicate skin.

The nurse observes that a new mother avoids making eye contact with her newborn. The nurse should do which of the following? a. Examine newborn's eyes for ability to focus. b. Assess for other attachment behaviors. c. Recognize this as a common reaction in new mothers. d. Ask mother why she won't look at infant.

ANS: B b. Attachment behaviors are thought to indicate the formation of emotional bonds between the newborn and the mother. The mother's failure to make eye contact with her newborn may indicate difficulties with the formation of emotional bonds. The nurse should perform a more thorough assessment. a. Newborns do not have binocularity and cannot focus. c. This is an uncommon reaction in new mothers. d. This is a confrontational question that would put the mother in a defensive position.

In a neonate's eyes, strabismus is a normal finding because of: a. congenital cataracts. b. lack of binocularity. c. absence of red reflex. d. inability of pupil to react to light.

ANS: B b. Newborns are unable to focus their eyes on an object. Binocularity does not develop until age 3 to 4 months. a, c, and d. These are not normal findings and need further evaluation.

A nursing intervention to promote parent-infant attachment would be which of the following? a. Delaying parent-child interactions until the second period of reactivity b. Explaining individual differences among infants to the parents c. Alleviating stress for parents by decreasing their participation in the infant's care d. Encouraging parents to hold child frequently unless he or she is fussy

ANS: B b. Nurses can positively influence the attachment of parent and child by recognizing and explaining individual differences to the parents. The nurse should emphasize the normalcy of these variations and demonstrate the uniqueness of each child. a. The nurse should facilitate parent-child interaction during the first period of reactivity. c. Decreasing the parents' participation in care will interfere with parent-infant attachment. d. The parents should be encouraged to hold the child when he or she is fussy and learn how best to soothe their child.

The American Academy of Pediatrics recommends that the best form of infant nutrition is: a. exclusive breastfeeding until age 2 months. b. exclusive breastfeeding until at least age 1 year. c. commercially prepared infant formula for 1 year. d. commercially prepared infant formula until age 4 to 6 months.

ANS: B b. The American Academy of Pediatrics has reaffirmed its position that an infant be breast-fed exclusively for the first year of life. This group also supports programs that enable women to return to work and continue breastfeeding. a. This is too short a period. c and d. The recommendation is for breastfeeding, not commercial formula. If the mother has stopped breastfeeding, then commercial formula, rather than whole milk, should be used until age 1 year.

The Apgar score of a neonate 5 minutes after birth is 8. Which of the following is the nurse's best interpretation of this? a. Resuscitation is likely to be needed. b. Adjustment to extrauterine life is adequate. c. Additional scoring in 5 more minutes is needed. d. Maternal sedation or analgesia contributed to the low score.

ANS: B b. The Apgar reflects the newborn's status in five areas: heart rate, respiratory effort, muscle tone, reflex irritability, and color. Scores of 7 to 10 indicate an absence of difficulty adjusting to extrauterine life. Scores of 0 to 3 indicate severe distress, and scores of 4 to 6 indicate moderate difficulty. a. The Apgar score is not used to determine the newborn's need for resuscitation at birth. c. All infants are rescored at 5 minutes. d. The infant does not have a low score.

The stump of the umbilical cord usually separates in how many days? a. 3 b. 10 to 14 c. 16 to 20 d. 28

ANS: B b. The average cord separates in 10 to 14 days. a. This is too soon. c and d. This is too late. The cord should be separated by these times.

The nurse is assessing a 3-day-old, breast-fed newborn who weighed 7 pounds, 8 ounces at birth. The infant's mother is now concerned that the infant weighs 6 pounds, 15 ounces. The most appropriate nursing intervention is which of the following? a. Recommend supplemental feedings of formula. b. Explain that this weight loss is within normal limits. c. Assess child further to determine cause of excessive weight loss. d. Encourage mother to express breast milk for bottle feeding the infant.

ANS: B b. The neonate normally loses about 10% of the birth weight by age 3 or 4 days. The birth weight is usually regained by the tenth day of life. a, c, and d. Because this is an expected occurrence, no further action is needed. The mother should be taught about normal infant feeding and growing patterns.

Which are characteristic of physical development of a 30-month-old child? (Select all that apply.) a. Birth weight has doubled. b. Primary dentition is complete. c. Sphincter control is achieved. d. Anterior fontanel is open. e. Length from birth is doubled. f. Left or right handedness is established.

ANS: B, C Usually by age 30 months, the primary dentition of 20 teeth is completed, and the child has sphincter control in preparation for bowel and bladder control. Birth weight doubles at approximately ages 5 to 6 months. The anterior fontanel closes at age 12 to 18 months. Birth length is doubled around age 4. Left or right handedness is not established until about age 5.

The nurse is conducting discharge teaching to parents regarding care of the umbilical cord. Which should the nurse include in the instructions? (Select all that apply.) a.Cover the umbilical cord with the diaper. b.The cord will fall off in 5 to 15 days. c.Clean around the umbilical cord stump with water. d.Watch for redness and drainage around the umbilical cord stump. e.A tub bath can be done every other day.

ANS: B, C, D The umbilical cord is cleansed initially with sterile water or a neutral pH cleanser and then subsequently with water. The stump deteriorates through the process of dry gangrene, with an average separation time of 5 to 15 days. The umbilical cord area should be watched for redness or drainage, which could indicate infection. The diaper is placed below the cord to avoid irritation and wetness on the site, and tub bathing is not allowed until the umbilical cord falls off.

The nurse is teaching parents strategies to manage their child's refusal to go to sleep. Which should the nurse include in the teaching session? (Select all that apply.) a. Keep bedtime early. b. Enforce consistent limits. c. Use a reward system with the child. d. Have a consistent before bedtime routine.

ANS: B, C, D Strategies to manage a child's refusal to go to sleep include enforcement of consistent limits, using a reward system, and having a consistent before bedtime routine. An evaluation of whether the hour of sleep is too early should be considered because an early bedtime could cause the child to resist sleep if not tired.

A nurse teaches parents that team play is important for school-age children. Which can children develop by experiencing team play? (Select all that apply.) a. Achieve personal goals over group goals. b. Learn complex rules. c. Experience competition. d. Learn about division of labor.

ANS: B, C, D Team play helps stimulate cognitive growth because children are called on to learn many complex rules, make judgments about those rules, plan strategies, and assess the strengths and weaknesses of members of their own team and members of the opposing team. Team play can also contribute to children's social, intellectual, and skill growth. Children work hard to develop the skills needed to become team members, to improve their contribution to the group, and to anticipate the consequences of their behavior for the group. Team play teaches children to modify or exchange personal goals for goals of the group; it also teaches them that division of labor is an effective strategy for attaining a goal.

The clinic nurse is assessing a 6-month-old infant during a well-child appointment. The nurse should use which approaches to alleviate the infant's stranger anxiety? (Select all that apply.) a. Talk in a loud voice. b. Meet the infant at eye level. c. Avoid sudden intrusive gestures. d. Maintain a safe distance initially. e. Pick up the infant and hold him or her closely.

ANS: B, C, D The best approaches for the nurse to alleviate the infant's stranger anxiety are to talk softly; meet the infant at eye level (to appear smaller); maintain a safe distance from the infant; and avoid sudden, intrusive gestures, such as holding out the arms and smiling broadly. Talking in a loud voice and picking the infant up would increase the infant's anxiety.

What are sources of stress in preschoolers? (Select all that apply.) a. Shares possessions b. Damages or destroys objects c. May fear dogs or other animals d. Seems to be in perpetual motion e. May stutter or stumble over words

ANS: B, C, D, E Sources of stress in preschoolers include damaging or destroying objects, fearing dogs or other animals, in perpetual motion, and may stutter or stumble over words. Guarding possessions, not sharing, is a source of stress.

A nurse is conducting a teaching session on the use of time-out as a discipline measure to parents of toddlers. Which are correct strategies the nurse should include in the teaching session? (Select all that apply.) a. Time-out as a discipline measure cannot be used when in a public place. b. A rule for the length of time-out is 1 minute per year. c. When the child misbehaves, one warning should be given. d. The area for time-out can be in the family room where the child can see the television. e. When the child is quiet for the specified time, he or she can leave the room.

ANS: B, C, E A rule for the length of time-out is 1 minute per year of age; use a kitchen timer with an audible bell to record the time rather than a watch. When the child misbehaves, one warning should be given. When the child is quiet for the duration of the time, he or she can then leave the room. Time-out can be used in public places and the parents should be consistent on the use of time-out. Implement time-out in a public place by selecting a suitable area or explain to children that time-out will be spent immediately on returning home. The time-out should not be spent in an area from which the child can view the television. Select an area for time-out that is safe, convenient, and unstimulating but where the child can be monitored, such as the bathroom, hallway, or laundry room.

A 12-month-old infant has been diagnosed with failure to thrive (FTT). Which assessment findings does the nurse expect to be documented with this infant? (Select all that apply.) a. Fear of strangers b. Minimal smiling c. Avoidance of eye contact d. Meeting developmental milestones e. Wide-eyed gaze and continual scan of the environment

ANS: B, C, E Signs and symptoms of FTT include minimal smiling, avoidance of eye contact, and a wide-eyed gaze and continual scan of the environment ("radar gaze"). There is no fear of strangers, and there are developmental delays, including social, motor, adaptive, and language.

Which screening tests should the school nurse perform for the adolescent? (Select all that apply.) a. Glucose b. Vision c. Hearing d. Cholesterol e. Scoliosis

ANS: B, C, E The school nurse should perform vision, hearing, and scoliosis screening tests according to the school district's required schedule. Glucose and cholesterol screening would be performed in the medical clinic setting.

Which should the nurse teach to parents of toddlers about accidental poison prevention? (Select all that apply.) a. Keep toxic substances in the garage. b. Discard empty poison containers. c. Know the number of the nearest poison control center. d. Remove colorful labels from containers of toxic substances. e. Caution child against eating nonedible items, such as plants.

ANS: B, C, E To prevent accidental poisoning, parents should be taught to promptly discard empty poison containers, know the number of the nearest poison control center and to caution the child against eating nonedible items, such as plants. Parents should place all potentially toxic agents, including cosmetics, personal care items, cleaning products, pesticides, and medications in a locked cabinet, not in the garage. Parents should be taught to never remove labels from containers of toxic substances.

What developmental achievements are demonstrated by a 4-year-old child? (Select all that apply.) a. Cares for self totally b. Throws a ball overhead c. Has a vocabulary of 1500 words d. Can skip and hop on alternate feet e. Tends to be selfish and impatient f. Commonly has an imaginary playmate

ANS: B, C, E, F Developmental achievements for a 4-year-old child include throwing a ball overhead, having a vocabulary of 1500 words, tending to be selfish and impatient, and perhaps having an imaginary playmate. Caring for oneself totally and skipping and hopping on alternate feet are achievements normally seen in the 5-year-old age group.

The nurse is teaching a group of parents at a community education program about introducing solid foods to their infants. Which recommendations should the nurse include? (Select all that apply.) a. Spoon feeding should be introduced after an entire milk feeding. b. It is best to introduce a wide variety of foods during the first year. c. As solid food consumption increases, the quantity of milk should decrease. d. Introduction of low-calorie milk and food should be done by the end of the first year. e. Introduction of citrus fruits, meats, and eggs should be delayed until after 6 months of age. f. Each new food item should be introduced at 5- to 7-day intervals.

ANS: B, C, E, F Teaching related to feeding an infant solid foods should include introducing a wide variety of foods because an infant has not developed a strong food preference as seen with a toddler. As solid food consumption increases, the amount of milk consumed should decrease to less than 1 L/day to prevent overfeeding. Introduction to citrus fruits, meats, and eggs should be delayed until after 6 months of age because of the potential to cause food allergies. New foods should be introduced at 5- to 7-day intervals to evaluate for food allergies. Spoon feedings should be introduced after a small ingestion of milk, not at the end of a milk feeding, to associate the activity with pleasure. In general, low-calorie milk and food should be avoided.

The nurse is instructing a new mother on safety measures for newborn abduction. Which should the nurse include in the instructions? (Select all that apply.) a.Publish the birth announcement in your local newspaper. b.Don't relinquish the newborn to anyone without identification. c.Keep your door open if the newborn is in the room while you shower. d.Use a password system with the staff when the newborn is taken from the room. e.When you use the restroom, ring for a nurse to stay in the room with your newborn.

ANS: B, D, E Safety measures to be taught to new mothers should include (1) not leaving the newborn alone in the crib while taking a shower or using the bathroom; rather, they should ask to have the newborn observed by a health care worker if a family member is not present in the room; (2) not relinquishing the newborn to anyone without identification; and (3) using a password system with the staff when the newborn is taken from the room as a routine security measure. The newborn should not be left alone while the mother is showering, even if the door is left open. It is recommended to not publish the birth announcement in the newspaper.

Which birth injuries should the nurse assess for if an infant was born with the use of a vacuum extractor? (Select all that apply.) a. Torticollis b. Brachial palsy c. Fractured clavicle d. Cephalhematoma e. Subgaleal hemorrhage

ANS: B, D, E Brachia palsy, cephalhematoma, and subgaleal hemorrhage are birth injuries associated with vacuum-assisted extraction. Fractured clavicles are injuries associated with infants who are large for gestational age or weigh more than 4000 g. Torticollis is a condition that occurs from a brachial plexus injury.

The community health nurse is reviewing risk factors for vitamin D deficiency. Which children are at high risk for vitamin D deficiency? (Select all that apply.) a. Children with fair pigmentation b. Children who are overweight or obese c. Children who are exclusively bottle fed d. Children with diets low in sources of vitamin D e. Children of families who use milk products not supplemented with vitamin D

ANS: B, D, E Populations at risk for vitamin D deficiency include overweight or obese children, children with diets low in sources of vitamin D, and children of families who use milk products not supplemented with vitamin D. Children with dark, not fair, pigmentation and children who are exclusively breast fed, not bottle fed, are also at risk.

The neonatal intensive care nurse is caring for a neonate born at 36 weeks of gestation in an incubator. Which actions should the nurse plan to assure adequate skin care for the neonate? (Select all that apply.) a. Changing any adhesives every 12 hours b. Removing adhesives or skin barriers slowly c. Using an adhesive remover when removing tape d. Applying emollient as needed for dry, flaking skin e. Using cleanser or soaps no more than two or three times a week

ANS: B, D, E Skin care for the neonate involves removing adhesive or skin barriers slowly, supporting the skin underneath with one hand and gently peeling away from the skin with the other hand. Emollient should be applied as needed for dry, flaking skin, and cleansers or soaps should be used no more than two or three times a week because they can dry the skin. Adhesive remover, solvents, and bonding agents should be avoided. Adhesives should not be removed for at least 24 hours after application, not 12.

In terms of language and cognitive development, a 4-year-old child would be expected to have which traits? (Select all that apply.) a. Think in abstract terms. b. Follow directional commands. c. Understand conservation of matter. d. Use sentences of eight words. e. Tell exaggerated stories. f. Comprehend another person's perspective.

ANS: B, E Children ages 3 to 4 years can give and follow simple commands and tell exaggerated stories. Children cannot think abstractly at age 4 years. Conservation of matter is a developmental task of the school-age child. Five-year-old children use sentences with eight words with all parts of speech. A 4-year-old child cannot comprehend another's perspective

Dunst, Trivette, and Deal identified the qualities of strong families that help them function effectively. Which qualities are included? (Select all that apply.) a. Ability to stay connected without spending time together b. Clear set of family values, rules, and beliefs c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events d. Sense of commitment toward growth of individual family members as opposed to that of the family unit e. Ability to engage in problem-solving activities f. Sense of balance between the use of internal and external family resources

ANS: B, E, F A clear set of family rules, values, and beliefs that establishes expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families also are able to engage in problem-solving activities and to find a balance between internal and external forces. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Strong families also use varied coping strategies. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit.

During a well-child visit, the father of a 4-year-old boy tells the nurse that he is not sure if his son is ready for kindergarten. The boys birthday is close to the cut-off date, and he has not attended preschool. What is the nurses best recommendation? a. Start kindergarten. b. Talk to other parents about readiness. c. Perform a developmental screening. d. Postpone kindergarten and go to preschool.

ANS: C A developmental assessment with a screening tool that addresses cognitive, social, and physical milestones can help identify children who may need further assessment. A readiness assessment involves an evaluation of skill acquisition. Stating the child should start kindergarten or go to preschool and postpone kindergarten does not address the fathers concerns about readiness for school. Talking to other parents about readiness does not ascertain if the child is ready and does not address the fathers concerns.

The nurse is talking to the parent of a 5-year-old child who refuses to go to sleep at night. What intervention should the nurse suggest in helping the parent to cope with this sleep disturbance? a. Establish a consistent punishment if the child does not go to bed when told. b. Allow the child to fall asleep in a different room and then gently move the child to his or her bed. c. Establish limited rituals that signal readiness for bedtime. d. Allow the child to watch television until almost asleep.

ANS: C An appropriate intervention for a child who resists going to bed is to establish limited rituals such as a bath or story that signal readiness for bed and consistently follow through with the ritual. Punishing the child will not alleviate the resistance problem and may only add to the frustration. Allowing the child to fall asleep in a different room and to watch television to fall asleep are not recommended approaches to sleep resistance.

Which is true regarding an infant's kidney function? a.Conservation of fluid and electrolytes occurs. b.Urine has color and odor similar to the urine of adults. c.The ability to concentrate urine is less than that of adults. d.Normally, urination does not occur until 24 hours after delivery

ANS: C At birth, all structural components are present in the renal system, but there is a functional deficiency in the kidney's ability to concentrate urine and to cope with conditions of fluid and electrolyte stress such as dehydration or a concentrated solute load. Infants' urine is colorless and odorless. The first voiding usually occurs within 24 hours of delivery. Newborns void when the bladder is stretched to 15 ml, resulting in about 20 voidings per day.

A mother who breastfeeds her 6-week-old infant every 4 hours tells the nurse that he seems "hungry all the time." The nurse should recommend which? a.Newborn cereal b.Supplemental formula c.More frequent feedings d.No change in feedings

ANS: C Infants who are breastfed tend to be hungry every 2 to 3 hours. They should be fed frequently. Six weeks is too early to introduce newborn cereal. Supplemental formula is not indicated. Giving additional formula or water to a breastfed infant may satiate the infant and create problems with breastfeeding. The infant requires additional feedings. Four hours is too long between feedings for a breastfed infant.

A parent taking a preschool child to school on the first day asks the nurse, What do I do if my child wants me to stay? What is an appropriate response by the nurse? a. It is better if you do not stay. b. It is best to stay and participate in the activities. c. It is OK to stay part of the first day, but be inconspicuous. d. It would be better to have a good friend take your child to class the first day.

ANS: C On the first day of preschool, in some instances, it is helpful for parents to remain for at least part of the first day until the child is comfortable. If parents stay, they should be available to the child but inconspicuous. It would not be appropriate not to stay, to have someone else take the child to school, or to stay and participate in activities.

What dysfunctional speech pattern is a normal characteristic of the language development of a preschool child? a. Lisp b. Echolalia c. Stammering d. Repetition without meaning

ANS: C Stammering and stuttering are normal dysfluency in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers language.

What signals the resolution of the Oedipus or Electra complex? a. Learns sex differences b. Learns sexually appropriate behavior c. Identifies with the same-sex parent d. Has guilt over feelings toward the father or mother

ANS: C The resolution of the Oedipus or Electra complex is identification with the same-sex parent. Learning sex differences and sexually appropriate behavior is a goal in further differentiation of oneself but does not signal the resolution of the Oedipus or Electra complex. Guilt over feelings toward the father or mother is seen as a stage in the complex, not the resolution.

The nurse is assessing the reflexes of a newborn. Stroking the outer sole of the foot assesses which reflex? a.Grasp b.Perez c.Babinski d.Dance or step

ANS: C This is a description of the Babinski reflex. Stroking the outer sole of the foot upward from the heel across the ball of the foot causes the big toes to dorsiflex and the other toes to hyperextend. This reflex persists until approximately age 1 year or when the newborn begins to walk. The grasp reflex is elicited by touching the palms or soles at the base of the digits. The digits will flex or grasp. The Perez reflex involves stroking the newborn's back when prone; the child flexes the extremities, elevating the head and pelvis. This disappears at ages 4 to 6 months. When the newborn is held so that the sole of the foot touches a hard surface, there is a reciprocal flexion and extension of the leg, simulating walking. This reflex disappears by ages 3 to 4 weeks.

Which should the nurse use when assessing the physical maturity of a newborn? a.Length b.Apgar score c.Posture at rest d.Chest circumference

ANS: C With the newborn quiet and in a supine position, the degree of flexion in the arms and legs can be used for determination of gestational age. Length and chest circumference reflect the newborn's size and weight, which vary according to race and gender. Birth weight alone is a poor indicator of gestational age and fetal maturity. The Apgar score is an indication of the newborn's adjustment to extrauterine life.

What explains why a neutral thermal environment is essential for a high-risk neonate? a. The neonate produces heat by increasing activity and shivering. b. Metabolism slows dramatically in the neonate experiencing cold stress. c. It permits the neonate to maintain a normal core temperature with minimum oxygen consumption. d. It permits the neonate to maintain a normal core temperature with increased caloric consumption.

ANS: C A high-risk neonate is at greater risk for cold stress than a term infant because of the smaller muscle mass and fewer deposits of brown fat for producing heat, lack of insulating subcutaneous fat, and poor reflex control of skin capillaries. By definition, a neutral thermal environment is one that permits the infant to maintain a normal core temperature with minimum oxygen consumption and caloric expenditure. Smaller muscle mass and poor reflex control of skin capillaries decrease the ability of a high-risk neonate to compensate for an environment that is not thermoneutral. Metabolism increases in an infant experiencing cold stress, creating a compensatory increase in oxygen and caloric consumption. Increased caloric consumption is to be avoided. Neonates need available calories for growth.

What is most descriptive of atopic dermatitis (AD) (eczema) in an infant? a. Easily cured b. Worse in humid climates c. Associated with hereditary allergies d. Related to upper respiratory tract infections

ANS: C AD is a type of pruritic eczema that usually begins during infancy and is associated with allergy with a hereditary tendency. Approximately 50% of children with AD develop asthma. AD can be controlled but not cured. Manifestations of the disease are worse when environmental humidity is lower. AD is not associated with respiratory tract infections

The nurse is performing an assessment on a 12-month-old infant. Which fine or gross motor developmental skill demonstrates the proximodistal acquisition of skills? a. Standing b. Sitting without assistance c. Fully developed pincer grasp d. Taking a few steps holding onto something

ANS: C Acquisition of fine and gross motor skills occurs in an orderly center-to-periphery (proximodistal) or head-to-toe (cephalocaudal) sequence. A fully developed pincer grasp is an example of the proximodistal development because infants use a palmar grasp before developing the finer pincer grasp. Standing, sitting without assistance, and taking a few steps are examples of a cephalocaudal development sequence.

A nurse is caring for an adolescent hospitalized for cellulitis. The nurse notes that the adolescent experiences many "mood swings" throughout the day. The nurse interprets this behavior as: a. requiring a referral to a mental health counselor. b. requiring some further lab testing. c. normal behavior. d. related to feelings of depression.

ANS: C Adolescents vacillate in their emotional states between considerable maturity and childlike behavior. One minute they are exuberant and enthusiastic; the next minute they are depressed and withdrawn. Because of these mood swings, adolescents are frequently labeled as unstable, inconsistent, and unpredictable, but the behavior is normal. The behavior would not require a referral to a mental health counselor or further lab testing. The mood swings do not indicate depression.

Which type of family should the nurse recognize when the paternal grandmother, the parents, and two minor children live together? a. Blended b. Nuclear c. Extended d. Binuclear

ANS: C An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one stepparent, stepsibling, or half-sibling. A nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

While a mother is feeding her high-risk neonate, the nurse observes the neonate having occasional apnea, pallor, and bradycardia. What is the most appropriate nursing action? a. Let the neonate rest before breastfeeding again. b. Resume gavage feedings until the neonate is asymptomatic. c. Recognize that this may indicate an underlying illness. d. Use a high-flow, pliable nipple because it requires less energy to use.

ANS: C Apnea, pallor, and bradycardia may be signs of an underlying illness. The infant should be evaluated to ensure he or she is not developing problems. The infant can rest while waiting for the evaluation. If the child is becoming ill, the capacity to digest enteral feedings may be compromised. The type of nipple that is being used should not produce the signs being observed.

A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, "I want to go back to work, but I don't want Eric to suffer because I'll have less time with him." Which is the nurse's most appropriate answer? a. "I'm sure he'll be fine if you get a good babysitter." b. "You will need to stay home until Eric starts school." c. "Let's talk about the child care options that will be best for Eric." d. "You should go back to work so Eric will get used to being with others."

ANS: C Asking the mother about child care options is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. The other three answers are directive; they do not address the effect that her working will have on Eric.

Which play is most typical of the preschool period? a. Solitary b. Parallel c. Associative d. Team

ANS: C Associative play is group play in similar or identical activities but without rigid organization or rules. Solitary play is that of infants. Parallel play is that of toddlers. School-age children play in teams

During the 2-month well-child checkup, the nurse expects the infant to respond to sound in which manner? a. Respond to name. b. React to loud noise with Moro reflex. c. Turn his or her head to side when sound is at ear level. d. Locate sound by turning his or her head in a curving arc.

ANS: C At 2 months of age, an infant should turn his or her head to the side when a noise is made at ear level. At birth, infants respond to sound with a startle or Moro reflex. An infant responds to his or her name and locates sounds by turning his or her head in a curving arc at age 6 to 9 months.

The child of 15 to 30 months is likely to be struggling with which developmental task? a. Trust b. Initiative c. Autonomy d. Intimacy

ANS: C Autonomy vs shame and doubt is the developmental task of toddlers. Trust vs mistrust is the developmental stage of infancy. Initiative vs guilt is the developmental stage of early childhood. Intimacy and solidarity vs isolation is the developmental stage of early adulthood.

A nurse is reviewing hormone changes that occur during adolescence. The hormone that is responsible for the growth of beard, mustache, and body hair in the male is: a. estrogen. b. pituitary. c. androgen. d. progesterone.

ANS: C Beard, mustache, and body hair on the chest, upward along the linea alba, and sometimes on other areas (e.g., back and shoulders) appears in males and is androgen dependent. Estrogen and progesterone are produced by the ovaries in the female and do not contribute to body hair appearance in the male. The pituitary hormone does not have any relationship to body hair appearance in the male.

A nurse is assessing a preschool-age child and notes the child exhibits magical thinking. According to Piaget, which describes magical thinking? a. Events have cause and effect. b. God is like an imaginary friend. c. Thoughts are all-powerful. d. If the skin is broken, the child's insides will come out.

ANS: C Because of their egocentrism and transductive reasoning, preschoolers believe that thoughts are all-powerful. Cause-and-effect implies logical thought, not magical thinking. Thinking God is like an imaginary friend is an example of concrete thinking in a preschooler's spiritual development. Thinking that if the skin is broken, the child's insides will come out is an example of concrete thinking in development of body image.

At which age should the nurse expect most infants to begin to say "mama" and "dada" with meaning? a. 4 months b. 6 months c. 10 months d. 14 months

ANS: C Beginning at about age 10 months, an infant is able to ascribe meaning to the words "mama" and "dada." Four to 6 months is too young for this behavior to develop. At 14 months, the child should be able to attach meaning to these words. By age 1 year, the child can say three to five words with meaning and understand as many as 100 words.

At which age do most infants begin to fear strangers? a. 2 months b. 4 months c. 6 months d. 12 months

ANS: C Between ages 6 and 8 months, fear of strangers and stranger anxiety become prominent and are related to infants' ability to discriminate between familiar and unfamiliar people. At 2 months, infants are just beginning to respond differentially to their mothers. The infant at age 4 months is beginning the process of separation-individuation, which involves recognizing the self and mother as separate beings. Twelve months is too late; the infant requires referral for evaluation if he or she does not fear strangers by this age

When should the nurse expect breastfeeding-associated jaundice to first appear in a normal infant? a. 2 to 12 hours b. 12 to 24 hours c. 2 to 4 days d. After the fifth day

ANS: C Breastfeeding-associated jaundice is caused by decreased milk intake related to decreased caloric and fluid intake by the infant before the mother's milk is well established. Fasting is associated with decreased hepatic clearance of bilirubin. Zero to 24 hours is too soon; jaundice within the first 24 hours is associated with hemolytic disease of the newborn. After the fifth day is too late. Jaundice associated with breastfeeding begins earlier because of decreased breast milk intake.

In the clinic waiting room, a nurse observes a parent showing an 18-month-old child how to make a tower out of blocks. The nurse should recognize in this situation that: a. blocks at this age are used primarily for throwing. b. toddlers are too young to imitate the behavior of others. c. toddlers are capable of building a tower of blocks. d. toddlers are too young to build a tower of blocks.

ANS: C Building with blocks is a good parent-child interaction. The 18-month-old child is capable of building a tower of three or four blocks. The ability to build towers of blocks usually begins at age 15 months. With ongoing development, the child is able to build taller towers. The 18-month-old child imitates others around him or her.

Developmentally, most children at age 12 months: a. use a spoon adeptly. b. relinquish the bottle voluntarily. c. eat the same food as the rest of the family. d. reject all solid food in preference to the bottle.

ANS: C By age 12 months, most children are eating the same food that is prepared for the rest of the family. Using a spoon usually is not mastered until age 18 months. The parents should be engaged in weaning a child from a bottle if that is the source of liquid. Toddlers should be encouraged to drink from a cup at the first birthday and be weaned from the bottle totally by 14 months. The child should be weaned from a milk- or formula-based diet to a balanced diet that includes iron-rich sources of food.

The nurse is examining an infant, age 10 months, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions. What is the most likely cause? a. Impetigo b. Urine and feces c. Candida albicans infection d. Infrequent diapering

ANS: C C. albicans infection produces perianal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal folds. Impetigo is a bacterial infection that spreads peripherally in sharply marginated, irregular outlines. Eruptions involving the skin in contact with the diaper but sparing the folds are likely to be caused by chemical irritation, especially urine and feces, and may be related to infrequent diapering

The nurse is caring for a preterm infant who is receiving caffeine citrate for treatment of apnea of prematurity. What signs should indicate caffeine toxicity? a. Bradycardia and hypotension b. Oliguria and sleepiness c. Vomiting and irritability d. Constipation and weight loss

ANS: C Caffeine citrate is the medication of choice for the treatment of apnea of prematurity because it has fewer side effects, requires once-daily dosing, has slower elimination, and has a wider therapeutic range than other options. Caffeine toxicity can still occur, so the preterm infant needs to be monitored for signs of toxicity, including vomiting and irritability. Bradycardia, hypotension, oliguria, sleepiness, constipation, and weight loss are not symptoms of toxicity

The nurse is planning care for an infant receiving calcium gluconate for treatment of hypocalcemia. Which route of administration should be used? a. Oral b. Intramuscular c. Intravenous d. Intraosseous

ANS: C Calcium gluconate is administered intravenously over 10 to 30 minutes or as a continuous infusion. If it is given more rapidly than this, cardiac dysrhythmias and circulatory collapse may occur. Early feedings are indicated, but when the ionized calcium drops below 3.0 to 4.4 mg/dL, intravenous calcium gluconate is necessary. Intramuscular or intraosseous administration is not recommended.

Which term is defined as a vaguely outlined area of edematous tissue situated over the portion of the scalp that presents in a vertex delivery? a. Hydrocephalus b. Cephalhematoma c. Caput succedaneum d. Subdural hematoma

ANS: C Caput succedaneum is defined as a vaguely outlined area of edematous tissue situated over the portion of the scalp that presents in a vertex delivery. The swelling consists of serum or blood (or both) accumulated in the tissues above the bone, and it may extend beyond the bone margin. Hydrocephalus is caused by an imbalance in production and absorption of cerebrospinal fluid. When production exceeds absorption, fluid accumulates within the ventricular system, causing dilation of the ventricles. A cephalhematoma has sharply demarcated boundaries that do not extend beyond the limits of the (bone) suture line. A subdural hematoma is located between the dura and the cerebrum. It should not be visible on the scalp.

A pregnant client asks the nurse to explain the meaning of "cephalopelvic disproportion." Which explanation should the nurse give to the client? a. "It means a large for gestational age fetus." b. "It is the narrow opening between the ischial spines." c. "There is an uneven size between the fetus' presenting part and the pelvis." d. "The shape of the pelvis is an android shape and is unfavorable for vaginal delivery."

ANS: C Cephalopelvic disproportion means a disproportion (or uneven size) between the fetus' presenting part and the maternal pelvis. It does not mean a large for gestational age fetus or that the pelvis is an android shape. The narrow opening between the ischial spines is called the transverse measurement.

A new parent asks the nurse, "How can diaper rash be prevented?" What should the nurse recommend? a. Wash the infant with soap before applying a thin layer of oil. b. Clean the infant with soap and water every time diaper is changed. c. Wipe stool from the skin using water and a mild cleanser. d. When changing the diaper, wipe the buttocks with oil and powder the creases.

ANS: C Change the diaper as soon as it becomes soiled. Gently wipe stool from the skin with water and mild soap. The skin should be thoroughly dried after washing. Applying oil does not create an effective barrier. Over washing the skin should be avoided, especially with perfumed soaps or commercial wipes, which may be irritating. Baby powder should not be used because of the danger of aspiration.

Which describes moral development in younger school-age children? a. The standards of behavior now come from within themselves. b. They do not yet experience a sense of guilt when they misbehave. c. They know the rules and behaviors expected of them but do not understand the reasons behind them. d. They no longer interpret accidents and misfortunes as punishment for misdeeds.

ANS: C Children who are ages 6 and 7 years know the rules and behaviors expected of them but do not understand the reasons for these rules and behaviors. Young children do not believe that standards of behavior come from within themselves, but that rules are established and set down by others. Younger school-age children learn standards for acceptable behavior, act according to these standards, and feel guilty when they violate them. Misfortunes and accidents are viewed as punishment for bad acts.

A newborn is diagnosed with retinopathy of prematurity. What should the nurse know about this condition? a. Blindness cannot be prevented. b. No treatment is currently available. c. Cryotherapy and laser therapy are effective treatments. d. Long-term administration of oxygen will be necessary.

ANS: C Cryotherapy and laser photocoagulation therapy can be used to minimize the vascular proliferation process that causes the retinal damage. Blindness can be prevented with early recognition and treatment. Long-term administration of oxygen is one of the causes. Oxygen should be used judiciously.

Although a 14-month-old girl received a shock from an electric outlet recently, her parent finds her about to place a paper clip in another outlet. Which is the best interpretation of this behavior? a. Her cognitive development is delayed. b. This is typical behavior because toddlers are not very developed. c. This is typical behavior because of the inability to transfer knowledge to new situations. d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

ANS: C During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. Her cognitive development is appropriate for her age. Trying to put things into an outlet is typical behavior for a toddler. Only some awareness exists of a causal relation between events.

During the preschool period, injury prevention efforts should emphasize: a. constant vigilance and protection. b. punishment for unsafe behaviors. c. education for safety and potential hazards. d. limitation of physical activities.

ANS: C Education for safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Constant vigilance and protection is not practical at this age because preschoolers are becoming more independent. Punishment may make children scared of trying new things. Limitation of physical activities is not appropriate

Which term best describes the sharing of common characteristics that differentiates one group from other groups in a society? a. Race b. Culture c. Ethnicity d. Superiority

ANS: C Ethnicity is a classification aimed at grouping individuals who consider themselves, or are considered by others, to share common characteristics that differentiate them from the other collectivities in a society, and from which they develop their distinctive cultural behavior. Race is a term that groups together people by their outward physical appearance. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perception and judgments. Superiority is the state or quality of being superior; it does not apply to ethnicity.

A new parent relates to the nurse that the family has many known food allergies. Which is considered a primary strategy for feeding the infant with many family food allergies? a. Using soy formula for feeding b. Maternal avoidance of cow's milk protein c. Exclusive breastfeeding for 4 to 6 months d. Delaying the introduction of highly allergenic foods past 6 months

ANS: C Exclusive breastfeeding for 4 to 6 months is now considered a primary strategy for avoiding atopy in families with known food allergies; however, there is no evidence that maternal avoidance (during pregnancy or lactation) of cow's milk protein or other dietary products known to cause food allergy will prevent food allergy in children. Researchers indicate that delaying the introduction of highly allergenic foods past 4 to 6 months of age may not be as protective for food allergy as previously believed. Likewise, studies have shown that soy formula does not prevent allergic disease in infants.

An infant has been diagnosed with failure to thrive (FTT) classified according to the pathophysiology of defective utilization. The nurse understands that the reason for the FTT is most likely related to what? a. Cystic fibrosis b. Hyperthyroidism c. Congenital infection d. Breastfeeding problems

ANS: C FTT classified according to the pathophysiology of defective utilization is related to a genetic anomaly, congenital infection of metabolic storage disease. Cystic fibrosis would be related to the pathophysiology of inadequate absorption, hyperthyroidism would be related to the pathophysiology of increased metabolism, and breastfeeding problems are related to inadequate caloric intake.

The school nurse understands that children are impacted by divorce. Which has the most impact on the positive outcome of a divorce? a. Age of the child b. Gender of the child c. Family characteristics d. Ongoing family conflict

ANS: C Family characteristics are more crucial to the child's well-being during a divorce than specific child characteristics, such as age or sex. High levels of ongoing family conflict are related to problems of social development, emotional stability, and cognitive skills for the child.

Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Interactional theory b. Developmental systems theory c. Family stress theory d. Duvall's developmental theory

ANS: C Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction.

The parent of 2-week-old infant asks the nurse if fluoride supplements are necessary because the infant is exclusively breastfed. What is the nurse's best response? a. "The infant needs to begin taking them now." b. "Supplements are not needed if you drink fluoridated water." c. "The infant may need to begin taking them at age 6 months." d. "The infant can have infant cereal mixed with fluoridated water instead of supplements."

ANS: C Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 6 months if the child is not drinking adequate amounts of fluoridated water. Supplementation is not recommended before age 6 months regardless of whether the mother drinks fluoridated water. Infant cereal is not recommended at 2 weeks of age.

A nurse is teaching parents of kindergarten children general guidelines to assist their children in school. Which statement by the parents indicates they understand the teaching? a. "We will only meet with the teacher if problems occur." b. "We will discourage hobbies so our child focuses on school work." c. "We will plan a trip to the library as often as possible." d. "We will expect our child to make all As in school."

ANS: C General guidelines for parents to help their child in school include sharing an interest in reading. The library should be used frequently and books the child is reading should be discussed. Hobbies should be encouraged. The parents should not expect all As. They should focus on growth more than grades.

At a well-child visit, parents ask the nurse how to know if a daycare facility is a good choice for their infant. Which observation should the nurse stress as especially important to consider when making the selection? a. Developmentally appropriate toys b. Nutritious snacks served to the children c. Handwashing by providers after diaper changes d. Certified caregivers for each of the age groups at the facility

ANS: C Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when handwashing and other hygienic measures are not consistently used. Developmentally appropriate toys are important, but hygiene and the prevention of disease transmission take precedence. An infant should not have snacks. This is a concern for an older child. Certified caregivers for each age group may be an indicator of a high-quality facility, but parental observation of good hygiene is a better predictor of care.

The school nurse tells adolescents in the clinic that confidentiality and privacy will be maintained unless a life-threatening situation arises. This practice is: a. not appropriate in a school setting. b. never appropriate because adolescents are minors. c. important in establishing trusting relationships. d. suggestive that the nurse is meeting his or her own needs.

ANS: C Health professionals who work with adolescents should consider adolescents' increasing independence and responsibility while maintaining privacy and ensuring confidentiality. However, in some circumstances, such as self-destructive behavior or maltreatment by others, they are not able to maintain confidentiality. Confidentiality and privacy are necessary to build trust with this age group. The nurse must be aware of the limits placed on confidentiality by local jurisdiction.

The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven and will be able to heat the baby's formula faster. What should the nurse recommend? a. Heat only 8 oz or more. b. Do not heat a plastic bottle in a microwave oven. c. Leave the bottle top uncovered to allow heat to escape. d. Shake the bottle vigorously for at least 30 seconds after heating.

ANS: C If a microwave is being used, the bottle should be left uncovered. This will allow heat to escape. No more than 4 oz should be heated at any one time. Bottles can be heated safely in microwave ovens if safety guidelines are followed. The bottle should be inverted 10 times; vigorous shaking is not necessary.

What is an appropriate action when an infant becomes apneic? a. Shake vigorously. b. Roll the infant's head to the side. c. Gently stimulate the trunk by patting or rubbing. d. Hold the infant by the feet upside down with the head supported.

ANS: C If an infant is apneic, the infant's trunk should be gently stimulated by patting or rubbing. If the infant is prone, turn onto the back. Vigorous shaking, rolling of the head, and hanging the child upside down can cause injury and should not be done.

A newborn has been diagnosed with brachial nerve paralysis. The nurse should assist the breastfeeding mother to use which hold or position during feeding? a. Reclining b. The cradle hold c. The football hold d. The cross-over hold

ANS: C In brachial nerve paralysis, the affected arm is gently immobilized on the upper abdomen. Tucking the newborn under the arm (football hold) puts less pressure on the newborn's affected extremity. The other positions place the newborn's body next to the mother's and can cause pressure on the affected arm.

The nurse is planning to counsel family members as a group to assess the family's group dynamics. Which theoretic family model is the nurse using as a framework? a. Feminist theory b. Family stress theory c. Family systems theory d. Developmental theory

ANS: C In family systems theory, the family is viewed as a system that continually interacts with its members and the environment. The emphasis is on the interaction between the members; a change in one family member creates a change in other members, which in turn results in a new change in the original member. Assessing the family's group dynamics is an example of using this theory as a framework. Family stress theory explains how families react to stressful events and suggests factors that promote adaptation to stress. Developmental theory addresses family change over time using Duvall's family life cycle stages based on the predictable changes in the family's structure, function, and roles, with the age of the oldest child as the marker for stage transition. Feminist theories assume that privilege and power are inequitably distributed based upon gender, race, and class.

A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicles, and juices, are left. Which statement best explains this? a. The parent is trying to feed the child only what the child likes most. b. Hispanics believe the "evil eye" enters when a person gets cold. c. The parent is trying to restore normal balance through appropriate "hot" remedies. d. Hispanics believe an innate energy called chi is strengthened by eating soup.

ANS: C In several cultures, including Filipino, Chinese, Arabic, and Hispanic, hot and cold describe certain properties completely unrelated to temperature. Respiratory conditions such as pneumonia are "cold" conditions and are treated with "hot" foods. The child may like broth but is unlikely to always prefer it to Jell-O, Popsicles, and juice. The evil eye applies to a state of imbalance of health, not curative actions. Chinese individuals, not Hispanic individuals, believe in chi as an innate energy.

According to Piaget, a 6-month-old infant should be in which developmental stage? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata

ANS: C Infants are usually in the secondary circular reaction stage from ages 4 to 8 months. This stage is characterized by a continuation of the primary circular reaction for the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. The use of reflexes stage is primarily during the first month of life. The primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from ages 1 to 4 months. The fourth sensorimotor stage is coordination of secondary schemata, which occurs at ages 9 to 12 months. This is a transitional stage in which increasing motor skills enable greater exploration of the environment.

An infant weighed 8 lb at birth and was 18 inches in length. What weight and length should the infant be at 5 months of age? a. 12 lb, 20 inches b. 14 lb, 21.5 inches c. 16 lb, 23 inches d. 18 lb, 24.5 inches

ANS: C Infants gain 680 g (1.5 lb) per month until age 5 months, when the birth weight has at least doubled. Height increases by 2.5 cm (1 inch) per month during the first 6 months. Therefore, at 5 months the infant should weigh 16 lb and be 23 inches in length.

The nurse is teaching parents guidelines for feeding their 8-month-old infant with failure to thrive (FTT). Which statement by the parents indicates a need for further teaching? a. "We will continue to use the 24-kcal/oz formula." b. "We will be sure to follow the formula preparation instructions." c. "We will be sure to give our infant at least 8 oz of juice every day." d. "We will be sure to feed our infant according to the written schedule."

ANS: C Juice intake in infants with FTT should be withheld until adequate weight gain has been achieved with appropriate milk sources; thereafter, no more than 4/oz day of juice should be given. Further teaching is needed if the parents indicate 8 oz of juice is allowed. For infants with FTT, 24-kcal/oz formulas may be provided to increase caloric intake. Because maladaptive feeding practices often contribute to growth failure, parents should follow specific step-by-step directions for formula preparation, as well as a written schedule of feeding times. Statements by the parents indicating they will use a 24-kcal/oz formula, follow directions for formula preparation, and feed their infant on schedule are accurate statements.

What is marasmus? a. Deficiency of protein with an adequate supply of calories b. Syndrome that results solely from vitamin deficiencies c. Not confined to geographic areas where food supplies are inadequate d. Characterized by thin, wasted extremities and a prominent abdomen resulting from edema (ascites)

ANS: C Marasmus is a syndrome of emotional and physical deprivation. It is not confined to geographic areas were food supplies are inadequate. Marasmus is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears old, with flabby and wrinkled skin. Marasmus is a deficiency of both protein and calories.

Which snack should the nurse recommend parents offer to their slightly overweight preschool child? a. Carbonated beverage b. 10% fruit juice c. Low fat chocolate milk d. Whole milk

ANS: C Milk and dairy products are excellent sources of calcium and vitamin D (fortified). Low-fat milk may be substituted, so the quantity of milk may remain the same while limiting fat intake overall. Parents should be educated regarding non-nutritious fruit drinks, which usually contain less than 10% fruit juice yet are often advertised as healthy and nutritious, sugar content is dramatically increased and often precludes an adequate intake of milk by the child. In young children, intake of carbonated beverages that are acidic or that contain high amounts of sugar is also known to contribute to dental caries. Low fat milk should be substituted for whole milk if the child is slightly overweight.

By which age should the nurse expect that an infant will be able to pull to a standing position? a. 5 to 6 months b. 7 to 8 months c. 11 to 12 months d. 14 to 15 months

ANS: C Most infants can pull themselves to a standing position at age 9 months. Infants who are not able to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months, infants have just obtained coordination of arms and legs. By age 8 months, infants can bear full weight on their legs.

A mother brings her 6-week-old infant in with complaints of poor feeding, lethargy, fever, irritability, and a vesicular rash. What does the nurse suspect? a. Impetigo b. Candidiasis c. Neonatal herpes d. Congenital syphilis

ANS: C Neonatal herpes is one of the most serious viral infections in newborns, with a mortality rate of up to 60% in infants with disseminated disease. Bullous impetigo is an infectious superficial skin condition most often caused by Staphylococcus aureus infection. It is characterized by bullous vesicular lesions on previously untraumatized skin. Candidiasis is characterized by white adherent patches on the tongue, palate, and inner aspects of the cheeks. Congenital syphilis has multisystem manifestations, including hepatosplenomegaly, lymphadenopathy, hemolytic anemia, and thrombocytopenia.

A preterm infant is being fed by gavage. What is an important consideration for this infant? a. Warm the feeding to body temperature before feeding. b. Feed the infant in an isolette to minimize handling. c. Provide a pacifier for nonnutritive sucking during bolus feeding. d. Do not allow the infant to have increased stress by becoming hungry.

ANS: C Nonnutritive sucking during feedings will help the infant associate sucking with food. This can minimize feeding resistance and aversion. Warming the feeding to body temperature is not necessary. The food can be at room temperature. If possible, the infant should be held in a feeding position. The infant should be allowed to become hungry so that the food and nonnutritive sucking are associated with satisfying the hunger.

What is an essential component in caring for the very low- or extremely low-birth-weight infant? a. Holding the infant to help develop trust b. Using electronic monitoring devices exclusively c. Coordinating care to reduce environmental stress d. Incorporating infant stimulation elements during assessment

ANS: C One of the principles of care for high-risk neonates is close observation and assessment with minimum handling. The nurse checks the apical rate against the monitor readings on a regular basis. The infant's care is then clustered, and the infant is disturbed as little as possible. Holding an infant to help develop trust is not part of the assessment. In some areas, parents use "skin-to-skin" care with their infants. Although electronic monitoring devices are used, the nurse must validate the readings with the infant's data. For an ill neonate, excessive stimulation creates stress.

Imaginary playmates are beneficial to the preschool child because they: a. take the place of social interactions. b. take the place of pets and other toys. c. become friends in times of loneliness. d. accomplish what the child has already successfully accomplished.

ANS: C One purpose of an imaginary friend is to be a friend in time of loneliness. Imaginary friends do not take the place of social interaction, but may encourage conversation. Imaginary friends do not take the place of pets or toys. Imaginary friends accomplish what the child is still attempting.

A 4-month-old infant is discharged home after surgery for the repair of a cleft lip. What should instructions to the parents include? a. Provide crib toys for distraction. b. Breast- or bottle-feeding can begin immediately. c. Give pain medication to the infant to minimize crying. d. Leave the infant in the crib at all times to prevent suture strain.

ANS: C Pain medication and comfort measures are used to minimize infant crying. Interventions are implemented to minimize stress on the suture line. Although crib toys are important, the child should not be left in the crib for prolonged periods. Feeding begins with alternative feeding devices. Sucking puts stress on the suture line in the immediate postoperative period. The infant should not be left in the crib but should be removed for appropriate holding and stimulation.

Parents need further teaching about the use of car safety seats if they make which statement? a. "Even if our toddler helps buckle the straps, we will double-check the fastenings." b. "We won't start the car until everyone is properly restrained." c. "We won't need to use the car seat on short trips to the store." d. "We will anchor the car seat to the car's anchoring system."

ANS: C Parents need to be taught to always use the restraint even for short trips. Further teaching is needed if they make this statement. Parents have understood the teaching if they encourage the child to help attach buckles, straps, and shields but always double-check fastenings, do not start the car until everyone is properly restrained, and anchor the car safety seat securely to the car's anchoring system and apply the harness snugly to the child.

A 4-year-old child tells the nurse that she does not want another blood sample drawn because "I need all my insides, and I don't want anyone taking them out." Which is the nurse's best interpretation of this? a. Child is being overly dramatic. b. Child has a disturbed body image. c. Preschoolers have poorly defined body boundaries. d. Preschoolers normally have a good understanding of their bodies.

ANS: C Preschoolers have little understanding of body boundaries, which leads to fears of mutilation. The child is not capable of being dramatic at 4 years of age. She truly has fear. Body image is just developing in the school-age child. Preschoolers do not have good understanding of their bodies.

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

ANS: C Puberty signals the beginning of the development of secondary sex characteristics. This begins earlier in girls than in boys. Usually a 2-year difference occurs in the age of onset. Girls and boys do not usually begin puberty at the same age. Girls generally begin puberty 2 years earlier than boys.

A 1-year-old child is on a pure vegetarian (vegan) diet. This diet requires supplementation with what? a. Niacin b. Folic acid c. Vitamins D and B12 d. Vitamins C and E

ANS: C Pure vegetarian (vegan) diets eliminate any food of animal origin, including milk and eggs. These diets require supplementation with many vitamins, especially vitamin B6, vitamin B12, riboflavin, vitamin D, iron, and zinc. Niacin, folic acid, and vitamins C and E are readily obtainable from foods of vegetable origin.

Which statement best describes the characteristics of preterm infants? a. Thermoregulation is well established. b. Extremities remain in attitude of flexion. c. Sucking reflex is absent, weak, or ineffectual. d. The head is proportionately small in relation to the body.

ANS: C Reflex activity is only partially developed. Sucking is absent, weak, or ineffectual. Thermoregulation is poorly developed, and a preterm infant needs to be in a neutral thermal environment. A preterm infant may be listless and inactive compared with the overall attitude of flexion and activity of a full-term infant. A preterm infant's head is proportionately larger than the body.

In terms of gross motor development, what should the nurse expect an infant age 5 months to do? a. Sit erect without support. b. Roll from the back to the abdomen. c. Turn from the abdomen to the back. d. Move from a prone to a sitting position.

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

At which age can most infants sit steadily unsupported? a. 4 months b. 6 months c. 8 months d. 12 months

ANS: C Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months, an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months, the infant can maneuver from a prone to a sitting position

Children are taught the values of their culture through observation and feedback relative to their own behavior. In teaching a class on cultural competence, the nurse should be aware that which factor may be culturally determined? a. Ethnicity b. Racial variation c. Status d. Geographic boundaries

ANS: C Status is culturally determined and varies according to each culture. Some cultures ascribe higher status to age or socioeconomic position. Social roles also are influenced by the culture. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. It is one component of culture. Race and culture are two distinct attributes. Whereas racial grouping describes transmissible traits, culture is determined by the pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. Cultural development may be limited by geographic boundaries, but the boundaries are not culturally determined.

The health care provider has prescribed surfactant, beractant (Survanta), to be administered to an infant with respiratory distress syndrome (RDS). The nurse understands that the beractant will be administered by which route? a. Orally b. Intravenously c. Via the ET tube d. Intramuscularly

ANS: C Surfactant is administered via the ET tube directly into the infant's trachea.

Which intervention is the most appropriate recommendation for relief of teething pain? a. Rub gums with aspirin to relieve inflammation. b. Apply hydrogen peroxide to gums to relieve irritation. c. Give the infant a frozen teething ring to relieve inflammation. d. Have the infant chew on a warm teething ring to encourage tooth eruption.

ANS: C Teething pain is a result of inflammation, and cold is soothing. A frozen teething ring or ice cube wrapped in a washcloth helps relieve the inflammation. Aspirin is contraindicated secondary to the risks of aspiration. Hydrogen peroxide does not have an anti-inflammatory effect. Warmth increases inflammation.

At what age is it safe to give infants whole milk instead of commercial infant formula? a. 6 months b. 9 months c. 12 months d. 18 months

ANS: C The American Academy of Pediatrics does not recommend the use of cow's milk for children younger than 12 months. At 6 and 9 months, the infant should be receiving breast milk or iron-fortified commercial infant formula. At age 18 months, milk and formula are supplemented with solid foods, water, and some fruit juices.

The parents of a young child ask the nurse for suggestions about discipline. When discussing the use of time-outs, which should the nurse include? a. Send the child to his or her room if the child has one. b. A general rule for length of time is 1 hour per year of age. c. Select an area that is safe and nonstimulating, such as a hallway. d. If the child cries, refuses, or is more disruptive, try another approach.

ANS: C The area must be nonstimulating and safe. The child becomes bored in this environment and then changes behavior to rejoin activities. The child's room may have toys and activities that negate the effect of being separated from the family. The general rule is 1 minute per year of age. An hour per year is excessive. When the child cries, refuses, or is more disruptive, the time-out does not start; the time-out begins when the child quiets.

At which age does an infant start to recognize familiar faces and objects, such as his or her own hand? a. 1 month b. 2 months c. 3 months d. 4 months

ANS: C The child can recognize familiar objects at approximately age 3 months. For the first 2 months of life, infants watch and observe their surroundings. The 4-month-old infant is beginning to develop hand-eye coordination.

The nurse is discussing parenting in reconstituted families with a new stepparent. The nurse is aware that the new stepparent understands the teaching when which statement is made? a. "I am glad there will be no disruption in my lifestyle." b. "I don't think children really want to live in a two-parent home." c. "I realize there may be power conflicts bringing two households together." d. "I understand contact between grandparents should be kept to a minimum."

ANS: C The entry of a stepparent into a ready-made family requires adjustments for all family members. Power conflicts are expected, and flexibility, mutual support, and open communication are critical in successful relationships. So the statement that power conflicts are possible means teaching was understood. Some obstacles to the role adjustments and family problem solving include disruption of previous lifestyles and interaction patterns, complexity in the formation of new ones, and lack of social supports. Most children from divorced families want to live in a two-parent home. There should be continued contact with grandparents.

An infant of a mother with herpes simplex infection has just been born. What should nursing considerations include? a. The infant should be isolated in a nursery. b. No special precautions are necessary. c. The mother and infant should be together in a private room. d. Immediate discharge is indicated to prevent spread of infection.

ANS: C The herpes virus can be transmitted to the infant intrapartum or by direct contact. The mother and infant should room together in a private room to reduce the risk of transmission to other infants and mothers. The infant should be kept with the mother. Placement in the nursery creates the possibility of transmission of the virus. Immediate discharge is not necessary. Good handwashing and a private room will minimize the risk of transmission while allowing the mother and infant to receive postpartum care.

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. Which is the most appropriate recommendation? a. Punish the child. b. Leave the child alone until the tantrum is over. c. Remain close by the child but without eye contact. d. Explain to child that this is wrong.

ANS: C The parent should be told that the best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common in toddlers as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The parent's presence is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

Parents are concerned about the number of hours their teenage daughter spends with peers. The nurse explains that peer relationships are important during adolescence for which reason? a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents.

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

What is a priority of care for an infant with an intraventricular hemorrhage? a. Avoid use of analgesia. b. Keep the infant's head to the right side. c. Minimize interventions that cause crying. d. Encourage the staff and parents to hold the infant.

ANS: C The priority goal is to decrease intracranial pressure (ICP). Allowing the infant to cry will cause an increase in pressure. Analgesia is used as necessary to maintain the child pain free. This reduces ICP. The infant should be positioned with the body and head in the midline position. Turning the child's head to the right side can cause cerebral venous congestion and increased ICP. The child should have minimum stimulation to avoid increases in ICP.

The nurse is placing an infant in a servocontrol radiant warmer. The nurse should attach the temperature probe to which area of the infant's body? a. Scapula b. Sternum c. Abdomen d. Front of the lower leg

ANS: C The temperature probe should be placed over a nonbony, well-perfused tissue area such as the abdomen or flank. The scapula, sternum, and front of the lower leg would be a bony area

Which of the following statements best represents the first stage of the first period of reactivity in the neonate? a. Begins when the infant awakes from a deep sleep b. Ends when the amount of respiratory mucus has decreased c. Is an excellent time to acquaint the parents with the infant d. Is an excellent time for mother to sleep and recover

ANS: C c. During the first period of reactivity, the infant is alert, cries vigorously, may suck the fist greedily, and appears interested in the environment. The neonate's eyes are usually wide open, suggesting that this is an excellent opportunity for mother, father, and child to see each other. a. This is when the second period of reactivity begins. b. This describes the end of the second period of reactivity. d. The mother should sleep and recover during the second stage, when the infant is sleeping.

Successful breastfeeding is most dependent on which of the following? a. Mother's socioeconomic level b. Size of mother's breasts c. Mother's desire to breastfeed d. Birth weight of infant

ANS: C c. The factors that contribute to successful breastfeeding are the mother's desire to breastfeed, satisfaction with breastfeeding, and available support systems. a. This may affect the mother's need to return to work and available support systems, but with support, the mother can be successful. b. This does not affect the success of breastfeeding. d. Very low-birth-weight infants may be unable to breastfeed. The mother can express milk, and it can be used for the child.

A newborn is being discharged at age 48 hours. The parents ask how the infant should be bathed this first week home. The nurse's best recommendation is to bathe the newborn: a. daily with mild soap. b. daily with an alkaline soap. c. two or three times this week with plain water. d. two or three times this week with mild soap.

ANS: C c. The newborn infant's skin has a pH of approximately 5. This acidic pH has a bacteriostatic effect. The parents should be taught to use only plain warm water for the bath and to bathe the child no more than two or three times a week for the first 2 weeks. a, b, and d. Soaps are alkaline. They will alter the acid mantle of the child's skin, providing a medium for bacterial growth.

The nurse should expect the apical heart rate of a stabilized neonate to be in which of the following ranges? a. 60 to 80 beats/min b. 80 to 100 beats/min c. 120 to 140 beats/min d. 160 to 180 beats/min

ANS: C c. The pulse rate of the newborn varies with periods of reactivity. Usually the pulse rate is between 120 and 140 beats/min. a and b. This is too slow for a neonate. d. This is too fast for a neonate.

What term describes irregular areas of deep blue pigmentation seen predominantly in newborns of African, Asian, Native American, or Hispanic descent? a. Acrocyanosis b. Erythema toxicum c. Mongolian spots d. Harlequin color changes

ANS: C c. This describes Mongolian spots, which are common variations found in newborns of African, Asian, Native American, or Hispanic descent. a. Acrocyanosis is cyanosis of the hands and feet that is a usual finding in newborns. b. Erythema toxicum is a pink papular with vesicles that may appear in 24 to 48 hours and resolve after several days. d. Harlequin color changes are clearly outlined areas of color change. As the infant lies on a side, the lower half of the body becomes pink, and the upper half is pale.

Stroking the neonate's cheek along the side of the mouth causes the infant to turn the head toward that side and begin to suck. This is which of the following reflexes? a. Perez b. Sucking c. Rooting d. Extrusion

ANS: C c. This is a description of the rooting reflex, which usually disappears by age 3 to 4 months but may persist for up to 12 months. a. The Perez reflex involves stroking the infant's back when prone; the child flexes extremities, elevating head and pelvis. It disappears at age 4 to 6 months. b. The infant begins strong sucking movements in response to circumoral stimulation. The reflex persists throughout infancy, even without stimulation. d. Infants force their tongues outward, when the tongue is touched or depressed. This reflex usually disappears by age 4 months.

Nursing interventions to maintain a patent airway in a neonate should include which of the following? a. Sleeping in the prone (on abdomen) position b. Wrapping neonate as snugly as possible c. Positioning neonate supine after feedings d. Using bulb syringe to suction as needed, suctioning nose first, and then pharynx

ANS: C c. This is the position recommended by the American Academy of Pediatrics to prevent sudden infant death syndrome. a. This is not advised because of the possible link between sleeping in the prone position and sudden infant death syndrome. b. The child can be wrapped snugly, but should be placed on side or back. d. A bulb syringe should be kept by the bedside if necessary, but the pharynx should be suctioned before the nose.

The nurse is presenting an in-service session on assessing gestational age in newborns. Which of the following information should be included? a. The infant's length and weight are the most accurate indicators of gestational age. b. The infant's Apgar score and the mother's estimated date of confinement (EDC) are combined to determine gestational age. c. The infant's posture at rest and arm recoil are two physical signs used to determine gestational age. d. The infant's chest circumference compared to the head circumference is thedeterminant for gestational age.

ANS: C c. With the infant quiet and in a supine position, the degree of flexion in the arms and legs and the arm recoil can be used to help determine gestational age. a and d. Length, weight, and the chest/head circumference reflect the infant's size and weight, which vary according to race and gender. Birth weight alone is a poor indicator of gestational age and fetal maturity. b. The Apgar score is an indication of the infant's adjustment to extrauterine life, and the mother's EDC is of no importance in determining gestational age.

The nurse understands that traits of gifted children include what? (Select all that apply.) a. Fair memory skills b. Limited sense of humor c. Perfectionism as a focus d. Inquisitive; always asking questions e. Displays intense feelings and emotion

ANS: C, D, E Characteristics of gifted children include perfectionism as a focus; inquisitive, always asking questions; and displaying intense feelings and emotion. Memory skills are pronounced, and humor is exceptional.

The nurse is teaching parents of a 4-year-old child about fine motor developmental milestones. What milestones should the nurse include in the teaching session? (Select all that apply.) a. Can lace shoes b. Uses scissors successfully c. Builds a tower of nine or 10 cubes d. Builds a bridge with three cubes e. Adeptly places small pellets in a narrow-necked bottle

ANS: C, D, E The fine motor milestones of a 4-year-old child include building a tower of nine or 10 cubes, building a bridge with three cubes, and adeptly placing small pellets in a narrow-necked bottle. Lacing shoes and using scissors successfully are fine motor milestones seen at the age of 5 years.

The nurse is providing anticipatory guidance to parents of a 6-month-old on preventing an accidental poisoning injury. Which should the nurse include in the teaching? (Select all that apply.) a. Place plants on the floor. b. Place medications in a cupboard. c. Discard used containers of poisonous substances. d. Keep cosmetic and personal products out of the child's reach. e. Make sure that paint for furniture or toys does not contain lead.

ANS: C, D, E Anticipatory guidance for a 7-month-old infant to prevent a suffocation injury takes into account that the infant will become more active and eventually crawl, cruise, and walk. Used containers of poisonous substances should be discarded, cosmetic and personal products should be kept out of the child's reach, and paint for furniture or toys should be lead free. Plants should be hung out of reach or placed on a high shelf. Medications should be locked, not just placed in a cupboard.

The nurse is teaching parents of a bottle-fed preterm infant techniques to facilitate feeding. Which techniques should the nurse include? (Select all that apply.) a. Choose a soft nipple. b. Avoid arousing the infant. c. Recognize the infant's limits. d. Prepare a calm, quiet area for the feeding. e. Ensure a restful environment between feedings.

ANS: C, D, E Feeding facilitation techniques for preterm infants include recognizing the infant's limits; preparing a calm, quiet area for the feeding; and ensuring a restful environment between feedings. Using a firm nipple with slower flow and gently arousing the infant for the feeding are other facilitation techniques. Using a soft nipple and avoiding arousing the infant are techniques that would not facilitate feeding.

What are risk factors for sudden infant death syndrome? (Select all that apply.) a. Postterm b. Female gender c. Low Apgar scores d. Recent viral illness e. Native American infants

ANS: C, D, E Infant risk factors for sudden infant death syndrome include those with low Apgar scores and recent viral illness and Native American infants. Preterm, not postterm, birth and male, not female, gender are other risk factors.

The nurse is positioning a preterm neonate. What are therapeutic positions the nurse should implement? (Select all that apply.) a. Elbows extended b. Hands at the side c. Neutral or slightly flexed neck d. Trunk slightly rounded with pelvic tilt e. Hips partially flexed and adducted to near midline

ANS: C, D, E Therapeutic positioning of the neonate includes a neutral or slightly flexed neck and the trunk slightly rounded with the pelvis tilted and hips partially flexed and adducted to near midline. The elbows should be flexed, not extended, and the hands should be brought to the face or midline as the position allows, not by the side.

The nurse is conducting an assessment of fine motor development in a 3-year-old child. Which is the expected drawing skill for this age? a. Can draw a complete stick figure b. Holds the instrument with the fist c. Can copy a triangle and diamond d. Can copy a circle and imitate a cross

ANS: D A 3-year-old child copies a circle and imitates a cross and vertical and horizontal lines. He or she holds the writing instrument with the fingers rather than the fist. A 3-year-old is not able to draw a complete stick figure but draws a circle, later adds facial features, and by age 5 or 6 years can draw several parts (head, arms, legs, body, and facial features). Copying a triangle and diamond are mastered sometime between ages 5 and 6 years.

At a seminar for parents with preschool-age children, the nurse has discussed anticipatory tasks during the preschool years. Which statement by a parent should indicate a correct understanding of the teaching? a. I should be worried if my 4-year-old child has an increase in sexual curiosity because this is a sign of sexual abuse. b. I should expect my 5-year-old to change from a tranquil child to an aggressive child when school starts. c. I should be concerned if my 4-year-old child starts telling exaggerated stories and has an imaginary playmate, since these could be signs of stress. d. I should expect my 3-year-old child to have a more stable appetite and an increase in food selections.

ANS: D A 3-year-old child exhibits a more stable appetite than during the toddler years and is more willing to try different foods. A 4-year-old child is imaginative and indulges in telling tall tales and may have an imaginary playmate; these are normal findings, not signs of stress. Also a 4-year-old child has an increasing curiosity in sexuality, which is not a sign of child abuse. A 5-year-old child is usually tranquil, not aggressive like a 4-year-old child.

An infant is being discharged at 48 hours of age. The parents ask how the infant should be bathed this first week home. Which is the best recommendation by the nurse? a.Bathe the infant daily with mild soap. b.Bathe the infant daily with an alkaline soap. c.Bathe the infant two or three times this week with mild soap. d.Bathe the infant two or three times this week with plain water.

ANS: D A newborn infant's skin has a pH of approximately 5. This acidic pH has a bacteriostatic effect. The parents should be taught to use only plain warm water for the bath and to bathe the infant no more than two or three times the first 2 weeks. Soaps are alkaline. They will alter the acid mantle of the infant's skin, providing a medium for bacterial growth.

Which type of play is most typical of the preschool period? a. Team b. Parallel c. Solitary d. Associative

ANS: D Associative play is group play in similar or identical activities but without rigid organization or rules. School-age children play in teams. Parallel play is that of toddlers. Solitary play is that of infants.

What characteristic best describes the language skills of a 3-year-old child? a. Asks meanings of words b. Follows directional commands c. Can describe an object according to its composition d. Talks incessantly regardless of whether anyone is listening

ANS: D Because of the dramatic vocabulary increase at this age, 3-year-old children are known to talk incessantly regardless of whether anyone is listening. A 4- to 5-year-old child asks lots of questions and can follow simple directional commands. A 6-year-old child can describe an object according to its composition.

The nurse quickly dries the newborn after delivery. This is to conserve the newborn's body heat by preventing heat loss through which method? a.Radiation b.Conduction c.Convection d.Evaporation

ANS: D Evaporation is the loss of heat through moisture. The newborn should be quickly dried of the amniotic fluid. Radiation is the loss of heat to a cooler solid object. The cold air from either the window or the air conditioner will cool the walls of the incubator and subsequently the body of the newborn. Conduction involves the loss of heat from the body because of direct contact of the skin with a cooler object. Convection is similar to conduction but is the loss of heat aided by air currents.

Parents of a preschool child tell the nurse, Our child seems to have many imaginary fears. What suggestion should the nurse give to the parents to help their child resolve the fears? a. Ignore the fears; they will go away. b. Explain to your child the fears are not real. c. Give your child some new toys to allay the fears. d. Help your child to resolve the fears through play activities.

ANS: D Preschoolers are able to work through many of their unresolved fears, fantasies, and anxieties through play, especially if guided with appropriate play objects (e.g., dolls or puppets) that represent family members, health professionals, and other children. The fears should not be ignored because they may escalate. Preschoolers are not cognitively prepared for explanations about the fears. They gain security and comfort from familiar objects such as toys, dolls, or photographs of family members, so new toys should not be introduced.

The nurse is teaching new parents about the benefits of breastfeeding their infant. Which statement by the parent should indicate a correct understanding of the teaching? a."I should breastfeed my baby so that she will grow at a faster rate than a bottle-fed newborn." b."One of the advantages of breastfeeding is that the baby will have fewer stools per day." c."I should breastfeed my baby because breastfed babies adapt more easily to a regular schedule of feedings." d."Some of the advantages of breastfeeding are that breast milk is economical and readily available for my baby."

ANS: D Some advantages of breastfeeding a newborn are that breast milk is more economical, is readily available, and is sanitary. Breastfed newborns usually grow at a satisfactory, slower rate than bottle-fed newborns, which research indicates aids in decreased obesity in children. Breastfed babies have an increased number of stools throughout a 24-hour period, and neither breastfed nor bottle-fed newborns should be placed on a regular schedule; they should be fed on demand

What is most descriptive of the shape of the anterior fontanel in a newborn? a.Circle b.Square c.Triangle d.Diamond

ANS: D The anterior fontanel is diamond shaped and measures from barely palpable to 4 to 5 cm. The shape of the posterior fontanel is a triangle. Neither of the fontanels is a circle or a square.

In term newborns, the first meconium stool should occur no later than within how many hours after birth? a.6 b.8 c.12 d.24

ANS: D The first meconium stool should occur within the first 24 hours. It may be delayed up to 7 days in very low-birth-weight newborns.

The nurse is planning to bring a preschool child a toy from the playroom. What toy is appropriate for this age group? a. Building blocks b. A 500-piece puzzle c. Paint by number picture d. Farm animals and equipment

ANS: D The most characteristic and pervasive preschooler activity is imitative, imaginative, and dramatic play. Farm animals and equipment would provide hours of self-expression. Building blocks are appropriate for older infants and toddlers. A 500-piece puzzle or a paint by number picture would be appropriate for a school-age child.

What should the nurse suggest to parents of preschoolers about sensitive questions regarding sex? a. Distract your child from the topic. b. Offer complete factual information. c. Dismiss the topic until the child is older. d. Find out what your child knows or thinks.

ANS: D Two rules govern answering sensitive questions about topics such as sex. The first is to find out what children know and think. By investigating the theories children have produced as a reasonable explanation, parents can not only give correct information but also help children understand why their explanation is inaccurate. Another reason for ascertaining what the child thinks before offering any information is to avoid giving an unasked for answer. The child should not be distracted from the topic. If parents offer too much information, the child will simply become bored or end the conversation with an irrelevant question. What matters is that parents are approachable and do not dismiss their childs inquiries.

The nurse is explaining the preconventional stage of moral development to a group of nursing students. What characterizes this stage? a. Children in this stage focus on following the rules. b. Children in this stage live up to social expectations and roles. c. Children in this stage have a concrete sense of justice and fairness. d. Children in this stage have little, if any, concern for why something is wrong.

ANS: D Young childrens development of moral judgment is at the most basic level in the preconventional stage. They have little, if any, concern for why something is wrong. Following the rules, living up to social expectations, and having a concrete sense of justice and fairness are characteristics in the conventional stage.

The parents of an infant with a cleft palate ask the nurse, "What follow-up care will our infant need after the repair?" Which is an accurate response by the nurse? a. "Your infant will not need any subsequent follow-up care." b. "Your infant will only need to be evaluated by an audiologist." c. "Your infant will only need follow-up with a speech pathologist." d. "Your infant will need follow-up with audiologists and orthodontists."

ANS: D A cleft palate means that audiologists will evaluate the child's hearing throughout early childhood and work closely with otolaryngologists to determine if pressure-equalizing (PE) tubes are needed. An infant with a cleft palate will also go through multiple phases of orthodontic intervention to align the teeth and the maxillary arches. Follow-up will be needed as the child grows. Following up with only an audiologist or only a speech pathologist would not be adequate.

The nurse is teaching parents about caring for their infant with seborrheic dermatitis (cradle cap). Which statement by the parents indicates understanding of the teaching? a. "We will rinse off the shampoo quickly and dry the scalp thoroughly." b. "We will shampoo the hair every other day with antiseborrheic shampoo." c. "We will be sure to shampoo the hair without removing any of the crusts." d. "We will use a fine-tooth comb to help remove the loosened crusts from the strands of hair."

ANS: D A fine-tooth comb or a soft facial brush helps remove the loosened crusts from the strands of hair after shampooing. This is an accurate statement. Shampoo should applied to the scalp and allowed to remain on the scalp until the crusts soften. Shampoo should not be rinsed off quickly. The crusts should be removed, and shampooing with antiseborrheic shampoo should be done daily, not every other day.

A woman in premature labor delivers an extremely low-birth-weight (ELBW) infant. Transport to a neonatal intensive care unit is indicated. The nurse explains that which level of service is needed? a. Level I b. Level IA c. Level II d. Level IIIB

ANS: D A level IIIB neonatal unit has the capability of providing care for ELBW infants, including high-frequency ventilation and on-site access to medical subspecialties and pediatric surgery. A level I facility manages normal maternal and newborn care. Infants at less than 35 weeks of gestation are stabilized and transported to a facility that can provide appropriate care. A level IA facility does not exist. Level II facilities provide care for infants born at 32 weeks of gestation and weighing more than 1500 g. If the infant is ill, the health problems are expected to resolve rapidly and are not anticipated to require specialty care.

Which refers to an infant whose rate of intrauterine growth has slowed and whose birth weight falls below the 10th percentile on intrauterine growth charts? a. Postterm b. Postmature c. Low birth weight d. Small for gestational age

ANS: D A small-for-gestational-age, or small-for-date, infant is one whose rate of intrauterine growth has slowed and whose birth weight falls below the 10th percentile on intrauterine growth curves. A postterm, or postmature, infant is any child born after 42 weeks of gestation, regardless of birth weight. A low-birth-weight infant is a child whose birth weight is less than 2500 g, regardless of gestational age.

The nurse is guiding parents in selecting a daycare facility for their child. Which is especially important to consider when making the selection? a. Structured learning environment b. Socioeconomic status of children c. Cultural similarities of children d. Teachers knowledgeable about development

ANS: D A teacher knowledgeable about development will structure activities for learning. A structured learning environment is not necessary at this age. Socioeconomic status is not the most important factor in selecting a preschool. Preschool is about expanding experiences with others, so cultural similarities are not necessary

The nurse is caring for a child after a cleft palate repair who is on a clear liquid diet. Which feeding device should the nurse use to deliver the clear liquid diet? a. Straw b. Spoon c. Sippy cup d. Open cup

ANS: D Acceptable feeding devices after a cleft palate repair include open cup for liquids, but rigid utensils such as spoons, straws, and hard-tipped sippy cups should be avoided to prevent accidental injury to the repair.

Which is an accurate description of homosexual (or gay-lesbian) families? a. A nurturing environment is lacking. b. The children become homosexual like their parents. c. The stability needed to raise healthy children is lacking. d. The quality of parenting is equivalent to that of nongay parents.

ANS: D Although gay or lesbian families may be different from heterosexual families, the environment can be as healthy as any other. Lacking a nurturing environment and stability is reflective on the parents and family, not the type of family. There is little evidence to support that children become homosexual like their parents.

The nurse is caring for an infant born at 37 weeks of gestation of a nondiabetic mother just admitted to the neonatal intensive care unit for observation. The nurse notes that which lecithin/sphingomyelin (L/S) ratio obtained before delivery indicates no risk of respiratory distress syndrome (RDS)? a. 1.4:1 b. 1.6:1 c. 1.8:1 d. 2:1

ANS: D An L/S ratio of 2:1 in nondiabetic mothers indicates virtually no risk of RDS.

At what age should the nurse expect a child to give both first and last names when asked? a. 15 months b. 18 months c. 24 months d. 30 months

ANS: D At 30 months, the child is able to give both first and last names and refer to self with an appropriate pronoun. At 15 and 18 months, the child is too young to give his or her own name. At 24 months, the child is able to give first name and refer to self by that name.

By which age should the nurse expect that most children could obey prepositional phrases such as "under," "on top of," "beside," and "behind"? a. 18 months b. 24 months c. 3 years d. 4 years

ANS: D At 4 years, children can understand directional phrases. Children at 18 months, 24 months, and 3 years are too young.

Which characteristic best describes the fine motor skills of an infant at age 5 months? a. Neat pincer grasp b. Strong grasp reflex c. Builds a tower of two cubes d. Able to grasp object voluntarily

ANS: D At age 5 months, the infant should be able to voluntarily grasp an object. The grasp reflex is present in the first 2 to 3 months of life. Gradually, the reflex becomes voluntary. The neat pincer grasp is not achieved until age 11 months. At age 12 months, an infant will attempt to build a tower of two cubes but will most likely be unsuccessful.

Which characteristic best describes the language of a 3-year-old child? a. Asks meanings of words b. Follows directional commands c. Describes an object according to its composition d. Talks incessantly regardless of whether anyone is listening

ANS: D Because of the dramatic vocabulary increase at this age, 3-year-olds are known to talk incessantly regardless of whether anyone is listening. A 4- to 5-year-old asks lots of questions and can follow simple directional commands. A 6-year-old can describe an object according to its composition.

The nurse is caring for a high-risk neonate who has an umbilical catheter and is in a radiant warmer. The nurse notes blanching of the feet. Which is the most appropriate nursing action? a. Place socks on the infant's feet. b. Elevate the infant's feet 15 degrees. c. Wrap the infant's feet loosely in a prewarmed blanket. d. Report the findings immediately to the practitioner.

ANS: D Blanching of the feet in a neonate with an umbilical catheter is an indication of vasospasm. Vasoconstriction of the peripheral vessels, triggered by the vasospasm, can seriously impair circulation. It is an emergency situation and must be reported immediately.

The nurse is teaching parents about expected language development for their 6-month-old infant. The nurse recognizes the parents understand the teaching if they make which statement? a. "Our baby should comprehend the word 'no.'" b. "Our baby knows the meaning of saying 'mama.'" c. "Our baby should be able to say three to five words." d. "Our baby should begin to combine syllables, such as 'dada.'"

ANS: D By 6 months, infants imitate sounds; add the consonants t, d, and w; and combine syllables (e.g., "dada"), but they do not ascribe meaning to the word until 10 to 11 months of age. By 9 to 10 months, they comprehend the meaning of the word "no" and obey simple commands accompanied by gestures. By age 1 year, they can say three to five words with meaning and may understand as many as 100 words.

The school nurse is conducting a class on bicycle safety. Which statement made by a participant indicates a need for further teaching? a. "Most bicycle injuries occur from a fall off the bicycle." b. "Head injuries are the major causes of bicycle-related fatalities." c. "I should replace my helmet every 5 years." d. "I can ride double with a friend if the bicycle has an extra large seat."

ANS: D Children should not ride double. Most injuries result from falls. The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission and should replace the helmet at least every 5 years.

Which statement best describes colic? a. Periods of abdominal pain resulting in weight loss b. Usually the result of poor or inadequate mothering c. Periods of abdominal pain and crying occurring in infants older than age 6 months d. A paroxysmal abdominal pain or cramping manifested by episodes of loud crying

ANS: D Colic is described as paroxysmal abdominal pain or cramping that is manifested by loud crying and drawing up the legs to the abdomen. Weight loss is not part of the clinical picture. There are many theories about the cause of colic. Emotional stress or tension between the parent and child is one component. This is not consistent throughout all cases. Colic is most common in infants younger than 3 months of age.

A school nurse is teaching a group of preadolescent boys about puberty. By which age should concerns about pubertal delay be considered? a. 12 to 12 1/2 years b. 12 1/2 to 13 years c. 13 to 13 1/2 years d. 13 1/2 to 14 years

ANS: D Concerns about pubertal delay should be considered for boys who exhibit no enlargement of the testes or scrotal changes from 13 1/2 to 14 years. Ages 12 to 13 1/2 years is too young for initial concern.

The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their children. Which is most likely lacking in their particular diet? a. Fat b. Protein c. Vitamins C and A d. Iron and calcium

ANS: D Deficiencies can occur when various substances in the diet interact with minerals. For example, iron, zinc, and calcium can form insoluble complexes with phytates or oxalates (substances found in plant proteins), which impair the bioavailability of the mineral. This type of interaction is important in vegetarian diets because plant foods such as soy are high in phytates. Fat and vitamins C and A are readily available from vegetable sources. Plant proteins are available.

Which term refers to the relative lactase deficiency observed in preterm infants of less than 34 weeks of gestation? a. Congenital lactase deficiency b. Primary lactase deficiency c. Secondary lactase deficiency d. Developmental lactase deficiency

ANS: D Developmental lactase deficiency refers to the relative lactase deficiency observed in preterm infants of less than 34 weeks of gestation. Congenital lactase deficiency occurs soon after birth after the newborn has consumed lactose-containing milk. Primary lactase deficiency, sometimes referred to as late-onset lactase deficiency, is the most common type of lactose intolerance and is manifested usually after 4 or 5 years of age. Secondary lactase deficiency may occur secondary to damage of the intestinal lumen, which decreases or destroys the enzyme lactase.

The nurse is providing care to a preterm infant. Which characteristic of daily care should be considered supportive? a. Coordinated with parental visiting times b. Given on a fixed schedule to ensure needs are met c. Provided when infant's heart rate is at its lowest level d. Directed toward development of sleep organization

ANS: D Developmentally supportive care uses both behavioral and physiologic information as the basis of caregiving. A focus in preterm infants is to be alert for infant behavioral states and intervene during alert times. The parents should be taught how to recognize the infant's behavioral states. Infants sleep for approximately 1 1/2 hours. The parents can provide care when the infant is awake. Care should not be delivered on a fixed schedule. It should always be responsive to the infant's cues. The heart rate is at its lowest when the infant is in a sleep period. The infant should not be disturbed during this time if possible.

A nurse is selecting a family theory to assess a patient's family dynamics. Which family theory best describes a series of tasks for the family throughout its life span? a. Interactional theory b. Developmental systems theory c. Structural-functional theory d. Duvall's developmental theory

ANS: D Duvall's developmental theory describes eight developmental tasks of the family throughout its life span. Interactional theory and structural-functional theory are not family theories. Developmental systems theory is an outgrowth of Duvall's theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others.

The nurse is caring for a newborn with Erb palsy. The nurse understands that which reflex is absent with this condition? a. Root reflex b. Suck reflex c. Grasp reflex d. Moro reflex

ANS: D Erb palsy (Erb-Duchenne paralysis) is caused by damage to the upper plexus and usually results from stretching or pulling away of the shoulder from the head. The Moro reflex is absent in a newborn with Erb palsy. The root and suck reflex are not affected. A grasp reflex is present in newborns because the finger and wrist movements remain normal.

Which term best describes the emotional attitude that one's own ethnic group is superior to others? a. Culture b. Ethnicity c. Superiority d. Ethnocentrism

ANS: D Ethnocentrism is the belief that one's way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of one's ethnic group are superior to those of others. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serves as a frame of reference for individual perception and judgments. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. Superiority is the state or quality of being superior; it does not include ethnicity.

An infant has been diagnosed with failure to thrive (FTT) classified according to the pathophysiology of inadequate caloric intake. The nurse understands that the reason for the FTT is most likely related to what? a. Cow's milk allergy b. Congenital heart disease c. Metabolic storage disease d. Incorrect formula preparation

ANS: D FTT classified according to the pathophysiology of inadequate caloric intake is related to incorrect formula preparation, neglect, food fads, excessive juice poverty, breastfeeding problems, behavioral problems affecting eating, parental restriction of caloric intake, or central nervous system problems affecting intake consumption. Cow's milk allergy would be related to the pathophysiology of inadequate absorption, congenital heart disease would be related to the pathophysiology of increased metabolism, and metabolic storage disease is related to defective utilization.

How is family systems theory best described? a. The family is viewed as the sum of individual members. b. A change in one family member cannot create a change in other members. c. Individual family members are readily identified as the source of a problem. d. When the family system is disrupted, change can occur at any point in the system.

ANS: D Family systems theory describes an interactional model. Any change in one member will create change in others. Although the family is the sum of the individual members, family systems theory focuses on the number of dyad interactions that can occur. The interactions, not the individual members, are considered to be the problem.

Rickets is caused by a deficiency in what? a. Vitamin A b. Vitamin C c. Folic acid and iron d. Vitamin D and calcium

ANS: D Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent rickets. No correlation exists between rickets and folic acid, iron, or vitamins A and C.

The nurse recommends to parents that peanuts are not a good snack food for toddlers. The nurse's rationale for this action is that they: a. are low in nutritive value. b. are high in sodium. c. cannot be entirely digested. d. can be easily aspirated.

ANS: D Foreign-body aspiration is common during the second year of life. Although they chew well, this age child may have difficulty with large pieces of food, such as meat and whole hot dogs, and with hard foods, such as nuts or dried beans. Peanuts have many beneficial nutrients, but should be avoided because of the risk of aspiration in this age group. The sodium level may be a concern, but the risk of aspiration is more important. Many foods pass through the gastrointestinal tract incompletely undigested. This is not necessarily detrimental to the child.

The most common cause of death in the adolescent age group involves: a. drownings. b. firearms. c. drug overdoses. d. motor vehicles.

ANS: D Forty percent of all adolescent deaths in the United States are the result of motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but are not the most common cause of death.

A preterm neonate has begun breastfeeding, but the infant tires easily and has weak sucking and swallowing reflexes. What is the most appropriate nursing intervention? a. Encourage the mother to breastfeed. b. Resume orogastric feedings of formula. c. Try nipple feeding the preterm infant formula. d. Feed the remainder of breast milk by the orogastric route.

ANS: D If a preterm infant tires easily or has weak sucking when breastfeeding is initiated, the nurse should feed the additional breast milk by the enteral route. The nurse supports the mother in the attempts to breastfeed and ensures that the infant is receiving adequate nutrition. Breast milk should be used as long as the mother can supply it.

The psychosocial developmental tasks of toddlerhood include which characteristic? a. Development of a conscience b. Recognition of sex differences c. Ability to get along with age-mates d. Ability to delay gratification

ANS: D If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that the toddler is concerned with is the ability to delay gratification. Development of a conscience occurs during the preschool years. The recognition of sex differences occurs during the preschool years. The ability to get along with age-mates develops during the preschool and school-age years.

In girls, the initial indication of puberty is: a. menarche. b. growth spurt. c. growth of pubic hair. d. breast development.

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

Which is a characteristic of postmature infants? a. Abundant lanugo b. Lack of scalp hair c. Plump appearance d. Parchment-like skin

ANS: D In postterm infants, the skin is often cracked, parchment-like, and desquamating. Lanugo is usually absent. Scalp hair is usually abundant. Subcutaneous fat is usually depleted, giving the child a thin, elongated appearance.

At an 8-month-old well-baby visit, the parent tells the nurse that her infant falls asleep at night during the last bottle feeding but wakes up when moved to the infant's crib. What is the most appropriate response for the nurse to make? a. "You should put your baby to sleep 1 hour earlier without the nighttime feeding but with a pacifier for soothing." b. "You could place rice cereal in the last bottle feeding of the day to ensure a longer sleep pattern." c. "You should have your partner give the last bottle of the day and observe whether your infant stays awake for your partner." d. "You could increase daytime feeding intervals to every 4 hours and put your baby in the crib while the baby is still awake."

ANS: D Increasing the daytime intervals to 4 hours and placing the baby in the crib while still awake are interventions for nighttime sleeping problems. Putting the baby to bed 1 hour earlier with a pacifier will not stop the need for the bedtime bottle; there is no research that rice cereal in the bottle helps to satisfy the baby longer at night, and switching partners does not guarantee that the baby will go to sleep better.

Women who smoke during pregnancy are most likely to have infants who are what? a. Large for gestational age b. Preterm but size appropriate for gestational age c. Growth restricted in weight only d. Growth restricted in weight, length, and chest and head circumference

ANS: D Infants born to mothers who smoke have retardation in all aspects of growth. Infants of mothers with diabetes are large for gestational age. Infants of mothers who smoke are small for gestational age.

Parents of an infant born at 36 weeks' gestation ask the nurse, "Will our infant need a car seat trial before being discharged?" What is the nurse's best response? a. "Yes, to see if the car seat is the appropriate size." b. "Yes, to determine if blanket rolls will be needed." c. "No, your infant was old enough at birth to not need a trial." d. "Yes, to monitor for possible apnea and bradycardia while in the seat."

ANS: D It is recommended that infants younger than 37 weeks of gestation have a period of observation in an appropriate car seat to monitor for possible apnea and bradycardia. The trial is not done to check the size of the car seat or to determine if blanket rolls will be needed. The infant was born at 36 weeks of gestation, so it is recommended to perform a car sear trial

The nurse is attending a delivery of a full-term infant with meconium noted in the amniotic fluid. The nurse should understand that what action should be performed in the delivery room? a. The infant will be suctioned with a DeLee trap suctioning device after delivery of the head while the chest is still compressed in the birth canal. b. The infant's nose will be suctioned at the delivery of the head; subsequent suctioning of the mouth will occur after completion of the delivery. c. The infant will need to take the first breath after delivery of the head and shoulders and will require tracheal suctioning. d. The infant's mouth, nose, and posterior pharynx will be suctioned just after the head is delivered while the chest is still compressed in the birth canal.

ANS: D Meconium aspiration syndrome can occur when a fetus is subjected to intrauterine stress that causes relaxation of the anal sphincter and passage of meconium into the amniotic fluid, and the meconium-stained fluid is aspirated with the first breath. To prevent meconium aspiration, the infant's mouth, nose, and posterior pharynx should be suctioned just after delivery of the head while the chest is still compressed in the birth canal. A DeLee trap is no longer used in the delivery room. The infant's mouth should be suctioned before the nose and during the delivery, not at the completion of delivery. The infant should not take its first breath without suctioning first and may or may not require tracheal suctioning.

A preterm infant with respiratory distress syndrome is receiving inhaled nitric oxide (NO). What is the reason for administering the inhaled nitric oxide? a. To mature the lungs b. To deliver a level of oxygen that is safe c. To increase the removal of pulmonary debris such as meconium d. To reduce pulmonary vasoconstriction and pulmonary hypertension

ANS: D NO is used for infants with conditions such as meconium aspiration syndrome, pneumonia, sepsis, and congenital diaphragmatic hernia. Most infants with these disorders do have mature lungs. NO is not oxygen. Inhaled NO is beneficial for infants with meconium aspiration syndrome, but it does not work by removing debris. Inhaled NO is a significant treatment for infants with persistent pulmonary hypertension, pulmonary vasoconstriction, and subsequent acidosis and severe hypoxia. When inhaled into the lungs, it causes smooth muscle relaxation and reduction of pulmonary vasoconstriction and subsequent pulmonary hypertension.

Parents of a preschool child ask the nurse, "Should we set rules for our child as part of a discipline plan?" Which is an accurate response by the nurse? a. "It is best to delay the punishment if a rule is broken." b. "The child is too young for rules. At this age, unrestricted freedom is best." c. "It is best to set the rules and reason with the child when the rules are broken." d. "Set clear and reasonable rules and expect the same behavior regardless of the circumstances."

ANS: D Nurses can help parents establish realistic and concrete "rules." The clearer the limits that are set and the more consistently they are enforced, the less need there is for disciplinary action. Delaying punishment weakens its intent. Children want and need limits. Unrestricted freedom is a threat to their security and safety. Reasoning involves explaining why an act is wrong and is usually appropriate for older children, especially when moral issues are involved. However, young children cannot be expected to "see the other side" because of their egocentrism.

The nurse is administering an oral antihistamine at bedtime to a child with atopic dermatitis (eczema). Which antihistamine should the nurse expect to be prescribed at bedtime? a. Cetirizine (Zyrtec) b. Loratadine (Claritin) c. Fexofenadine (Allegra) d. Diphenhydramine (Benadryl)

ANS: D Oral antihistamine drugs such as hydroxyzine or diphenhydramine usually relieve moderate or severe pruritus. Nonsedating antihistamines such as cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra) may be preferred for daytime pruritus relief. Because pruritus increases at night, a mildly sedating antihistamine such as Benadryl is prescribed.

Parents ask the nurse whether it is common for their school-age child to spend a lot of time with peers. The nurse should respond, explaining that the role of the peer group in the life of school-age children provides: a. opportunity to become defiant. b. time to remain dependent on their parents for a longer time. c. time to establish a one-on-one relationship with the opposite sex. d. security as they gain independence from their parents.

ANS: D Peer-group identification is an important factor in gaining independence from parents. Children learn how to relate to people in positions of leadership and authority and how to explore ideas and the physical environment. Becoming defiant in a peer-group relationship may lead to bullying. Peer-group identification helps in gaining independence rather than remaining dependent. One-on-one opposite sex relationships do not occur until adolescence. School-age children form peer groups of the same sex.

The nurse is caring for an infant with hemolytic disease. Which medication should the nurse anticipate to be prescribed to decrease the bilirubin level? a. Phenytoin (Dilantin) b. Valproic acid (Depakene) c. Carbamazepine (Tegretol) d. Phenobarbital (Phenobarbital)

ANS: D Phenobarbital is used to decrease the bilirubin level in a newborn with hemolytic disease. Phenobarbital promotes (1) hepatic glucuronyl transferase synthesis, which increases bilirubin conjugation and hepatic clearance of the pigment in bile, and (2) protein synthesis, which may increase albumin for more bilirubin binding sites. Dilantin, Depakene, and Tegretol are antiseizure medications and do not lower bilirubin levels.

The nurse is planning care for a family expecting their newborn infant to die because of an incurable birth defect. What should the nurse's interventions be based on? a. Tangible remembrances of the infant (e.g., lock of hair, picture) prolong grief. b. Photographs of infants should not be taken after death. c. Funerals are not recommended because the mother is still recovering from childbirth. d. The parents should be given the opportunity to "parent" the infant, including seeing, holding, touching, or talking to the infant in private.

ANS: D Providing care for the neonate is an important step in the grieving process. It gives the parents a tangible person for whom to grieve, which is a key component of the grieving process. Tangible remembrances and photographs can make the infant seem more real to the parents. Many neonatal intensive care units make bereavement memory packets, which may include a lock of hair, handprints, footprints, a bedside name card, and other individualized objects. Families need to be informed of their options. The ritual of a funeral provides an opportunity for the parents to be supported by relatives and friends.

What is a characteristic of most neonatal seizures? a. Clonic b. Generalized c. Well organized d. Subtle and barely discernible

ANS: D Seizures in newborns may be subtle and barely discernible or grossly apparent. Most neonatal seizures are subcortical and do not have the etiologic or prognostic significance of seizures in older children. Clonic seizures are slow, rhythmic jerking movements. Generalized seizures are bilateral jerks of the upper and lower limbs that are associated with electroencephalographic discharges. Neonatal seizures are not well organized.

An infant, age 6 months, has six teeth. The nurse should recognize that this is what? a. Normal tooth eruption b. Delayed tooth eruption c. Unusual and dangerous d. Earlier than expected tooth eruption

ANS: D Six months is earlier than expected to have six teeth. At age 6 months, most infants have two teeth. Although unusual, having six teeth at 6 months is not dangerous.

Which is a bright red, rubbery nodule with a rough surface and a well-defined margin that may be present at birth? a. Port-wine stain b. Juvenile melanoma c. Cavernous hemangioma d. Strawberry hemangioma

ANS: D Strawberry hemangiomas (or capillary hemangiomas) are benign cutaneous tumors that involve only capillaries. They are bright red, rubbery nodules with rough surfaces and well-defined margins. They may or may not be apparent at birth but enlarge during the first year of life and tend to resolve spontaneously by ages 2 to 3 years. A port-wine stain is a vascular stain that is a permanent lesion and is present at birth. Initially, it is a pink; red; or, rarely, purple stain of the skin that is flat at birth; it thickens, darkens, and proportionately enlarges as the infant grows. Melanoma is not differentiated into juvenile and adult forms. A cavernous hemangioma involves deeper vessels in the dermis and has a bluish red color and poorly defined margins.

What can stroking infants who are physiologically unstable result in? a. Fewer sleep periods b. Increased weight gain c. Shortened hospital stay d. Decreased oxygen saturation

ANS: D Tactile interventions can have both positive and negative effects on neonates. For physiologically unstable infants and those who are disturbed during sleep, outcomes such as gasping, grunting, decreased oxygen saturation, apnea, and bradycardia have been observed. Fewer sleep periods are not associated with tactile stimulation in physiologically unstable infants. Increased weight gain and shortened hospital stays are positive outcomes that are observed when tactile stimulation is done at developmentally supportive times

A school nurse is teaching dental health practices to a group of sixth-grade children. How often should the nurse recommend the children brush their teeth? a. Twice a day b. Three times a day c. After meals d. After meals, snacks, and bedtime

ANS: D Teeth should be brushed after meals, after snacks, and at bedtime. Children who brush their teeth frequently and become accustomed to the feel of a clean mouth at an early age usually maintain the habit throughout life. Twice a day, three times a day or after meals would not be often enough.

A nurse is planning care for a 17-month-old child. According to Piaget, which stage should the nurse expect the child to be in cognitively? a. Trust b. Preoperational c. Secondary circular reaction d. Tertiary circular reaction

ANS: D The 17-month-old child is in the fifth stage of the sensorimotor phase, tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Trust is Erikson's first stage. Preoperational is the stage of cognitive development usually present in older toddlers and preschoolers. Secondary circular reactions last from about ages 4 to 8 months.

Which characteristic best describes the gross motor skills of a 24-month-old child? a. Skips and can hop in place on one foot b. Rides tricycle and broad jumps c. Jumps with both feet and stands on one foot momentarily d. Walks up and down stairs and runs with a wide stance

ANS: D The 24-month-old child can go up and down stairs alone with two feet on each step and runs with a wide stance. Skipping and hopping on one foot are achieved by 4-year-old children. Jumping with both feet and standing on one foot momentarily are achieved by 30-month-old children. Tricycle riding and broad jumping are achieved at age 3.

A 14-year-old male mentions that he now has to use deodorant but never had to before. The nurse's response should be based on knowledge that which occurs during puberty? a. Eccrine sweat glands in the axillae become fully functional during puberty. b. Sebaceous glands become extremely active during puberty. c. New deposits of fatty tissue insulate the body and cause increased sweat production. d. Apocrine sweat glands reach secretory capacity during puberty.

ANS: D The apocrine sweat glands, nonfunctional in children, reach secretory capacity during puberty. They secrete a thick substance as a result of emotional stimulation that, when acted on by surface bacteria, becomes highly odoriferous. They are limited in distribution and grow in conjunction with hair follicles, in the axilla, genital, anal, and other areas. Eccrine sweat glands are present almost everywhere on the skin and become fully functional and respond to emotional and thermal stimulation. Sebaceous glands become extremely active at this time, especially those on the genitalia and the "flush" areas of the body such as face, neck, shoulders, upper back, and chest. This increased activity is important in the development of acne. New deposits of fatty tissue is not the etiology of apocrine sweat gland activity.

The parents of a newborn say that their toddler "hates the baby, he suggested that we put him in the trash can so the trash truck could take him away." Which is the nurse's best reply? a. "Let's see if we can figure out why he hates the new baby." b. "That's a strong statement to come from such a small boy." c. "Let's refer him to counseling to work this hatred out. It's not a normal response." d. "That is a normal response to the birth of a sibling. Let's look at ways to deal with this."

ANS: D The arrival of a new infant represents a crisis for even the best-prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. The nurse should work with parents on ways to involve the toddler in the newborn's care and to help focus attention on the toddler. The toddler does not hate the infant. This is an expected response to the changes in routines and attention that affect the toddler. The toddler can be provided with a doll to tend to the doll's needs at the same time the parent is performing similar care for the newborn.

A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is: a. a sign the child is spoiled. b. a way to exert unhealthy control. c. regression, common at this age. d. ritualism, common at this age.

ANS: D The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain sameness and reliability. It provides a sense of comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. Ritualism is not indicative of a child who has unreasonable expectations, but rather normal development. Toddlers use ritualistic behaviors to maintain necessary structure in their lives. This is not regression, which is a retreat from a present pattern of functioning.

The nurse is interviewing the parents of a 4-month-old boy brought to the hospital emergency department. The infant is dead, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. The nurse might initially suspect his death was caused by what? a. Suffocation b. Child abuse c. Infantile apnea d. Sudden infant death syndrome (SIDS)

ANS: D The description of how the child was found in the crib is suggestive of SIDS. The nurse is careful to tell the parents that a diagnosis cannot be confirmed until an autopsy is performed

What signs should the nurse expect when a pneumothorax occurs in an infant on mechanical ventilation? a. Tachycardia b. Clear, distinct heart tones c. Widened pulse pressure d. Abrupt duskiness or cyanosis

ANS: D The early signs of a pneumothorax in an infant on mechanical ventilations include the abrupt onset of duskiness or cyanosis. Tachypnea is the presenting sign. Usually the heart rate is decreased. The heart sounds usually become muffled, diminished, or shifted. The pulse pressure decreases in pneumothorax.

The nurse is preparing to administer a gavage feeding to an infant. The nurse should place the infant in which position for the feeding? a. Supine with the head flat b. Sitting upright in a car seat c. Left side-lying with the head flat d. Prone with the head slightly elevated

ANS: D The gavage feeding is best performed when an infant is in a prone or a right side-lying position with the head slightly elevated. Supine and left side-lying with the head flat would not be a recommended position. The infant should not be gavage fed sitting in a car seat.

A woman who is Rh-negative is pregnant with her first child, and her husband is Rh positive. During her 12-week prenatal visit, she tells the nurse that she has been told that this is dangerous. What should the nurse tell her? a. That no treatment is necessary b. That an exchange transfusion will be necessary at birth c. That no treatment is available until the infant is born d. That administration of Rh immunoglobulin is indicated at 26 to 28 weeks of gestation

ANS: D The goal is to prevent isoimmunization. If the mother has not been previously exposed to the Rh-negative antigen, Rh immunoglobulin (RhIg) is administered at 26 to 28 weeks of gestation and again within 72 hours of birth. The intramuscular administration of RhIg has virtually eliminated hemolytic disease of the infant secondary to the Rh factor. Unless other problems coexist, the newborn will not require transfusions at birth.

Where do eczematous lesions most commonly occur in an infant? a. Abdomen, cheeks, and scalp b. Buttocks, abdomen, and scalp c. Back and flexor surfaces of the arms and legs d. Cheeks and extensor surfaces of the arms and legs

ANS: D The lesions of atopic dermatitis are generalized in infants. They are most common on the cheeks, scalp, trunk, and extensor surfaces of the extremities. The abdomen and buttocks are not common sites of lesions. The back and flexor surfaces are not usually involved.

What should the nurse anticipate in an infant who was exposed to cocaine during pregnancy? a. Seizures b. Hyperglycemia c. Large for gestational age d. Hypertonia and jitteriness

ANS: D The nurse should anticipate neurobehavioral depression or excitability and implement care directed at the infant's manifestations. Few or no neurologic sequelae appear in infants born to mothers who used cocaine during pregnancy. The infant is usually a poor feeder, so hypoglycemia should be more likely than hyperglycemia. The infant usually has intrauterine growth restriction.

A parent asks the nurse about negativism in toddlers. Which is the most appropriate recommendation? a. Punish the child. b. Provide more attention. c. Ask child not always to say "no." d. Reduce the opportunities for a "no" answer.

ANS: D The nurse should suggest to the parent that questions be phrased with realistic choices rather than yes or no answers. This provides the toddler with a sense of control and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention, the child is testing limits to gain an understanding of the world. The toddler is too young to be asked to not always say "no."

The parents of an infant who has just died decide they want to hold the infant after their infant has gone to the morgue. What is the most appropriate nursing intervention at this time? a. Explain gently that this is no longer possible. b. Encourage the parents to accept the loss of their infant. c. Offer to take a photograph of their infant because they cannot hold the infant. d. Have the infant brought back to the unit, wrapped in a blanket, and rewarmed in a radiant warmer.

ANS: D The parents should be allowed to hold their infant in the hospital setting. The infant's body should be retrieved and rewarmed in a radiant warmer. The nurse should provide a private place where the parents can hold their child for a final time. If possible, to facilitate the parents' grieving, the nurse should bring the infant back to the unit. A photograph is an excellent idea, but it does not replace the parents' need to hold the child.

What is most descriptive of the signs observed in neonatal sepsis? a. Seizures b. Sudden hyperthermia c. Decreased urinary output d. Subtle, vague, and nonspecific physical signs

ANS: D The signs of neonatal sepsis are usually characterized by the infant generally "not doing well." Poor temperature control, usually with hypothermia, lethargy, poor feeding, pallor, cyanosis or mottling, and jaundice, may be evident. Seizures are not a manifestation of sepsis. Severe neurologic sequelae may occur in low-birth-weight infants with sepsis. Hyperthermia is rare in neonatal sepsis. Urinary output is not affected by sepsis.

Which is a central factor responsible for respiratory distress syndrome in a newborn? a. Absence of alveoli b. Immature bronchioles c. Overdeveloped alveoli d. Deficient surfactant production

ANS: D The successful adaptation to extrauterine breathing requires numerous factors, which most term infants successfully accomplish. Preterm infants with respiratory distress are not able to adjust. The most likely central cause is the abnormal development of the surfactant system. The number and state of development of the alveoli are not central factors in respiratory distress syndrome. The instability of the alveoli related to the lack of surfactant is the causative issue. The bronchioles are sufficiently developed in newborns.

An adolescent boy tells the nurse that he has recently had homosexual feelings. The nurse's response should be based on knowledge that: a. this indicates the adolescent is homosexual. b. this indicates the adolescent will become homosexual as an adult. c. the adolescent should be referred for psychotherapy. d. the adolescent should be encouraged to share his feelings and experiences.

ANS: D These adolescents are at increased risk for health-damaging behaviors, not because of the sexual behavior itself, but because of society's reaction to the behavior. The nurse's first priority is to give the young man permission to discuss his feelings about this topic, knowing that the nurse will maintain confidentiality, appreciate his feelings, and remain sensitive to his need to talk about the topic. In recent studies among self-identified gay, lesbian, and bisexual adolescents, many of the adolescents report changing self-labels one or more times during their adolescence. An assessment must be made about any risks to himself or others. If these do not exist, the adolescent needs a supportive person to talk with.

Which should the nurse expect of a healthy 3-year-old child? a. Jump rope. b. Ride a two-wheel bicycle. c. Skip on alternate feet. d. Balance on one foot for a few seconds.

ANS: D Three-year-olds are able to accomplish this gross motor skill. Jumping rope, riding a two-wheel bicycle, and skipping on alternate feet are gross motor skills of 5-year-olds.

Which is most characteristic of the physical punishment of children, such as spanking? a. Psychological impact is usually minimal. b. Children rarely become accustomed to spanking. c. Children's development of reasoning increases. d. Misbehavior is likely to occur when parents are not present.

ANS: D Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake, but rather out of fear of punishment. Spanking can cause severe physical and psychological injury and interfere with effective parent-child interaction. Children do become accustomed to spanking, requiring more severe corporal punishment each time. The use of corporal punishment may interfere with the child's development of moral reasoning.

Which factor is most important in predisposing toddlers to frequent infections? a. Respirations are abdominal. b. Pulse and respiratory rates are slower than those in infancy. c. Defense mechanisms are less efficient than those during infancy. d. Toddlers have a short, straight internal ear canal and large lymph tissue.

ANS: D Toddlers continue to have the short, straight internal ear canal of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose the toddler to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy

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

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

The nurse has been caring for an infant who has just died. The parents are present but appear to be "afraid" to hold the dead infant. What is the most appropriate nursing intervention? a. Tell them there is nothing to fear. b. Insist that they hold the infant "one last time." c. Respect their wishes and release the body to the morgue. d. Keep the infant's body available for a few hours in case they change their minds.

ANS: D When the parents are hesitant about holding and touching their infant, the nurse should wrap the infant in blankets and keep the infant's body on the unit for a few hours. Many parents change their minds after the initial shock of the infant's death. This will provide the parents time to see and hold their infant if they desire. Telling the parents there is nothing to fear minimizes the parents' feelings. The nurse should allow the family to parent their child as they wish in death, as in life.

The nurse is caring for an infant who will be discharged on home phototherapy. What instructions should the nurse include in the discharge teaching to the parents? a. Apply an oil-based lotion to the infant's skin two times per day to prevent the skin from drying out under the phototherapy light. b. Keep the eye shields on the infant's eyes even when the phototherapy light is turned off. c. Take the infant's temperature every 2 hours while the newborn is under the phototherapy light. d. Make a follow-up visit with the health care provider within 2 or 3 days after your infant has been on phototherapy.

ANS: D With short hospital stays, infants may be discharged with a prescription for home phototherapy. It is the responsibility of the nurse planning discharge to include important information such as the need for a follow-up visit with the health care provider in 2 or 3 days to evaluate feeding and elimination pattern and to have blood work done if needed. The parents should be taught to not apply oil or lotions to prevent increased tanning; the baby's eye shields can come off when the phototherapy lights are turned off, and the infant's temperature needs to be monitored but not taken every 2 hours.

Which of the following is characteristic of a neonate's vision at birth? a. Ciliary muscles are mature. b. Blink reflex is absent. c. Tear glands function. d. Pupils react to light.

ANS: D d. Although at birth the eye is still structurally incomplete, the pupils do react to light. a. The ciliary muscles are immature, limiting the eyes' ability to focus on an object for any length of time. b. The blink reflex is responsive to minimal stimulus. c. The tear glands do not begin to function until age 2 to 4 weeks.

Which of the following is a function of brown adipose tissue (BAT) in the newborn? a. Provides ready source of calories in the newborn period b. Insulates the body against lowered environmental temperature c. Protects the infant from injury during the birth process d. Generates heat for distribution to other parts of body

ANS: D d. Brown fat is a unique source of heat for the newborn. It has a larger content of mitochondrial cytochromes and a greater capacity for heat production through intensified metabolic activity than does ordinary adipose tissue. Heat generated in brown fat is distributed to other parts of the body by the blood. a. It is effective only in heat production. b. The newborn has a thin layer of subcutaneous fat, which does not provide for conservation of heat. c. Brown fat is located in superficial areas such as between the scapulae, around the neck, in the axillae, and behind the sternum. These areas would not protect the infant from injury during the birth process.

A new mother wants to be discharged with her newborn as soon as possible. Before discharge, the nurse should make certain that: a. newborn has voided at least once. b. newborn does not spit up after feeding. c. jaundice, if present, appeared before 24 hours. d. appointment is made for home care or a primary care practitioner office visit within next 2 or 3 days.

ANS: D d. The American Academy of Pediatrics recommends that newborns discharged early receive follow-up care within 48 hours of a short stay in either a primary practitioner's office or the home. a. The child should void every 4 to 6 hours. b. Spitting up small amounts after feeding is a normal occurrence in newborns. It would not delay discharge. c. Jaundice within the first 24 hours of life must be evaluated.

Which of the following is the most critical physiologic change required of the newborn? a. Closure of fetal shunts in the heart b. Stabilization of fluid and electrolytes c. Body-temperature maintenance d. Onset of breathing

ANS: D d. The onset of breathing is the most immediate and critical physiologic change required for transition to extrauterine life. Factors that interfere with this normal transition increase fetal asphyxia, which is a condition of hypoxemia, hypercapnia, and acidosis. This affects the fetus's adjustment to extrauterine life. a, b, and c. These are important changes that must occur in the transition to extrauterine life, but breathing and the exchange of oxygen for carbon dioxide must come first.

In the newborn, intramuscular vitamin K is administered into which muscle? a. Deltoid b. Dorsogluteal c. Vastus medialis d. Vastus lateralis

ANS: D d. The vastus lateralis is the traditionally recommended injection site. a and b. These sites are not recommended for the vitamin K administration. The ventrogluteal may be used as an alternative site to the vastus lateralis. c. This site is not used for intramuscular injections.

A nurse is assisting a group of parents of adolescents to develop skills that will improve communication within the family. The nurse hears one parent state, "My son knows he better do what I say." Which of the following parenting styles is the parent exhibiting? A. authoritarian b. permissive c. authoritative d. passive

Ans: A This parent is exhibiting an authoritarian parenting style. The parent controls the adolescent's behaviors and attitudes through unquestioned rules and expectations.

The nurse is performing a family assessment. Which of the following should the nurse include? (select all that apply) A. Medical History B. parents' educational level c. child's physical growth d. support systems e. Stressors

Ans: A, B, D, E

A nurse manager on a pediatric floor is preparing an education program on working with families for a group of newly hired nurses. Which of the following should the nurse include when discussing the developmental theory? A. Describes that stress in inevitable B. Emphasizes that change with one member affects the entire family C. Provides guidance to assist families adapting to stress D. Defines consistencies in how families change

Ans: D The nurse should include that the developmental theory defines consistencies in how families change. The family stress theory describes that stress is inevitable. The family system theory emphasizes that change with one family member affects the entire family. The family stress theory provides guidance to assist families adapting to stress.

A nurse is working in a clinic that serves a culturally diverse population of children. The nurse should plan care, understanding that the following complementary and alternative practices may be used by this patient population (Select all that apply): a. Seeking another doctor's opinion b. Seeking advice from a curandero or curandera c. Using acupuncture or acupressure as a therapy d. Consulting an herbalist e. Consulting a kahuna

B, C, D, E

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

C. Characteristic of social development of this age

Which of the following should the nurse include when giving parents guidelines about helping their children in school? A. Punish children who fail to perform adequately. B. Help children as much as possible with their homework. C. Communicate with teachers if there appears to be a problem. D. Accept responsibility for children's successes and failures.

C. Communicate with teachers if there appears to be a problem.

Which of the following is characteristic of the psychosocial development of school-age children? A. Peer approval is not yet a motivating power. B. A developing sense of initiative is very important. C. Motivation comes from extrinsic rather than intrinsic sources. D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

Which of the following describes the cognitive abilities of school-age children? A. Have developed the ability to reason abstractly B. Become capable of scientific reasoning and formal logic C. Progress from making judgments based on what they reason to making judgments based on what they see D. Have the ability to place things in a logical order, to group and sort, and to hold a concept in their minds while making decisions based on that concept

D. Have the ability to place things in a logical order, to group and sort, and to hold a concept in their minds while making decisions based on that concept

to what age of you have a obligation to report any suspicions of abuse? A.Up until age 21 b. when the child not capable of speaking for itself c. up until the child is competent of there rights d. up until age 16

D. up until age 16

The nurse has just given a subcutaneous injection to a preschool child, and the child asks for a Band-Aid over the site. Which action should the nurse implement? a. Place a Band-Aid over the site. b. Massage the injection site with an alcohol swab. c. Show the child there is no bleeding from the site. d. Explain that a Band-Aid is not needed after a subcutaneous injection.

Despite the advances in body image development, preschoolers have poorly defined body boundaries and little knowledge of their internal anatomy. Intrusive experiences are frightening, especially those that disrupt the integrity of the skin (e.g., injections and surgery). They fear that all their blood and insides can leak out if the skin is broken. Therefore, preschoolers may believe it is critical to use bandages after an injury. The nurse should place a Band-Aid over the site.

A school nurse is teaching a group of preadolescent girls about puberty. Which is the mean age of menarche for girls in the United States? a. 11 1/2 years b. 12 3/4 years c. 13 1/2 years d. 14 years

The average age of menarche is 12 years 9.5 months in North American girls, with a normal range of 10 1/2 to 15 years. Ages 11 1/2, 13 1/2, and 14 are within the normal range for menarche, but these are not the average ages.

What does Duvall's Developmental Stages of the Family include? Select all that apply a. stages an individual progresses through in their moral & spiritual development b. stages families progress through in adulthood c. stages that designate how parenting progresses as a child develops d. stages that designate appropriate discipline related to developmental stages e. stages that describe the journey a couple will take as their children mature

b, c, e

Place in order the sequence of maturational changes for girls. Begin with the first change seen, sequencing to the last change. Provide answer in using lowercase letters, separated by commas (e.g., a, b, c, d, e). a. Growth of pubic hair b. Rapid increase in height and weight c. Breast changes d. Menstruation e. Appearance of axillary hair

c, b, a, e, d The usual sequence of maturational changes for girls is breast changes, rapid increase in height and weight, growth of public hair, appearance of axillary hair, and then menstruation, which usually begins 2 years after the first signs.

What does family systems theory include? a. direct causality, meaning each change effects the whole family b. Family systems react to change as they take place, not initiate it c. a balance between morphogenesis & morphostasis is necessary d. Theory is used primarily for family dysfunction and pathology

c. a balance between morphogenesis & morphostasis is necessary

The nurse is performing an assessment on a 10-week-old infant. The nurse understands that the developmental characteristic of hearing at this age is which? a. The infant responds to his own name. b. The infant localizes sounds by turning his head directly to the sound. c. The infant turns his head to the side when sound is made at the level of the ear. d. The infant locates sound by turning his head to the side and then looking up or down.

qANS: C At 8 to 12 weeks of age, the infant turns the head to the side when sound is made at the level of the ear. At 16 to 24 weeks, the infant locates sound by turning the head to the side and then looking up or down. At 24 to 32 weeks, infants respond to their own name. At 32 to 40 weeks, the infant localizes sounds by turning the head directly toward the sound.

In terms of fine motor development, what should the 3-year-old child be expected to do? a. Tie shoelaces. b. Copy (draw) a circle. c. Use scissors or a pencil very well. d. Draw a person with seven to nine parts.

ANS: B Three-year-old children are able to accomplish the fine motor skill of copying (drawing) a circle. The ability to tie shoelaces, to use scissors or a pencil very well, and to draw a person with seven to nine parts are fine motor skills of 5-year-old children.

The school nurse recognizes that pubertal delay in boys is considered if no enlargement of the testes or scrotal changes have occurred by what age? a. 11 1/2 to 12 years b. 12 1/2 to 13 years c. 13 1/2 to 14 years d. 14 1/2 to 15 years

ANS: C Concerns about pubertal delay should be considered for boys who exhibit no enlargement of the testes or scrotal changes by ages 13 1/2 to 14 years or if genital growth is not complete 4 years after the testicles begin to enlarge.

An adolescent asks the nurse what causes primary dysmenorrhea. The nurse's response should include which of the following? A. It is an inherited problem. B. Excessive estrogen production causes uterine pain. C. There is no physiologic cause; it is a psychologic reaction. D. One factor is the onset of ovulatory cycles.

D. One factor is the onset of ovulatory cycles.

Girls experience an increase in weight and fat deposition during puberty. What do nursing considerations related to this include? a. Give reassurance that these changes are normal. b. Suggest dietary measures to control weight gain. c. Encourage a low-fat diet to prevent fat deposition. d. Recommend increased exercise to control weight gain.

ANS: A A certain amount of fat is increased along with lean body mass to fill the characteristic contours of the adolescents gender. A healthy balance must be achieved between expected healthy weight gain and obesity. Suggesting dietary measures or increased exercise to control weight gain would not be recommended unless weight gain was excessive because eating disorders can develop in this group. Some fat deposition is essential for normal hormonal regulation. Menarche is delayed in girls with body fat contents that are too low.

The development of sexual orientation during adolescence is what? a. Inflexible b. A developmental process c. Differs for boys and girls d. Proceeds in a defined sequence

ANS: B The development of sexual orientation as a part of sexual identity includes several developmental milestones during late childhood and throughout adolescence. The sequence and time spent in phases are different for each individual. Boys and girls pass through the same developmental milestones.

what are some major issues affecting Adolescent

-Body image -Bullying/Cyberbullying -iPod use -Cell phone habits- sexting

8

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According to Erikson, acquiring a sense of _________ is the chief psychosocial task of preschoolers. Development of the superego occurs during this period, and conscience begins to emerge.

initiative

The most critical period for speech development occurs between _______ and ________ years of age.

2 and 4 years of age.

The school nurse needs to obtain authorization for a child who requires medications while at school. From whom does the nurse obtain the authorization? a. The parents b. The pharmacist c. The school administrator d. The prescribing practitioner

ANS: A A child who requires medication during the school day requires written authorization from the parent or guardian. Most schools also require that the medication be in the original container appropriately labeled by the pharmacist or physician. Some schools allow children to receive over-the-counter medications with parental permission. The pharmacist may be asked to appropriately label the medication for use at the school, but authorization is not required. The school administration should have a policy in place that facilitates the administration of medications for children who need them. The prescribing practitioner is responsible for ensuring that the medication is appropriate for the child. Because the child is a minor, parental consent is required.

What is most descriptive of the spiritual development of older adolescents? a. Beliefs become more abstract. b. Rituals and practices become increasingly important. c. Strict observance of religious customs is common. d. Emphasis is placed on external manifestations, such as whether a person goes to church.

ANS: A Because of their abstract thinking abilities, adolescents are able to interpret analogies and symbols. Rituals, practices, and strict observance of religious customs become less important as adolescents question values and ideals of families. Adolescents question external manifestations when not supported by adherence to supportive behaviors.

According to Piaget, magical thinking is the belief of which? a. Thoughts are all powerful. b. God is an imaginary friend. c. Events have cause and effect. d. If the skin is broken, the insides will come out.

ANS: A Because of their egocentrism and transductive reasoning, preschoolers believe that thoughts are all powerful. Believing God is an imaginary friend is an example of concrete thinking in a preschoolers spiritual development. Cause-and-effect implies logical thought, not magical thinking. Believing that if the skin is broken, the insides will come out is an example of concrete thinking in development of body image.

An 8-year-old girl tells the nurse that she has cancer because God is punishing her for being bad. What should the nurse interpret this as? a. A common belief at this age b. Indicative of excessive family pressure c. Faith that forms the basis for most religions d. Suggestive of a failure to develop a conscience

ANS: A Children at this age may view illness or injury as a punishment for a real or imagined misbehavior. School-age children expect to be punished and tend to choose a punishment that they think fits the crime. This is a common belief and not related to excessive family pressure. Many faiths do not include a God that causes cancer in response for bad behavior. This statement reflects the childs belief in what is right and wrong.

What is an important consideration in preventing injuries during middle childhood? a. Achieving social acceptance is a primary objective. b. The incidence of injuries in girls is significantly higher than it is in boys. c. Injuries from burns are the highest at this age because of fascination with fire. d. Lack of muscular coordination and control results in an increased incidence of injuries.

ANS: A School-age children often participate in dangerous activities in an attempt to prove themselves worthy of acceptance. The incidence of injury during middle childhood is significantly higher in boys compared with girls. Motor vehicle collisions are the most common cause of severe injuries in children. Children have increasing muscular coordination. Children who are risk takers may have inadequate self-regulatory behavior.

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

ANS: A Signs of stress include stomach pains or headache, sleep problems, bedwetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to earlier behaviors. The child is completing school work satisfactorily; any developmental delay would have been diagnosed earlier. The teacher reports that this is a departure from the childs normal behavior. Adjustment issues would most likely be evident soon after a change. Medical intervention is not immediately required. Recognizing that this constellation of symptoms can indicate stress, the nurse should help the child identify sources of stress and how to use stress reduction techniques. The parents are involved in the evaluation process.

How does the onset of the pubertal growth spurt compare in girls and boys? a. In girls, it occurs about 1 year before it appears in boys. b. In girls, it occurs about 3 years before it appears in boys. c. In boys. it occurs about 1 year before it appears in girls. d. It is about the same in both boys and girls.

ANS: A The average age of onset is 9 1/2 years for girls and 10 1/2 years for boys. Although pubertal growth spurts may occur in girls 3 years before it appears in boys on an individual basis, the average difference is 1 year. Usually girls begin their pubertal growth spurt earlier than boys.

What are the goals of organized athletics for preadolescent children? (Select all that apply.) a. Physical fitness b. Basic motor skills c. A positive self-image d. Commitment to winning

ANS: A, B, C The goals of organized athletics for preadolescent children include physical fitness, basic motor skills, and a positive self-image. The commitment is to the values of teamwork, fair play, and sportsmanship, not to winning.

The nurse is planning strategies to assist difficult or easily distracted children when they participate in activities. What strategies should the nurse plan? (Select all that apply.) a. Role-play before the activity. b. Handle behavior with firmness. c. Acquaint them with what to expect. d. Be patient with inappropriate behavior. e. Dont give them much information about the activity.

ANS: A, B, C, D Difficult or easily distracted children may benefit from practice sessions in which they are prepared for a given event by role-playing, visiting the site, reading or listening to stories, or using other methods to acquaint them with what to expect. Nurses need to handle children with difficult temperaments with exceptional patience, firmness, and understanding so they can learn appropriate behavior in their interactions with others.

The school nurse recognizes that students who are targeted for repeated harassment and bullying may exhibit what? (Select all that apply.) a. Skip school b. Attempt suicide c. Bring weapons to school d. Attend extracurricular activities e. Report symptoms of depression

ANS: A, B, C, E Students targeted for repeated teasing and harassment are more likely to skip school, to report symptoms of depression, and to attempt suicide. Equally troubling, teens who are regularly harassed or bullied are also more likely to bring weapons to school to feel safe. Students who are bullied do not want to attend extracurricular activities.

What are characteristics of middle adolescence (1517 years) with regard to relationships with peers? (Select all that apply.) a. Behavioral standards set by peer group b. Acceptance of peers extremely important c. Seeks peer affiliations to counter instability d. Exploration of ability to attract opposite sex e. Peer group recedes in importance in favor of individual friendship

ANS: A, B, D Characteristics of middle adolescence relationships with peers include behavioral standards set by the peer group, acceptance of peers is extremely important, and exploration of the ability to attract opposite sex. Seeking peer affiliations to counter instability is a characteristic of early adolescence relationships with peers. Peer groups receding in importance in favor of individual friendships is characteristic of late adolescence relationships with peers.

An adolescent asks the nurse about the safety of getting a tattoo. The nurse explains to the adolescent that it is important to find a qualified operator using proper sterile technique because an unsterilized needle or contaminated tattoo ink can cause what? (Select all that apply.) a. Hepatitis C virus b. Hepatitis B virus c. Hepatitis E virus d. Human immunodeficiency virus (HIV) e. Mycobacterium chelonae skin infections

ANS: A, B, D, E Using the same unsterilized needle to tattoo body parts of multiple teenagers presents the same risk for human immunodeficiency virus (HIV), hepatitis C virus, and hepatitis B virus transmission as occurs with other needle-sharing activities. Contaminated tattoo ink can cause nontuberculous M. chelonae skin infections. The hepatitis E virus is transmitted via the fecaloral route, principally via contaminated water, not by contaminated needles.

What growth and development milestones are expected between the ages of 8 and 9 years? (Select all that apply.) a. Can help with routine household tasks b. Likes the reward system for accomplished tasks c. Uses the telephone for practical purposes d. Chooses friends more selectively e. Goes about home and community freely, alone or with friends

ANS: A, B, E Children between the age of 8 and 9 years accomplish many growth and development milestones, including helping with routine household tasks, liking the reward system when a task is accomplished well, and going out with friends or alone more independently and freely. Using the telephone for practical reasons, choosing friends more selectively, and finding enjoyment in family with new-found respect for parents are tasks accomplished between the ages of 10 and 12 years.

Parents of an adolescent ask the school nurse, It is OK for our adolescent to get a job? The nurse should answer telling the parents the effects of adolescents who work more than 20 hours a week are what? (Select all that apply.) a. Can lead to fatigue b. Can lead to poorer grades c. Improves an interest in school d. Enhances development and identity e. Can reduce extracurricular involvement

ANS: A, B, E Detrimental effects are likely for adolescents who work more than 20 hours a week. Greater involvement in work can lead to fatigue, decreased interest in school, reduced extracurricular involvement, and poorer grades. Involvement in work may take time away from other activities that could contribute to identity development. Adolescent work as it exists today may negatively affect development.

What guidelines should the nurse use when interviewing adolescents? (Select all that apply.) a. Ensure privacy. b. Use open-ended questions. c. Share your thoughts and assumptions. d. Explain that all interactions will be confidential. e. Begin with less sensitive issues and proceed to more sensitive ones.

ANS: A, B, E Guidelines for interviewing adolescents include ensuring privacy, using open-ended questions, and beginning with less sensitive issues and proceeding to more sensitive ones. The nurse should not share thoughts but maintain objectivity and should avoid assumptions, judgments, and lectures. It may not be possible for all interactions to be confidential. Limits of confidentiality include a legal duty to report physical or sexual abuse and to get others involved if an adolescent is suicidal.

A school-age child has been a victim of bullying. What characteristics does the nurse assess for in this child? (Select all that apply.) a. Anxiety b. Outgoing c. Low self-esteem d. Psychosomatic complaints e. Good academic performance

ANS: A, C, D Victims of bullying are at increased risk for low self-esteem; anxiety; depression; feelings of insecurity and loneliness; poor academic performance; and psychosomatic complaints such as feeling tense, tired, or dizzy.

Parents are concerned about their child riding an all-terrain vehicle. What should the nurse tell the parents about safe use of all-terrain vehicles? (Select all that apply.) a. Restrict riding to familiar terrain. b. Limit street use to the neighborhood. c. Nighttime riding should not be allowed. d. Vehicles should not carry more than two persons. e. Vehicles should include seat belts, roll bars, and automatic headlights.

ANS: A, C, E Safe use of all-terrain vehicles includes restricting riding to familiar terrain; not allowing nighttime riding; and assuring the vehicle has seat belts, roll bars, and automatic headlights. Street use should not be allowed, and the vehicle should not carry more than one person.

The nurse is teaching parents about safety for their latchkey children. What should the nurse include in the teaching session? (Select all that apply.) a. Teach the child first-aid procedures. b. Keep the key in an easy place to find. c. Teach the child weather-related safety. d. Teach the child to open the door for delivery people. e. Emphasize fire safety rules and conduct practice fire drills.

ANS: A, C, E Safety for latchkey children includes teaching the child first-aid procedures, teaching the child weather-related safety, and emphasizing fire safety rules and conducting practice fire drills. Teach the child not to display keys and to always lock doors. The child should be taught to not open the door to anyone, even delivery people.

The nurse is planning strategies to assist a slow-to-warm child to try new experiences. What strategies should the nurse plan? (Select all that apply.) a. Attend after-school activities with a friend. b. Suggest the child move quickly into a new situation. c. Avoid trying new experiences until the child is ready. d. Allow the child to adapt to the experience at his or her own pace. e. Contract for permission to withdraw after a trial of the experience.

ANS: A, D, E The nurse should encourage slow-to-warm children to try new experiences but allow them to adapt to their surroundings at their own speed. Pressure to move quickly into new situations only strengthens their tendency to withdraw. After-school activities can be a cause for reaction, but attending with a friend or contracting for permission to withdraw after a trial of a specified number of times may provide them with sufficient incentive to try.

What aspects of cognition develop during adolescence? a. Ability to see things from the point of view of another b. Capability of using a future time perspective c. Capability of placing things in a sensible and logical order d. Progress from making judgments based on what they see to making judgments based on what they reason

ANS: B Adolescents are no longer restricted to the real and actual. They also are concerned with the possible; they think beyond the present. During concrete operations (between ages 7 and 11 years), children exhibit thought processes that enable them to see things from the point of view of another, place things in a sensible and logical order, and progress from making judgments based on what they see to making judgments based on what they reason.

A male school-age student asks the school nurse, How much with my height increase in a year? The nurse should give which response? a. Your height will increase on average 1 inch a year. b. Your height will increase on average 2 inches a year. c. Your height will increase on average 3 inches a year. d. Your height will increase on average 4 inches a year.

ANS: B Between the ages of 6 and 12 years, children grow an average of 5 cm (2 inches) per year.

The school nurse is providing guidance to families of children who are entering elementary school. What is essential information to include? a. Meet with teachers only at scheduled conferences. b. Encourage growth of a sense of responsibility in children. c. Provide tutoring for children to ensure mastery of material. d. Homework should be done as soon as child comes home from school.

ANS: B By being responsible for school work, children learn to keep promises, meet deadlines, and succeed in their jobs as adults. Parents should meet with the teachers at the beginning of the school year, for scheduled conferences, and whenever information about the child or parental concerns needs to be shared. Tutoring should be provided only in special circumstances in elementary school, such as in response to prolonged absence. The parent should not dictate the study time but should establish guidelines to ensure that homework is done.

A 12-year-old girl asks the nurse about an increase in clear white odorless vaginal discharge. What response should the nurse give? a. This may mean a yeast infection. b. This is normal before menstruation starts. c. This is caused by an increase in progesterone. d. This is possibly a sign of a sexually transmitted infection.

ANS: B Early in puberty, there is often an increase in normal vaginal discharge (physiologic leukorrhea) associated with uterine development. Girls or their parents may be concerned that this vaginal discharge is a sign of infection. The nurse can reassure them that the discharge is normal and a sign that the uterus is preparing for menstruation. It is caused by an increase in estrogen, not progesterone.

What is descriptive of the social development of school-age children? a. Identification with peers is minimum. b. Children frequently have best friends. c. Boys and girls play equally with each other. d. Peer approval is not yet an influence for the child to conform.

ANS: B Identification with peers is a strong influence in childrens gaining independence from parents. Interaction among peers leads to the formation of close friendships with same-sex peersbest friends. Daily relationships with age mates in the school setting provide important social interactions for school-age children. During the later school years, groups are composed predominantly of children of the same sex. Conforming to the rules of the peer group provides children with a sense of security and relieves them of the responsibility of making decisions.

A school-age child has begun to sleepwalk. What does the nurse advise the parents to perform? a. Wake the child and help determine what is wrong. b. Leave the child alone unless he or she is in danger of harming him- or herself or others. c. Arrange for psychologic evaluation to identify the cause of stress. d. Keep the child awake later in the evening to ensure sufficient tiredness for a full night of sleep.

ANS: B Sleepwalking is usually self-limiting and requires no treatment. The child usually moves about restlessly and then returns to bed. Usually the actions are repetitive and clumsy. The child should not be awakened unless in danger. If there is a need to awaken the child, it should be done by calling the childs name to gradually bring to a state of alertness. Some children, who are usually well behaved and tend to repress feelings, may sleepwalk because of strong emotions. These children usually respond to relaxation techniques before bedtime. If a child is overly fatigued, sleepwalking can increase.

The American Academy of Pediatrics (AAP) recommends that children younger than the age of 16 years be prohibited from participating in what? a. Skateboarding b. Snowmobiling c. Trampoline use d. Horseback riding

ANS: B The AAP views the use of snowmobiles and all-terrain vehicles as major health hazards for children. This group opposes the use of these vehicles by children younger than 16 years of age. The AAP recommends that children younger than the age of 10 years not use skateboards without parental supervision. Protective gear is always suggested. Trampoline use has increased along with injuries. Adults should supervise use. Horseback riding injuries are also a source of concern. Parents should determine the instructors safety record with students.

What is true concerning masturbation during adolescence? a. Homosexuality is encouraged by the practice of masturbation. b. Many girls do not begin masturbation until after they have intercourse. c. Masturbation at an early age leads to sexual intercourse at an earlier age. d. Development of intimate relationships is delayed when masturbation is regularly practiced.

ANS: B The age of first masturbation for girls is variable. Some begin masturbating in early adolescence; many do not begin until after they have had intercourse. Boys typically begin masturbation in early adolescence. Masturbation provides an opportunity for self-exploration. Both heterosexual and homosexual youth use masturbation. It does not affect the development of intimacy.

When teaching injury prevention during the school-age years, what should the nurse include? a. Teach children about the need to fear strangers. b. Teach basic rules of water safety. c. Avoid letting children cook in microwave ovens. d. Caution children against engaging in competitive sports.

ANS: B Water safety instruction is an important component of injury prevention at this age. The child should be taught to swim, select safe and supervised places to swim, swim with a companion, check sufficient water depth for diving, and use an approved flotation device. Teach stranger safety, not fear of strangers. This includes telling the child not to go with strangers, not to wear personalized clothing in public places, to tell parents if anyone makes child feel uncomfortable, and to say no in uncomfortable situations. Teach the child safe cooking. Caution against engaging in dangerous sports such as jumping on trampolines.

The school nurse recognizes that children respond to stress by using which tactics? (Select all that apply.) a. Passivity b. Delinquency c. Daydreaming d. Delaying tactics e. Becoming outgoing

ANS: B, C, D Children respond to stress by using coping mechanisms that include internalizing symptoms such as withdrawal, delaying tactics, and daydreaming, along with externalizing symptoms such as aggression and delinquency.

The school nurse teaches adolescents that the detrimental long-term effects of tanning are what? (Select all that apply.) a. Vitamin D deficiency b. Premature aging of the skin c. Exacerbates acne outbreaks d. Increased risk for skin cancer e. Possible phototoxic reactions

ANS: B, D, E Adolescents should be educated regarding the detrimental effects of sunlight on the skin. Long-term effects include premature aging of the skin; increased risk for skin cancer; and, in susceptible individuals, phototoxic reactions. Exposure to levels of sunlight cause an increase in vitamin D production. Tanning can often reduce outbreaks of acne.

The school nurse is teaching bicycle safety to a group of school-age children. What should the nurse include in the session? (Select all that apply.) a. Ride double file when possible. b. Watch for and yield to pedestrians. c. Only ride double with someone your own size. d. Ride bicycles with traffic away from parked cars. e. Keep both hands on the handlebars except when signaling.

ANS: B, D, E Bicycle safety includes watching for and yielding to pedestrians, riding bicycles with traffic away from parked cars, and keeping both hands on handlebars except when signaling. It is best to ride single file, not double file, and never to ride double on a bicycle.

Characteristics of bullies include what? (Select all that apply.) a. Female b. Depressed c. Good peer relationships d. Poor academic performance e. Exposed to domestic violence

ANS: B, D, E Children who are bullies are likely to be male, depressed, have poor academic performance, be exposed to domestic violence, have poor peer relationships, and have poor communication with their parents.

What are characteristics of dating relationships in early adolescence? (Select all that apply.) a. One-on-one dating b. Follow ritualized scripts c. Are psychosocially intimate d. Involve playing stereotypic roles e. Participating in mixed-gender group activities

ANS: B, D, E Early dating relationships typically follow highly ritualized scripts in which adolescents are more likely to play stereotypic roles than to really be themselves. Participating in mixed-gender group activities, such as going to parties or other events, may have a positive impact on young teenagers well-being. One-on-one dating during early adolescence, however, with a lot of time spent alone, may lead to sexual intimacy before a teen is ready. Although teenagers may begin dating during early adolescence, these early dating relationships are not usually psychosocially intimate.

The nurse is caring for children on an adolescent-only unit. What growth and development milestones should the nurse expect from 11- and 14-year-old adolescents? (Select all that apply.) a. Self-centered with increased narcissism b. No major conflicts with parents c. Established abstract thought process d. Have a rich, idealistic fantasy life e. Highly value conformity to group norms f. Secondary sexual characteristics appear

ANS: B, E, F Growth and development milestones in the 11- to 14-year-old age group include minimal conflicts with parents (compared with the 15- to 17-year-old age group), a high value placed on conformity to the norm, and the appearance of secondary sexual characteristics. Self-centeredness and narcissism are seen in the 15- to 17-year-old age group along with a rich and idealistic fantasy life. Abstract thought processes are not well established until the 18- to 20-year-old age group.

A female school-age child asks the school nurse, How many pounds should I expect to gain in a year? The nurse should give which response? a. You will gain about 2.4 to 4.6 lb per year b. You will gain about 3.4 to 5.6 lb per year. c. You will gain about 4.4 to 6.6 lb per year. d. You will gain about 5.5 to 7.6 lb per year.

ANS: C Between the ages of 6 and 12 years, children will almost double in weight, increasing 2 to 3 kg (4.4 to 6.6 lb) per year.

What statement accurately describes physical development during the school-age years? a. The childs weight almost triples. b. Muscles become functionally mature. c. Boys and girls double strength and physical capabilities. d. Fat gradually increases, which contributes to childrens heavier appearance.

ANS: C Boys and girls double both strength and physical capabilities. Their consistent refinement in coordination increases their poise and skill. In middle childhood, growth in height and weight occurs at a slower pace. Between the ages of 6 and 12 years, children grow 5 cm/yr and gain 3 kg/yr. Their weight will almost double. Although the strength increases, muscles are still functionally immature when compared with those of adolescents. This age group is more easily injured by overuse. Children take on a slimmer look with longer legs in middle childhood.

The parents of 9-year-old twin children tell the nurse, They have filled up their bedroom with collections of rocks, shells, stamps, and bird nests. The nurse should recognize that this is which? a. Indicative of giftedness b. Indicative of typical twin behavior c. Characteristic of cognitive development at this age d. Characteristic of psychosocial development at this age

ANS: C Classification skills involve the ability to group objects according to the attributes they have in common. School-age children can place things in a sensible and logical order, group and sort, and hold a concept in their mind while they make decisions based on that concept. Individuals who are not twins engage in classification at this age. Psychosocial behavior at this age is described according to Eriksons stage of industry versus inferiority.

What statement best describes fear in school-age children? a. Increasing concerns about bodily safety overwhelm them. b. They should be encouraged to hide their fears to prevent ridicule by peers. c. Most of the new fears that trouble them are related to school and family. d. Children with numerous fears need continuous protective behavior by parents to eliminate these fears.

ANS: C During the school-age years, children experience a wide variety of fears, but new fears related predominantly to school and family bother children during this time. Parents and other persons involved with children should discuss childrens fear with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding the fears does not end them and may lead to phobias.

The nurse is assessing the Tanner stage in an adolescent female. The nurse recognizes that the stages are based on which? a. The stages of vaginal changes b. The progression of menstrual cycles to regularity c. Breast size and the shape and distribution of pubic hair d. The development of fat deposits around the hips and buttocks

ANS: C In females, the Tanner stages describe pubertal development based on breast size and the shape and distribution of pubic hair. The stages of vaginal changes, progression of menstrual cycles to regularity, and the development of fat deposits occur during puberty but are not used for the Tanner stages.

The school nurse is teaching an adolescent about social networking and texting on phones. What statement by the adolescent indicates a need for further teaching? a. Social networking can help me develop interpersonal skills. b. I will have an opportunity to interact with people like myself. c. My text messaging during class time in school will not cause any disruption. d. I should be cautious, as the online environment can create opportunities for cyberbullying.

ANS: C Internet chatrooms and social networking sites have created a more public arena for trying out identities and developing interpersonal skills with a wider network of people, occasionally with anonymity. This can create opportunities for young people who have a limited access to friends (because of rural location, shyness, or rare chronic conditions) to interact with people like themselves. Both the online and text environment can create opportunities for cyberbullying, in which teens engage in insults, harassment, and publicly humiliating statements online or on cell phones. Text messaging and instant messaging via cell phones has become a common activity and can sometimes be disruptive during school. If the adolescent indicates it will not be disruptive, further teaching is needed.

What is characteristic of dishonest behavior in children ages 8 to 10 years? a. Cheating during games is now more common. b. Stealing can occur because their sense of property rights is limited. c. Lying is used to meet expectations set by others that they have been unable to attain. d. Dishonesty results from the inability to distinguish between fact and fantasy.

ANS: C Older school-age children may lie to meet expectations set by others to which they have been unable to measure up. Cheating usually becomes less frequent as the child matures. Young children may lack a sense of property rights; older children may steal to supplement an inadequate allowance, or it may be an indication of serious problems. In this age group, children are able to distinguish between fact and fantasy.

A parent asks about whether a 7-year-old child is able to care for a dog. Based on the childs age, what does the nurse suggest? a. Caring for an animal requires more maturity than the average 7-year-old possesses. b. This will help the parent identify the childs weaknesses. c. A dog can help the child develop confidence and emotional health. d. Cats are better pets for school-age children.

ANS: C Pets have been observed to influence a childs self-esteem. They can have a positive effect on physical and emotional health and can teach children the importance of nurturing and nonverbal communication. Most 7-year-old children are capable of caring for a pet with supervision. Caring for a pet should be a positive experience. It should not be used to identify weaknesses. The pet chosen does not matter as much as the childs being responsible for a pet.

What is descriptive of the play of school-age children? a. They like to invent games, making up the rules as they go. b. Individuality in play is better tolerated than at earlier ages. c. Knowing the rules of a game gives an important sense of belonging. d. Team play helps children learn the universal importance of competition and winning.

ANS: C Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age, children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play, children learn about competition and the importance of winning, an attribute highly valued in the United States but not in all cultures.

What does the nurse understand about caloric needs for school-age children? a. The caloric needs for the school-age children are the same as for other age groups. b. The caloric needs for school-age children are more than they were in the preschool years. c. The caloric needs for school-age children are lower than they were in the preschool years. d. The caloric needs for school-age children are greater than they will be in the adolescent years.

ANS: C School-age children do not need to be fed as carefully, as promptly, or as frequently as before. Caloric needs are lower than they were in the preschool years and lower than they will be during the coming adolescent growth spurt.

What statement best describes the relationship school-age children have with their families? a. Ready to reject parental controls b. Desire to spend equal time with family and peers c. Need and want restrictions placed on their behavior by the family d. Peer group replaces the family as the primary influence in setting standards of behavior and rules

ANS: C School-age children need and want restrictions placed on their behavior, and they are not prepared to cope with all the problems of their expanding environment. Although increased independence is the goal of middle childhood, they feel more secure knowing that an authority figure can implement controls and restriction. In the middle school years, children prefer peer group activities to family activities and want to spend more time in the company of peers. Family values usually take precedence over peer value systems.

The nurse is teaching a class on nutrition to a group of parents of 10- and 11-year-old children. What statement by one of the parents indicates a correct understanding of the teaching? a. My child does not need to eat a variety of foods, just his favorite food groups. b. My child can add salt and sugar to foods to make them taste better. c. I will serve foods that are low in saturated fat and cholesterol. d. I will continue to serve red meat three times per week for extra iron.

ANS: C School-age children should be eating foods that are low in saturated fat and cholesterol to prevent long-term consequences. The childs diet should include a variety of foods, include moderate amounts of extra salt and sugar, emphasize consumption of lean protein (chicken and pork), and limit red meat.

In boys, what is the initial indication of puberty? a. Voice changes b. Growth of pubic hair c. Testicular enlargement d. Increased size of penis

ANS: C Testicular enlargement is the first change that signals puberty in boys; it usually occurs between the ages of 9 1/2 and 14 years during Tanner stage 2. Voice change occurs between Tanner stages 3 and 4. Fine pubic hair may occur at the base of the penis; darker hair occurs during Tanner stage 3. The penis enlarges during Tanner stage 3.

The school nurse is teaching female school-age children about the average age of puberty. What is the average age of puberty for girls? a. 10 years b. 11 years c. 12 years d. 13 years

ANS: C The average age of puberty is 12 years in girls.

The school nurse is teaching male school-age children about the average age of puberty. What is the average age of puberty for boys? a. 12 years b. 13 years c. 14 years d. 15 years

ANS: C The average age of puberty is 14 years in boys. Boys experience little sexual maturation during preadolescence.

What is an important consideration for the school nurse planning a class on injury prevention for adolescents? a. Adolescents generally are not risk takers. b. Adolescents can anticipate the long-term consequences of serious injuries. c. Adolescents need to discharge energy, often at the expense of logical thinking. d. During adolescence, participation in sports should be limited to prevent permanent injuries.

ANS: C The physical, sensory, and psychomotor development of adolescents provides a sense of strength and confidence. There is also an increase in energy coupled with risk taking that puts them at risk. Adolescents are risk takers because their feelings of indestructibility interfere with understanding of consequences. Sports can be a useful way for adolescents to discharge energy. Care must be taken to avoid overuse injuries.

The nurse is explaining about the developmental sequence in childrens capacity to conserve matter to a group of parents. What type of matter is last in the sequence for a child to develop? a. Mass b. Length c. Volume d. Numbers

ANS: C There is a developmental sequence in childrens capacity to conserve matter. Children usually grasp conservation of numbers (ages 5 to 6 years) before conservation of substance. Conservation of liquids, mass, and length usually is accomplished at about ages 6 to 7 years, conservation of weight sometime later (ages 9 to 10 years), and conservation of volume or displacement last (ages 9 to 12 years).

The school nurse is presenting sexual information to a group of school-age girls. What approach should the nurse take when presenting the information? a. Put off answering questions. b. Give technical terms when giving the presentation. c. Treat sex as a normal part of growth and development. d. Plan to give the presentation with boys and girls together.

ANS: C When nurses present sexual information to children, they should treat sex as a normal part of growth and development. Nurses should answer questions honestly, matter-of-factly, and at the childrens level of understanding. School-age children may be more comfortable when boys and girls are segregated for discussions.

The nurse is explaining to an adolescent the rationale for administering a Tdap (tetanus, diphtheria, acellular pertussis) vaccine 3 years after the last Td (tetanus) booster. What should the nurse tell the adolescent? a. It is time for a booster vaccine. b. It is past the time for a booster vaccine. c. This vaccine will provide pertussis immunity. d. This vaccine will be the last booster you will need.

ANS: C When the Tdap is used as a booster dose, it may be administered earlier than the previous 5-year interval to provide adequate pertussis immunity (regardless of interval from the last Td dose). It is not time or past time for a booster because they are required every 5 years. Another booster will be needed in 5 years, so it is not the last dose.

What are characteristics of early adolescence (1114 years) with regard to identity? (Select all that apply.) a. Mature sexual identity b. Increase in self-esteem c. Trying out of various roles d. Conformity to group norms e. Preoccupied with rapid body changes

ANS: C, D, E Characteristics of early adolescence identity include trying out of various roles, conformity to group norms, and preoccupation with rapid body changes. Mature sexual identity and increase in self-esteem are characteristics of late adolescent identity.

What are characteristics of late adolescence (1820 years) with regard to sexuality? (Select all that apply.) a. Exploration of self-appeal b. Limited dating, usually group c. Intimacy involves commitment d. Growing capacity for mutuality and reciprocity e. May publicly identify as gay, lesbian, or bisexual

ANS: C, D, E Characteristics of late adolescence sexuality include intimacy involving commitment; growing capacity for mutuality and reciprocity; and publicly identifying as gay, lesbian, or bisexual. Exploration of self-appeal is a characteristic of middle adolescence sexuality. Limited dating, usually group, is a characteristic of early adolescence sexuality.

What is the role of the peer group in the life of school-age children? a. Decreases their need to learn appropriate sex roles b. Gives them an opportunity to learn dominance and hostility c. Allows them to remain dependent on their parents for a longer time d. Provides them with security as they gain independence from their parents

ANS: D Peer group identification is an important factor in gaining independence from parents. Through peer relationships, children learn ways to deal with dominance and hostility. They also learn how to relate to people in positions of leadership and authority and how to explore ideas and the physical environment. A childs concept of appropriate sex roles is influenced by relationships with peers.

The nurse is developing a teaching pamphlet for parents of school-age children. What anticipatory guidelines should the nurse include in the pamphlet? a. At age 6 years, parents should be certain that the child is reading independently with books provided by school. b. At age 8 years, parents should expect a decrease in involvement with peers and outside activities. c. At age 10 years, parents should expect a decrease in admiration of the parents with little interest in parentchild activities. d. At age 12 years, parents should be certain that the childs sex education is adequate with accurate information.

ANS: D A 12-year-old child should have been introduced to sex education, and parents should be certain that the information is adequate and accurate and that the child is not embarrassed to talk about sexual feelings or other aspects of sex education. At age 6 years, a child does not need to be reading independently and usually still needs help with reading and enjoys being read to. At 8 years of age, parents should expect their child to show increased involvement with peers and outside activities and should encourage this behavior. A 10-year-old child exhibits increased feelings of admiration of parents, especially fathers, and parentchild activities should be encouraged.

The school nurse recognizes that adolescents should get how many hours of sleep each night? a. 6 hours b. 7 hours c. 8 hours d. 9 hours

ANS: D Adolescents should generally get around 9 hours of sleep each night.

The nurse is preparing a pamphlet for parents of adolescents about guidance during the adolescent years. What suggestion should the nurse include in the pamphlet? a. Provide criticism when mistakes are made or when views are different. b. Use comparisons with older siblings or extended family to promote good outcomes. c. Begin to disengage from school functions to allow the adolescent to gain independence. d. Provide clear, reasonable limits and define consequences when rules are broken.

ANS: D An anticipatory guideline to include when teaching parents of adolescents is to provide clear, reasonable limits and have clear consequences when rules are broken. Parents should avoid criticism when mistakes are made and should allow opportunities for the teen to voice different views and opinions. Parents should try to avoid comparing the teen with a sibling or extended family member. Parents should try to be more engaged in the teens school functions to show support and unconditional love.

According to Piaget, adolescents tend to be in what stage of cognitive development? a. Concrete operations b. Conventional thought c. Postconventional thought d. Formal operational thought

ANS: D Cognitive thinking culminates in the capacity for abstract thinking. This stage, the period of formal operations, is Piagets fourth and last stage. Concrete operations usually occur between ages 7 and 11 years. Conventional and postconventional thought refers to Kohlbergs stages of moral development.

What is true concerning the development of autonomy during adolescence? a. Development of autonomy typically involves rebellion. b. Development of autonomy typically involves parentchild conflicts. c. Parent and peer influences are opposing forces in the development of autonomy. d. Conformity to both parents and peers gradually declines toward the end of adolescence.

ANS: D During middle and late adolescence, the conformity to parents and peers declines. Subjective feelings of self-reliance increase steadily over the adolescent years. Adolescents have genuine behavioral autonomy. Rebellion is not typically part of adolescence. It can occur in response to excessively controlling circumstances or to growing up in the absence of clear standards. Parent and peer relationships can play complementary roles in the development of a healthy degree of individual independence.

The school nurse recognizes that pubertal delay in girls is considered if breast development has not occurred by which age? a. 10 years b. 11 years c. 12 years d. 13 years

ANS: D Girls may be considered to have pubertal delay if breast development has not occurred by age 13 years or if menarche has not occurred within 2 to 2 1/2 years of the onset of breast development.

The nurse is assessing the Tanner stage in an adolescent male. The nurse recognizes that the stages are based on what? a. Hair growth on the face and chest b. Changes in the voice to a deeper timbre c. Muscle growth in the arms, legs, and shoulders d. Size and shape of the penis and scrotum and distribution of pubic hair

ANS: D In males, the Tanner stages describe pubertal development based on the size and shape of the penis and scrotum and the shape and distribution of pubic hair. During puberty, hair begins to grow on the face and chest; the voice becomes deeper; and muscles grow in the arms, legs, and shoulders, but these are not used for the Tanner stages.

Adolescents often do not use reasoned decision making when issues such as substance abuse and sexual behavior are involved. What is this because of? a. They tend to be immature. b. They do not need to use reasoned decision making. c. They lack cognitive skills to use reasoned decision making. d. They are dealing with issues that are stressful and emotionally laden.

ANS: D In the face of time pressures, personal stress, or overwhelming peer pressure, young people are more likely to abandon rational thought processes. Many of the health-related decisions adolescents confront are emotionally laden or new. Under such conditions, many people do not use their capacity for formal decision making. The majority of adolescents have cognitive skills and are capable of reasoned decision making. Stress affects their ability to process information. Reasoned decision making should be used in issues that are crucial such as substance abuse and sexual behavior.

What statement characterizes moral development in the older school-age child? a. Rule violations are viewed in an isolated context. b. Judgments and rules become more absolute and authoritarian. c. The child remembers the rules but cannot understand the reasons behind them. d. The child is able to judge an act by the intentions that prompted it rather than just by the consequences.

ANS: D Older school-age children are able to judge an act by the intentions that prompted the behavior rather than just by the consequences. Rule violation is likely to be viewed in relation to the total context in which it appears. Rules and judgments become less absolute and authoritarian. The situation and the morality of the rule itself influence reactions.

The parents of a 5-year-old child ask the nurse, How many hours of sleep a night does our child need? The nurse should give which response? a. A 5-year-old child requires 8 hours of sleep. b. A 5-year-old child requires 9.5 hours of sleep. c. A 5-year-old child requires 10 hours of sleep. d. A 5-year-old child requires 11.5 hours of sleep.

ANS: D Sleep requirements decrease during school-age years; 5-year-old children generally require 11.5 hours of sleep.

The school nurse is teaching a class on injury prevention. What should be included when discussing firearms? a. Adolescents are too young to use guns properly for hunting. b. Gun carrying among adolescents is on the rise, primarily among inner-city youth. c. Nonpowder guns (air rifles, BB guns) are a relatively safe alternative to powder guns. d. Adolescence is the peak age for being a victim or offender in the case of injury involving a firearm.

ANS: D The increase in gun availability in the general population is linked to increased gun deaths among children, especially adolescents. Gun carrying among adolescents is on the rise and not limited to the stereotypic inner-city youth. Adolescents can be taught to safely use guns for hunting, but they must be stored properly and used only with supervision. Nonpowder guns (air rifles, BB guns) cause almost as many injuries as powder guns.

A 16-year-old adolescent boy tells the school nurse that he is gay. The nurses response should be based on what? a. He is too young to have had enough sexual activity to determine this. b. The nurse should feel open to discussing his or her own beliefs about homosexuality. c. Homosexual adolescents do not have concerns that differ from those of heterosexual adolescents. d. It is important to provide a nonthreatening environment in which he can discuss this.

ANS: D The nurse needs to be open and nonjudgmental in interactions with adolescents. This will provide a safe environment in which to provide appropriate health care. Adolescence is when sexual identity develops. The nurses own beliefs should not bias the interaction with this student. Homosexual adolescents face very different challenges as they grow up because of societys response to homosexuality.

What do nursing interventions to promote health during middle childhood include? a. Stress the need for increased calorie intake to meet increased demands. b. Instruct parents to defer questions about sex until the child reaches adolescence. c. Advise parents that the child will need increasing amounts of rest toward the end of this period. d. Educate parents about the need for good dental hygiene because these are the years in which permanent teeth erupt.

ANS: D The permanent teeth erupt during the school-age years. Good dental hygiene and regular attention to dental caries are vital parts of health supervision during this period. Caloric needs are decreased in relation to body size for this age group. Balanced nutrition is essential to promote growth. Questions about sex should be addressed honestly as the child asks questions. The child usually no longer needs a nap, but most require approximately 11 hours of sleep each night at age 5 years and 9 hours at age 12 years.

The school nurse is discussing after-school sports participation with parents of children age 10 years. The nurses presentation includes which important consideration? a. Teams should be gender specific. b. Organized sports are not appropriate at this age. c. Competition is detrimental to the establishment of a positive self-image. d. Sports participation is encouraged if the type of sport is appropriate to the childs abilities.

ANS: D Virtually every child is suited for some type of sport. The child should be matched to the type of sport appropriate to his or her abilities and physical and emotional makeup. At this age, girls and boys have the same basic structure and similar responses to exercise and training. After puberty, teams should be gender specific because of the increased muscle mass in boys. Organized sports help children learn teamwork and skill acquisition. The emphasis should be on playing and learning. Children do enjoy appropriate levels of competition.

An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4 months ago. She has not received any medical care. She smokes but denies any other substance use. The priority nursing action is which of the following? A. Notify her parents. B. Refer her for prenatal care. C. Explain the importance of not smoking. D. Discuss dietary needs for adequate fetal growth.

B. Refer her for prenatal care.

The school nurse is discussing dental health with some children in first grade. Which of the following should be included? A. Teach how to floss teeth properly. B. Recommend a toothbrush with hard nylon bristles. C. Emphasize the importance of brushing before bedtime. D. Recommend nonfluoridated toothpaste approved by the American Dental Association.

C. Emphasize the importance of brushing before bedtime.

The school nurse is discussing testicular self-examination with adolescent male students. Why is this important? a. Epididymitis is common during adolescence. b. Asymptomatic sexually transmitted infections may be present. c. Testicular tumors during adolescence are generally malignant. d. Testicular tumors, although usually benign, are common during adolescence.

C. Testicular tumors during adolescence are generally malignant.

What Yearly screening are needed for adolescents ? a. hypertension, hyperlipidemia, and obesity b. chickenpox c. lactose allergy / penut allergy d. measures/ mumps

a. hypertension, hyperlipidemia, and obesity

Which of the following are the primary causes of mortality among adolescents in United States select all that apply a.injuries b. suicide c.congenital anomalies D. homicide e.chronic illness

a.injuries b. suicide D. homicide

When teaching the adolescent about the management of acne, the nurse should include which of the following interventions? a. Clean face with an antibacterial soap twice a day. b. Clean face gently with a mild soap once or twice a day. c. Avoid foods with a high fat content such as French fries and chocolate. d. Express comedones by gentle squeezing them followed by cleansing with alcohol.

b. Clean face gently with a mild soap once or twice a day.

What is the primary cause of death from injury in the adolescent years ? a. drowning b. Motor vehicle injuries c. cliff jumping d. bike, skateboard, rollerblade accidents

b. Motor vehicle injuries --- often involve alcohol use, unrestrained passenger or driver, excess speeds, and distraction by such things as cellular telephones (especially "texting").

Which of the following immunization booster vaccine should be considered for a 13-year-old adolescent who is has completed all recommended routine childhood vaccinations? Select all that apply a. DTaP Vaccine b. Tdap vaccine c. meningococcal vaccine d. pneumococcal vaccine e.hepatitis b vaccine f. Hib vaccine

b. Tdap vaccine c. meningococcal vaccine

Which of the following statements accurately describes physical development during the school-age years? A. The child's weight almost triples. B. The child grows an average of 5 cm (2 inches) per year. C. Few physical differences are apparent among children of different genders at the end of middle childhood. D. Fat gradually increases, which contributes to the child's heavier appearance.

b.The child grows an average of 5 cm (2 inches) per year.

Which of the following hormones have the most impact on the development puberty and females and males? select all that apply a. follicle stimulating hormone (FSH) b. insulin c. luteinizing hormone (LH) d. estrogen e. testosterone

c. luteinizing hormone (LH) a. follicle stimulating hormone (FSH)