Practice HESI

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The nurse is explaining the home care plan to the parent of a one-year-old infant who has developed atopic dermatitis with crusting of lesions on the face. Which instruction included in the care plan of the child is correct? 1 "Use bubble bath." 2 "Avoid using colloid bath." 3 "Give loratadine before bedtime." 4 "Apply pimecrolimus on the face."

4 "Apply pimecrolimus on the face." The nurse should instruct the parent to apply pimecrolimus, a topical immunomodulator on the face of a child who has developed atopic dermatitis. A bubble bath should be avoided, because the foam and surfactants would cause irritation and worsen the child's condition. A colloid bath is prepared by adding 2 cups of cornstarch to warm water. This might provide temporary relief of itching to the child, so a colloid bath can be given sometimes before bedtime. Loratadine is a nonsedating antihistamine that can be taken during daytime. Pruritus increases at night so a mildly sedating antihistamine would be helpful at night.

A parent of a 2-month-old baby asks the nurse if the baby's pacifier can be coated with honey, because it is good for the immune health. What should the nurse tell the parent? 1 Honey should not be given to infants. 2 Honey is a good source of vitamin A. 3 Honey prevents the incidence of childhood caries. 4 Honey improves the child's ability to suck.

1 Honey should not be given to infants. The parent should be informed that honey should be avoided in infants, because it can lead to botulism. Honey is not a good source of vitamin A. Evidence shows that it can lead to early childhood cavities. There is no evidence that it improves the ability of a child to suck.

A nurse is teaching an expectant mother about ways to minimize sibling rivalry. Which statement made by the mother regarding communicating with the toddler needs further learning? 1 "A new playmate will come home soon." 2 "I will read stories for you and the baby." 3 "I will take you and the baby to the park." 4 "We have to feed the baby when the baby comes home."

1 "A new playmate will come home soon." Toddlers need to have a realistic idea about what will happen when a new baby comes home. Therefore, an unrealistic expectation will be set when the mother says that a new playmate will come home soon. The mother needs to emphasize that things such as reading stories and going to the park will not change once the baby arrives. Parents should also stress activities such as bottle-feeding to the toddler, so that he or she has a realistic idea of what to expect once the newborn arrives.

An infant is vomiting, has blood in the stool and often cries for no apparent reason. The parents tell the nurse that the infant was given cow's milk. Which instruction included in the diet plan of the infant is most appropriate? 1 "Give the infant soy milk." 2 "Give the infant goat's milk." 3 "Give the infant chilled cow's milk." 4 "Give the infant cow's milk with vitamin supplements."

1 "Give the infant soy milk." The infant has developed cow's milk allergy (CMA). Hence, the nurse should instruct the parents to give soy milk and soy-based formula to the infant. Goat's milk is not a suitable substitute for cow's milk because goat's milk is deficient in folic acid, and has high sodium and protein content. The infant should not be given chilled or cold cow's milk, but infants with CMA might tolerate extensively heated cow's milk. The infant has developed CMA so cow's milk with vitamin supplements would not help the infant outgrow the hypersensitivity he or she has developed.

A nurse is teaching a parent about handling a toddler with temper tantrums. Which statement made by the parent indicates a requirement for further learning? 1 "I would not talk to the child." 2 "I would take the child out daily." 3 "I would praise the child for positive behavior." 4 "I would comfort the child once the tantrum subsides."

1 "I would not talk to the child." The parent should offer the child a choice during a temper tantrum rather than simply not talking to him or her. Taking the child out for a while will help in managing temper tantrums, especially during bedtime. The parent should praise the child for positive behaviors, so that it helps manage temper tantrums. Once the temper tantrum subsides, the parent should comfort the child so the child will feel secure.

A 2-year-old child is taken to the hospital for mild respiratory tract infection symptoms. The parent asks the nurse why her child often gets these infections. Which would be the best response from the nurse? 1 "Immunoglobulin A and D reach adult levels only in later childhood." 2 "Immunoglobulin E reaches adult levels by the end of 4 years of age." 3 "Immunoglobulin G reaches adult levels only when the child is 3 years of age." 4 "Immunoglobulin M reaches adult levels only when the child is 2.5 years of age."

1 "Immunoglobulin A and D reach adult levels only in later childhood." Immunoglobulin A (IgA) is responsible for mucosal immunity in the body. Immunoglobulin D (IgD) activates the basophils and mast cells to produce antimicrobial substances. IgA and IgD reach adult levels in later childhood. Therefore, young children are more susceptible to infections than older children. Immunoglobulin E (IgE) plays a major role in allergic reactions and diseases. IgE reaches adult levels during later childhood. Immunoglobulin G (IgG) is required to control infections in the body. IgG reaches adults levels by the end of 2 years of life. Immunoglobulin M (IgM) is responsible for elimination of pathogens, and it attains adult levels between 1 and 2 years of age.

The nurse is teaching the parent of a child who has developed atopic dermatitis about the care plan that needs to be followed at home. Which statement made by the parent indicates effective learning? 1 "Synthetic fabric should be used for hats." 2 "Soft rubber gloves would cause less itching." 3 "Woolen blankets would provide better comfort." 4 "Fabric softeners should be used to soften fabric fibers."

1 "Synthetic fabric should be used for hats." Caring for a child with atopic dermatitis is challenging. Controlling the intensity of pruritus in atopic dermatitis is important because scratching might lead to new lesions and secondary infection. Synthetic fabrics instead of wool for hats should be used during cold months to reduce skin irritation. The use of latex products such as rubber should be avoided in patients with atopic dermatitis because such products can trigger allergic dermatitis and worsen the condition. Woolen fiber causes irritation when used in patients with atopic dermatitis. Fabric softeners or antistatic chemicals should be avoided in patients with atopic dermatitis because such chemicals might worsen the condition and increase itching.

During a health assessment interview, the nurse notices that the 2.5-year-old child angrily says to the chair: "Why you push me?" What kind of behavior does the child exhibit? 1 Animism 2 Centration 3 Transduction 4 Inability to conserve

1 Animism Attributing life-like qualities to inanimate objects is called animism; therefore, this child is exhibiting animistic behavior. Centration is focusing on one reason rather than thinking about all possible alternatives. A child refusing to eat a particular food because of its color although the taste of the food is good is an example of centration. Transductive behavior is reasoning from specific cases to specific cases. If a child refuses to eat food because the previously eaten food did not taste good, the child exhibits transductive behavior. Inability to conserve is the inability to understand the idea that mass can be changed in size or shape without adding anything to the original mass.

An infant has beefy red central erythema with satellite pustules in the diaper area. Which treatment should the nurse provide for this condition? 1 Application of miconazole 2 Application of chlorhexidine 3 Application of nystatin-triamcinolone 4 Application of clotrimazole-betamethasone

1 Application of miconazole The condition described is candidiasis of the diaper area. Miconazole is a topical antifungal medication used to treat candidal infection. Chlorhexidine is an antibacterial agent that is used to reduce bacteria in the mouth. Nystatin-triamcinolone is an antifungal medication combined with halogenated topical steroid. It should not be used to treat candidiasis because its use on thin skin of infants increases systemic absorption of the medication and might cause drug toxicity. Clotrimazole-betamethasone is also an antifungal combined with halogenated topical steroid; therefore, it should not be used to treat candidiasis.

A nurse is caring for a 5-year-old child who has a new order for the insertion of an intravenous line. What intervention will be the most effective way of providing analgesia before this procedure? 1 Applying LMX (4% liposomal lidocaine cream) 1 hour before the procedure 2 Applying a transdermal fentanyl (Duragesic) patch at the site of venipuncture 3 Applying EMLA (eutectic mixture of local anesthetics) immediately before the procedure 4 Administering TAC (tetracaine, epinephrine [Adrenalin], cocaine) 15 minutes before the procedure

1 Applying LMX (4% liposomal lidocaine cream) 1 hour before the procedure LMX is an effective analgesic agent when applied to the skin 1 hour before a procedure. It eliminates or reduces the pain of most procedures involving skin puncture. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control. EMLA needs to be applied 60 minutes before the procedure to be effective. TAC provides skin anesthesia about 15 minutes after application to nonintact skin.

Apnea of infancy has been diagnosed in an infant who is now scheduled for discharge with home monitoring. The discharge teaching plan should include which information? 1 Cardiopulmonary resuscitation 2 Administration of intravenous fluids 3 Foreign airway obstruction removal with the Heimlich maneuver 4 Advice that the infant not be left with caregivers other than the parents

1 Cardiopulmonary resuscitation Knowledge of how to perform cardiopulmonary resuscitation (CPR) is essential for all parents and caregivers, especially when an infant has a history of apnea of infancy that is being monitored at home. Most likely the child will not be undergoing home intravenous therapy as part of the discharge care. The Heimlich maneuver is used to intervene when a child or an adult is experiencing a choking episode. It would not be necessary for the parents to learn the maneuver at this time. (Back slaps and chest thrusts are used on the responsive infant who is choking.) The parents should arrange for other caregivers to help when possible. There is no reason that the infant cannot be left with capable and trained individuals. Anyone caring for the infant will need to be taught to use the necessary equipment and how to perform CPR.

In which way is chronic pain in children differentiated from recurrent pain? 1 Chronic pain persists for 3 months or more. 2 Chronic pain is episodic and reoccurs. 3 Depression is elevated in children with recurrent pain. 4 Anxiety is elevated in children with chronic pain.

1 Chronic pain persists for 3 months or more. Pain that persists for 3 months or more is known as chronic pain. Recurrent pain is pain that is episodic and recurs in 3 months. Chronic pain is not episodic. It persists for a long time. Anxiety and depression are elevated in children with chronic as well as recurrent pain, because they interfere with their normal functioning.

What condition is also known as paroxysmal abdominal pain? 1 Colic 2 Cow's milk allergy 3 Positional plagiocephaly 4 Sudden infant death syndrome (SIDS)

1 Colic Paroxysmal abdominal pain is also known as colic. Cow's milk allergy is a multifaceted disorder representing adverse systemic and local gastrointestinal reactions to cow's milk protein. Positional plagiocephaly is an oblique or asymmetric head resulting from cranial molding during infancy. Sudden infant death syndrome, or SIDS, is defined as the sudden death of an infant younger than 1 year that remains unexplained after a complete postmortem examination.

The nurse is performing the pain assessment of a 6 year old child with a developmental disorder. The child has limited speech and lacks the ability to understand spoken words and sentences. What tool does the nurse use to assess pain in the child? 1 FLACC scale 2 Poker chip tool 3 Visual analog scale 4 Word-graphic rating scale

1 FLACC scale The child has limited speech and moreover lacks the ability to understand sentences; therefore the nurse has to assess the child's pain using a behavioral tool such as FLACC scale. The child lacks the ability to understand what the nurse says, so the nurse cannot use the Poker Chip tool for pain assessment in the child. The child lacks the intelligence to understand the instructions for using the Visual analogue Scale or the Word-graphic rating scale; therefore the nurse cannot use these scales for assessing the pain in the child.

The nurse is assessing a 4-year-old child for intensity of pain after administering an injection. What does the nurse use for this purpose? 1 Faces pain scales 2 Numerical rating scale 3 Pain Assessment Tool (PAT) 4 Postoperative Pain Score

1 Faces pain scales The nurse uses a faces pain scale, which shows a series of facial expressions depicting the degrees of pain. The child can easily point at the face that represents how the child is feeling. The numerical rating scale is used for children more than 8 years old, whereby the child can rate the intensity of pain on a scale of 0 to 10. The PAT is used to examine pain in infants. The Postoperative Pain Score is used for testing postoperative pain in infants less than 7 months old.

What has the preschooler's body image developed to include? 1 Fear of intrusive procedures 2 A well-defined body boundary 3 Knowledge about his or her internal anatomy 4 Fear of looking different from his or her friends

1 Fear of intrusive procedures Preschoolers fear that their insides will come out with intrusive procedures. Preschoolers have poorly defined body images. Preschoolers have little or no knowledge of their internal anatomy. The fear of looking different is a concept that occurs in later school-aged children and adolescents.

In which place in the birth order are feelings of sibling rivalry most pronounced? 1 Firstborn 2 Second born 3 Middle 4 Youngest

1 Firstborn Firstborn children experience dethronement and therefore tend to have the most pronounced sibling rivalry. Second born children do not have the most pronounced sibling rivalry. Middle children do not experience as difficult time with sibling rivalry as firstborn children. Firstborn children, rather than youngest children, have more pronounced sibling rivalry.

A toddler is given pasta, but refuses the dish because it does not taste good to the child. The nurse then gives the child a banana to eat, but the child refuses to try it, because he doesn't think it will taste good. What is the nurse's next step? 1 Give the banana to the child later. 2 Inform the pediatrician about the child's behavior. 3 Force the child to eat the banana now to avoid hunger. 4 Tell the child that a banana is different from pasta.

1 Give the banana to the child later. A toddler may refuse to eat something when a previous food did not taste good. This type of reasoning is called transductive reasoning. In such situations the nurse should accept the response and offer the refused food at a later time. It is not necessary to inform the pediatrician at this stage. The nurse should never force-feed a child. Telling a toddler that a banana is different from pasta will not necessarily be helpful, because this sort of reasoning may not be understood by the child.

What is the most consistent indicator of pain in infants? 1 Increased heart rate 2 Squirming and jerking 3 Quickened respiration 4 Facial expression of pain

1 Increased heart rate A facial expression of pain is the most consistent indicator of pain in infants. Increased heart rate may or may not be a symptom of pain in infants. Squirming and jerking are common in infants with and without pain. An increased rate of respiration may or may not be a symptom of pain in infants.

The nurse recognizes that an important part of palliative care is decision making at the end of life. What common ethical dilemma might the nurse encounter in end-of-life care? 1 Issues related to euthanasia 2 Issues relating to curative treatment 3 Issues relating to restoring the child to normal function 4 Issues related to setting long-term goals for the child and family

1 Issues related to euthanasia Nurses encounter many ethical dilemmas in end-of-life care, including euthanasia, assisted suicide, and do-not-resuscitate orders. Issues related to curative treatment and normal function are not ethical dilemmas for end-of-life care. Setting long-term goals for the child and family is not an ethical dilemma that the nurse commonly encounters in end-of-life care.

The nurses caring for a child are concerned about the child's frequent requests for pain medication. During a team conference a nurse suggests that they consider administering a placebo instead of the usual pain medication. The decision should be based on which principle? 1 It is unjustified and unethical to administer placebos instead of pain medication. 2 The absence of a response to a placebo indicates an organic basis for the pain. 3 A positive response to a placebo will not occur if the child's pain has an organic basis. 4 Administering a placebo instead of the usual pain medication is effective in determining whether a child's pain is real.

1 It is unjustified and unethical to administer placebos instead of pain medication. Placebos should never be given, by any route, in the assessment or management of pain. The response to a placebo is not a measure of the origin of pain and should never be used as a means of assessing pain. Placebos should never be given as a means of determining whether pain is real. Individuals respond differently to placebos; therefore the patient's response may not be an accurate measure of pain.

Which statement is the most descriptive of kwashiorkor? 1 Kwashiorkor is of multifactorial origin. 2 Kwashiorkor occurs primarily in breastfed infants. 3 Kwashiorkor results from excessive amounts of vitamin K. 4 Kwashiorkor is related to inadequate calories, not adequate protein.

1 Kwashiorkor is of multifactorial origin. Cultural, environmental, and infectious components contribute to kwashiorkor, a deficiency of protein with an adequate supply of calories. Kwashiorkor occurs in infants and children who are beyond the age of breastfeeding. There is no correlation between excessive vitamin K and kwashiorkor. Kwashiorkor is a disorder in which there are adequate calories but a deficiency of protein.

The parent of a 3-year-old child tells the nurse, "I offer food as a reward for appropriate behavior. I'm very pleased, because it works very well." The nurse informs the parent that the child may be at risk for which condition? 1 Obesity 2 Early childhood caries 3 Iron-deficiency anemia 4 Rickets

1 Obesity If food is offered as reward, the child may overeat for nonnutritive reasons. Therefore the child may be at risk for obesity. Caries is caused by frequent nocturnal breastfeeding or coating pacifiers in honey. Iron-deficiency anemia may occur if the child does not consume enough iron-enriched foods. Rickets is caused by vitamin D deficiency.

A primary healthcare provider has ordered oxycodone for a 16-year-old child for treating pain. What is the route of administration of the drug? 1 Oral 2 Intravenous infusion 3 Intravenous injection 4 Subcutaneous infusion

1 Oral Oxycodone is available in the form of a tablet, which is given orally and is quickly released into the circulation. The drug morphine is given through various routes of administration such as intravenous infusion, intravenous injection, and subcutaneous infusion.

A 1-month-old infant is admitted to the hospital for failure to thrive (FTT) secondary to a cardiac condition. How is this type of FTT categorized? 1 Organic 2 Idiopathic 3 Nonorganic 4 Generalized

1 Organic Organic failure to thrive (FTT) is the result of a physical cause, such as a cardiac condition, neurologic condition, renal failure, endocrine system disorder, or other possible chronic or acute disease process. Nonorganic FTT is most often the result of psychosocial factors, such as inadequate nutritional information by the parent. Idiopathic FTT is unexplained by the usual organic and environmental etiologies. Generalized FTT is not a recognized term.

A child is prescribed a buccal analgesic for pain relief. How should the nurse administer the drug to the child? 1 Place the drug between cheeks and gums. 2 Place the drug above the tongue. 3 Instruct the child to swallow the drug. 4 Instruct the child to chew the drug.

1 Place the drug between cheeks and gums. A transmucosal route of administration helps in rapid absorption of drug due to the rich blood supply to the oral mucosa. The drug should be placed between cheeks and gums for proper absorption through the oral mucosa. The drugs are placed under the tongue during buccal administration of drug. A drug meant to be administered through the transmucosal route should not be swallowed or chewed, because this can affect the therapeutic levels of the drug.

A nurse is administering a hepatitis B vaccine to a 1-year-old child. Which nursing intervention should the nurse refrain from doing in order to reduce injection pain? 1 Placing the child in the supine position 2 Using topical anesthesia prior to injection 3 Administering the injection rapidly without aspiration 4 Using proper injection site and needle size based on the age of the child

1 Placing the child in the supine position The nurse should place the child in an upright position. The supine position causes increased fear, which may make the child cry and can increase pain. Using topical anesthesia, administering the injection rapidly without aspiration, and using a proper injection site and needle size will help in reducing pain during injection.

The best approach for effective communication with a preschooler is through what? 1 Play 2 Action 3 Speech 4 Drawing

1 Play Preschoolers' most effective means of communication is play. Play allows preschoolers to understand, adjust to, and work out life's experiences through the imagination and ability to invent and imitate. Actions are not an appropriate means of communication for a preschooler. Speech is not effective because preschoolers assume that everyone thinks as they do and that a brief explanation of their thinking makes them understood by others, which is often not true. Also, preschoolers often do not understand the meanings of words and often take statements literally. Drawing is still being developed as a fine motor skill; therefore it is not the most effective means of communication.

What is the best approach in managing pain in children? 1 Preventing the pain 2 Administering medications early 3 Administering medications as needed 4 Administering the maximum dose of pain medications

1 Preventing the pain Prevention of pain is the best approach to pain management in children. Administering medications early is not a good approach to pain management in children. Administering medications as needed is not a good approach to pain management. Administering the minimum, not the maximum, dose of pain medications is appropriate.

What is the most effective strategy for obtaining postoperative pain control in children? 1 Providing preemptive analgesia 2 Administering pain medications around the clock 3 Teaching the child nonpharmacologic pain-control measures 4 Increasing the dose of analgesic until the child is adequately sedated

1 Providing preemptive analgesia Preemptive analgesia is the administration of medications (local and regional anesthetics and analgesics) before the child experiences pain or before surgery is performed so the sensory activation and changes in the pain pathways of the peripheral and central nervous system can be controlled. Giving medications around the clock, teaching the child nonpharmacologic pain control measures, and providing an increased dosage of analgesic until the child is adequately sedated are not the most effective strategies for obtaining postoperative pain control in children.

A parent asks the nurse about the activities that can help her 1-year-old develop language skills. Which activity suggested by the nurse best helps in improving the language skill of the child? 1 Reading books together 2 Playing computer games together 3 Allowing the child to watch television 4 Watching l DVDs together

1 Reading books together Reading books together with the child enables language development. Computer games do not respond to children's ideas even though children love playing them; therefore, children should be restricted from playing them. Television also does not interact or respond to the child. Moreover, the American Academy of Pediatrics suggests that children under the age of 2 years of age should not be allowed to watch television.

A 4½-year-old boy has been having increasingly frequent angry outbursts in preschool for approximately 8 to 10 weeks. He is also aggressive toward the other children and teachers. His parents ask the nurse for advice. What is the most appropriate nursing intervention? 1 Referring the child for counselling with a competent provider 2 Explaining that this is normal in preschoolers, especially boys 3 Encouraging the parent to try more consistent and firm discipline 4 Talking to the preschool teacher to obtain validation for the behavior the parent reports

1 Referring the child for counselling with a competent provider This is not expected behavior. The child should be referred to a competent professional to deal with his aggression so an accurate assessment can be made and a care plan formulated. Outward aggression to others is not normal behavior and should be evaluated. The validation will be helpful for the referral, but the referral is the priority action. Consistent and firm discipline may be recommended by the professional once an accurate assessment is made.

The parent of a toddler, concerned that the child is not getting enough calories, tells the nurse, "She'll only eat crackers, cheese, and turkey." How can the nurse characterize the typical toddler's eating behavior? 1 Ritualism 2 Regression 3 Negativism 4 Abnormal behavior

1 Ritualism Ritualism is common in toddlers, who often go on food jags during which they insist on having the same foods, same dish, same cup, or same spoon. In regression there is a retreat from one's current pattern of function to a past level of behavior; it has nothing to do with a toddler's food patterns. Negativism is the toddler's answer of no to every request; it is not associated with only eating certain foods. Eating only crackers, cheese, and turkey is not abnormal behavior for a toddler.

A parent of a 2-month-old infant tells the nurse, "How can I calm my baby after vaccination? My poor baby cries a lot, and I'm unable to stop it from crying." What is the nurse's best response? 1 Swaddling 2 Bouncing 3 Speaking excitedly 4 Breastfeeding

1 Swaddling Swaddling is an effective technique to reduce crying in infants after painful experiences such as injections. It comforts the infants, decreases their heart rate, and helps them to return to sleep. The nurse advises the parent to rock the child or sway back and forth to relax the child instead of bouncing. The nurse advises the parent to speak softly to soothe the crying infant. Nonnutritive sucking is more effective than breastfeeding to calm the infant, because it reduces behavioral, physiologic, and hormonal responses to pain.

The nurse observes that the usual dose of analgesic is unable to relieve pain in a 12-year-old child with sickle cell anemia after 3 weeks. What does the nurse conclude from this finding? 1 The child has developed tolerance to analgesic. 2 The child has developed another complication. 3 The doses were not spaced efficiently. 4 The child has become addicted to analgesic

1 The child has developed tolerance to analgesic. If the body gets adapted to the drug, the usual doses of the drug are unable to have the desired effect. This is called tolerance to the drug. Development of other complications is evident from fever, nausea, or other physical symptoms. Tolerance is caused by the neuroadaptation to the effects of the drug, not by ineffective spacing of the drug. Addiction is indicated by preoccupation with obtaining the drug and using it continually, even if there is adequate analgesia.

The parents of an 18-month-old child tell the nurse that they have prolonged bottle feeding to decrease the child's crying. What does the nurse conclude from this behavior? 1 The child is at risk for early childhood caries. 2 The child will have delayed language development. 3 The child is at risk for iron deficiency. 4 The child will have sleep problems.

1 The child is at risk for early childhood caries. Prolonged bottle feeding may cause a type of tooth decay called early childhood caries, which most affects the upper incisors and molars. Delayed language development is caused by other factors, such as exposure to television constantly before the age of 24 months or other cognitive impairments. The child is at risk for iron deficiency if the child does not consume iron-enriched foods. Sleep problems are due to factors such as fears, awareness of separation, or heavy meals before bedtime.

The nurse observes increased irritability, nausea, diarrhea, sweating, and fever in a child on the second day after discontinuing the opioid dose. What does the nurse conclude from the child's condition? 1 The child is having withdrawal symptoms. 2 The child is addicted to opioids. 3 The child is having a painful episode due to sickle cell disease. 4 The child is displaying side effects of opioids.

1 The child is having withdrawal symptoms. Withdrawal symptoms such as increased irritability, nausea, diarrhea, sweating, and fever are seen when an opioid is abruptly discontinued. This happens because the use of opioids causes physical dependence. These need to be gradually weaned to avoid withdrawal symptoms. The child is not addicted to opioids, but there is physical dependence on the drug. Painful episodes, indicated by chest pain, enlarged spleen, and fever, are observed in children with sickle cell disease. Increased irritability, nausea, diarrhea, sweating, and fever are not side effects of opioids but are withdrawal symptoms.

During an assessment of an 18-month-old child, the nurse finds that the child can say four to six words and can build a tower of four cubes. The child also throws temper tantrums occasionally. Which statement describes the child's development? 1 The child may have delayed language development. 2 The child may have delayed fine motor development. 3 The child may have delayed gross motor development. 4 The child may have delayed socialization development.

1 The child may have delayed language development. An 18-month-old child should be able to say 10 or more words. Therefore this child's language development is delayed. The ability to build a tower of four cubes is normal for the child's age and indicates normal fine motor skill development. Pulling a toy shows normal gross motor development for this age. Temper tantrums and showing signs of ownership by saying "my toy" are normal indications of socialization development at 18 months.

n infant is brought to the health care clinic for measles, mumps, rubella and varicella (MMRV) vaccination. Upon reviewing the medical history, the child is found to be allergic to eggs. Which is the best nursing intervention in this situation? 1 The nurse should administer the MMRV vaccine. 2 The nurse should administer epinephrine after vaccination. 3 The nurse should administer diphenhydramine prior to the vaccination. 4 The nurse should notify the primary health care provider about the child's allergies.

1 The nurse should administer the MMRV vaccine. Measles, mumps, rubella and varicella (MMRV) vaccine can be given safely to patients who are allergic to eggs because the vaccine does not contain egg protein. Epinephrine is administered to patients during emergencies to treat life-threatening allergic reactions and is not necessary after vaccination. Diphenhydramine is used to treat symptoms of allergic reactions and is not necessary prior to the vaccination. The nurse need not notify the primary health care provider regarding the allergies the child has because the MMRV vaccine can be safely administered to patients with severe egg allergies.

Which statement characterizes toddlers' eating behavior? 1 They become fussy eaters. 2 They have increased appetites. 3 They have few food preferences. 4 Their table manners are predictable.

1 They become fussy eaters. Toddlers have physiologic anorexia, which contributes to picky, fussy eating (not an increased appetite). This usually begins around 18 months of age. Children also have strong taste preferences at this age. Use of finger foods contributes to the unpredictable table manners of toddlers.

What is one of the major tasks of toddlerhood? 1 Toilet training 2 Establishing an identity 3 Developing the ability to conserve objects 4 Engaging in imaginative and dramatic play

1 Toilet training Toilet training is one of the major tasks of toddlerhood. Establishing an identity is a task of adolescence. Toddlers have an inability to conserve objects, so the ability to conserve objects is not a major task of toddlerhood. Imaginative and dramatic play is a task of preschoolers rather than of toddlers.

What recommendation should be provided to the parents of toddlers about car restraints? 1 Use car restraints even for short trips. 2 Add extra head cushions for comfort. 3 Discourage the toddler from holding a toy. 4 Add padding between the child and the restraint strap.

1 Use car restraints even for short trips. Car restraints should be used even for a short trip to provide safety to the toddler. Adding an extra head cushion for comfort should be avoided, because this creates spaces between the child and the restraint, and decreases support to the head. Encouraging the toddler to hold his or her favorite toy will help the toddler to play quietly. Adding any padding between the child and the restraint strap should be discouraged, because it will create space between the child and the restraint. This will result in decreased support to the back of the toddler.

The nurse is caring for a child on opioid medication. What initial signs of withdrawal does the nurse monitor for in the child? Select all that apply. 1 Yawning 2 Rhinorrhea 3 Anaphylaxis 4 Constipation 5 Hallucinations

1,2 Opioids result in several side effects during the course of medication. The initial signs of withdrawal observed in clients with opioid medication are yawning and rhinorrhea. Anaphylaxis, constipation, and hallucinations are general adverse symptoms of opioid medication.

An infant is diagnosed with an allergy to cow's milk. What nursing interventions are appropriate for this infant? Select all that apply. 1 Eliminate cow's milk-based formula from the diet. 2 Emphasize a milk-free diet for 12 months duration. 3 Shift to casein hydrolysate milk formula in the diet. 4 Substitute with goat's milk, because it is rich in folic acid. 5 Use soy-based substitutes to eliminate allergy.

1,2,3 Elimination of cow's milk-based formula prevents worsening of the allergic condition. Emphasizing a milk-free diet for 12 months helps the infant's body to heal. Slowly the milk can be reintroduced in the diet with adequate monitoring for allergic reactions. Casein hydrolysate milk formula includes protein that has been broken down into amino acids through enzymatic hydrolysis. This protein does not cause allergic reactions. Goat's milk is deficient in folic acid and is not an acceptable substitute. Soy-based substitutes do not eliminate allergies, because 50% of children allergic to cow's milk are allergic to soy-based substitutes.

Which strategies are nonpharmacologic strategies for pain management? Select all that apply. 1 Use of relaxation 2 Use of positive self-talk 3 Use of thought stopping 4 Use of behavioral contracting 5 Use of nonsteriodal antiinflammatory drugs (NSAIDs)

1,2,3,4 Nonpharmacologic strategies for pain management include use of relaxation, positive self-talk, thought stopping, and behavioral contracting. Even though NSAIDs are not narcotics, they are considered pharmacologic treatment.

The nurse is assessing a 10-year-old child with recurrent headaches. Which questions does the nurse ask the parents in order to analyze the cause of the headaches? Select all that apply. 1 "Tell me about your child's school-related work." 2 "What kind of medications is your child taking?" 3 "When was the last time your child visited an ophthalmologist?" 4 "How often does your child complain of headache?" 5 "What kind of outdoor games does your child prefer?"

1,2,3,4 Tension, medications, and weakness of the eye muscles are some of the factors that may cause headaches. The nurse can assess whether the child experiences tension related to school or peer relationships. Drug history helps to assess whether any medications are causing headaches. Information about visits to an ophthalmologist helps the nurse to assess whether the child has eye problems that may be causing headaches. The nurse can also assess the nature of the headache by asking the patient to describe it. Asking about outdoor games is more relevant for assessing the physical activity of the child.

A child who has growth failure is suspected to be in the initial stages of failure to thrive. What should be primary goals in nutrition management of this child? Select all that apply. 1 Allowing for catch-up growth in the infant 2 Correcting nutritional deficiency in the infant 3 Restoring correct body composition in the infant 4 Emphasizing tube feeding and intravenous therapy 5 Educating caretakers about nutritional requirements

1,2,3,5 The child who has failure to thrive has suboptimal growth; therefore the child should be followed for catch-up growth. Nutritional deficiency should be corrected to promote achievement of ideal weight for height. The diet should be planned with the objective of restoring the optimum composition of the body. Educating the parents or caregivers regarding the child's nutritional requirements and appropriate feeding methods helps to provide optimal nutrition. Tube feeding and intravenous therapy are required in extreme cases of malnourishment, not in early stages of failure to thrive.

What instructions should the nurse include when teaching parents about injury prevention at the toddler's well-child visit? Select all that apply. 1 Put matches out of reach 2 Supervise the child while playing outside. 3 Never leave the child unsupervised in a bathtub. 4 Make the child wear a seatbelt when sitting in the front passenger seat. 5 Turning pot handles toward the back of the stove

1,2,3,5 The nurse should teach parents about injury prevention at the toddler's well-child visit. Such information includes the need to put matches out of reach; the need to supervise when the child plays outside; turning pot handles toward the back of the stove; and to never leave the child unsupervised in a bathtub. The nurse should teach the parents that the safest place in the car for a toddler is in an appropriate car seat in the back, not the front, seat of the vehicle.

During an office visit, the parent inquires to the nurse how to best prepare their preschooler for school. Which actions help best prepare a child for starting school? Select all that apply. 1 The parent behaving positively and confidently on the first day of school. 2 Parents speaking of going to school as an exciting and pleasurable experience. 3 Parents honestly explaining to the children about the need for hard work and discipline to be successful in school. 4 Telling the child about activities to look forward to in school such as playing with children, painting, and building with blocks. 5 The parent sending their child with an older child to preschool and encouraging the child to introduce themselves to the teacher and classmates

1,2,4 Actions that help best prepare a child for starting school include the parent speaking about school as being a positive pleasurable experience, including telling the child of fun activities that surround school, such as playing. The parent should behave positively and confidently on the first day of school to help the child have a positive experience. Anticipation of the hard work and discipline needed for school is premature and does not foster positive thoughts towards school. Parents should go with their child to their first day of school and introduce the child to the teacher and facility.

The nurse is assessing the fine motor skills in a 24-month-old toddler. Which action by the toddler indicates delayed development? Select all that apply. 1 The toddler is unable to release an object at will. 2 The toddler is unable to build a block tower. 3 The toddler is unable to draw circles on paper. 4 The toddler loses balance while throwing a ball. 5 The toddler cannot drop objects into a narrow-necked bottle.

1,2,4,5 At 15 months the child can grasp and release an object at will. The toddler is able to build a block tower at the age of 24 months. The toddler can throw a ball without losing balance at 18 months. The toddler can drop objects into a narrow-necked bottle at the age of 15 months. The child is able to draw circles on paper from the age of 36 months.

Which children would have significant difficulties in communicating with others about their pain? Select all that apply. Correct 1 A child with cerebral palsy Correct 2 A child with severe brain injury 3 A child with diabetes Correct 4 A child with hearing loss Correct 5 A heavily sedated child

1,2,4,5 Children who have significant difficulties in communicating with others about their pain include those who have significant neurologic impairments (e.g., cerebral palsy), cognitive impairment, metabolic disorders, autism, severe brain injury, and communication barriers (e.g., critically ill children who are on ventilators or heavily sedated or have neuromuscular disorders, loss of hearing, or loss of vision) and consequently are at greater risk for undertreatment of pain. Children with diabetes should not have significant problems communicating about the pain they are experiencing.

An infant has a food allergy. Which conditions in the infant may require the nurse to administer an intramuscular injection of epinephrine to this infant? Select all that apply. 1 Cyanosis 2 Wheezing 3 Headaches 4 Tachycardia 5 Barky cough

1,2,5 The nurse may administer an intramuscular injection of epinephrine if the allergic child develops cyanosis, wheezing, or barky cough. These symptoms indicate worsening of the allergic reactions and need to be treated. Headache and tachycardia are adverse reactions of epinephrine, not manifestations of allergic reactions.

What are some of the most common side effects of opioid analgesics? Select all that apply. 1 Sedation 2 Mania 3 Constipation 4 Nausea and vomiting 5 Respiratory depression

1,3,4,5 Sedation, constipation, nausea and vomiting, and respiratory depression are common side effects of opioids. Addiction is not a common side effect of opioids because the risk of addiction with opioids is low. www.drugabuse.gov and the NIH websites both state the risk of addiction with opioids is increasing in the United States. Opioids are central nervous system depressants, not stimulants. Mania is more likely to occur with stimulant use.

A toddler is brought to the emergency room following an accidental swallowing of a foreign body. The child undergoes treatment and is well now. What instructions does the nurse give the parents during discharge? Select all that apply. 1 Avoid contact with small plastic balls. 2 Give toys with removable parts to the child. 3 Cut fruits in small pieces and give to the child. 4 Give marshmallows or chewing gum to the toddler. 5 Slice hot dogs lengthwise into short pieces for the child to eat.

1,3,5 A toddler can swallow hard or inedible pieces of food, which can lead to choking and suffocation. Therefore parents should be advised to avoid the child's contact with small plastic balls. Big pieces of fruits may cause choking; therefore fruits should be cut into small pieces before giving them to the child. Foods such as hot dogs should be cut lengthwise into short pieces. Parents should not allow toys with removable parts and should not give chewing gum or marshmallows to their children.

Which are physiologic manifestations of acute pain in the neonate? Select all that apply. 1 Diaphoresis 2 Pinpoint pupils 3 Palmar sweating 4 Decreased heart rate 5 Decreased arterial oxygen saturation

1,3,5 Physiologic manifestations of acute pain in the neonate include diaphroesis, palmar sweating, and decreased arterial oxygen saturation. Dilated pupils (not pinpoint) and increased, rather than decreased, heart rate are manifestations of acute pain in the neonate.

The nurse is preparing an 8-year-old child for a subcutaneous injection. Which statement by the nurse is most effective? 1 "I promise that it is going to hurt just a little bit." 2 "It may feel like pinching. You tell me how it feels." 3 "It feels like burning pain, but it goes away soon." 4 "This is terrible, but I know you are very strong."

2 "It may feel like pinching. You tell me how it feels." The nurse prepares the child by saying that the injection may feel like pinching so that the child is not anxious or scared. Telling the child that it is going to hurt just a little may make the child scared. If the nurse says that it feels like burning pain, the child perceives it as threatening. Instead the nurse can say that it feels like heat. Using evaluative statements such as "this is terrible" increases the child's anxiety.

The parents of a 5-year-old child are worried because the child stutters when speaking. On examination the nurse finds that the child has no problem with hearing. What should the nurse tell the parents? 1 "The vocal cords are inflamed and infected with bacteria, and need antibiotics." 2 "Stuttering is common at this age and usually resolves during late childhood." 3 "A deviated nasal septum may be one of the causes of stuttering in children." 4 "Stuttering typically happens due to poor vocabulary and hearing difficulties."

2 "Stuttering is common at this age and usually resolves during late childhood." Stuttering is common during the age group of 2 to 5 years. This is the period when children speak faster than they can produce the words. This failure of sensorimotor integration leads to stuttering. However, parents should be reassured that it usually resolves in childhood. Stuttering is more common in boys than girls. It is not caused by bacterial infection, deviated nasal septum, or hearing problems.

A parent of an 18-month-old child informs the nurse that the child does not eat properly and is very fussy. Sometimes the child does not eat anything; on other days the child eats a lot. What is the most appropriate response of the nurse? 1 "Is the child taking any medications for any sort of health problems?" 2 "This is a normal phenomenon at this age. Your child is fine." 3 "The child may need some blood tests because there is a problem with the gastrointestinal (GI) system." 4 "The child needs to be admitted into the hospital immediately for treatment."

2 "This is a normal phenomenon at this age. Your child is fine." Most toddlers at 18 months of age have decreased nutritional needs, manifested as decreased appetite. This phenomenon is called physiologic anorexia. During this stage they become fussy eaters with strong taste preferences, and they may eat nothing one day and large amounts the next day. Therefore the parent should be informed that this is normal, and the child is fine. This phenomenon is not caused by medications. The parent should be reassured that the child has no health issues and does not require any treatment at a hospital.

A community nurse is conducting an awareness program about the role of vitamins in the prevention of health problems in children. Which vitamin should the nurse recommend for all pregnant women to prevent neural tube defects in infants? 1 16.0 mg of niacin 2 0.4 mg of folic acid 3 1.2 mg of thiamine 4 90 mg of ascorbic acid

2 0.4 mg of folic acid A daily dose of 0.4 mg of folic acid is recommended for all women of reproductive age. If supplemental folic acid is taken daily during early pregnancy, the risk of neural tube defects such as spina bifida is reduced by as much as 70%. Folic acid is also recommended for women on contraceptive pills and antidepressant drugs. A deficiency of niacin causes pellagra, deficiency of thiamine causes beriberi, and deficiency of ascorbic acid causes scurvy.

Which strategy might be recommended to increase caloric intake in an infant with failure to thrive? 1 Avoid solids until after the bottle is well accepted. 2 Be persistent through 10 to 15 minutes of food refusal. 3 Vary the schedule for routine activities on a daily basis. 4 Use developmental stimulation by a specialist during feedings.

2 Be persistent through 10 to 15 minutes of food refusal. Calm perseverance is important. Parents often cannot persist through the child's refusals, but they should be encouraged to do so and supported. Feeding should take place in a nonstimulating environment so the focus is on feeding, enhancing the chances of increasing caloric intake. Solids should be introduced slowly to decrease dependence on the bottle, beginning at 6 months of age. The feeding schedule should be structured for the infant to have consistency and develop a routine for feeding.

Macrominerals are those minerals with daily intake requirements greater than 100 mg. Which is a macromineral? 1 Iron 2 Calcium 3 Fluoride 4 Vitamin D

2 Calcium Calcium is a macromineral. Iron, fluoride, and vitamin D are all microminerals.

A 2-year-old child has recently started having temper tantrums, holding her breath and occasionally fainting. What is the most appropriate action by the nurse? 1 Referring the child for a respiratory evaluation 2 Explaining to the parent that this is not harmful 3 Explaining to the parent that the child is spoiled 4 Referring the child for a psychological evaluation

2 Explaining to the parent that this is not harmful The rising carbon dioxide level restarts the breathing process when a child holds his or her breath; therefore the process is self-limiting and not harmful. A respiratory evaluation is not indicated for this toddler. Temper tantrums are part of this developmental stage as the toddler asserts his or her independence; there are no data to indicate that this child is spoiled. A psychological evaluation is not warranted.

When providing the parent with anticipatory guidance, what information might the nurse include about the differences between the behavior of a 4-year-old and a 5-year-old child? 1 Four-year-old children need more choices than do 5-year-old children. 2 Five-year-old children are typically more tranquil than are 4-year-old children. 3 Five-year-old children are typically more aggressive than are 4-year-old children. 4 Five-year-old children have long attention spans and are ready for kindergarten.

2 Five-year-old children are typically more tranquil than are 4-year-old children. Five-year-old children are typically more tranquil than 4-year-old children are. Although all children prefer choices, they are especially important to a 3-year-old child, more so than to a 4-year-old child. Five-year-old children are typically less aggressive than 4-year-old children are. There are no absolute indicators for school readiness. Social maturity and a good attention span, important criteria for academic readiness, are not always present at age 5.

What should the nurse recommend to the parents to help a toddler cope with the birth of a new sibling? 1 Explain to the toddler that a new playmate will soon come home. 2 Give the toddler a doll with which he or she can imitate the parents. 3 Prepare the toddler about 1 to 2 weeks before the birth of a new sibling. 4 Discourage the toddler from helping until the baby is much older.

2 Give the toddler a doll with which he or she can imitate the parents. The toddler can participate in the activity of caring for a new family member; this will make him or her feel included and important. The child should be encouraged to participate within his or her capabilities. The toddler should never be discouraged, because this will make him or her feel isolated and left out. Preparation should begin when obvious changes begin to happen to the mother's body and at home. Explaining that a new playmate is coming home will establish unrealistic expectations for the toddler. Toddlers take language literally and therefore the child will be disappointed when the new baby cannot play when he or she comes home.

A child who is treated with morphine for cancer-related pain develops tolerance to the drug. Which intervention is performed to treat tolerance in the child? 1 Increase the duration between doses. 2 Increase the dose of the drug. 3 Administer an adjuvant to morphine. 4 Administer an antagonist to morphine.

2 Increase the dose of the drug. Clients treated with morphine may develop tolerance to the drug if administered for 3 weeks or more. As a result, the client may not experience the same therapeutic effect. To treat tolerance, the dose of the drug should be increased to achieve the desired pain relief. Another way is to decrease the duration between the doses, so that the therapeutic effect does not subside. Administering an adjuvant or an antagonist may not bring about the desired pain relief.

Which infant is at a high risk for sudden infant death syndrome (SIDS)? 1 Infant weighing 2.7 kg 2 Infant with an Apgar score of 4 3 Infant with campylobacter infection 4 Infant with gestational age of 42 weeks

2 Infant with an Apgar score of 4 The infant with an Apgar score of 4 is at a high risk of sudden infant death syndrome (SIDS). The infant who weighs 2.7 kg at birth is considered to be of normal birth weight. Campylobacter infection is caused by bacteria and is not a risk factor for SIDS. A gestational age of 42 weeks is not associated with SIDS.

According to Erikson, the primary psychosocial task of the preschool period is developing a sense of what? 1 Identity 2 Initiative 3 Intimacy 4 Industry

2 Initiative Preschoolers focus on developing initiative. The stage is known as initiative versus guilt. Identity versus role confusion is associated with adolescence. Intimacy versus isolation is associated with young adulthood. Industry versus inferiority is associated with the school-aged child.

The nurse is caring for an infant who has protein-energy malnutrition. Which nutritional supplement is administered only when the infant is able to tolerate a steady food source? 1 Zinc 2 Iron 3 Copper 4 Vitamin A

2 Iron Iron supplementation in a protein-energy malnourished child should not be recommended until the child is able to tolerate a steady food source. Zinc, copper, and vitamin A are recommended nutritional supplements for a child with protein-energy malnutrition even when the child is unable to tolerate a steady food source.

The parent of a 2-year-old child tells the nurse, "My child mostly drinks milk and fruit juice and consumes very little solid food." The nurse further assesses the child for which condition? 1 Rickets 2 Iron deficiency 3 Phosphorous deficiency 4 Amino acid deficiency

2 Iron deficiency Milk is a poor source of iron, and if the child drinks mostly milk, it may lead to iron deficiency. Rickets is caused by vitamin D deficiency. Milk is a chief source of calcium and phosphorous. Amino acids are found in milk and milk products.

What gross motor skill is developmentally appropriate for a toddler who is 18 months of age? 1 Creeps up stairs 2 Jumps in place with both feet 3 Stands on one foot momentarily 4 Kicks ball forward without overbalancing

2 Jumps in place with both feet At 18 months of age toddlers are expected to jump in place with both feet. Creeping up stairs occurs at 15 months of age. At 30 months of age most toddlers can stand on one foot momentarily. Kicking the ball forward without overbalancing is developmentally appropriate at 24 months of age.

A mother tells the nurse that her toddler always says "No" to her requests. How does Erikson describe this toddler's behavior? 1 Ritualism 2 Negativism 3 Development of ego 4 Development of superego

2 Negativism In negativism, a common stage of toddler development, the child attempts to express him- or herself with consistently negative responses to requests. Ritualism is the need to maintain sameness and reliability, which provides the infant with a sense of comfort. In the development of the superego, the toddler incorporates the morals of society and begins the process of acculturation. Development of the superego is thought to be the beginning of reason or common sense.

What are the most common allergenic foods? 1 Nuts, legumes, wheat, berries 2 Nuts, eggs, wheat, shellfish, soy 3 Nuts, eggs, wheat, soy, potatoes 4 Nuts, spices, chocolate, shellfish

2 Nuts, eggs, wheat, shellfish, soy The most common allergens are nuts, eggs, wheat, shellfish, soy, and legumes (peanuts). Other foods that are allergenic include chocolate, spices, milk, corn, and citrus fruits.

The father of a preschooler has died in an accident and the mother brings the child for counseling. The nurse discovers in the child an overwhelming guilt for having wished and therefore caused the death. Which condition has not been resolved in the child? 1 Electra complex 2 Oedipus complex 3 Instrumental orientation 4 Punishment and obedience orientation

2 Oedipus complex During the preschool years, a particularly stressful thought is wishing a parent to be dead. As a sense of rivalry and competition develops between the child and the parent of the same sex, the child wishes death for the parent. This is known as the Oedipus complex for boys and the Electra complex for girls. This situation is resolved when the child strongly identifies with the same sex parent. However, if that parent dies before this identification has taken place, then the child suffers from the guilt of wishing and causing the death. Because the nurse identifies the guilt in the child after the death of the father, the Oedipus complex must have not been resolved in him. An unresolved Electra complex would cause the same guilt in a girl with a dead mother. Instrumental orientation and punishment and obedience orientation are stages of moral development of a child and are not related directly to the scenario.

When explaining the proper restraint of toddlers in motor vehicles to a group of parents, what should the nurse include? 1 Fitting the seat belt snugly over the toddler's abdomen 2 Placing the car seat in the back seat of the car, facing forward 3 Using lap and shoulder belts when child is over 3 years of age 4 Placing the car seat in the front passenger seat if there is an airbag

2 Placing the car seat in the back seat of the car, facing forward Car seats are required for toddlers to prevent injury in case of a motor vehicle accident. The car seat should be placed in the back seat, facing forward. A seat belt can cause injuries if it is placed over a toddler's abdomen. Car seats should be placed in the rear of the car because airbags can injure the toddler. Three-year-old children should be restrained in car seats.

A nurse is caring for an 8-year-old child who has undergone surgery for multiple fractures and other trauma resulting from a motor vehicle injury. The child is experiencing severe pain. What is an important consideration in the management of the child's pain? 1 Giving only an opioid analgesic at this time 2 Planning a preventive schedule of pain medication around the clock 3 Increasing the dosage of analgesic until the child is adequately sedated 4 Giving the child a clock and explaining when he may have pain medications

2 Planning a preventive schedule of pain medication around the clock An around-the-clock administration strategy should be used for a child recovering from trauma and surgery. This schedule will help prevent a low plasma level of the drug, which could result in breakthrough pain. It is appropriate for the immediate concern of the child's pain to give an opioid analgesic, but this will not facilitate the more long-term plan of pain management. The dosage of analgesic is increased until the pain is controlled, not until sedation is adequate. The child should be frequently assessed for pain and doses titrated accordingly. It is inappropriate to give a child a clock with instructions for when pain medication may be given, especially a child who has experienced a traumatic event.

A 2-year-old child resists going to bed and has the habit of banging his or her head against the wall and crying when a parent tries to place the child in the bed. What advice should the nurse to the parent? 1 During temper tantrums ignore the behavior of the child. 2 Praise the child after the temper tantrum for any positive, appropriate behavior. 3 Never be lenient with the child; otherwise tantrums will become a habit. 4 Do not tell stories to children who throw tantrums before bedtime.

2 Praise the child after the temper tantrum for any positive, appropriate behavior. Temper tantrums are common in children, but if the child is banging his or her head against the wall, the parent should not ignore the behavior, because the child could be injured. After the tantrum ends the parent should reinforce any positive behavior of the child by praising or by giving a reward. The child should not be punished during or after tantrums. Telling stories to the child at bedtime can also be useful.

The parents report to the nurse that their preschooler watches television for about 9 hours a day. What will the nurse advise the parents to do? 1 Give strict punishment to the preschooler. 2 Set limits for television viewing. 3 Force the preschooler to read books. 4 Avoid allowing the preschooler to watch television.

2 Set limits for television viewing. Watching television may have potential negative effects on preschoolers; therefore watching it should be limited. Parents should supervise the selection of programs and watch and discuss programs with their children. Strict punishment should be avoided because it may lead to psychological problems later in life. Preschoolers should not be forced to read books, because they may not enjoy them unless they can read them by themselves, which requires self-motivation. Gentle persuasion should be used instead. Preschoolers should not be completely prevented from watching television, because they may gain knowledge from the educational programs.

The parents of a 5-month-old child complain to the nurse that they are exhausted because the infant still wakes up as often as every 1 to 2 hours during the night. When the child awakens, the parents change the diaper and the mother nurses the child back to sleep. Which should the nurse suggest to help the parents deal with this problem? 1 Put the child in the parents' bed to cuddle. 2 Start putting the infant to bed while still awake. 3 Give the infant a bottle of formula instead of breastfeeding so often at night. 4 Allow the infant to cry for 30 minutes, then rock the infant back to sleep before putting the infant back in the crib.

2 Start putting the infant to bed while still awake. Parents need to develop bedtime rituals that involve putting the child in bed while awake. This will allow the infant to become accustomed to falling asleep somewhere besides the parent's arms or in the parent's presence. The issue of a child sleeping with the parents should be discussed fully. Having the infant in bed with them may still interfere with their sleep and increases the risk of injury to an infant of this age. The elimination of crying episodes should be done progressively, beginning with checking on the infant every 5 minutes during the first night and extending this interval by 5 minutes on subsequent nights. This will allow the infant to learn to self-soothe. Providing formula in a bottle at night will contribute to bottle-mouth caries. Additionally, 5-month-old infants generally wake up during the night not to feed but rather to be soothed. Using feeding as a mechanism to soothe begins a pattern that may lead to eating problems later in childhood.

every 1 to 2 hours during the night. When the child awakens, the parents change the diaper and the mother nurses the child back to sleep. Which should the nurse suggest to help the parents deal with this problem? 1 Put the child in the parents' bed to cuddle. 2 Start putting the infant to bed while still awake. 3 Give the infant a bottle of formula instead of breastfeeding so often at night. 4 Allow the infant to cry for 30 minutes, then rock the infant back to sleep before putting the infant back in the crib.

An infant who has severe diarrhea is suspected to have lactose intolerance. Which diagnostic test would the primary health care provider prescribe to confirm lactose intolerance? 1 Skin-prick test 2 Stool acidity test 3 Blood glucose test 4 IgE antibody blood test

2 Stool acidity test A stool acidity test of the infant would be prescribed by the primary health care provider to confirm lactose intolerance. The fermented undigested lactose will produce lactic acid and other acids in the infant, which would increase the pH of the infant's stool. An acidic fecal pH of the infant indicates malabsorption of lactose. A skin prick test is used for demonstrating an allergic response to a specific allergen such as cow's milk. A blood glucose test is done to check the serum glucose level of the patient; it is not a diagnostic test to confirm lactose intolerance. A blood test for checking IgE antibodies is done if the infant has an IgE mediated allergy. Lactose intolerance is not an IgE mediated allergy, so a blood test is not a diagnostic test for confirming lactose intolerance in the infant. An IgE antibody blood test is done for checking IgE antibodies if the infant has an IgE-mediated allergy. Lactose intolerance is not an IgE-mediated allergy, so a blood test is not a diagnostic test for confirming lactose intolerance in the infant.

A newborn is diagnosed with gastroesophageal reflux. Which is the best position the mother should place the newborn in after nursing to prevent sudden infant death syndrome? 1 Prone 2 Supine 3 Side-lying 4 Semi Fowler's position

2 Supine The mother should place the infant in a supine position when the infant sleeps to prevent sudden infant death syndrome (SIDS). Placing the infant in prone position when the infant sleeps may causes oropharyngeal obstruction and rebreathing of carbon dioxide, which are possible causes of SIDS. The side-lying position is not recommended for infants because infants placed in a side-lying position are found to have increased incidence of SIDS. A semi Fowler's position is when a patient is lying in a bed in supine position with the head lifted to approximately 30 degrees. A Semi Fowler's position is used to provide maximum lung expansion if the infant has breathing difficulties but it is not the recommended position when the infant sleeps.

Parents of a toddler are worried, because their child touches his or her genitalia in public. What should the nurse advise? 1 Do not allow the child to play with genitalia in public or private places. 2 Teach that genital stimulation in private is acceptable but not in public. 3 Take the toddler to a psychologist or psychiatrist for a health checkup. 4 Ignore it, because it is a normal phenomenon in psychosocial development.

2 Teach that genital stimulation in private is acceptable but not in public. Activities of a toddler should be dealt with carefully because reactions of parents influence the attitudes of children and can affect their psychosocial development. It is a normal phenomenon for toddlers to stimulate their genital organs, but they should be taught that such activities are not accepted in public places and should be done in private. At this stage parents need not consult a psychologist or psychiatrist for a health checkup of the toddler. However it is also inappropriate to ignore such behavior.

Which statement is correct with regard to temper tantrums in toddlers? 1 Temper tantrums normally appear 10 times a day. 2 Temper tantrums that last for 5 minutes are normal. 3 Temper tantrums normally appear till 10 years of age. 4 Temper tantrums appearing for 20 minutes are normal.

2 Temper tantrums that last for 5 minutes are normal. Temper tantrums in toddlers lasting for 5 minutes are normal. Temper tantrums occur when the child is ill, hungry, frustrated, or tired. Temper tantrums appearing 5 times a day, appearing in children over 5 years of age, and lasting for more than 15 minutes are indications of serious problems. The healthcare provider should be notified immediately if any of these situations take place.

A hospitalized toddler clings to a worn, tattered blanket and screams when anyone tries to take it away. What is the best explanation for the toddler's attachment to the blanket? 1 The blanket encourages immature behavior. 2 The blanket is an important transitional object. 3 The child and mother have inadequate bonding. 4 The developmental task of individuation-separation has not been mastered

2 The blanket is an important transitional object The blanket is an important transitional object that provides security when the child is separated from her parents. Transitional objects are important in helping toddlers separate, and attachment to them does not indicate immature behavior. Transitional objects are helpful when a toddler experiences increased stress, such as during hospitalization. The attachment to the blanket does not reflect inadequate bonding with the mother.

The parent of a 20-month-old toddler tells the nurse, "I don't understand my child's eating habits. Sometimes my child eats a lot and the next day nothing at all. Sometimes my child may push away the plate and reject a favorite food for no reason." What does the nurse understand from the child's behavior? 1 The child is displaying symptoms of anorexia. 2 The child is influenced by the psychological components of food. 3 The child becomes unpredictable after 20 months of age. 4 The parent is consistent about mealtimes with the child.

2 The child is influenced by the psychological components of food. At the age of 18 months, toddlers show signs of decreased appetite by being fussy eaters or having strong taste preferences. These children are influenced by the psychological components of the food instead of taste. They are more interested in the pleasure of eating or the social aspect of mealtime. This phenomenon is called physiologic anorexia. The child may become unpredictable during mealtimes, but it does not mean that the child generally becomes unpredictable after 20 months. A consistent mealtime contributes to the child's need for ritualism and helps to reduce undesirable behavior at mealtimes.

The parents tell a nurse that they prefer giving an all-fruit diet to their child to improve the health status. They have been practicing this for about 6 months. What problems can the nurse anticipate due to this practice in the child? 1 The patient may have hypokalemia. 2 The patient may have dental caries. 3 The patient may have constipation. 4 The patient may have obesity.

2 The patient may have dental caries. Dental caries is a common complication associated with excessive intake of fruits. Delayed growth, constipation, and obesity are not complications associated with excess fruit intake. Fruits are a good source of potassium. Thus excess intake of fruits would not cause hypokalemia. Diarrhea is a complication associated with excess fruit intake. Fruits have less fat content and can be helpful in prevention of obesity in children.

Which factor or habit of a preschooler does the nurse expect to be responsible for inadequate development of the child's musculoskeletal system? 1 The preschooler has enough rest. 2 The preschooler plays travel soccer. 3 The preschooler has proper nutrition. 4 The preschooler generally maintains good posture.

2 The preschooler plays travel soccer. The proper development of the musculoskeletal system is very important in preschoolers. Excessive activity and overexertion can injure delicate tissues and be a hindrance for adequate development. For the preschooler who has inadequate development of the musculoskeletal system, the nurse would conclude that excessive exercising may be the factor responsible for this inadequacy. Adequate rest, nutrition, and good posture are essential for the optimum development of the musculoskeletal system.

Which is an important consideration when the FACES Pain Rating Scale is used with children? 1 The scale is not appropriate for use with adolescents. 2 The scale may be used with most children as young as 3 years of age. 3 Children color the face with the color they choose to best describe their pain. 4 The scale is useful in pain assessment but is not as accurate when physiologic responses are being assessed.

2 The scale may be used with most children as young as 3 years of age. The FACES scale has been validated for children as young as 3 years of age as a means of rating pain. The child points at the face that best describes the pain being experienced. The scale is useful for people of all ages above 3 years, including adults. The scale does not have a means of assessing physiologic data.

Which statement is most characteristic of the motor skills of a 24-month-old child? 1 The toddler walks alone but falls easily. 2 The toddler's activities begin to produce purposeful results. 3 The toddler is able to grasp small objects but cannot release them at will. 4 The toddler's motor skills are fully developed but occur in isolation from the environment.

2 The toddler's activities begin to produce purposeful results. Gross and fine motor mastery occurs with other activities that have a purpose, such as walking to a particular location or putting down one toy and picking up a new one. By 2 years of age children are able to walk up and down stairs without falling. Grasping small objects without being able to release them is characteristic of infancy. Interaction with the environment is essential for mastery of both fine and gross motor skills at this age and beyond.

What information should the nurse give to parents of toddlers about the regular use of fluoridated water or beverages that contain fluoride? 1 All fluoridated water is toxic to children. 2 These drinks can cause stains or pits in the teeth. 3 Regular use of fluoridated water is recommended for toddlers. 4 It is not necessary to check the fluoride level in your water supply.

2 These drinks can cause stains or pits in the teeth. Parents should be cautioned that regular use of fluoridated water or beverages such as bottled water containing fluoride can result in staining or pitting of the child's teeth. Fluoridated water is not toxic to children. Regular use of fluoridated water is not recommended for toddlers. Supplementation based on fluoride concentration of water supply less than 0.3 ppm (parts per million) is 0.25 mg for a child 6 months to 3 years of age and 0.5 mg for a child 3 to 6 years of age, according to the American Academy of Pediatric Dentistry.

The nurse is explaining the health problems of infants and children to a student nurse. The student nurse is working with a parent who is upset because his or her child is diagnosed with a dyssomnia. What should the student nurse look for in this child to understand about dyssomnias? 1 Parents noticed child sleepwalks 2 Trouble in falling asleep at night 3 Signs of protein-energy malnutrition 4 Allergic to milk and milk products

2 Trouble in falling asleep at night The nurse should be aware that in dyssomnias children have trouble with either falling asleep or staying asleep at night. They may have problems with staying awake during the daytime as well. Therefore, to understand dyssomnias, the student nurse has to observe the child's sleeping patterns. Sleepwalking is a parasomnia, not a dyssomnia. There may be other signs and symptoms of the deficiency of vitamins, protein-energy malnutrition, or allergy to milk and its products.

What should the nurse recognize as the most reliable indicator of pain in school-age children? 1 Crying 2 Verbal report 3 Increased heart rate 4 Increased blood pressure

2 Verbal report A verbal report of pain is the most reliable indicator of pain in school-age children. Crying, increased heart rate, and increased blood pressure are not always indicative of pain but can be complex responses to emotional stress.

A mother is bringing her 4-month-old infant into the clinic for a routine well-baby check. The mother is exclusively breastfeeding. No other liquids are given to the infant. What vitamin does the nurse anticipate the provider will prescribe for this infant? 1 Vitamin B 2 Vitamin D 3 Vitamin C 4 Vitamin K

2 Vitamin D The American Academy of Pediatrics recommends that infants who are exclusively breastfed receive 200 IU of vitamin D daily by the age of 2 months to decrease vitamin D deficiency. Vitamins B, C, and K are not needed.

The nurse is performing a well-child assessment of an infant. The infant's mother tells the nurse that the family follows a strict vegan diet. For what nutritional deficiencies is this child at risk? 1 Vitamin D, vitamin B12 vitamin C, iron, calcium, zinc 2 Vitamin D, vitamin 12 vitamin B6 iron, calcium, zinc 3 Vitamin D, vitamin B12, vitamin C, iron, calcium, magnesium 4 Vitamin D, vitamin B12 vitamin B6 iron, calcium, magnesium

2 Vitamin D, vitamin 12 vitamin B6 iron, calcium, zinc Children who consume a strict vegan diet are at risk for vitamin D, vitamin B12, vitamin B6, iron, calcium, and zinc deficiencies. They are also at risk for inadequate intake of protein and calories and poor digestion. Deficiencies in vitamin C and magnesium are not as likely as deficiencies in vitamin B6 and zinc.

With regard to imaginary playmates, which children have a higher tendency to impersonate characters? 1 Young girls 2 Young boys 3 Older girls 4 Firstborn child

2 Young boys Young boys have a higher tendency to impersonate television characters. Girls and firstborn children tend to have imaginary companions. Older children develop concrete thinking. They no longer have imaginary playmates and do not tend to impersonate characters.

The nurse assesses a toddler and finds that the child is in a growth spurt. What should the nurse tell the family regarding feeding the child to meet his or her nutritional needs? Select all that apply. 1 Plan a nutritionally balanced day. 2 Plan a nutritionally balanced week. 3 Serve food in various physical forms. 4 The toddler shouldn't smell a new food. 5 Feed the child when it is actively playing.

2,3 Toddlers try to control their environment as they grow. Parents should be advised to plan for a nutritionally balanced week. By serving food in different forms and shapes, "food jags" can be prevented. New food should be introduced in a stepwise pattern, such as having the child smell, touch, taste, and then eat the new food. Feeding the toddler when he or she is actively playing can cause choking and is not recommended.

The nurse is assessing pain in a 3-month-old infant. Which physiologic signs indicate acute pain in the infant? Select all that apply. 1 Decreased heart rate 2 Increased muscle tone 3 Pallor or flushing 4 Rapid, shallow respirations 5 Dilated pupils

2,3,4,5 Increased muscle tone, pallor or flushing, rapid, shallow respirations, and dilated pupils indicate that the infant experiences acute pain. Acute pain is indicated by increased heart rate, not decreased heart rate.

The nurse is providing education to a parent of a 10-month-old infant with the diagnosis of cow's milk allergy. What will be included in the teaching? Select all that apply. 1 Use of milk to desensitize the child 2 To not substitute goat's milk for cow's milk 3 Introduction of soy-based products to replace milk 4 Reading of all food labels to avoid products with milk 5 Signs and symptoms associated with potential accidental ingestion of milk.

2,3,4,5 The nurse will teach the parent to read all food labels to avoid products with milk. This infant will not be desensitized to milk, and goat's milk is not an acceptable substitute for cow's milk. Milk and milk-based products should be avoided with this child. Introduction of soy-based products to replace milk will be included in the teaching. Signs and symptoms associated with potential accidental ingestion of milk will be included in the teaching.

The nurse is educating parents about growth and development of preschoolers. What instructions does the nurse give the parents to help them make preschoolers feel comfortable with their body image? Select all that apply. 1 Suggest that preschoolers observe others. 2 Instill positive principles regarding body image. 3 Emphasize the importance of accepting other individuals. 4 Restrict the children from communicating with the others. 5 Give the children encouraging feedback regarding their appearance.

2,3,5 Preschoolers are aware of the meaning of words such as pretty or ugly. Preschoolers reflect the opinions of others regarding their own appearance. In this situation the parents should take care that children do not feel uncomfortable with their body image. The parents should instill positive principles regarding body image, emphasize accepting people the way they are, and give their children encouraging feedback regarding their appearance. The parents should not restrict children from communicating with others, because this can result in loneliness. The parents should avoid suggesting that children observe others, because comparisons with others may cause discomfort.

A 24-month-old child is seen in the clinic for a well-child exam. Which characteristics can be observed in the child? Select all that apply. 1 The ability to name many colors Correct 2 The ability to refer to self by name 3 The ability to tell first and last name Correct 4 The ability to dress self in simple clothing 5 The ability to recognize gender difference

2,4 A 24-month-old child will be able to refer to him- or herself by name and would tell his or her first name when asked. The child would also be able to dress himself or herself in simple clothing. A 30-month-old child would be able to name many colors, give his or her first and last name, and refer to him- or herself by the appropriate pronoun. The 30-month-old would also be able to recognize gender differences and would recognize his or her own gender.

During assessment the nurse finds that a child lacks fine motor coordination. Which games does the nurse suggest to help the child develop fine motor coordination? Select all that apply. 1 Skating 2 Painting 3 Tricycling 4 Puzzles 5 Flash cards

2,4,5 After a certain age, children develop fine motor coordination, but some develop more slowly than others. But some children have poor fine motor coordination. Games such as painting, puzzles, and flash cards are helpful in improving the fine motor coordination of the child. Skating and tricycling are helpful for improving muscle strength of the child.

What are clinical manifestations of failure to thrive? Select all that apply. 1 Smiling 2 Growth failure 3 Fear of strangers 4 Developmental delays 5 Avoidance of eye contact

2,4,5 Clinical manifestations of failure to thrive (FTT) include growth failure, developmental delays, malnutrition, apathy, withdrawn behavior, feeding or eating disorders, and avoidance of eye contact. Smiling and fear of strangers are not clinical manifestations of failure to thrive.

What are the primary goals in the nutritional management of infants with failure to thrive? Select all that apply. 1 Don't allow catch-up growth. 2 Correct nutritional deficiencies. 3 Achieve excess weight for height. 4 Restore optimal body composition. 5 Educate the parents or primary caregivers on the child's nutritional requirements. 6 Explain to the parents or primary caregiver that the child will need tube feedings first.

2,4,5 Correction of nutritional deficiencies is a goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treatment of any coexisting medical problems. Optimization of body composition is a goal of treatment. Another goal is to provide education to the parents or primary caregiver of the child's nutritional requirements, along with appropriate feeding methods. The goal is to provide sufficient calories to support "catch-up" growth, a rate of growth greater than the expected rate for age. Accurate assessment of the child's initial weight and height are important, as is the daily recording of weight, food intake, and feeding behavior. One more primary goal is to avoid the need for tube feedings.

What are the clinical situations in which a nurse expects occurrence of sudden infant death syndrome (SIDS)? Select all that apply. 1 Firstborn child 2 Preterm infant 3 Postterm infant 4 Bronchopulmonary dysplasia 5 Neonates with low Apgar score

2,4,5 Preterm infants, infants with bronchopulmonary dysplasia, and neonates with low Apgar scores have immature or underdeveloped lungs. Therefore they are at increased risk of developing SIDS. Subsequent siblings have a higher risk than firstborns. Postterm infants are not at higher risk of developing SIDS.

An infant has torticollis and plagiocephaly. What nursing interventions are appropriate for this infant? Select all that apply. 1 Use customized helmet 4 hours daily. 2 Switch head position sides regularly. 3 Refer to craniofacial surgeon by 2 years. 4 Refer to pediatric neurosurgeon by 1 year. 5 Promote exercises to loosen the tight muscles.

2,5 Torticollis is characterized by abnormal and asymmetrical head or neck position. Plagiocephaly is asymmetrical distortion of the skull. Management includes switching head position sides during feeding, carrying, and while asleep; this helps to promote development of symmetrical shape. Exercises should be encouraged to loosen tight muscles. After 4 to 8 weeks of physical therapy, a customized helmet should be worn for 23 hours a day and for the recommended duration. Referral to a craniofacial surgeon or a pediatric neurosurgeon has to be done by 4 to 6 months of age.

A parent tells the nurse that her preschool child refuses to sleep in his bed alone. Which instruction given by the nurse to the parent is most appropriate? 1 "Punish him if he does not sleep in his bed." 2 "Keep the television on when the child sleeps." 3 "Allow the child to hold his favorite toy when he sleeps." 4 "Lie in the child's bed and talk with the child until the child sleeps."

3 "Allow the child to hold his favorite toy when he sleeps." The parent should allow the child to hold his or her favorite toy when the child sleeps, because this provides security to the child, and helps the child deal with the new stress of being separated from parents. The parent should not punish the child for refusing to sleep in his or her bed. Instead, the parent can reward the child in the morning for sleeping alone in his or her bed. Television should be switched off when the child sleeps because the light from the television screen makes it difficult for the child to fall asleep. The room should be kept dark while sleeping, because the brain is stimulated to produce sleep hormones when the room is dark. Nightlights can be kept on, if required. The parent should avoid lying in the child's bed and avoid interacting with the child until the child sleeps to reduce the child's dependence on the parent at night.

A mother tells a nurse that her 26-month-old child refuses to use the potty. Which suggestion given by the nurse is most appropriate? 1 "Force the child to sit on the potty for 30 minutes." 2 "It is too early for to start toilet training for the child." 3 "Make up a game to encourage the child to use the potty." 4 "Give lactulose in the morning and place the child on the potty."

3 "Make up a game to encourage the child to use the potty." The parent should make up a game to encourage the child to use the potty, and make toilet training easy and as simple as possible. Forcing the child to sit on the potty will not support the child's sense of control. At 26 months old, the child is at the appropriate age for toilet training. Children attain voluntary control of anal and urethral sphincters usually when they are 22 months old. Lactulose is a laxative. Laxatives should not be given to children unless prescribed by a physician.

The parent of a 1½-year-old child asks the nurse whether meat and hot dogs can be included in the child's diet. How does the nurse respond? 1 "Yes, but you must serve it in the child's favorite dish." 2 "Serve it less often, because it may cause early childhood caries." 3 "Slice the meat into small pieces before serving." 4 "No, the child will not be able to chew it properly."

3 "Slice the meat into small pieces before serving." The nurse advises the parent to slice the meat and hot dogs into small pieces to prevent choking. A child may be more accepting of foods served in a favorite dish, but it must be cut into smaller pieces. Meat and hot dogs do not cause early childhood caries; it is caused by frequent nocturnal breastfeeding or coating pacifiers in honey. A child is able to chew small pieces of food after 1 year of age.

A parent tells the nurse that his/her child wakes up at night because of fear and seeks the physical presence of the parent nearby to return to sleep. What should the nurse instruct the parent to do to manage the child's night fear? 1 "Sleep with the child." 2 "Take the child to your room." 3 "Use a reward system to motivate the child." 4 "Put the child to bed after he or she falls asleep."

3 "Use a reward system to motivate the child." The nurse should encourage the parents to use a reward system to motivate the child to deal with the fear. The parents should not sleep with the child, but should reassure the child that everything is fine and the child is safe in his or her own bed. The parents should not take the child to their room if the child wakes up at night because of fear. Parents should teach the child to trust that the child's bed is a safe place and keep him or her from leaving his or her room. The parents should put the child to bed when the child is awake.

During a health assessment interview, a mother tells the nurse that her child has recently been imitating her and doing some of household chores like cleaning and dusting. The nurse recognizes this behavior of the child as domestic mimicry. What age is the child most likely to be? 1 13 months 2 15 months 3 24 months 4 32 months

3 24 months Domestic mimicry is observed in children who are 19 to 24 months old, which is the final stage of sensorimotor stage. Children are aware of other people's actions, and they attempt to copy them at this sensorimotor stage. Children who are 13 to 15 months old are in the fifth sensorimotor stage. Domestic mimicry is not a behavior of children in this stage. Children who are 32 months old are in the preoperational phase; in this stage, increased use of language and mental symbolization is observed.

What is the youngest age for which the FACES Pain Rating Scale is recommended? 1 1 year 2 2 years 3 3 years 4 4 years

3 3 years The FACES Pain Rating Scale can be used in children as young as 3 years. One or 2 years is too young for the FACES scale. Four years old is not the youngest age for which the FACES scale is appropriate.

A primary healthcare provider has ordered ibuprofen for a 1-year-old child. What is the maximum advised dosage of the drug that can be administered in a day? 1 1250 mg/day 2 3000 mg/day 3 3200 mg/day 4 4000 mg/day

3 3200 mg/day Ibuprofen may be administered to children to reduce the pain. The maximum dosage of ibuprofen that can be administered to the child is 3200 mg per day. The maximum dosage of naproxen that can be administered to children above 2 years of age is 1250 mg per day. The maximum dosage of choline magnesium salicylate that can be administered to children above 2 years of age is 3000 mg per day. The maximum dosage of acetaminophen that can be administered to children above 2 years of age is 4000 mg per day.

The nurse is teaching a group of nursing students alternate versions of pain assessment scales for children who do not speak English. Which pain assessment scales are available in alternate versions? 1 Pain Rating Scale 2 Scale for Use in Newborns 3 Adolescent Pediatric Pain Tool 4 Non-communicating Children's Pain Checklist

3 Adolescent Pediatric Pain Tool For effective management of pain of non-English-speaking children, the Adolescent Pediatric Pain Tool may be given to the child. Encourage the child to use the diagram for communicating the location and extensiveness of pain. The Pain Rating Scale, the Scale for Use in Newborns, and the Non-communicating Children's Pain Checklist are available only in English and are not effective for use with non-English-speaking children.

A mother tells the nurse that she wants to start toilet training her 22-month-old child. Which factor should the nurse stress? 1 Consistency in approach 2 Positive attitude of the mother 3 Developmental readiness of the child 4 Developmental level of the child's peers

3 Developmental readiness of the child If the child is not ready developmentally, it would be frustrating for both the parent and the child during toilet training. Consistency in approach is important once toilet training has already started. A positive attitude from the primary caregivers is also important once the child is ready for toilet training. Developmental levels are different for every child, and comparison with peers is not appropriate.

The nurse is teaching a group of children about strategies of pain management. Which teaching strategy does the nurse use to educate the children? 1 Get assistance from their parents. 2 Provide the children with medical journals. 3 Educate using interactive audio visual aids. 4 Get assistance from primary health care provider.

3 Educate using interactive audio visual aids. Prior education of children about pain management strategies is important for effective pain management. Children can be educated with the help of an interactive session in which the instructions are recorded and played. Assistance from parents may not promote learning in children. Children may not be interested in reading medical journals. Assistance from a healthcare provider may not be helpful in promoting learning in children.

During assessment the nurse finds that a child has poor muscle coordination. Which instruction does the nurse provide the parents to help develop muscle coordination in the child? 1 Compel the child to eat food. 2 Restrict the child from skating. 3 Encourage the child to swim. 4 Encourage the child to play with flash cards.

3 Encourage the child to swim. Swimming helps in developing muscle coordination in the child and promotes physical growth and refinement of motor skills. Therefore the parents should encourage the child with poor muscle coordination to swim. Compelling a child to eat may not help in the development of muscle coordination. The child should be encouraged to skate, because it helps in developing muscle coordination. Playing with flash cards is helpful for fine motor development and self-expression, but may not help improve muscle coordination.

A student nurse is attempting to use nonpharmacologic strategies for pain management for a child. Which strategy warrants the nurse to further educate the student? 1 Consult a child-life specialist 2 Involve the child in playing or singing 3 Explaining to the child, "This is going to hurt" 4 Staying with the child during a painful procedure

3 Explaining to the child, "This is going to hurt" Nonpharmacologic strategies for pain management for a child include avoidance of "planting" the idea of pain so the student nurse should be further educated about explaining to a child "This is going to hurt". Effective nonpharmacologic strategies include consulting a child-life specialist, involving the child in playing or singing, and being with the child during painful procedures.

A 6-year-old child is hospitalized with a fractured femur. The nurse draws on knowledge of pain assessment tools and child development to select the assessment tools that are most appropriate for this age of child. Which is most appropriate for the age of this child? 1 CRIES scale 2 CHIPPS scale 3 FACES pain scale 4 Postoperative pain score

3 FACES pain scale A 6-year-old child should be able to use the FACES pain scale to choose the face that best matches his pain level. The CHIPPS scale assesses newborns. The CRIES scale was developed for the assessment of pain in the preterm and term neonate. The postoperative pain score is used to assess pain in 1- to 7-month-old infants.

Which information about early childhood caries should be given to parents? 1 This syndrome can be completely prevented by breastfeeding. 2 Giving the child juice in the bottle instead of milk at bedtime prevents this syndrome. 3 Giving a bottle of milk or juice at naptime or bedtime predisposes the child to this syndrome. 4 This syndrome is distinguished by protruding upper front teeth, the result of sucking on a hard nipple.

3 Giving a bottle of milk or juice at naptime or bedtime predisposes the child to this syndrome. Sweet liquids, or the sugars in milk and even breast milk, pooling in a toddler's mouth during sleep increase the incidence of early childhood caries. Changes in the positioning of the teeth may result from pacifier use or thumb-sucking and are not related to bottle-mouth caries. Frequent breastfeeding before sleep can cause bottle-mouth caries, because breast milk does contain lactose, which is present in higher concentrations than in cow's milk-based formula. Juice, which contains varying concentrations of sugar in bottles, contributes to bottle-mouth caries when a child is allowed to have a bottle of it before sleep.

A child who has been receiving morphine intravenously will now start receiving the medication orally. For equianalgesia to be achieved, what adjustment must be made for the oral dose? 1 Same as the IV dose 2 One half of the IV dose 3 Greater than the IV dose 4 One fourth of the IV dose

3 Greater than the IV dose When the route of morphine administration is changed from IV to PO (by mouth), it is essential that the dose be increased to produce an equianalgesic effect. Oral morphine is not as effective at the same dose as IV morphine. The dosage of morphine is increased, not decreased, when the administration route changes from IV to PO.

The addition of vitamins to commercially prepared infant foods increases the risk of which condition? 1 Kwashiorkor 2 Malabsorption 3 Hypervitaminosis 4 Vitamin D deficiency

3 Hypervitaminosis Hypervitaminosis—excessive dosage of a vitamin, usually defined as 10 or more times the Recommended Dietary Allowance (RDA)—is more common today with the addition of vitamins to commercially prepared infant foods. Kwashiorkor is a deficiency of protein with an adequate supply of calories that has nothing to do with the addition of vitamins to commercially prepared foods. The potential for malabsorption has not increased as a result of vitamins being added to commercially prepared foods.

Parents of a toddler are worried because the child behaves abnormally after the birth of a baby sister. The toddler now likes to drink milk from the feeding bottle rather than from a favorite cup and demands to be given the same toys as the baby sister. What is the best approach in handling this behavior? 1 Teach the toddler new skills for further development. 2 Take the toddler to a psychologist for behavioral therapy. 3 Ignore this behavior and praise appropriate behavior. 4 Refer the toddler to an experienced psychiatrist for a checkup.

3 Ignore this behavior and praise appropriate behavior. The behavior of the child indicates regression, which means retreat from present behaviors to behaviors adopted as a baby. It is common in toddlers when they face additional stress such as illness or adjustment to a new sibling. During this time the toddler needs understanding and patience from the parents and caregivers. Therefore the best approach is to ignore regressive behavior and praise appropriate behavior. Learning new skills causes additional stress and is not advised. Regression is not a psychological disorder, and there is no need for behavioral therapy or a health checkup by a psychiatrist at this stage.

Which activity documented by the nurse best describes the fine motor skills appropriate with age in a child who is 2 years old? 1 Throws a ball 2 Imitates drawing a circle 3 Imitates drawing a vertical line 4 Drops a pellet into a narrow-necked bottle

3 Imitates drawing a vertical line Fine motor skills can be demonstrated in a 2-year-old child by the child's adeptness to imitate drawing a vertical line or a circular stroke. When a child is 18 months old, the child is able to throw a ball without losing his or her balance. By the end of the toddler period, that is, by the end of 3 years of life, the child is able to copy a circle and mimic a cross. A 15-month-old child is able to drop a pellet into a narrow-necked bottle.

The nurse is caring for a child who needs continuous pain control medications. Which medication route for analgesic administration proves to be most effective for the child? 1 Oral 2 Sublingual 3 Intravenous (IV) 4 Transmucosal

3 Intravenous (IV) IV route is the best route for administering pain medications because it enables the rapid control of severe pain. The child may need rest and may not be able to take oral medications, and oral medications do not provide rapid control of severe pain. Sublingual and transmucosal medications have an increased risk of swallowing in small children.

The nurse is assessing pain in a 7-year-old child with cognitive impairment and communication difficulties. Which sign does the nurse observe for pain in the child? 1 Rapid talking 2 Sleeping often 3 Moaning 4 Fist clenching

3 Moaning Moaning is an indication of pain experienced by a child with cognitive impairment. Children with pain interact and speak less instead of talking rapidly. Children with pain sleep less, because they are uncomfortable. Fist clenching is observed in infants who experience pain.

A nurse is assessing the pain of a child using the FACES pain rating scale. The child chooses the fourth face. What does the nurse interpret from the face the child has chosen? 1 Pain hurts a little bit 2 Pain hurts a whole lot 3 Pain hurts even more 4 Pain hurts a little more

3 Pain hurts even more The nurse interprets that the pain score of the child is 4, which means that it hurts even more. A score of 1 is given if the pain hurts a little bit. A score of 4 is given if the pain hurts a whole lot. A score of 2 is given if the pain hurts a little more.

he nurse is caring for a comatose child with multiple injuries. The nurse should recognize which information about pain? 1 Cannot occur if a child is comatose 2 May occur if the child regains consciousness 3 Requires astute nursing assessment and management 4 Is best assessed by family members who are familiar with the child

3 Requires astute nursing assessment and management Because the child cannot communicate pain through one of the standard pain-rating scales, the nurse must focus on physiologic and behavioral manifestations to accurately assess his pain. Pain can occur in the comatose child. The family can provide insight into the child's responses, but the nurse should be monitoring physiologic and behavioral manifestations.

A school nurse observes that a 4-year-old child is hitting another child. The child finds hitting enjoyable. What is the reason behind this? 1 The child is abnormal. 2 The child is aggressive. 3 The child is not punished. 4 The child is being teased.

3 The child is not punished. Young children's development of moral judgment is at the most basic level. Children's behavior depends on the freedom or restrictions placed on their actions. At this age children judge whether an action is good or bad depending on whether it results in a reward or a punishment. If children are punished for hitting, they understand that it is a bad thing. If they are not punished, they consider the action to be good, regardless of the meaning of the act. Hitting another child is not abnormal or aggressive behavior. The child hits another child because of the inability to differentiate between good or bad actions and not because another child teases him.

The mother of a toddler tells the nurse that her son has started kicking, screaming at the top of his lungs, and holding his breath until he faints when the two are grocery shopping. What does the nurse recognize as the cause of temper tantrums in toddlers? 1 A spoiled child 2 A pathologic condition 3 The child's desire for independence 4 The child's ability to control his or her emotions

3 The child's desire for independence Temper tantrums in toddlers represent a combination of the child's desire for independence combined with an inability to control and communicate emotions. They do not indicate that a child is spoiled or that the child is developmentally abnormal; nor do they reflect an inability to control emotions.

Why are physiologic measurements in the assessment of pain in children not as useful as other measurements of pain? 1 Children tend to underestimate pain. 2 Parental report of children's pain is more reliable than physiologic measurements. 3 The same physiologic signs that suggest fear, anxiety, or anger can also indicate pain. 4 Physiologic measurements are of limited value in assessing pain when the child is hospitalized.

3 The same physiologic signs that suggest fear, anxiety, or anger can also indicate pain. Physiologic manifestations of pain may vary considerably and therefore do not provide a consistent measure of pain. Children do not tend to underestimate pain when pain is appropriately assessed. Parental report of children's pain has not been found to be more reliable than physiologic measurements. Whether a child is hospitalized or not, physiologic measurements of pain are not as useful as a child's self-report of pain.

The nurse is teaching pain management strategies to the parents of a 6-year-old child with recurrent abdominal pain. The nurse instructs the parents to not give excessive attention to the child's abdominal pain. What is the purpose of this advice? 1 To teach the child not to complain about pain 2 To make the child feel comfortable with the pain 3 To prevent positive reinforcement of the sick behavior 4 To help the child learn to deal with the pain

3 To prevent positive reinforcement of the sick behavior The nurse tells the parents to employ cognitive-behavioral strategy in which the parents avoid paying excessive attention to the pain. Instead the parents reward the healthy behavior of the child. This helps the child to modify the sick behavior and demand less attention. The strategy is not to prevent the child from complaining but to avoid paying special attention to it. The child is taught self-control skills to feel comfortable about the pain and to deal with it effectively.

For a toddler with sleep problems, what should the nurse suggest that the parents do? 1 Vary the bedtime ritual. 2 Explain away their fears. 3 Use a transitional object at bedtime. 4 Restrict stimulating activities throughout the day.

3 Use a transitional object at bedtime. Transitional objects may help ease the toddler's anxiety and facilitate sleep. A consistent set of bedtime rituals will facilitate a toddler's sleep. Toddlers should engage in stimulating physical activity during the day to help them sleep at night. Toddlers do not understand verbal explanations, so parents cannot explain away their fears.

An infant has persistent diarrhea. Following an assessment, the nurse learns that the infant also has developed protein-energy malnutrition due to diarrhea. What are the treatment strategies to manage this child? Select all that apply. 1 Use of antimotility agents 2 Use of opioids for managing diarrhea 3 Provision for adequate nutrition intake 4 Use of antibiotics for controlling infection 5 Rehydration with oral rehydration solution

3,4,5 The infant with persistent diarrhea may develop protein-energy malnutrition. The nurse should ensure adequate nutrition either through breastfeeding or through an appropriate weaning diet to promote growth and development in the infant. Antibiotics should be used for managing recurrent infections to prevent complications. Oral rehydration solution should be used for rehydration of the child to replace the lost electrolytes. Antimotility agents are avoided to prevent retention of toxins in the body. Opioids are used only in secondary diarrhea, not in persistent diarrhea.

An 18-month-old child is seen at the clinic for a well-child exam. Which behaviors does the nurse expect the toddler to possess at this age? Select all that apply. 1 Possessive of own toys 2 Imitates sounds of animals 3 Fits smaller objects into each other 4 Places square objects exactly in a hole 5 Opens door and drawers to find objects

3,5 Tertiary circular reactions are observed in children who are 13 to 18 months old. Tertiary circular reactions are schemes in which an infant purposely explores new possibilities with objects, continually changing what is done to them and exploring the results. Children in the fifth sensorimotor stage, or tertiary circular reactions, would possess the ability to fit smaller objects into each other. They open doors and drawers to find objects and have object permanence, indicating they are able to realize that objects out of sight are not out of their reach. Children in the preoperational stage, which ranges from about ages 2 to 4 are found to be possessive of their own toys and they use the word "mine." Children in this stage can mentally represent events and objects and engage in symbolic play. Children in the sixth sensorimotor stage, or the stage in which the child invents new means through mental combinations, imitate sounds of animals and words of adults. This stage ranges from about ages 19-24 months. Children in the fifth sensorimotor stage can place a round object into a hole exactly, but they cannot do so with a square until they are 2 years old.

A mother tells the nurse that her infant wakes up frequently at night and returns to sleep only with a bottle. Which advice given by the nurse is most appropriate to manage the infant's sleep disorder? 1 "Offer a last feeding an hour before bedtime." 2 "Give a pacifier when the child wakes up at night." 3 "Offer a bottle as soon as the child is awake at night." 4 "Avoid holding the child in your arms when the child wakes at night."

4 "Avoid holding the child in your arms when the child wakes at night." The child should not be held in the parent's arms or taken to a parent's bed when the child cries at night. Instead, the child should be reassured and checked at progressive longer intervals each night. The last feeding should be offered to the child as late as possible before bedtime. Giving pacifiers or bottles when the child cries or wakes up at night should be avoided. Bottles should not be offered to the child in bed.

4 "Give the infant cow's milk with vitamin supplements. The infant has developed cow's milk allergy (CMA). Hence, the nurse should instruct the parents to give soy milk and soy-based formula to the infant. Goat's milk is not a suitable substitute for cow's milk because goat's milk is deficient in folic acid, and has high sodium and protein content. The infant should not be given chilled or cold cow's milk, but infants with CMA might tolerate extensively heated cow's milk. The infant has developed CMA so cow's milk with vitamin supplements would not help the infant outgrow the hypersensitivity he or she has developed.

A child has abdominal pain, diarrhea, and flatulence due to lactose intolerance. The parent is worried that the lactose-free diet given to the child might affect the bone mass density of the child. What instruction should the nurse provide the parent to prevent calcium deficiency in the child? 1 "Include cheese and avocados in the child's diet." 2 "Include oranges and bananas in the child's diet." 3 "Give frozen yogurt and cold milk to the child after meals." 4 "Include dark green and leafy vegetables in the child's diet."

4 "Include dark green and leafy vegetables in the child's diet." Abdominal pain, diarrhea, flatulence, and bloating are the symptoms of lactose intolerance, and are treated by decreasing dairy products in the patient's diet. Dairy products are the major sources of calcium and vitamin D, so elimination of these products might cause deficiency of calcium and vitamin D. Therefore, foods rich in calcium and vitamin D should be given to the patient. The nurse must advise the parent to include dark green and leafy vegetables in the child's diet such as spinach and lettuce, both good nondairy sources of calcium. Only hard cheese could not be given to the child, but avocado is a rich source of potassium, monounsaturated fatty acids, fiber, and vitamin K, not calcium. Oranges are a good sources of vitamin D, but bananas are rich in vitamin K and potassium, not calcium. Frozen yogurt and cold milk should not be given to the child after meals, because they would contain concentrated lactose. The child can be given fresh yogurt.

A parent brings a 2-year-old toddler to the clinic for a well-child visit. Which statement by the parent indicates to the nurse that the parent needs more instruction regarding accident prevention? 1 "We locked all of the medicine in the medicine chest." 2 "We turned down the temperature on our water heater." 3 "We put gates at the top and bottom of the basement steps." 4 "We put him in the seat belt now that he's older."

4 "We put him in the seat belt now that he's older." A car seat should be used until the child weighs 18 kg (40 lb) and is approximately 4 years old. Locking up medicines and any other harmful household products, turning down the thermostat on the water heater, and placing gates at the top and bottom of the basement stairs are all appropriate actions, and so there is no need for further instruction.

An infant brought to the emergency department is pronounced dead by the primary health care provider. Which question is appropriate to ask the parent? 1 "Did the siblings get along with the infant?" 2 "Did you hear the infant cry out or anything?" 3 "Did you check the infant earlier today?" 4 "What time did you find the infant nonresponsive?"

4 "What time did you find the infant nonresponsive?" The parents should be asked only factual questions such as "What time did you find the infant nonresponsive?" The nurse should not ask questions that suggest responsibility for the infant's condition such as "Did the siblings like the infant?", "Did you hear the infant cry out?", or "Did you check the infant earlier today?" Asking nonfactual questions imply blame and neglect.

A child was brought to the hospital for a well visit. The child is able to distinguish finger and spoon foods and chews food with mouth closed by moving food inside the mouth. What is the most likely age of the child? 1 12 months 2 16 months 3 18 months 4 24 months

4 24 months Toddlers who are 24 months old will be able to distinguish between finger food and spoon food; therefore, this is the age of the child. They chew food with their mouth closed and are able to move the food inside the mouth. Toddlers who are 12-18 months old are able to hold and drink well from a cup with a lid, and drop it when finished.

What is the normal age by which children can skip on alternating feet, jump rope, and swim? 1 2 years 2 3 years 3 4 years 4 5 years

4 5 years By the age of 5 years, a normal child acquires the ability to skip on alternating feet, jump rope, and swim. Two years of age is too early to perform skipping on alternating feet. By 3 years normal children can ride a tricycle, walk on tiptoe, and balance on one foot for a few seconds. By the age of 4 years children can skip and hop proficiently on one foot.

For which child would fluoride supplementation be recommended? 1 Fluoride supplementation is not recommended for infants. 2 A child 4 months or older whose drinking water is deficient in fluoride 3 A child 5 months or older whose drinking water is deficient in fluoride 4 A child 6 months or older whose drinking water is deficient in fluoride

4 A child 6 months or older whose drinking water is deficient in fluoride Fluoride supplementation is recommended for children 6 months or older whose drinking water is deficient in fluoride. Fluoride supplementation is not recommended at 4 or 5 months of age.

A child who has developed hives and become unconscious after eating pasta is brought to the hospital. On review of the records, the child is found to have a wheat allergy. The child has a slow heart rate, reduced blood pressure, respiratory arrest, and cyanosis of extremities. Which is the most appropriate nursing intervention in this situation? 1 Administer cetirizine intravenously. 2 Administer cetirizine subcutaneously. 3 Administer epinephrine intravenously. 4 Administer epinephrine intramuscularly.

4 Administer epinephrine intramuscularly. The child has developed an anaphylactic reaction. The nurse should administer intramuscular epinephrine immediately to the child. Cetirizine is used to treat mild allergic reactions and nasal manifestations; however, it is not effective in treating airway manifestations. Epinephrine is administered intravenously only when the patient does not respond to three or four doses of epinephrine injection given intramuscularly. Epinephrine is administered intravenously when the patient is experiencing a cardiac collapse.

A child develops hives and urticaria after having shellfish. The child says, "My throat is getting tight." Which is the primary nursing intervention in this situation? 1 Administer alprazolam. 2 Check the blood glucose level. 3 Administer subcutaneous antihistamine. 4 Assess the child's airway and breathing

4 Assess the child's airway and breathing The child might have developed anaphylactic reaction, because many children are hypersensitive to shellfish. The nurse needs to assess the child's airway and breathing immediately, because anaphylactic reactions can be life-threatening. Aprazolam is used to treat anxiety disorders and panic disorders. The nurse need not check the blood glucose level. The nurse has to support the blood pressure of the child and primarily assess the child's breathing. The nurse has to administer epinephrine to treat anaphylactic reactions immediately. Benadryl is used to treat mild allergic reactions.

What are some characteristics of preoperational thought in toddlers? 1 Considering all possible alternatives 2 Ability to see the event or object from another perspective 3 Ability to understand that something can be different than the way it appears 4 Belief that their thoughts are all-powerful and caused the event that occurred

4 Belief that their thoughts are all-powerful and caused the event that occurred Children who use preoperational thought believe that their thoughts are all-powerful and can cause the event that occurred, otherwise known as magical thinking. Centration, a term given to preoperational thought, means that toddlers are unable to consider all possible alternatives. They are unable to see the event or object from another perspective because of their egocentrism. They do not have the ability to understand that something can be different than the way it appears to be, also known as the inability to conserve.

The nurse is teaching the parent of a 2-year-old child how to care for the child's teeth. Which instruction should be included? 1 Flossing is not recommended at this age to prevent gum damage. 2 Toddlers are old enough to brush their teeth effectively with supervision. 3 The toddler's toothbrush should be small and have hard, rounded, nylon bristles. 4 Brush the toddler's teeth with plain water if the child does not like toothpaste.

4 Brush the toddler's teeth with plain water if the child does not like toothpaste. Some toddlers do not like the flavor of toothpaste, so water can be used for tooth brushing at this age. Flossing should be done after brushing to establish it as part of dental care for the toddler. Two-year-old toddlers cannot effectively brush their own teeth; parental assistance is necessary. Soft multitufted bristled toothbrushes are recommended to avoid damaging the toddler's teeth or gums.

Research has revealed that infants who are fed an organic diet deficient in vegetables and fruits are more likely to be deficient in which vitamin? 1 A 2 D 3 B 4 C

4 C Research has shown that children fed an organic diet deficient in vegetables and fruits are more likely to be deficient in vitamin C than in vitamins A, D, or B.

A 3-month-old bottle-fed infant is allergic to cow's milk. What is the best substitute for the nurse to teach the parents to use? 1 Goat's milk 2 Soy-based formula 3 Skim milk diluted with water 4 Casein hydrolysate milk formula

4 Casein hydrolysate milk formula The milk protein is broken down in casein hydrolysate milk formulas, making them a safe alternative for the infant who is allergic to cow's milk. The milk protein in goat's milk cross-reacts with cow's milk protein, and goat's milk is therefore not a safe alternative. Soy-based formulas are avoided because of the cross-reaction with cow's milk protein; they are not a safe alternative. Cow's milk protein is contained in skim milk, making it an unsafe alternative.

A nurse is starting an intravenous (IV) line for a school-aged child with cancer. The child says, "I've had a million IVs. They hurt." The nurse's response should be based on which pain principle? 1 Children tolerate pain better than adults who are undergoing treatment for similar chronic illnesses. 2 Children often lie about experiencing pain to avoid negative opinions from caregivers and healthcare providers. 3 Children become accustomed to painful procedures over time, especially with chronic illnesses. 4 Children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

4 Children often demonstrate increased behavioral signs of discomfort with repeated painful procedures. Children with chronic illnesses are more likely to identify invasive procedures as stressful than are children with acute illnesses. There are no data to support the theory that children tolerate pain better than adults. The child has increasing difficulty with numerous and repeated painful procedures rather than becoming accustomed to them. Pain is subjective.

Which action should be avoided in order to control stress in school-age children? 1 Giving drums to play 2 Using imagery technique 3 Increasing the rest period 4 Encouraging supervision during play

4 Encouraging supervision during play The parents should avoid supervising the toddlers while they are playing; this will help in controlling stress in toddlers. Playing with drums and a toy nail and hammer will help the toddler to cope with stress. Using imagery and relaxation techniques will help the toddler in controlling stress. Increasing the rest period of the toddlers is an effective way of controlling stress.

A child is being seen in the emergency department with multiple facial abrasions and lacerations. The combination agent lidocaine, adrenaline, and tetracaine (LAT) is applied topically to the wounds. What is the purpose of this combination therapy? 1 To cleanse the wound 2 To promote scab formation 3 To prevent infection of the wound 4 To provide anesthesia for the wound

4 To provide anesthesia for the wound The combination of lidocaine, adrenaline, and tetracaine provides anesthesia within 10 to 15 minutes of application. LAT does not have a cleansing or antibacterial effect, nor does it have an effect on scab formation.

The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy? 1 Helping the toddler complete tasks 2 Helping the toddler learn the difference between right and wrong 3 Providing opportunities for the toddler to play with other children 4 Encouraging the toddler to do things for himself or herself when capable

4 Encouraging the toddler to do things for himself or herself when capable Toddlers have an increased ability to control their bodies, themselves, and the environment. Autonomy develops when children complete tasks of which they are capable. To successfully achieve autonomy, the toddler needs to have a sense of accomplishment. This does not occur if parents complete tasks. Children at this age engage in parallel play. This will not foster autonomy. The concept of right and wrong is too advanced for toddlers and will not contribute to autonomy.

The parents of a 4½-year-old girl are worried because she has an imaginary playmate. What is the most appropriate response by the nurse, drawing on knowledge of the preschooler? 1 A psychosocial evaluation is indicated for this child. 2 An evaluation of possible parent-child conflict is indicated. 3 Having imaginary playmates is abnormal after the age of 2 years. 4 Having imaginary playmates is normal and useful in children of this age.

4 Having imaginary playmates is normal and useful in children of this age. Imaginary playmates are a part of normal development at this age and serve many purposes, including being a friend in times of loneliness, accomplishing what the preschooler is still attempting, and experiencing what the preschooler wants to forget or remember. Because an imaginary playmate is part of normal development, a psychosocial evaluation or evaluation of the parent-child relationship is not warranted. Imaginary playmates are commonly present during the preschool years; therefore they are not abnormal after the age of 2 years.

A child indicates "worst possible pain" on the Word-Graphic Rating Scale. What medication is most appropriate to be ordered for the child as a substitute for morphine? 1 Ibuprofen 2 Acetaminophen 3 Meperidine 4 Hydromorphone

4 Hydromorphone The Word-Graphic Rating Scale is a pain assessment technique used in children of the age group 4 years to 17 years. "Worst possible pain" has a score of 10 on the scale and can be treated by hydromorphone (Dilaudid), an effective substitute for morphine. Ibuprofen and acetaminophen are used to treat mild pain in children. Meperidine is not the drug of choice, because it is associated with many side effects.

What type of play is the most characteristic of preschoolers? 1 Parallel 2 Solitary 3 Telegraphic 4 Imaginative

4 Imaginative Preschoolers engage in lots of imitative, imaginative, and dramatic play. Parallel play is characteristic of toddlers. Solitary play is characteristic of infants. Telegraphic is the term given to a type of speech in which a child uses three or four words at a time and includes only the most essential words to convey meaning.

Which statement is the best description of colic for parents who are asking whether their infant is experiencing this alteration? 1 Colic is usually the result of poor or inadequate mothering. 2 The infant will experience periods of abdominal pain that result in weight loss. 3 Periods of abdominal pain and crying occur in infants primarily over the age of 6 months. 4 Infants with colic have paroxysmal abdominal pain or cramping marked by episodes of loud crying.

4 Infants with colic have paroxysmal abdominal pain or cramping marked by episodes of loud crying. Colic, or paroxysmal abdominal pain, occurs primarily in infants under the age of 3 months and is manifested by episodes of excessive crying and the infant drawing the legs up toward the abdomen. The infant with colic experiences abdominal pain but gains weight and usually thrives. Colic is usually gone by the age of 6 months. There is no identified relationship between mothering behavior and the development of colic. Test-Taking Tip: Record the information you find to be most difficult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traffic or for an appointment, just pull out the cards and review again. This "found" time may add points to your test scores that you have lost in the past.

A school nurse observes that children demonstrate mutual play. What is the effect of mutual play in preschoolers? 1 It reduces interaction between preschoolers and their parents. 2 It minimizes verbal abilities of preschoolers. 3 It minimizes language abilities of preschoolers. 4 It provides kinesthetic experiences for preschoolers.

4 It provides kinesthetic experiences for preschoolers. Mutual play is helpful for the development of motor skills in preschoolers. Through mutual play parents can provide kinesthetic experiences for their children. Mutual play encourages positive interactions between the parent and child and thus strengthens their relationship. It also maximizes verbal and language abilities.

A nurse is providing education to a community group in preparation for a mission trip to a third world country with limited access to protein-based food sources. Which condition should the nurse assess for in the infants in this country? 1 Rickets 2 Pellagra 3 Marasmus 4 Kwashiorkor

4 Kwashiorkor Kwashiorkor is defined primarily as a deficiency of protein with an adequate supply of calories. Rickets results from a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones. Marasmus results from general malnutrition of both calories and protein. Pellagra is a vitamin-deficiency disease most commonly caused by a chronic lack of niacin (vitamin B3) in the diet.

An infant has diaper dermatitis. The nurse documents the infection as "Epidermis not intact and candidal infection present." Which type of diaper rash has the infant developed? 1 Type 1 2 Type 2 3 Type 3 4 Type 4

4 Type 4

A child who is terminally ill with bone cancer is in severe pain. Nursing interventions should be based on which knowledge? 1 Children tend to be overmedicated for pain. 2 Giving large doses of opioids results in death. 3 Narcotic addiction is common in terminally ill children. 4 Large doses of opioids are justified when there are no other treatment options.

4 Large doses of opioids are justified when there are no other treatment options. Large doses of opioids may be needed because the child has become physiologically tolerant of the drug, requiring higher doses to achieve the same degree of pain control. Pain is considered the fifth vital sign, and management of pain is critical to treatment of a child with bone cancer. Continuing studies report that children are consistently undermedicated for pain. The dosage of opioids is titrated to relieve pain, not cause death. Addiction is a psychological dependence on the narcotic medication, which does not occur in terminal care.

The nurse is educating a group of parents of infants about the excessive use of vitamins. The nurse teaches the group that there can be toxic side effects from hypervitaminosis. What complication can happen as a result of overuse of vitamin A? 1 Sepsis 2 Arthritis 3 Psoriasis 4 Osteoporosis

4 Osteoporosis Excessive intake of vitamin A is shown to result in physeal growth arrest. This in turn can result in osteoporosis, fractures, or metaphyseal irregularity. Sepsis, arthritis, and psoriasis are not caused by vitamin deficiencies or excessive intake. Sepsis is an infection, arthritis is an inflammatory condition, and psoriasis is an immune-mediated condition.

A 9-month-old infant is seen in the emergency department after exhibiting an urticaric rash with a cough and wheezing. When collecting the history of events preceding the sudden onset of these symptoms, the mother states that the parents have been "feeding the baby new foods." Which food is the most likely cause of this reaction in the infant? 1 Spinach 2 Potatoes 3 Green beans 4 Peanut butter

4 Peanut butter Nuts of any type, including peanuts, have a high allergy index in children and infants. The infant has demonstrated cutaneous and respiratory reactions after possible ingestion of peanut butter. Potatoes, green beans, and spinach are not highly allergenic foods.

Around 18 months of age most toddlers manifest a decreased nutritional need and a diminished appetite. This condition is known as what? 1 Grazing 2 Ritualism 3 Regression 4 Physiologic anorexia

4 Physiologic anorexia In physiologic anorexia, a normal phenomenon that occurs around 18 months of age, the toddler manifests a decreased nutritional need and diminished appetite. In ritualism, the toddler prefers to have the same food, cup, or spoon with every meal. In regression, the toddler retreats from the current level of function to a past level of behavior. Grazing is an eating pattern of nibbling or snacking throughout the day.

During a home visit to a toddler, the nurse finds that the home has a balcony with rails, and the opening between the rails is 3 inches. There is a carbon monoxide detector in the home. Cough syrup has been placed in a childproof container on a high level shelf. The house has an old refrigerator in a storage room, and its doors have been removed. Which finding in the home should be addressed by the nurse? 1 Openings of the railings in balcony 2 Presence of carbon monoxide detector 3 Placing of old refrigerator with doors removed 4 Placing of cough syrup in a container at high level

4 Placing of cough syrup in a container at high level It is important for a nurse to give appropriate instructions to the parents to prevent any accidental injuries to toddlers at home. Toddlers are often able to remove childproof containers and can access high-level, tight-security areas. They try to explore things by tasting them and therefore can ingest cough syrup, which could lead to poisoning. Parents should be advised to lock such containers or medicines in a cabinet where the child is unlikely to see it. Most toddlers cannot pass through an opening of 4 inches or less. It is important to have a carbon monoxide detector in homes where the heating system is old. Parents should be advised to remove the doors of old appliances such as refrigerators or ovens before storing them or discarding them to prevent accidental trapping of their toddlers.

The nurse is educating working parents of a preschooler about daycare centers. Which statement by the parents indicates that they need additional teaching about day care centers? 1 Daycare centers help increase self-confidence of preschoolers. 2 Daycare centers help preschoolers adjust to sociocultural differences. 3 Daycare centers expose preschoolers to opportunities to learn group cooperation. 4 Preschoolers who attend daycare centers are healthier than those who stay at home.

4 Preschoolers who attend daycare centers are healthier than those who stay at home. Preschoolers in daycare centers have more illnesses than children at home. There is a high possibility of acquiring hepatitis A, varicella-zoster virus, gastrointestinal tract infections, and respiratory tract infections in daycare centers due to lack of sanitation. One can be more sure about hygiene at home than in daycare centers. There are some advantages to daycare centers, such as that they increase self-confidence in the child, help children adjust to sociocultural differences, and expose children to opportunities for learning group cooperation.

What clinical manifestations are most likely to be seen in an infant with kwashiorkor? 1 Sunken abdomen with dermatoses 2 Sunken abdomen and severe muscle wasting 3 Prominent abdomen with generalized edema 4 Prominent abdomen with severe muscle atrophy

4 Prominent abdomen with severe muscle atrophy The child with kwashiorkor presents with a prominent abdomen and severe muscle atrophy. A sunken abdomen is not correlated with kwashiorkor. Dermatoses may be present in a child with kwashiorkor, but they will be accompanied by a prominent, rather than sunken, abdomen. Generalized edema is not correlated with kwashiorkor.

Which activity can be easily performed by the preschooler? 1 Rope jumping 2 Roller skating 3 Swimming 4 Riding a tricycle

4 Riding a tricycle A preschooler can easily ride a tricycle due to developed motor abilities. Climbing, jumping, walking, and running are well established by 3 years of age. A 5-year-old child can perform activities such as jumping a rope, skating, and swimming. These activities require more muscle coordination.

Which statement is correct with regard to the safety of toddlers in car restraints? 1 Front seat is the best place for toddlers. 2 Restraints are used till the age of 7 years. 3 Seat belt should be worn on the abdominal area. 4 Shoulder belt is used if it does not cross child's neck or face.

4 Shoulder belt is used if it does not cross child's neck or face. Shoulder belts are used for toddlers only if they do not cross the child's neck or face, which may lead to choking. The backseat is the safest area in the car for children. Car restraints are used for children until they are 12 years of age. Seat belts should not be worn on the abdomen; they should be worn low on the hips and fit snugly.

A primary healthcare provider recommends fluoride supplements for a toddler. What special instructions should the nurse provide to the family of the toddler? 1 Give fluoride supplements after breakfast. 2 Give fluoride supplements along with milk. 3 Administer supplements at a convenient time. 4 Store fluoride supplements away from the toddler.

4 Store fluoride supplements away from the toddler. Fluoride supplements should be stored at a place where the toddlers cannot reach, because accidental excess consumption of fluoride leads to fluorosis. Fluoride supplements should be provided on an empty stomach. Fluoride supplements should not be given along with calcium-rich products such as milk. Fluoride supplements should be administered at the same time each day.

The nurse should teach parents of toddlers how to prevent poisoning by instructing them to do what? 1 Keep ipecac in the home. 2 Consistently use safety caps. 3 Store poisonous substances out of reach. 4 Store poisonous substances in a locked cabinet.

4 Store poisonous substances in a locked cabinet. Safe storage of poisonous substances is an appropriate way to prevent the curious toddler from getting into them. Not all poisonous substances have safety caps, and safety caps are not always foolproof. Ipecac does not prevent poisoning and is not recommended as a treatment for poisoning. Toddlers can climb and are curious; therefore storing substances out of reach only does not eliminate the potential for poisoning.

What is sexual development during preschool years formed by? 1 Strong attachments to the same-sex friends 2 Strong attachments to the opposite-sex friends 3 Strong attachment to the same-sex parent and identification with the opposite-sex parent 4 Strong attachment to the opposite-sex parent and identification with the same-sex parent

4 Strong attachment to the opposite-sex parent and identification with the same-sex parent Sexual development during the preschool years is formed by a strong attachment to the opposite-sex parent and identification with the same-sex parent. Strong attachments to opposite-sex or same-sex friends are not characteristic of sexual development during the preschool years. Strong attachment to the same-sex parent tends to occur in the toddler and infant years.

The parents report to the nurse that their child avoids going out of the house due to fear of dogs. What advice should the nurse provide the parents to help them reduce their preschooler's fear? 1 Scold the preschooler for being fearful of going outside. 2 Avoid any contact with dogs in and outside the home. 3 Compel the preschooler to touch the dogs and pet them gently. 4 Suggest the preschooler observe other children playing with dogs.

4 Suggest the preschooler observe other children playing with dogs. A variety of real and imagined fears are present during the preschool years. The exact cause of these fears is unknown. Some preschoolers are fearful of dogs. In such cases the parents should suggest that the child observe other preschoolers playing with dogs. This type of modeling is effective in gradually reducing fear. Scolding the preschooler may make the child more fearful. Avoiding contact with dogs may increase the preschooler's fear. The parents should not compel the child to touch the dogs, because this may cause more fear.

The nurse is asked to administer the prescribed dose of an analgesic via the oral route to a 7-year-old child. The nurse observes that the child is unwilling to take the medication orally. The nurse obtains a prescription to change the route to intravenous (IV) administration. Which nursing action first ensures that the medication is administered safely? 1 The nurse uses a conversion table to calculate the dose. 2 The nurse administers the dose as prescribed in the original order. 3 The nurse documents the change of route in the records. 4 The nurse asks whether the child can take the medication intravenously.

4 The nurse asks whether the child can take the medication intravenously. The nurse should first assess whether the child can take the medication intravenously and has patent IV access. The conversion table is used to calculate the dose when the change is made from oral to the IV route, because the measurement may be different for oral and IV doses. The nurse does not administer the dose as prescribed, because the dose needs to be calculated and administered according to the body weight of the child. The dose is documented after it is administered safely to the child.

A child who has been receiving intravenous morphine is switched to oral morphine. What should the nurse understand about this change in the treatment plan? 1 The oral dose will be half the intravenous dose. 2 The oral dose will be a fourth of the intravenous dose. 3 The oral dose will be the same as the intravenous dose. 4 The oral dose will be greater than the intravenous dose.

4 The oral dose will be greater than the intravenous dose. Oral morphine undergoes significant metabolism from the first-pass effect. For this reason, a higher oral dose is necessary to achieve the same effect as parenteral morphine. An oral dose that is half the intravenous dose will not provide similar pain relief. An oral dose that is one fourth of the intravenous dose will not provide similar pain relief. The same oral and intravenous doses will not provide similar pain relief.

What is the current understanding for how nonpharmacologic strategies for pain management work in children? 1 They make the pharmacologic strategies less effective. 2 They work faster than most pharmacologic strategies do. 3 The convince children that they are not experiencing pain. 4 They provide coping strategies that help reduce pain perception.

4 They provide coping strategies that help reduce pain perception. Nonpharmacologic techniques provide children with coping strategies that may help reduce pain perception. Nonpharmacologic techniques may enhance the effectiveness of pharmacologic strategies rather than making them less effective. Nonpharmacologic strategies may take longer to reduce pain perception than pharmacologic strategies do. Nonpharmacologic strategies do not trick children into believing that they are not experiencing pain.

Which infant is at risk for vitamin D-deficiency rickets? 1 Lacto-ovo-vegetarians 2 Those exposed to daily sunlight 3 Those who are breastfed exclusively 4 Those in whom yogurt is used as a primary source of milk

4 Those in whom yogurt is used as a primary source of milk Yogurt may not be supplemented with vitamin D; therefore the infant may be at risk for the development of rickets. Individuals who follow a lacto-ovo-vegetarian diet consume milk and its products and therefore receive vitamin D. Breast milk provides sufficient vitamin D to the infant if the mother is not deficient in this vitamin. Lack of sunlight contributes to vitamin D-deficiency rickets.

4 Type 4 If the epidermis is not intact and candidal infection is present, then it is categorized as type 4 diaper dermatitis. Diaper dermatitis in which epidermis is intact and no candidal infection is present is categorized as type 1 diaper dermatitis. If the epidermis is intact and candidal infection is present, then it is categorized as type 2 diaper dermatitis. If the epidermis is not intact and candidal infection is absent, then it is classified as type 3 diaper dermatitis.

An infant is diagnosed with colic due to sensitivity to cow's milk. What treatment does the nurse expect to be included in the care plan? 1 Use of phenobarbital 2 Use of acetaminophen elixir 3 Use of simethicone 4 Use of extensively hydrolyzed formula

4 Use of extensively hydrolyzed formula Colic due to sensitivity to cow's milk can be relieved by use of extensively hydrolyzed formula. Phenobarbital, acetaminophen, and simethicone are not useful in curing colic due to sensitivity to cow's milk; however they may offer symptomatic relief to the infant.

What are some characteristics of physical development in a 30-month-old child? Select all that apply. 1 Genital fondling is noted. 2 The anterior fontanel is open. 3 The birth weight has doubled. 4 Sphincter control has been achieved. 5 Primary dentition is complete.

4,5 Sphincter control in preparation for bowel and bladder control is usually achieved by 30 months of age. Primary dentition is usually completed by 30 months of age. The anterior fontanel closes between 12 and 18 months of age. Birth weight should have doubled at 5 to 6 months of age and quadrupled by 2½ years of age. Genital fondling is not a characteristic of physical development in this age group; this is part of the development of gender identity.

A three-month-old infant is brought to the well-child clinic for positional plagiocephaly. Which nursing interventions to treat this condition are correct? Select all that apply. 1 Place the infant to sleep in an infant seat. 2 Have the infant wear a soft helmet for 15 hours a day. 3 Place the infant in prone position when the infant sleeps. 4 Place the infant in prone position for 15-20 minutes while awake. 5 Keep alternating the infant's head position when the infant sleeps.

4,5 The infant should be placed in prone position for 15-20 minutes when the infant is awake to prevent plagiocephaly. This is also called tummy time. The infant's head position should be altered when the infant is sleeping to prevent unilateral molding. Placing the infant to sleep in an infant seat or restraint seat increases the risk of developing plagiocephaly. Infants with plagiocephaly should wear a soft helmet for 23 hours a day for a prescribed period of time. The infant should not be placed in prone position when the infant sleeps because it increases the risk of sudden infant death syndrome (SIDS).

The nurse is using the CRIES pain assessment tool on a preterm infant in the neonatal intensive care unit (NICU). What is a component of this tool? 1 Color 2 Reflexes 3 Oxygen saturation 4 Posture of extremities

Oxygen saturation The components of the scale are C rying, R equires increased oxygen, I ncreased vital signs, E xpression, and S leepless. Changes in oxygen saturation would affect scoring. Color is not a component of this scale; neither are reflexes or posture of the arms and legs.

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