PEDS week 1: Evolve, Canvas, etc.

Tanner stage ___ describes an immature stage of pubertal growth.

1

Children reach an adult pattern of sleep by ___ years of age.

3

By ___ months an infant can roll from abdomen to back.

5

A normal apical pulse for a non-crying infant is: A. 150 B. 200 C. 180 D. 175

A. 150

Which is the leading cause of death in infants younger than 1 year? A. Congenital abnormalities B. SIDS C. Respiratory distress syndrome D. Bacterial sepsis of the newborn

A. Congenital abnormalities Congenital anomalies account for 20.1% of deaths in infants younger than 1 year. Sudden infant death syndrome accounts for 8.2% of deaths in this age group. Respiratory distress syndrome accounts for 3.4% of deaths in this age group. Infections specific to the perinatal period account for 2.7% of deaths in this age group.

Based on Piaget's theory of cognitive development, what is one basic concept a child is expected to attain during the first year of life? A. If an object is hidden, that does not mean that it is gone. B. He or she cannot be fooled by changing shapes. C. Parents are not perfect. D. Most procedures can be reversed.

A. If an object is hidden, that does not mean that it is gone.

The nurse is observing parents playing with their 10-month-old daughter. Which of the following should the nurse recognize as evidence that the child is developing object permanence? A. Looks for the toy parents hide under the blanket B. Returns the blocks to the same spot on the table C. Recognizes that a ball of clay is the same when flattened out D. Bangs two cubes held in her hands

A. Looks for the toy parents hide under the blanket Object permanence is the realization that items that leave the visual field still exist. When the infant searches for the toy under the blanket, it is an indication that object permanence has developed.

The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as which of the following? A. Normal finding B. Questionable finding—indicates infant should be rechecked in 1 month C. Abnormal finding—indicates need for immediate referral to practitioner D. Abnormal finding—indicates need for developmental assessment

A. Normal finding This is a normal finding. The anterior fontanel closes between ages 12 and 18 months.

What is probably the single most important influence on growth at all stages of development? A. Nutrition B. Heredity C. Culture D. Environment

A. Nutrition

During this age group magical thinking is the norm. A. Pre-school B. School age C. Adolescent D. Infancy

A. Pre-school

According to Piaget, at what stage of development do children typically solve problems through trial and error? A. Sensorimotor stage B. Preoperational stage C. Formal operational stage D. Concrete operational stage

A. Sensorimotor stage

A preschool child watches a nurse pour medication from a tall, thin glass to a short, wide glass. Which statement is appropriate developmentally for this age group? A. The amount of medicine is less. B. The amount of medicine did not change, only its appearance. C. Pouring medicine makes the medicine hot. D. The glass changed shape to accommodate the medicine.

A. The amount of medicine is less.

Which of the following 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

A. Tie shoelaces

During their school-age years, children best understand concepts that can be seen or illustrated. The nurse knows this type of thinking is termed as A. concrete operations. B. preoperational. C. school-age rhetoric. D. formal operations.

A. concrete operation

During a well-baby visit, the parents of a 12-month-old ask the nurse for advice on age-appropriate toys for their child. Based on the nurse's knowledge of developmental levels, the most appropriate toys to suggest are A. push-pull toys. B. toys with black-white patterns. C. pop-up toy such as Jack-in-the-box. D. soft toys that can be put in the mouth. E. toys that pop apart and go back together.

A. push-pull toys. C. pop-up toy such as Jack-in-the-box. E. toys that pop apart and go back together.

Infant stage of development according to Erickson is A. trust vs. mistrust B. sense of industry C. sense of initiative D. sense of independence

A. trust vs. mistrust

According to Erikson, infancy is concerned with acquiring a sense of A. trust. B. industry. C. initiative. D. separation.

A. trust.

A nurse is admitting a toddler to the hospital. The toddler is with both parents and is currently sitting comfortably on a parent's lap. The parents state they will need to leave for a brief period. Which type of nursing diagnosis should the nurse formulate for this child? a. Risk for anxiety b. Anxiety c. Readiness for enhanced coping d. Ineffective coping

ANS: A A potential problem is categorized as a risk. The toddler has a risk to become anxious when the parents leave. Nursing interventions will be geared toward reducing the risk. The child is not showing current anxiety or ineffective coping. The child is not at a point for readiness for enhanced coping, especially because the parents will be leaving.

A nurse makes the decision to apply a topical anesthetic to a child's skin before drawing blood. Which ethical principle is the nurse demonstrating? a. Autonomy b. Beneficence c. Justice d. Truthfulness

ANS: B Beneficence is the obligation to promote the patient's well-being. Applying a topical anesthetic before drawing blood promotes reducing the discomfort of the venipuncture. Autonomy is the patient's right to be self-governing. Justice is the concept of fairness. Truthfulness is the concept of honesty.

Which is most descriptive of clinical reasoning? a. A simple developmental process b. Purposeful and goal-directed c. Based on deliberate and irrational thought d. Assists individuals in guessing what is most appropriate

ANS: B Clinical reasoning is a complex, developmental process based on rational and deliberate thought. Clinical reasoning is not a developmental process. Clinical reasoning is based on rational and deliberate thought. Clinical reasoning is not a guessing process.

A school nurse is conducting vision and hearing testing on fifth-grade children. Which level of prevention is the nurse demonstrating? a. Primary b. Secondary c. Tertiary d. Health promotion

ANS: B Secondary prevention focuses on screening and early diagnosis of disease. Vision and hearing testing are screening tests to detect problems. Primary prevention focuses on health promotion and prevention of disease or injury. Tertiary prevention focuses on optimizing function for children with a disability or chronic disease. Health promotion is focused on preventing disease or illness.

Which statement is true about the basal metabolic rate (BMR) in children? a. It is reduced by fever. b. It is slightly higher in boys than in girls at all ages. c. It increases with age of child. d. It decreases as proportion of surface area to body mass increases.

ANS: B The BMR is the rate of metabolism when the body is at rest. At all ages, the rate is slightly higher in boys than in girls. The rate is increased by fever. The BMR is highest in infancy and then closely relates to the proportion of surface area to body mass. As the child grows, the proportion decreases progressively to maturity.

A nurse manager at a home-care agency is planning a continuing education program for the home-care staff nurses. Which type of continuing education program should the nurse manager plan? a. On-line training modules b. A structured written teaching module each nurse completes individually c. A workshop training day, with a professional speaker, where nurses can interact with each other d. One-on-one continuing education training with each nurse

ANS: C Because of the unique practice environment of home care nurses, it is important for an agency to facilitate sharing among peers to decrease work-related stress, increase job satisfaction, and support high-quality patient care. On-line training, written teaching modules, and one-on-one training would not allow for any sharing with peers.

A child has a postoperative appendectomy incision covered by a dressing. The nurse has just completed a prescribed dressing change for this child. Which description is an accurate documentation of this procedure? a. Dressing change to appendectomy incision completed, child tolerated procedure well, parent present b. No complications noted during dressing change to appendectomy incision c. Appendectomy incision non-reddened, sutures intact, no drainage noted on old dressing, new dressing applied, procedure tolerated well by child d. No changes to appendectomy incisional area, dressing changed, child complained of pain during procedure, new dressing clean, dry and intact

ANS: C The nurse should document assessments and reassessments. Appearance of the incision described in objective terms should be included during a dressing change. The nurse should document patient's response and the outcomes of the care provided. In this example, these include drainage on the old dressing, the application of the new dressing, and the child's response. The other statements partially fulfill the requirements of documenting assessments and reassessments, patient's response, and outcome, but do not include all three.

Which action by the nurse demonstrates use of evidence-based practice (EBP)? a. Gathering equipment for a procedure b. Documenting changes in a patient's status c. Questioning the use of daily central line dressing changes d. Clarifying a physician's prescription for morphine

ANS: C The nurse who questions the daily central line dressing change is ascertaining whether clinical interventions result in positive outcomes for patients. This demonstrates EBP, which implies questioning why something is effective and whether a better approach exists. Gathering equipment for a procedure and documenting changes in a patient's status are practices that follow established guidelines. Clarifying a physician's prescription for morphine constitutes safe nursing care.

A nurse is collecting subjective and objective information about target populations to diagnose problems based on community needs. This describes which step in the community nursing process? a. Planning b. Diagnosis c. Assessment d. Establishing objectives

ANS: C The nursing process stages are similar, whether the client is one child or a population of children. The assessment phase of the nursing process focuses on collecting subjective and objective data. Planning is the development of community-centered goals and objectives. Diagnosis is the identification of problems specific to the community.

A nurse is planning play activities for school-age children. Which type of a play activity should the nurse plan? a. Solitary b. Parallel c. Associative d. Cooperative

ANS: D School-age children engage in cooperative play where it is organized and interactive. Playing a game is a good example of cooperative play. Solitary play is appropriate for infants, parallel play is an activity appropriate for toddlers, and associative play is an activity appropriate for preschool-age children.

A nurse is establishing several health programs, such as bicycle safety, to improve the health status of a target population. This describes which step in the community nursing process? a. Planning b. Evaluation c. Assessment d. Implementation

ANS: D The nurse working with the community to put into practice a program to reach community goals is the implementation phase of the community nursing process. Planning involves designing the program to meet community-centered goals. The evaluation stage would determine the effectiveness of the program. During the assessment phase, the nurse would identify the resources necessary and the barriers that would interfere with implementation.

The nurse is caring for a hospitalized 4-year-old boy, Ryan. His parents tell the nurse that they will be back to visit at 6 PM. When Ryan asks the nurse when his parents are coming, the nurse's best response is which of the following? 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."

B. "They will come after dinner."

When may most girls have pubescent changes begin? A. 8-10 B. 10-12 C. 12-14 D. 4-6

B. 10-12

At what age would a child demonstrate the ability to understand the concept of compromise as related to social play interactions? A. 2 years of age B. 5 to 6 of age C. It depends on the child's ability to reason and therefore may vary considerably D. It is a learned concept and is typically present by 10 years of age.

B. 5 to 6 of age

A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was "bad." Which of the following 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

B. Common at this age Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think they are directly responsible for events, making them feel guilt for things outside of their control.

Which factor most impacts the type of injury a child is susceptible to, according to the child's age? A. Physical health of child B. Developmental level of child C. Education level of child D. Number of responsible adults in the home

B. Developmental level of child The child's developmental stage determines the type of injury that is likely to occur. The child's physical health may facilitate the child's recovery from an injury but does not impact the type of injury. Educational level is related to developmental level, but it is not as important as the child's developmental level in determining the type of injury. The number of responsible adults in the home may affect the number of unintentional injuries, but the type of injury is related to the child's developmental stage.

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.

B. Explain that this weight loss is within normal limits. 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.

Which of the following is a characteristic of 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

B. Increasing level of comprehension 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

Which one of the following statements 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.

B. Most of the new fears that trouble them are related to school and family.

Which statements provides the best description of parallel play? Select all that apply. A. Two children playing checkers together. B. One child playing with his truck while another child plays with a car while seated on the floor. C. Three children playing each playing with a deck of cards but performing different actions with the respective deck of cards. D. Two children playing with dolls together while a third child walks by with a doll stroller and asks if she could play with them.

B. One child playing with his truck while another child plays with a car while seated on the floor. C. Three children playing each playing with a deck of cards but performing different actions with the respective deck of cards.

Which of the following 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"

B. Realizes that "out of sight" is not out of reach 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

A nurse is knowledgeable about both growth and development. Which assessment finding indicates the child's development is on target? A. The child has not gained weight for 3 months. B. The child can throw a large ball but not a small ball. C. The child's arms are the most rapidly growing part of the child's body. D. The child can pull herself or himself to her or his feet before the child is able to sit steadily.

B. The child can throw a large ball but not a small ball.

Which statement helps explain the growth and development of children? A. Development proceeds at a predictable rate. B. The sequence of developmental milestones is predictable. C. Rates of growth are consistent among children. D. At times of rapid growth, there is also acceleration of development.

B. The sequence of developmental milestones is predictable.

Which of the following statements 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.

B. Wanting to please the parent helps motivate the child to use the toilet. 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.

Parents are often confused by the terms growth and development and use the terms interchangeably. Based on the nurse's knowledge of growth and development, the most appropriate explanation of development is A. a child grows taller all through early childhood. B. a child learns to throw a ball overhand. C. a child's weight triples during the first year. D. a child's brain increases in size until school age.

B. a child learns to throw a ball overhand.

A nurse is examining a toddler and is discussing with the mother psychosocial development according to Erikson's theories. Based on the nurse's knowledge of Erikson, the most age-appropriate activity to suggest to the mother at this stage is to A. feed lunch. B. allow the toddler to start making choices about what to wear. C. allow the toddler to pull a talking-duck toy. D. turn on a TV show with bright colors and loud songs.

B. allow the toddler to start making choices about what to wear.

In terms of genetic presentations, if a disease pattern exists without known correlation of symptoms, this would be characterized as a A. syndrome. B. association. C. sequence. D. mutation.

B. association.

Parents of a 4-month-old infant bring the infant to the clinic for a well-baby checkup. Which instruction should the nurse include at this time about injury prevention? A. "Never shake baby powder directly on the infant because it can be aspirated into the lungs." B. "Do not permit the child to chew paint from window ledges, because the child might absorb too much lead." C. "When the child learns to roll over, you must offer supervision whenever the child is on a surface from which the child might fall." D. "Keep doors of appliances closed at all times."

C. "When the child learns to roll over, you must offer supervision whenever the child is on a surface from which the child might fall."

At what age would the nurse expect an infant to be able to say "mama" and "dada" with meaning? A. 4 months B. 6 months C. 10 months D. 14 months

C. 10 months

Which of the following statements best describes the infant's physical development? A. Anterior fontanel closes by age 6 to 10 months. B. Binocularity is well established by age 8 months. C. Birth weight doubles by age 6 months and triples by age 1 year. D. Maternal iron stores persist during the first 12 months of life.

C. Birth weight doubles by age 6 months and triples by age 1 year.

In general children older than 4 years that weigh betweeen 40-80 lbs should use what kind of car seat until they are 8-12 years old? A. Rear facing car seat B. Front facing car seat. C. Booster with safety strap D. Regular car safety belts.

C. Booster with safety strap

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

C. Characteristic of social development at this age

Which leading cause of death topic should the nurse emphasize to a group of African-American boys ranging in age from 15 to 19 years? A. Suicide B. Cancer C. Firearm homicide D. Occupational injuries

C. Firearm homicide Firearm homicide is the second overall cause of death in this age group and the leading cause of death in African-American males. Suicide is the third-leading cause of death in this population. Cancer, although a major health problem, is the fourth-leading cause of death in this age group. Occupational injuries do not contribute to a significant death rate for this age group.

A nurse is discussing various developmental theories at a parenting class. Which individual is associated with the moral development theory? A. Erikson B. Fowler C. Kohlberg D. Freud

C. Kohlberg

Which is the leading cause of death from unintentional injuries for females ranging in age from 1 to 14? A. Mechanical suffocation B. Drowning C. MVA-related fatalities D. Fire and burn-related fatalities

C. MVA-related fatalities Motor vehicle-related fatalities are the leading cause of death for females ranging in age from 1 to 14, either as passengers or as pedestrians. Mechanical suffocation is fourth or fifth, depending on the age. Drowning is the second- or third-leading cause of death, depending on the age. Fire- and burn-related fatalities are the second-leading cause of death.

Which behavioral pattern would be a cause for concern to a nurse for in a pediatric male patient, 8 years of age, who is presenting to the clinic with his parents for a well-child visit? A. Child is quiet playing with his iPad while his parents answer questions posed by the nurse. B. Parents are laughing and joking with their son regarding an earlier event that occurred that day. C. Parents are telling their son that he is going to get fat if he continues to keep eating pretzels before dinner. D. Child asks to borrow the nurse's stethoscope to see how it works.

C. Parents are telling their son that he is going to get fat if he continues to keep eating pretzels before dinner.

At this developmental stage the child knows colors, numbers, alphabet and is fully able to converse. A. Toddler B. School-age C. Pre-school D. Adolescent

C. Pre-school

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

C. Rooting 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.

The major task according to Erickson during grade school is? A. Sense of independence B. Trust verses mistrust C. Sense of industry D. Sense of initiative

C. Sense of industry

Which of the following 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.

C. They know the rules and behaviors expected of them but do not understand the reasons behind them.

Which is the major cause of death for children older than 1 year? A. Cancer B. Heart disease C. Unintentional injuries D. Congenital abnormalities

C. Unintentional injuries Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. Congenital anomalies are the leading cause of death in those younger than 1 year. Cancer ranks either second or fourth, depending on the age group, and heart disease ranks fifth in the majority of the age groups.

A nurse is observing children at play. Which figure depicts associative play? (There weren't any answers lol) a. b. c. d.

C. associative play The children depicted in the figure at the carnival ride are demonstrating associative play. They are engaged in similar or identical activities. The child depicted playing alone is demonstrating solitary play. The children playing on the beach depict parallel play. They are playing side by side but are participating in different activities. The children depicted playing a board game are engaging in cooperative play.

The nurse is observing a child who appears to be daydreaming while seated in a chair in the clinic waiting for her scheduled appointment with her mother. This behavior is noted as being an example of A. pretend play. B. dramatic play. C. unoccupied behavior. D. Skill play.

C. unoccupied behavior.

The parent of a 12-month-old says to the nurse, "He pushes the teaspoon right out of my hand when I feed him. I can't let him feed himself; he makes too much mess." The most appropriate response by the nurse is A. "It's important not to give in to this kind of temper tantrum at this age." B. "Maybe you need to try a different type of spoon, one designed for children." C. "It's important to let him make a mess. Just don't worry about it so much." D. "He is at the age when he should begin to feed himself. Let's think of ways to make the mess more tolerable."

D. "He is at the age when he should begin to feed himself. Let's think of ways to make the mess more tolerable."

Which characteristic best describes the fine motor skills of a 5-month-old infant? A. Transfers objects from one hand to another B. Crude pincer grasp C. Able to build a tower of two cubes D. Able to grasp an object voluntarily

D. Able to grasp an object voluntarily

At this developmental stage the child has the ability to think abstractly. A. Pre-school B. School age C. Toddler D. Adolescent

D. Adolescent

Which of the following describes the cognitive abilities of school-age children? A. Have developed the ability to reason abstractly B. Are 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. Are able to classify, to group and sort, and to hold a concept in their minds while making decisions based on that concept

D. Are able to classify, to group and sort, and to hold a concept in their minds while making decisions based on that concept

The father of 12-year-old Ryan tells the nurse that he is concerned about his son getting "fat." Ryan is at the 50th percentile for height and the 75th percentile for weight on the growth chart. The most appropriate nursing action is which of the following? A. Reassure father that Ryan is not fat. B. Reassure father that Ryan is just a growing child. C. Suggest a low-calorie, low-fat diet. D. Explain that this is typical of the growth pattern of boys at this age.

D. Explain that this is typical of the growth pattern of boys at this age. This is a characteristic pattern of growth in preadolescent boys, where the growth in height has slowed in preparation for the pubertal growth spurt, but weight is still gained. The nurse should review this with both the father and Ryan and develop a plan to maintain physical exercise and a balanced diet.

A nurse is planning a teaching session for parents of preschool children. Which statement explains why the nurse should include information about morbidity and mortality? A. Lifespan statistics are included in the data B. It explains effectiveness of treatment C. Cost-effective treatment is detailed for the general population D. High-risk age groups for certain disorders or hazards are identified.

D. High-risk age groups for certain disorders or hazards are identified. Analysis of morbidity and mortality data provides the parents with information about which groups of individuals are at risk for which health problems. Life span statistics is a part of the mortality data. Treatment modalities and cost are not included in morbidity and mortality data.

Which one of the following functions of play is a major component of play at all ages? A. Creativity B. Socialization C. Intellectual development D. Sensorimotor activity

D. Sensorimotor activity Sensorimotor activity is a major component of play at all ages. Active play is essential for muscle development and allows the release of surplus energy. Through sensorimotor play, children explore their physical world by using tactile, auditory, visual, and kinesthetic stimulation.

A clinic nurse is planning a teaching session about childhood obesity prevention for parents of school-age children. The nurse should include which associated risk of obesity in the teaching plan? A. Type 1 diabetes B. Respiratory disease C. Celiac disease D. Type 2 diabetes

D. Type 2 diabetes Childhood obesity has been associated with the rise of type II diabetes in children. Type I diabetes is not associated with obesity and has a genetic component. Respiratory disease is not associated with obesity, and celiac disease is the inability to metabolize gluten in foods and is not associated with obesity.

By one year of age an infant should ____ their birth weight

Triple

T/F: Warning signs of teen suicide may include social withdrawal, change in school performance, and sleep patterns.

True

What factors indicate parents should seek genetic counseling for their child? (Select all that apply.) a. Abnormal newborn screen b. Family history of a hereditary disease c. History of hypertension in the family d. Severe colic as an infant e. Metabolic disorder

a. Abnormal newborn screen b. Family history of a hereditary disease e. Metabolic disorder Factors that are indicative parents should seek genetic counseling for their child include an abnormal newborn screen, family history of a hereditary disease, and a metabolic disorder. A history of hypertension or severe colic as an infant is not an indicator of a genetic disease.

Turner syndrome is suspected in an adolescent girl with short stature. What is the cause of this syndrome? a. Absence of one of the X chromosomes b. Presence of an incomplete Y chromosome c. Precocious puberty in an otherwise healthy child d. Excess production of both androgens and estrogens

a. Absence of one of the X chromosomes Turner syndrome is caused by an absence of one of the X chromosomes. Most girls who have this disorder have one X chromosome missing from all cells. No Y chromosome is present in individuals with Turner syndrome. This young woman has 45 rather than 46 chromosomes.

A nurse is preparing to administer a Denver II. Which is a correct statement about the Denver II? (Select all that apply.) a. All items intersected by the age line should be administered. b. There is no correction for a child born preterm. c. The tool is an intelligence test. d. Toddlers and preschoolers should be prepared by presenting the test as a game. e. Presentation of the toys from the kit should be done one at a time.

a. All items intersected by the age line should be administered. d. Toddlers and preschoolers should be prepared by presenting the test as a game. e. Presentation of the toys from the kit should be done one at a time. To identify "cautions," all items intersected by the age line are administered. Toddlers and preschoolers should be tested by presenting the Denver II as a game. Because children are easily distracted, perform each item quickly and present only one toy from the kit at a time. Before beginning the screening, ask whether the child was born preterm and correctly calculate the adjusted age. Up to 24 months of age, allowances are made for preterm infants by subtracting the number of weeks of missed gestation from their present age and testing them at the adjusted age. Explain to the parents and child, if appropriate, that the screenings are not intelligence tests but rather are a method of showing what the child can do at a particular age.

A nurse is planning a class on accident prevention for parents of toddlers. Which safety topic is the priority for this class? a. Appropriate use of car seat restraints b. Safety crossing the street c. Helmet use when riding a bicycle d. Poison control numbers

a. Appropriate use of car seat restraints Motor vehicle accidents (MVAs) continue to be the most common cause of death in children older than 1 year, therefore the priority topic is appropriate use of car seat restraints. Safety crossing the street and bicycle helmet use are topics that should be included for preschool parents but are not priorities for parents of toddlers. Information about poison control is important for parents of toddlers and would be a safety topic to include but is not the priority over appropriate use of car seat restraints.

An infant gains head control before sitting unassisted. The nurse recognizes that this is which type of development? a. Cephalocaudal b. Proximodistal c. Mass to specific d. Sequential

a. Cephalocaudal The pattern of development that is head-to-tail, or cephalocaudal, direction is described by an infant's ability to gain head control before sitting unassisted. The head end of the organism develops first and is large and complex, whereas the lower end is smaller and simpler, and development takes place at a later time. Proximodistal, or near to far, is another pattern of development. Limb buds develop before fingers and toes. Postnatally, the child has control of the shoulder before achieving mastery of the hands. Mass to specific is not a specific pattern of development. In all dimensions of growth, a definite, sequential pattern is followed.

Play serves many purposes. In teaching parents about appropriate activities, the nurse should inform them that play serves which of the following function? (Select all that apply.) a. Intellectual development b. Physical development c. Socialization d. Creativity e. Temperament development

a. Intellectual development c. Socialization d. Creativity A common statement is that play is the work of childhood. Intellectual development is enhanced through the manipulation and exploration of objects. Socialization is encouraged by interpersonal activities and learning of social roles. In addition, creativity is developed through the experimentation characteristic of imaginative play. Physical development depends on many factors; play is not one of them. Temperament refers to behavioral tendencies that are observable from the time of birth. The actual behaviors, but not the child's temperament attributes, may be modified through play.

The nurse is observing parents playing with their 10-month-old child. Which should the nurse recognize as evidence that the child is developing object permanence? a. Looks for the toy that parents hide under the blanket b. Returns the blocks to the same spot on the table c. Recognizes that a ball of clay is the same when flattened out d. Bangs two cubes held in her hands

a. Looks for the toy that parents hide under the blanket Object permanence is the realization that items that leave the visual field still exist. When the infant searches for the toy under the blanket, it is an indication that object permanence has developed. Returning the blocks to the same spot on the table is not an example of object permanence. Recognizing that a ball of clay is the same when flattened out is an example of conservation, which occurs during the concrete operations stage from 7 to 11 years. Banging two cubes together is a simple repetitive activity characteristic of developing a sense of cause and effect.

Which is probably the single most important influence on growth at all stages of development? a. Nutrition b. Heredity c. Culture d. Environment

a. Nutrition Nutrition is the single most important influence on growth. Dietary factors regulate growth at all stages of development, and their effects are exerted in numerous and complex ways. Adequate nutrition is closely related to good health throughout life. Heredity, culture, and environment contribute to the child's growth and development. However, good nutrition is essential throughout the life span for optimal health.

Which refers to those times in an individual's life when he or she is more susceptible to positive or negative influences? a. Sensitive period b. Sequential period c. Terminal points d. Differentiation points

a. Sensitive period Sensitive periods are limited times during the process of growth when the organism will interact with a particular environment in a specific manner. These times make the organism more susceptible to positive or negative influences. The sequential period, terminal points, and differentiation points are developmental times that do not make the organism more susceptible to environmental interaction.

Which is most suggestive that a nurse has a nontherapeutic relationship with a patient and family? a. Staff is concerned about the nurse's actions with the patient and family. b. Staff assignments allow the nurse to care for same patient and family over an extended time. c. Nurse is able to withdraw emotionally when emotional overload occurs but still remains committed. d. Nurse uses teaching skills to instruct patient and family rather than doing everything for them.

a. Staff is concerned about the nurse's actions with the patient and family. A clue to a nontherapeutic staff-patient relationship is concern of other staff members. Allowing the nurse to care for the same patient over time would be therapeutic for the patient and family. Nurses who are able to somewhat withdraw emotionally can protect themselves while providing therapeutic care. Nurses using teaching skills to instruct patient and family will assist in transitioning the child and family to self-care.

Parents are asking the clinic nurse about an appropriate toy for their toddler. Which response by the nurse is appropriate? a. "Your child would enjoy playing a board game." b. "A toy your child can push or pull would help develop muscles." c. "An action figure toy would be a good choice." d. "A 25-piece puzzle would help your child develop recognition of shapes."

b. "A toy your child can push or pull would help develop muscles." Toys should be appropriate for the child's age. A toddler would benefit from a toy he or she could push or pull. The child is too young for a board game, action figure, or 25-piece puzzle.

Parents of an 8-year-old child ask the nurse how many inches their child should grow each year. The nurse bases the answer on the knowledge that after age 7 years, school-age children usually grow what number of inches per year? a. 1 b. 2 c. 3 d. 4

b. 2 The growth velocity after age 7 years is approximately 5 cm (2 inches) per year. One inch is too small an amount. Three and 4 inches are greater than the average yearly growth after age 7 years.

Which behaviors by the nurse indicate a therapeutic relationship with children and families? (Select all that apply.) a. Spending off-duty time with children and families b. Asking questions if families are not participating in the care c. Clarifying information for families d. Buying toys for a hospitalized child e. Learning about the family's religious preferences

b. Asking questions if families are not participating in the care c. Clarifying information for families e. Learning about the family's religious preferences Asking questions if families are not participating in the care, clarifying information for families, and learning about the family's religious preferences are positive actions and foster therapeutic relationships with children and families. Spending off-duty time with children and families and buying toys for a hospitalized child are negative actions and indicate overinvolvement with children and families, which is nontherapeutic.

The nurse observes some children in the playroom. Which play situation exhibits the characteristics of parallel play? a. Kimberly and Amanda sharing clay to each make things b. Brian playing with his truck next to Kristina playing with her truck c. Adam playing a board game with Kyle, Steven, and Erich d. Danielle playing with a music box on her mother's lap

b. Brian playing with his truck next to Kristina playing with her truck Playing with trucks next to each other but not together is an example of parallel play. Both children are engaged in similar activities in proximity to each other; however, they are each engaged in their own play. Sharing clay to make things is characteristic of associative play. Friends playing a board game together is characteristic of cooperative play. A child playing with something by herself on her mother's lap is an example of solitary play.

A school nurse notes that school-age children generally obey the rules at school. The nurse recognizes that the children are displaying which stage of moral development? a. Preconventional b. Conventional c. Postconventional d. Undifferentiated

b. Conventional Conventional stage of moral development is described as obeying the rules, doing one's duty, showing respect for authority, and maintaining the social order. This stage is characteristic of school-age children's behavior. The preconventional stage is characteristic of the toddler and preschool age. At this stage, the child has no concept of the basic moral order that supports being good or bad. The postconventional level is characteristic of an adolescent and occurs at the formal stage of operation. Undifferentiated describes an infant's understanding of moral development.

A mother reports that her 6-year-old child is highly active, irritable, and irregular in habits and that the child adapts slowly to new routines, people, or situations. How should the nurse chart this type of temperament? a. Easy b. Difficult c. Slow-to-warm-up d. Fast-to-warm-up

b. Difficult Being highly active, irritable, irregular in habits, and adapting slowly to new routines, people, or situations is a description of difficult children, which compose about 10% of the population. Negative withdrawal responses are typical of this type of child, who requires a more structured environment. Mood expressions are usually intense and primarily negative. These children exhibit frequent periods of crying and often violent tantrums. Easy children are even tempered, regular, and predictable in their habits. They are open and adaptable to change. Approximately 40% of children fit this description. Slow-to-warm-up children typically react negatively and with mild intensity to new stimuli and adapt slowly with repeated contact. Approximately 10% of children fit this description. "Fast-to-warm-up" is not one of the categories identified.

Which behaviors by the nurse indicate therapeutic nurse-family boundaries? (Select all that apply.) a. Nurse visits family on days off. b. House rules are negotiated. c. Nurse buys child expensive gifts. d. Communication is open and two-way.

b. House rules are negotiated. d. Communication is open and two-way. A home care nurse can establish therapeutic nurse-family boundaries by negotiating house rules and ensuring that communication is open and two-way. Visiting the family of off-duty days and buying expensive gifts for the child would be boundary crossing and nontherapeutic.

A 12-year-old child enjoys collecting stamps, playing soccer, and participating in Boy Scout activities. The nurse recognizes that the child is displaying which developmental task? a. Identity b. Industry c. Integrity d. Intimacy

b. Industry Industry is engaging in tasks that can be carried through to completion, learning to compete and cooperate with others, and learning rules. Industry is the developmental task characteristic of the school-age child. Identity is the developmental task of adolescence. Integrity and intimacy are not developmental tasks of childhood.

Parents express concern that their pubertal daughter is taller than the boys in her class. The nurse should respond with which statement regarding how the onset of pubertal growth spurt compares in girls and boys? a. It occurs earlier in boys. b. It occurs earlier in girls. c. It is about the same in both boys and girls. d. In both boys and girls, the pubertal growth spurt depends on growth in infancy.

b. It occurs earlier in girls. Usually, the pubertal growth spurt begins earlier in girls. It typically occurs between the ages of 10 and 14 years for girls and 11 and 16 years for boys. The average earliest age at onset is 1 year earlier for girls. There does not appear to be a relation to growth during infancy.

The nurse is preparing an in-service education to staff about atraumatic care for pediatric patients. Which intervention should the nurse include? a. Prepare the child for separation from parents during hospitalization by reviewing a video. b. Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal. c. Help the child accept the loss of control associated with hospitalization. d. Help the child accept pain that is connected with a treatment or procedure.

b. Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal. Preparing the child for any unfamiliar treatments, controlling pain, allowing privacy, providing play activities for expression of fear and aggression, providing choices, and respecting cultural differences are components of atraumatic care. In the provision of atraumatic care, the separation of child from parents during hospitalization is minimized. The nurse should promote a sense of control for the child. Preventing and minimizing bodily injury and pain are major components of atraumatic care.

What should the nurse consider when discussing language development with parents of toddlers? a. Sentences by toddlers include adverbs and adjectives. b. The toddler expresses himself or herself with verbs or combination words. c. The toddler uses simple sentences. d.Pronouns are used frequently by the toddler.

b. The toddler expresses himself or herself with verbs or combination words. The first parts of speech used are nouns, sometimes verbs (e.g., "go"), and combination words (e.g., "bye-bye"). Responses are usually structurally incomplete during the toddler period. The preschool child begins to use adjectives and adverbs to qualify nouns followed by adverbs to qualify nouns and verbs. Pronouns are not added until the later preschool years. By the time children enter school, they are able to use simple, structurally complete sentences that average five to seven words.

A visitor arrives at a daycare center during lunchtime. The preschool children think that every time they have lunch a visitor will arrive. Which preoperational characteristic is being displayed? a. Egocentrism b. Transductive reasoning c. Intuitive reasoning d. Conservation

b. Transductive reasoning Transductive reasoning is when two events occur together, they cause each other. The expectation that every time lunch is served a visitor will arrive is descriptive of transductive reasoning. Egocentrism is the inability to see things from any perspective than their own. Intuitive reasoning (e.g., the stars have to go to bed just as they do) is predominantly egocentric thought. Conservation (able to realize that physical factors such as volume, weight, and number remain the same even though outward appearances are changed) does not occur until school age.

Which syndrome involves a common sex chromosome defect? a. Down b. Turner c. Marfan d. Hemophilia

b. Turner Turner syndrome is caused by an absence of one of the X chromosomes. Down syndrome is caused by trisomy 21, three copies rather than two copies of chromosome 21. Marfan syndrome is a connective tissue disorder inherited in an autosomal dominant pattern. Hemophilia is a disorder of blood coagulation inherited in an X-linked recessive pattern.

A nurse is counseling an adolescent, in her second month of pregnancy, about the risk of teratogens. The adolescent has understood the teaching if she makes which statement? a. "I will be able to continue taking isotretinoin (Accutane) for my acne." b. "I can continue to clean my cat's litter box." c. "I should avoid any alcoholic beverages." d. "I will ask my physician to adjust my phenytoin (Dilantin) dosage."

c. "I should avoid any alcoholic beverages." Teratogens are agents that cause birth defects when present in the prenatal period. Avoidance of alcoholic beverages is recommended to prevent fetal alcohol syndrome. Isotretinoin (Accutane) and phenytoin (Dilantin) have been shown to have teratogenic effects and should not be taken during pregnancy. Cytomegalovirus, an infectious agent and a teratogen, can be transmitted through cat feces, and cleaning the litter box during pregnancy should be avoided.

By what age does birth length usually double? a. 1 year b. 2 years c. 4 years d. 6 years

c. 4 years Linear growth or height occurs almost entirely as a result of skeletal growth and is considered a stable measurement of general growth. On average, most children have doubled their birth length at age 4 years. One and 2 years are too young for doubling of length. Most children will have achieved the doubling by age 4 years.

In which type of play are children engaged in similar or identical activity, without organization, division of labor, or mutual goal? a. Solitary b. Parallel c. Associative d.Cooperative

c. Associative In associative play, no group goal is present. Each child acts according to his or her own wishes. Although the children may be involved in similar activities, no organization, division of labor, leadership assignment, or mutual goal exists. Solitary play describes children playing alone with toys different from those used by other children in the same area. Parallel play describes children playing independently but being among other children. Cooperative play is organized. Children play in a group with other children who play in activities for a common goal.

A father tells the nurse that his child is "filling up the house with collections" like seashells, bottle caps, baseball cards, and pennies. What should the nurse recognize the child is developing? a. Object permanence b. Preoperational thinking c. Concrete operational thinking d. Ability to use abstract symbols

c. Concrete operational thinking During concrete operations, children develop logical thought processes. They are able to classify, sort, order, and otherwise organize facts about the world. This ability fosters the child's ability to create collections. Object permanence is the realization that items that leave the visual field still exist. This is a task of infancy and does not contribute to collections. Preoperational thinking is concrete and tangible. Children in this age group cannot reason beyond the observable, and they lack the ability to make deductions or generalizations. Collections are not typical for this developmental level. The ability to use abstract symbols is a characteristic of formal operations, which develops during adolescence. These children can develop and test hypotheses.

The home health nurse asks a child's mother many questions as part of the assessment. The mother answers many questions, then stops and says, "I don't know why you ask me all this. Who gets to know this information?" The nurse should take which action? a. Determine why the mother is so suspicious. b. Determine what the mother does not want to tell. c. Explain who will have access to the information. d. Explain that everything is confidential and that no one else will know what is said.

c. Explain who will have access to the information.

The home health nurse asks a child's mother many questions as part of the assessment. The mother answers many questions, then stops and says, "I don't know why you ask me all this. Who gets to know this information?" The nurse should take which action? a. Determine why the mother is so suspicious. b. Determine what the mother does not want to tell. c. Explain who will have access to the information. d. Explain that everything is confidential and that no one else will know what is said.

c. Explain who will have access to the information. Communication with the family should not be invasive. The nurse needs to explain the importance of collecting the information, its applicability to the child's care, and who will have access to the information. The mother is not being suspicious and is not necessarily withholding important information. She has a right to understand how the information she provides will be used. The nurse will need to share, through both oral and written communication, clinically relevant information with other involved health professionals.

Which behavior is most characteristic of the concrete operations stage of cognitive development? a. Progression from reflex activity to imitative behavior b. Inability to put oneself in another's place c. Increasingly logical and coherent thought processes d. Ability to think in abstract terms and draw logical conclusions

c. Increasingly logical and coherent thought processes During the concrete operations stage of development, which occurs approximately between ages 7 and 11 years, increasingly logical and coherent thought processes occur. This is characterized by the child's ability to classify, sort, order, and organize facts to use in problem solving. The progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage of development. The inability to put oneself in another's place is characteristic of the preoperational stage of development. The ability to think in abstract terms and draw logical conclusions is characteristic of the formal operations stage of development.

A nurse on a pediatric unit is practicing family-centered care. Which is most descriptive of the care the nurse is delivering? a. Taking over total care of the child to reduce stress on the family b. Encouraging family dependence on health care systems c. Recognizing that the family is the constant in a child's life d. Excluding families from the decision-making process

c. Recognizing that the family is the constant in a child's life The three key components of family-centered care are respect, collaboration, and support. Family-centered care recognizes the family as the constant in the child's life. Taking over total care does not include the family in the process and may increase stress instead of reducing stress. The family should be enabled and empowered to work with the health care system. The family is expected to be part of the decision-making process.

When communicating with other professionals, what is important for the nurse to do? a. Ask others what they want to know. b. Share everything known about the family. c. Restrict communication to clinically relevant information. d. Recognize that confidentiality is not possible.

c. Restrict communication to clinically relevant information. The nurse will need to share, through both oral and written communication, clinically relevant information with other involved health professionals. Asking others what they want to know and sharing everything known about the family is inappropriate. Patients have a right to confidentiality. The nurse is not permitted to share information about clients, except clinically relevant information that pertains to the child's care. Confidentiality permits the disclosure of information to other health professionals on a need-to-know basis.

An infant who weighs 7 pounds at birth would be expected to weigh how many pounds at age 1 year? a. 14 b. 16 c. 18 d. 21

d. 21 In general, birth weight triples by the end of the first year of life. For an infant who was 7 pounds at birth, 21 pounds would be the anticipated weight at the first birthday; 14, 16, or 18 pounds is below what would be expected for an infant with a birth weight of 7 pounds.

According to Kohlberg, children develop moral reasoning as they mature. Which statement is most characteristic of a preschooler's stage of moral development? a. Obeying the rules of correct behavior is important. b. Showing respect for authority is important behavior. c. Behavior that pleases others is considered good. d. Actions are determined as good or bad in terms of their consequences.

d. Actions are determined as good or bad in terms of their consequences. Preschoolers are most likely to exhibit characteristics of Kohlberg's preconventional level of moral development. During this stage, they are culturally oriented to labels of good or bad, right or wrong. Children integrate these concepts based on the physical or pleasurable consequences of their actions. Obeying the rules of correct behavior, showing respect for authority, and engaging in behavior that pleases others are characteristics of Kohlberg's conventional level of moral development.

A 13-year-old girl asks the nurse how much taller she will get. She has been growing about 2 inches per year but grew 4 inches this past year. Menarche recently occurred. The nurse should base her response on which statement? a. Growth cannot be predicted. b. Pubertal growth spurt lasts about 1 year. c. Mature height is achieved when menarche occurs. d. Approximately 95% of mature height is achieved when menarche occurs.

d. Approximately 95% of mature height is achieved when menarche occurs. At the time of the beginning of menstruation or the skeletal age of 13 years, most girls have grown to about 95% of their adult height. They may have some additional growth (5%) until the epiphyseal plates are closed. Although growth cannot be definitively predicted, on average, 95% of adult height has been reached with the onset of menstruation. Pubertal growth spurt lasts about 1 year does not address the girl's question. Young women usually will grow approximately 5% more after the onset of menstruation.

What is now referred to as the "new morbidity"? a. Limitations in the major activities of daily living b. Unintentional injuries that cause chronic health problems c. Discoveries of new therapies to treat health problems d. Behavioral, social, and educational problems that alter health

d. Behavioral, social, and educational problems that alter health The new morbidity reflects the behavioral, social, and educational problems that interfere with the child's social and academic development. It is currently estimated that the incidence of these issues is from 5% to 30%. Limitations in major activities of daily living and unintentional injuries that result in chronic health problems are included in morbidity data. Discovery of new therapies would be reflected in changes in morbidity data over time.

Trauma to which site can result in a growth problem for children's long bones? a. Matrix b. Connective tissue c. Calcified cartilage d. Epiphyseal cartilage plate

d. Epiphyseal cartilage plate The epiphyseal cartilage plate is the area of active growth. Bone injury at the epiphyseal plate can significantly affect subsequent growth and development. Trauma or infection can result in deformity. The matrix, connective tissue, and calcified cartilage are not areas of active growth. Trauma in these sites will not result in growth problems for the long bones.

How is a child's skeletal age best determined? a. Assessment of dentition b. Assessment of height over time c. Facial bone development d. Radiographs of the hand and wrist

d. Radiographs of the hand and wrist The most accurate measure of skeletal age is radiologic examinations of the growth plates. These are the epiphyseal cartilage plates. Radiographs of the hand and wrist provide the most useful screening to determine skeletal age. Age of tooth eruption has considerable variation in children. It would not be a good determinant of skeletal age. Assessment of height over time will provide a record of the child's height but not skeletal age. Facial bone development will not reflect the child's skeletal age, which is determined by radiographic assessment.

A nurse observes a toddler playing with sand and water. How should the nurse document this type of play? a. Skill b. Dramatic c. Social-affective d. Sense-pleasure

d. Sense-pleasure The toddler playing with sand and water is engaging in sense-pleasure play. This is characterized by nonsocial situations in which the child is stimulated by objects in the environment. Infants engage in skill play when they persistently demonstrate and exercise newly acquired abilities. Dramatic play is the predominant form of play in the preschool period. Children pretend and fantasize. Social-affective play is one of the first types of play in which infants engage. The infant responds to interactions with people.

Which following function of play is a major component of play at all ages? a. Creativity b. Socialization c. Intellectual development d. Sensorimotor activity

d. Sensorimotor activity Sensorimotor activity is a major component of play at all ages. Active play is essential for muscle development and allows the release of surplus energy. Through sensorimotor play, children explore their physical world by using tactile, auditory, visual, and kinesthetic stimulation. Creativity, socialization, and intellectual development are each functions of play that are major components at different ages.

A nurse has completed a teaching session for adolescents regarding lymphoid tissue growth. Which statement, by the adolescents, indicates understanding of the teaching? a. The tissue reaches adult size by age 1 year. b. The tissue quits growing by 6 years of age. c. The tissue is poorly developed at birth. d. The tissue is twice the adult size by ages 10 to 12 years.

d. The tissue is twice the adult size by ages 10 to 12 years. Lymphoid tissue continues growing until it reaches maximal development at ages 10 to 12 years, which is twice its adult size. A rapid decline in size occurs until it reaches adult size by the end of adolescence. The tissue reaches adult size at 6 years of age but continues to grow. The tissue is well developed at birth.

A nurse is conducting parenting classes for parents of children ranging in ages 2 to 7 years. The parents understand the term egocentrism when they indicate it means: a. selfishness. b. self-centeredness. c. preferring to play alone. d. unable to put self in another's place.

d. unable to put self in another's place. According to Piaget, children ages 2 to 7 years are in the preoperational stage of development. Children interpret objects and events not in terms of their general properties but in terms of their relationships or their use to them. This egocentrism does not allow children of this age to put themselves in another's place. Selfishness, self-centeredness, and preferring to play alone do not describe the concept of egocentricity.