Wellness 2 Test 1

A female client reports to her primary care physician with aggravated chest pain. The physician orders a stress test. The client tells the nurse that she does not want to take the test and feels that she should instead continue with the medication a little longer. Understanding that the client is anxious, what is an appropriate response by the nurse?

" Tell me more about how you are feeling" . The nurse should try to explore the client's feelings by letting her express her concerns. Asking the client open- ended questions is best because it expresses concern for the client and encourages her to verbalize her feelings.

When the preoperative client tells the nurse he cannot sleep because he keeps thinking about the surgery, an appropriate reflection of the statement by the nurse is?

" The thought of having surgery is keeping you awake?"

A client scheduled to have hip replacement surgery states that she is scared of surgery and anesthesia. Best response by nurse is:

" What questions do you have about the surgery?" The nurse should allow the client time to express his own fears .

A nurse is examining a 3 year old with conjunctivitis. During the exam, the child cries and refuses to sit still. The nurse should say...

" Would you like to see my flashlight?" To decrease fear, the children should be actively involved.

A client will be taking disulfiram (Antabuse) after discharge from an alcohol treatment program. Which statement would indicate that teaching has been effective?

"Drinking alcohol while taking Antabuse can cause dangerous symptoms." Taking alcohol in any form while taking Antabuse causes a severe adverse reaction. Antabuse is not safe to take with OTC medications. It does not block cravings for alcohol. Antabuse does not restrict the effect of alcohol on the body.

The nurse is caring for an 8-year-old girl who requires medication that is only available in an enteric tablet form. The nurse is teaching the mother how to help the girl swallow the medication. Which of the following statements indicates a need for further teaching?

"I can pinch her nose to make it easier to swallow." The mother should be advised to never pinch the child's nose as it increases the risk for aspiration. The other statements are correct.

A client is being discharged from treatment for addiction to cocaine. Which statement made by the client would cause the most concern for the nurse?

"I can still hang out with my old friends. I am just not going to use." Clients are likely to have exercised poor judgment. They may still believe they can control the substance use. The nurse can help clients to find ways to relieve stress or anxiety that do not involve substance use. Relaxing, exercising, listening to music, or engaging in activities may be effective. Clients also may need to develop new social activities or leisure pursuits if most of their friends or habits of socializing involved the use of substances. Acknowledging difficulties shows insight into the changes needed for recovery. Assuming that old friends will not be a relapse trigger shows a lack of understanding of the relapse dynamics associated with former leisure activities.

The nurse is assessing the drinking history of a client being admitted for alcohol abuse. What statement would the nurse expect the client to make?

"I don't really have a problem with alcohol. I've just been having a streak of bad luck lately." Substance use typically includes the use of defense mechanisms, especially denial. Clients may deny directly having any problems or may minimize the extent of problems or actual substance use. During assessment of thought process and content, clients are likely to minimize their substance use, blame others for their problems, and rationalize their behavior. They may believe that they could quit "on their own" if they wanted to, and they continue to deny or minimize the extent of the problem. Upon admission, the nurse would not expect the client have the insight to know how badly help is needed, or to express powerlessness over alcohol. The client would have some motivation for treatment if admission was underway. Often the motivation is external, such as pressure from family or employers.

The nurse is coleading a family therapy group with a client addicted to alcohol. Which statement made by the wife indicates the need for additional education regarding alcoholism as a family illness?

"I have to call in sick for my husband when he is too hung over to go to work." Alcoholism (and other substance abuse) often is called a family illness. One type of codependent behavior is called enabling, which is a behavior that seems helpful on the surface but actually perpetuates the substance use. Family members should be referred to Al-anon 12-step self-help groups.

A client calls the emergency department of the local hospital reporting that after 16 years of heavy drinking, he is tired and wants to quit "cold turkey." What would be the best response by the nurse?

"It is not safe to stop drinking suddenly without medicine." Because alcohol withdrawal can be life threatening, detoxification needs to be accomplished under medical supervision. If the client's withdrawal symptoms are mild and he or she can abstain from alcohol, he or she can be treated safely at home. For more severe withdrawal or for clients who cannot abstain during detoxification, a short admission of 3 to 5 days is the most common setting. Some psychiatric units also admit clients for detoxification, but this is less common.

The nurse is supporting an 8-year-old child who is having blood specimens drawn. Which method would be least appropriate to use for distraction?

"It's okay to scream if it hurts." Although it is appropriate to tell the child that is okay to scream or cry, this is not a method of distraction. Squeezing the hand, focusing the eyes on the ceiling, and counting slowly are appropriate methods for distraction.

The nurse is discussing expectations of raising a child with a pregnant teenager expecting her first baby. The father will not be a participant in the parenting. What statements made by the expectant mother would be of greatest concern to the nurse?

"My child will love me unlike my parents ever did." Feedback: In some instances, the parent feels the need to have children to replace his or her own faulty and disappointing childhood; the parent wants to feel the love between child and parent that he or she missed as a child. The reality of the tremendous emotional, physical, and financial demands that comes with raising children usually shatters these unrealistic expectations. When the parent's unrealistic expectations are not met, abuse often follows. Having a support system and a sense of discipline can contribute to effective parenting. Financial worries may be a concern, but relying on a baby to meet emotional needs is a high-risk dynamic for child abuse.

Which slogans would be used in a 12-step program?

"One day at a time." "Easy does it." "Let go and let God." Before the illness of addiction was fully understood, most of the society and even the medical community viewed chemical dependency as a personal problem; the user was advised to "pull yourself together" and "get control of your problem." Key slogans in AA reflect the ideas in the 12 steps, such as "One day at a time" (approach sobriety one day at a time), "easy does it" (don't get frenzied about daily life and problems, and "let go and let God" (turn your life over to a higher power).

A nurse is working with a couple seeking counseling for marital discord. The history indicates the husband was treated for substance abuse 4 years ago and attends AA meetings occasionally. Which statement made by the recovering husband should alert the nurse for the need for further education?

"She gets upset when I hang out with my old buddies on the weekends." Family members and friends should be aware that clients who begin to revert to old behaviors, return to substance-using acquaintances, or believe they can "handle myself now" are at high risk for relapse, and loved ones need to take action. The nurse must dispel myths and misconceptions such as, "It's a matter of will power," "I can't be an alcoholic if I only drink beer or if I only drink on weekends," "I can learn to use drugs socially," or "I'm okay now; I could handle using once in a while."

The nurse is providing teaching on how to administer nasal drops. Which of the following responses by the parents indicates a need for further teaching?

"She needs to remain still for at least 10 minutes after administration." Once the drops are instilled, the child should remain in hyperextension for at least 1 minute to ensure the drops have come in contact with the nasal membranes. Ten minutes would be excessive. The other statements are correct.

The nurse is providing care for a 10-year-old girl who has required multiple venipunctures and a computed tomography (CT) scan in a single day. The girl has expressed no fear or need for comfort. How should the nurse respond?

"Tell me about your day today." The nurse should ask an open-ended question to elicit a conversation so that the girl has the opportunity to express her feelings and be comforted. School-age children and adolescents may not outwardly demonstrate behavior that indicates the need for comforting. It is important to praise the girl for the appropriate behavior during the procedure and after all interventions are completed, but the nurse should first give the girl an opportunity to express her feelings so the nurse can address her concerns. Asking the girl whether she is feeling okay or doing okay is likely to elicit a positive response no matter how she is feeling.

A client is readmitted to the substance abuse program for the second time in 6 months for alcohol abuse. On admission, he tells the nurse, "I am so ashamed." What should the nurse reply?

"Tell me what has happened since your last admission." This is a therapeutic communication technique designed to help the client talk about himself and his current situation.

The wife of a client who is alcoholic asks the nurse how to respond to him in a helpful way when he is disruptive in family life. Which is the nurse's best response?

"Try to maintain a normal home environment for yourself and the children." Focusing on self and family members is the first step in breaking codependent behavior. Answer choices A, B, and C would not be the best response.

The nurse is preparing a 5-year-old for a radiograph. Which of the following would be the best communication to prepare the child for the procedure?

"We are going to use a big camera to take pictures inside your body." It is best to use simple terms and phrases that are easily understood. It is important to avoid certain phrases that might confuse or mislead the younger child. Referring to an organ might indicate a musical instrument. Using the term "pain" should be avoided as it may be too explicit and cause undue worry. The term "x-ray" is too technical and is not likely to be understood by a 5-year-old.

The nurse is providing teaching for the mother of an infant who receives all of his nutrition through a tube. The nurse is reviewing interventions to promote growth and development. Which of the following responses from the mother indicates a need for further teaching?

"We need to keep feeding time very quiet." The nurse needs to emphasize that it is important to talk, play music, cuddle, and rock the infant to promote a normalized feeding time. The other statements are correct.

A client grieving the recent loss of her husband asks if she is becoming mentally ill because she is so sad. The nurse's best response would be,

"You are not mentally ill. This is an expected reaction to the loss you have experienced."

The child life specialist (CLS) is preparing a 6-year-old child for a magnetic resonance imaging (MRI) scan. Which of the following statements reflects the use of atraumatic principles when explaining the procedure?

"You may hear some loud noises when you are lying in the machine, but they won't hurt you." When using atraumatic principles, the CLS would explain any sensations, such as noises that will be experienced. The language should be simple and at the child's developmental age; using the technical term for the machine might frighten the child. Telling the child there is nothing to worry about does not allay the child's fears. Allowing the child to experience the machine without explaining the sensations does not follow atraumatic principles.

Which is a positive aspect of treating clients with mental illness in a community-based care?

"You will be able to live in your own home while you still see a therapist regularly." Clients can remain in their communities, maintain contact with family and friends, and enjoy personal freedom that is not possible in an institution. Full-time home care is not included in community-based programs.

The client asks the nurse, "What will happen if I drink while taking Antabuse?" What should be the nurse's reply?

"You will experience a severe reaction, including a throbbing headache and vomiting." Disulfiram (Antabuse) may be prescribed to help deter clients from drinking. If a client taking disulfiram drinks alcohol, a severe adverse reaction occurs with flushing, a throbbing headache, sweating, nausea, and vomiting. In severe cases, severe hypotension, confusion, coma, and even death may result.

Issues and concerns of Mental illness

"revolving door" effect due to deinstitutionalization. Shorter hospital stays, decompensation, rehospitalization, dual diagnoses Homelessness (1/3 estimated to have serious mental illness; over 1/2 with substance abuse problems) Increase in physical illness comorbidities Lack of adequate community resources

First psychiatric nursing textbook

(Nursing Mental Diseases) published in 1920

The nurse is determining the amount of IV fluids to administer in a 24-hour period to a child who weighs 40 kg. How many milliliters should the nurse administer?

1,900 mL Typically, the amount of fluid to be administered in a day (24 hours) is determined by the child's weight (in kg) using the following formula: 100 mL per kg of body weight for the first 10 kg (1,000) 50 mL per kg of body weight for the next 10 kg (500) 20 mL per kg of body weight for the remainder of body weight in kg (400)

The school nurse is teaching a health class about recognizing the signs of abusive relationships. The nurse describes the cycle of violence. The nurse would document effective teaching if the students identify the cycle of violence to be which of the following patterns?

1. Tension Building 2. Violent behavior 3. Period of remorse 4. Honeymoon period Feedback: The tension-building phase begins; there may be arguments, stony silence, or complaints from the husband. The tension ends in another violent episode after which the abuser once again feels regret and remorse and promises to change. This cycle continually repeats itself. Each time, the victim keeps hoping the violence will sto

What takes place during the working phase of the nurse-client relationship?

1. the client participates actively in the relationship and 2. the client genuinely expresses his or her concerns to the nurse. The working phase of the nurse-client relationship involves active participation towards goals and genuine expressions of concerns and feelings. Identification of goals and relationships occurs in the orientation phase. Identifying goals that have been accomplished is characteristic of the termination phase.

The nurse is preparing to administer a medication to a 5-year-old who weighs 35 pounds. The prescribed single dose is 1 to 2 mg/kg/day. Which of the following is the appropriate dose range for this child?

16 to 32 mg The nurse should convert the child's weight in pounds to kilograms by dividing the child's weight in pounds by 2.2. (35 pounds divided by 2.2 = 16 kg). The nurse would then multiply the child's weight in kilograms by 1 mg for the low end (16 kg × 1 mg = 16 mg) and then by 2 mg for the high end (16 kg × 2 mg = 32 mg).

Psychiatric nursing became a requirement in nursing education in which year?

1950

The nurse is preparing to administer oral ampicillin to a child who weighs 40 kg. The safe dose for children is 50 to 100 mg/kg/day divided in doses administered every 6 hours. What would be the low single safe dose and high single safe dose per day for this child?

500 to 1,000 mg per dose To calculate the dosage, the nurse would set up a proportion to calculate the low dose as follows: 50 mg/1 kg = x mg/40 kg; solve for x by cross-multiplying: 1 × x = 50 × 40; x = 2,000 mg divided by 4 doses per day = 500 mg. Then calculate the high safe dose range using the following proportion: 100 mg/1 kg = x mg/40 kg; solve for x by cross-multiplying: 1 × x = 100 × 40; x = 4,000 mg divided by 4 doses per day = 1,000 mg.

J. Mellow

: focus on client's psychosocial needs, strengths

Which of the nursing roles is primarily performed during the working phase of the helping relationship? A) teacher and counselor B) provider of care C) leader and manager D) researcher

A

The nurse is caring for a child who is recovering from an appendectomy. Which of the following is the appropriate term for the pain this child is experiencing? A) Nociceptive pain B) Neuropathic pain C) Chronic pain D) Superficial somatic pain

A Feedback: Nociceptive pain reflects pain due to noxious stimuli that damages normal tissues or has the potential to do so if the pain is prolonged. Nociceptive pain ranges from sharp or burning; to dull, aching, or cramping; to deep aching or sharp stabbing. Examples of conditions that result in nociceptive pain include chemical burns, sunburn, cuts, appendicitis, and bladder distention. Neuropathic pain is pain due to malfunctioning of the peripheral or central nervous system. Chronic pain is defined as pain that continues past the expected point of healing for injured tissue. Superficial somatic pain, often called cutaneous pain, involves stimulation of nociceptors in the skin, subcutaneous tissue, or mucous membranes.

A mother brings her 6-year-old son in for a check-up because the child is complaining of stomachaches. It is the beginning of the school year. Which of the following might the mother also mention? A) The child cries before going to school. B) The child made friends the first day of school. C) The child fights with siblings more often. D) The child loves the crowds in the lunchroom.

A Ans:Feedback: This child has a slow-to-warm-up temperament. The child may also be crying before going to school. Making friends the first day of school and enjoying the crowds in the lunchroom are typical of a child with an easy temperament. Irritability is typical of a child with a difficult temperament.

The nurse is caring for a 7-year-old girl who is scheduled for a hernia repair and is very scared. Which of the following fears would she also most likely have at this age? A) Fear of being kidnapped B) Fear of cutting her finger C) Fear of sudden loud noises D) Fear of the neighbor's dog

A Feedback: At this age, the child will be fearful of being kidnapped. She should have outgrown her fears of harm to her body, noises, and dogs, all of which are typical preschooler fears.

After teaching the parents of a 9-year-old girl about safety, which statement indicates the need for additional teaching? A) "She can ride in the front seat of the car once she is 10 years old." B) "We need to buy her a helmet so she can ride her scooter." C) "She should ride her bike with the traffic on the side of the road." D) "We signed her up for swim lesions at the local community center."

A Feedback: Children younger than 12 years of age must sit in the back seat of the car. Laws in most states require helmets for riding bicycles and scooters. When riding a bike, the child should ride on the side of the road traveling with the traffic. Children should know how to swim. If swimming skills are limited, the child must wear a life preserver at all times.

The nurse explains to parents of school-age children that according to Kohlberg's theory of moral development, their child is at the conventional stage of moral development. What is the motivation for school-age children to follow rules? A) They follow rules out of a sense of being a "good person." B) They follow rules out of fear of being punished. C) They follow rules in order to receive praise from caretakers. D) They follow rules because it is in their nature to do so.

A Feedback: During the school-age years, the child's sense of morality is constantly being developed. According to Kohlberg, the school-age child is at the conventional stage of moral development. The 7- to 10-year-old usually follows rules out of a sense of being a "good person." He or she wants to be a good person to his or her parents, friends, and teachers and to himself or herself.

The nurse knows that the school-age child is in Erikson's stage of industry versus inferiority. Which of the following is the best example of a school-ager working toward accomplishing this developmental task? A) The child signs up for after-school activities. B) The child performs his bedtime preparations autonomously. C) The child becomes aware of the opposite sex. D) The child is developing a conscience.

A Feedback: Erikson (1963) describes the task of the school-age years to be a sense of industry versus inferiority. During this time, the child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community, which develops his or her cognitive and social skills. Achieving independence is a task of the preschooler who also is developing a conscience at that age. Awareness of the opposite sex occurs in, but is not the focus of, the school-age child.

The mother of a 7-year-old girl tells the school nurse that her child is deathly afraid of going to school. What would be the best intervention the nurse could suggest in this situation? A) Return the child to school and investigate the cause of the fear. B) Have the child stay home from school until any issues causing this fear are resolved. C) Investigate a new school for the child to attend that the child will not be afraid of. D) Tell the child that privileges will be taken away if she does not return to school.

A Feedback: It is important to investigate specific causes of school refusal/school phobia and take appropriate action. The parents should return the child to school, investigate the cause of the fear, support the child, collaborate with teachers, and praise success in school attendance. This is not a situation for punishment, and changing schools would not solve the child's school phobia.

The nurse is performing an annual check-up for an 8-year-old child. Compared to the previous assessment of this child, which of the following characteristics would most likely be observed? A) Breathing is diaphragmatic. B) Pulse rate is increased. C) Secondary sex characteristics are present. D) Blood pressure has reached adult level.

A Feedback: The child's respiratory system is maturing, so abdominal breathing has been replaced by diaphragmatic breathing. Pulse rate will decrease, rather than increase, during this time. Secondary sex characteristics will not appear until the late school-age years. Blood pressure will not reach the adult level until adolescence.

A mother brings her 6-year-old son in for a check-up because the child is complaining of stomachaches. It is the beginning of the school year. Which of the following might the mother also mention? A) The child cries before going to school. B) The child made friends the first day of school. C) The child fights with siblings more often. D) The child loves the crowds in the lunchroom.

A Feedback: This child has a slow-to-warm-up temperament. The child may also be crying before going to school. Making friends the first day of school and enjoying the crowds in the lunchroom are typical of a child with an easy temperament. Irritability is typical of a child with a difficult temperament.

The nurse is caring for children who are receiving IV therapy in the hospital setting. For which of the following children would a central venous device be indicated?

A child who is receiving chemotherapy for leukemia Although central venous access devices can be used short term, the majority are used for moderate- to long-term therapy, such as chemotherapy. Central venous access devices are indicated when the child lacks suitable peripheral access, requires IV fluid or medication for more than 3 to 5 days, or is to receive specific treatments, such as the administration of highly concentrated solutions or irritating drugs that require rapid dilution. Peripheral IV devices are used for most other IV therapies.

An example of a situation where SBAR technique is most appropriate

A nurse is calling a physician to report a client's new onset of chest pain.

The school nurse providing school health screenings knows that the 7- to 11-year-old is in Piaget's stage of concrete operational thoughts. Which of the following should this age group accomplish when developing operations? Select all answers that apply. A) Ability to assimilate and coordinate information about the world from different dimensions B) Ability to see things from another person's point of view and think through an action C) Ability to use stored memories of past experiences to evaluate and interpret present situations D) Ability to think about a problem from all points of view, ranking the possible solutions while solving the problem E) Ability to think outside of the present and incorporate into thinking concepts that do exist as well as concepts that might exist F) Ability to understand the principle of conservation—that matter does not change when its form changes

A, B, C, F Feedback: Piaget's stage of cognitive development for the 7- to 11-year-old is the period of concrete operational thoughts. In developing concrete operations, the child is able to assimilate and coordinate information about the world from different dimensions. He or she is able to see things from another person's point of view and think through an action, anticipating its consequences and the possibility of having to rethink the action. The school-age child is able to use stored memories of past experiences to evaluate and interpret present situations. Also, during concrete operational thinking, the school-age child develops an understanding of the principle of conservation—that matter does not change when its form changes. According to Piaget, the adolescent progresses from a concrete framework of thinking to an abstract one in the formal operational period. During this period, the adolescent is able to think about a problem from all points of view, ranking the possible solutions while solving the problem. The adolescent also develops the ability to think outside of the present; that is, he or she can incorporate into thinking concepts that do exist as well as concepts that might exist. His or her thinking becomes logical, organized, and consistent.

A female client comes to an urgent care clinic and says, "I've just been raped." What should the nurse do? A. Allow the client to express whatever she wants. B. Ask the client if staff can call a friend or family member for her. C. Offer the client coffee, tea, or whatever she likes to drink. D. Get the examination completed quickly to decrease trauma to the client. E. Provide the client privacy—let her go to a room to make phone calls. F. Stay with the client until someone else arrives to be with her.

A, B, F

The nurse is managing children who have chronic diseases in a neighborhood clinic. Which of the following are examples of chronic conditions? Select all answers that apply. A) Diabetes mellitus B) Myocardial infarction C) Rheumatoid arthritis D) Compound fracture E) Acute asthma F) Bronchopneumonia

A, C, E Feedback: Chronic pain is defined as pain that continues past the expected point of healing for injured tissue. Diabetes, arthritis, and asthma are examples of chronic pain. Acute pain is defined as pain that is associated with a rapid onset of varying intensity. It usually indicates tissue damage and resolves with healing of the injury. Examples include heart attack, fractures, and bronchopneumonia.

Which of the following statements accurately describe the relationship between therapeutic communication and the nursing process? Select all that apply. A) Effective communication techniques, as well as observational skills, are used extensively during the assessment step. B) Only the written word in the form of a medical record is used during the diagnosing step of the nursing process. C) The implementing step requires communication among the patient, nurse, and other team members to develop interventions and outcomes. D) Verbal and nonverbal communication are used to teach, counsel, and support patients and their families during the implementation phase. E) Nurses rely on the verbal and nonverbal cues they receive from their patients to evaluate whether patient objectives or goals have been achieved. F) Because one nurse cannot provide 24-hour coverage for patients, significant information must be passed on to others through implementatio

A, D, E

The parents of a 4-year-old who is a picky eater ask the nurse what foods to include in their child's diet to provide adequate iron consumption. Which of the following foods would the nurse recommend? A) Cooked lentils B) Whole milk C) Oranges D) Sweet potatoes

ANS: A Feedback: Lentils are a good source of iron. Whole milk, oranges, and sweet potatoes are good sources of calcium.

When providing anticipatory guidance to parents about lying during the preschool period, which of the following would the nurse emphasize? A) "You need to determine the reason for lying before punishing the child." B) "Lying typically occurs because the child is afraid of being punished." C) "The misbehavior is usually more serious than the lying itself." D) "It is okay to become angry when dealing with the child's lying."

ANS: A Feedback: Lying is common in preschool children and occurs for a variety of reasons, such as fearing punishment, getting carried away by imagination, or imitating what another person has done. Regardless, the parent should ascertain the reason for the lying before punishing the child. The child also needs to learn that the lying is usually far worse than the misbehavior. Parents need to remain calm and serve as a role model of an even temper.

When observing a group of preschoolers at play in the clinic waiting room, which type of play would the nurse be least likely to note? A) Parallel play B) Cooperative play C) Dramatic play D) Fantasy play

ANS: A Feedback: Parallel play is associated with toddlers. Cooperative, dramatic, and fantasy play are commonly used by preschoolers.

The nurse is conducting a well-child assessment for a 5-year-old boy in preparation for kindergarten. The boy's grandmother is his primary caregiver because the boy's mother has suffered from depression and substance abuse issues. The nurse understands that the child is at increased risk for which developmental problem? A) Lack of social and emotional readiness for school B) Stuttering C) Speech and language delays D) Fine motor skills delay

ANS: A Feedback: Risk factors for lack of social and emotional readiness for school include insecure attachment in the early years, maternal depression, parental substance abuse, and low socioeconomic status.

The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally happy and outgoing 5-year-old sister is acting sad and withdrawn. The nurse understands that due to her developmental stage, the girl is at risk of which of the following? A) Viewing her baby sister's illness as her fault B) Harming the baby C) Experiencing clinical depression D) Creating an imaginary friend to cope with the situation

ANS: A Feedback: Since the preschool child is facing the psychosocial task of initiative versus guilt, it is natural for the child to experience guilt when something goes wrong. The child may have a strong belief that if someone is ill or dying, he or she may be at fault and the illness or death is punishment. It is less likely that the girl would be at risk of harming the baby or experiencing clinical depression as a result of the baby's illness. The child may create an imaginary friend to cope with the illness, but would not withdraw or express sadness as a result of the imaginary friend.

The nurse is explaining to parents that the preschooler's developmental task is focused on the development of initiative rather than guilt. Which of the following is a priority intervention the nurse might recommend for parents of preschoolers to stimulate initiative? A) Reward the child for initiative in order to build self-esteem. B) Change the routine of the preschooler often to stimulate initiative. C) Do not set limits on the preschooler's behavior as this results in low self-esteem. D) As a parent, decide how and with whom the child will play.

ANS: A Feedback: The building of self-esteem continues throughout the preschool period. It is of particular importance during these years, as the preschooler's developmental task is focused on the development of initiative rather than guilt. A sense of guilt will contribute to low self-esteem, whereas a child who is rewarded for his or her initiative will have increased self-confidence. Routine and ritual continue to be important throughout the preschool years, as they help the child to develop a sense of time as well as provide the structure for the child to feel safe and secure. Also, consistent limits provide the preschooler with expectation and guidance. Giving children opportunities to decide how and with whom they want to play also helps them develop initiative.

The nurse is caring for a 5-year-old girl posttonsillectomy. The girl looks out the window and tells the nurse that it is raining and says, "The sky is crying because it is sad that my throat hurts." The nurse understands that the girl is demonstrating which mental process? A) Magical thinking B) Centration C) Transduction D) Animism

ANS: A Feedback: The nurse understands that the girl is demonstrating magical thinking. Magical thinking is a normal part of preschool development. The preschool-age child believes her thoughts to be all-powerful. Transduction is reasoning by viewing one situation as the basis for another situation whether or not they are truly causally linked. Animism is attributing life-like qualities to inanimate objects. Centration is focusing on one aspect of a situation while neglecting others.

The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration? A) A less discriminating sense of taste B) A lack of fully developed hearing C) Visual acuity that has not fully developed D) A less discriminating sense of touch

ANS: A Feedback: The young preschooler may have a less discriminating sense of taste than the older child, making him or her at increased risk for accidental ingestion. A less discriminating sense of touch and developing visual acuity would not increase the risk. Hearing is intact at birth and it does not increase the child's risk for accidental ingestion.

The nurse is assessing the psychosocial development of a preschooler. Which of the following are normal activities characteristic of the preschooler? Select all answers that apply. A) Plans activities and makes up games B) Initiates activities with others C) Acts out roles of other people D) Engages in parallel play with peers E) Classifies or groups objects by their common elements F) Understands relationships among objects

ANS: A, B, C Feedback: The many activities of the preschooler include beginning to plan activities, making up games, initiating activities with others, and acting out the roles of other people (real and imaginary). Toddlers engage in parallel play; preschoolers engage in cooperative play. School-age children classify or group objects by common elements and understand relationships among objects.

The nurse is caring for preschoolers in a day care center. Of which of the following developmental milestones of this age group should the nurse be aware? Select all answers that apply. A) Counting 10 or more objects B) Correctly naming at least four colors C) Understanding the concept of time D) Knowing everyday objects E) Understanding the differences of others F) Forming concepts as logical as an adult's

ANS: A, B, C, D Feedback: The child in the intuitive phase can count 10 or more objects, correctly name at least four colors, and better understand the concept of time, and he or she knows about things that are used in everyday life, such as appliances, money, and food. The preschooler forms concepts that are not as complete or as logical as the adult's, and tolerates others' differences but doesn't understand them.

The nurse is teaching the parents of a 4-year-old boy about the normal maturations of the child's organs during the preschool years and their effect on body functions. Which of the following statements accurately describe these changes? Select all answers that apply. A) Myelination of the spinal cord allows for bowel and bladder control to be complete in most children by age 3 years. B) The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult number at about 7 years of age. C) Heart rate increases and blood pressure decreases slightly during the preschool years; an innocent heart murmur may be heard upon auscultation. D) The bones continue to increase in length and the muscles continue to strengthen and mature; however, the musculoskeletal system is still not fully mature. E) The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average preschooler. F) The urethra remains long in both boys and girls, making them more susceptible to urinary tract infections than adults.

ANS: A, B, D, E Feedback: Most of the body systems have matured by the preschool years. Myelination of the spinal cord allows for bowel and bladder control to be complete in most children by age 3 years. The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult number at about 7 years of age. The bones continue to increase in length and the muscles continue to strengthen and mature. However, the musculoskeletal system is still not fully mature. The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average preschooler. The 4-year-old generally has adequate bowel control. Heart rate decreases and blood pressure increases slightly during the preschool years. An innocent heart murmur may be heard upon auscultation. The urethra remains short in both boys and girls, making them more susceptible to urinary tract infections than adults.

The school nurse is helping parents choose books for their preschoolers. What literacy skills present in the preschooler would the nurse consider when making choices? Select all answers that apply. A) Preschoolers enjoy books with pictures that tell stories. B) Preschoolers like stories with repeated phrases as they help keep their attention. C) Preschoolers like stories that describe experiences different from their own. D) Preschoolers demonstrate early literacy skills by reciting stories or portions of books. E) Preschoolers may retell the story from the book, pretend to read books, and ask questions about the story. F) Preschoolers do not have enough focus and expanded attention to notice when a page is skipped during reading.

ANS: A, B, D, E Feedback: Preschoolers enjoy books with pictures that tell stories. Stories with repeated phrases help to keep the child's attention. Also, children like stories that describe experiences similar to their own. The preschool child demonstrates early literacy skills by reciting stories or portions of books. He or she also may retell the story from the book, pretend to read books, and ask questions about the story. The preschool child has enough focus and expanded attention to notice when a page is skipped during reading and will call it to the parent's attention.

The parents of a 5-year-old boy tell the nurse that their son is having frequent episodes of night terrors. Which of the following statements would indicate that the boy is having nightmares instead of night terrors? A) "It usually happens about an hour after he falls asleep." B) "He will tell us about what happened in his dream." C) "He is completely unaware that we are there." D) "When we try to comfort him, he screams even more."

ANS: B Feedback: During a nightmare, a child will have a memory of the occurrence and may remember the dream and talk about it later. With night terrors, the child has no memory of the event. The other statements are indicative of night terrors.

The nurse is providing anticipatory guidance for parents of a preschooler regarding sex education. Which of the following is a recommended guideline when dealing with this issue? A) Be prepared to thoroughly cover a topic before the child asks about it. B) Before answering questions, find out what the child thinks about the subject. C) Expand upon the topic when answering questions to prevent further confusion. D) Provide a less than honest response to shelter the child from knowledge that is too advanced.

ANS: B Feedback: Preschoolers are very inquisitive and want to learn about everything around them; therefore, they are very likely to ask questions about sex and where babies come from. Before attempting to XANSwer questions, parents should try to find out first what the child is really asking and what the child already thinks about that subject. Then they should provide a simple, direct, and honest answer. The child needs only the information that he or she is requesting.

The nurse is conducting a well-child examination of a 5-year-old girl, who was 40 inches tall at her last examination at age 4. Which of the following height measurements would be within the normal range of growth expected for a preschooler? A) 41 inches B) 43 inches C) 45 inches D) 47 inches

ANS: B Feedback: The average preschool-age child will grow 2.5 to 3 inches (6.5 to 7.8 cm) per year. The average 3-year-old is 37 inches tall (96.2 cm), the average 4-year-old is 40.5 inches tall (103.7 cm), and the average 5-year-old is 43 inches tall (118.5 cm).

The mother of a 5-year-old boy calls the nurse and seeks advice on how to assist the child with the recent death of his paternal grandfather. The boy keeps asking when his grandpa is coming back. How should the nurse respond? A) "It is best to just ignore this and to not respond to his questions." B) "This is normal; children his age do not understand the permanence of death." C) "You have to keep repeating that his grandfather is never coming back." D) "He will eventually figure this out on his own."

ANS: B Feedback: The nurse needs to remind the mother that preschoolers do not completely understand the concept of death or its permanence. Telling the mother that it is best to ignore the boy's questions or that the boy will eventually figure this out on his own does not teach. Repeating that the grandfather is not coming back does not consider the developmental stage of the child and is inappropriate.

The nurse is counseling parents of a picky eater on how to promote healthy eating habits in their child. Which of the following interventions would be appropriate advice? A) Allow the child to pick out his or her own foods for meals. B) Present the food matter-of-factly and allow the child to choose what to eat. C) Offer high-fat snacks if the child does not eat to get him or her to eat something. D) Offer the child a special treat if he or she eats all the food on the plate.

ANS: B Feedback: The parents should maintain a matter-of-fact approach, offer the meal or snack, and then allow the child to decide how much of the food, if any, he or she is going to eat. High-fat, nutrient-poor snacks should not be substituted for healthy foods just to coax the child to "eat something." If the preschooler is growing well, then the pickiness is not a cause for concern. A larger concern may be the negative relationship that can develop between the parent and child relating to mealtime. The more the parent coaxes, cajoles, bribes, and threatens, the less likely the child is to try new foods or even eat the ones he or she likes that are served. The child should be offered a healthy diet, with foods from all groups over the course of the day as recommended by the U.S. Department of Agriculture.

The parents of a 4-year-old ask the nurse when their child will be able to differentiate right from wrong and develop morals. What would be the best response of the nurse? A) "The preschooler has no sense of right and wrong." B) "The preschooler is developing a conscience." C) "The preschooler sees morality as internal to self." D) "The preschooler's morals are their own, right or wrong."

ANS: B Feedback: The preschool child can understand the concepts of right and wrong and is developing a conscience. Preschool children see morality as external to themselves; they defer to power (that of the adult). The child's moral standards are those of their parents or other adults who influence them, not necessarily their own.

Which food suggestion would be most appropriate for the mother of a preschooler to ensure an adequate intake of calcium? A) Spinach B) White beans C) Enriched bread D) Fortified cereal

ANS: B Feedback: To ensure an adequate intake of calcium, the nurse should suggest white beans, because 1 ounce of dried white beans when cooked provides 160 mg of calcium. Spinach, enriched bread, and fortified cereal are good sources of iron.

The parents of a preschooler ask the nurse to help them choose a preschool for their child. Which of the following are recommended guidelines and goals for choosing a preschool? Select all answers that apply. A) The main goal of preschool is to improve reading and writing skills and readiness for entering into grade school. B) When selecting a preschool the parent may want to consider the accreditation of the school and the teachers' qualifications. C) The teachers should decide how focused on curriculum the school should be for each individual student. D) The parent should observe the classroom, evaluating the environment, noise level, and sanitary practices. E) The type of discipline used in the school is also an important factor. Parents should choose a preschool that uses corporal punishment. F) The parent should observe the classroom to determine how the children interact with each other and how the teachers interact with the children.

ANS: B, D, F Feedback: When selecting a preschool the parent may want to consider the accreditation of the school, the teachers' qualifications, and recommendations of other parents. The parent should observe the classroom, evaluating the environment, noise level, and sanitary practices, as well as how the children interact with each other and how the teachers interact with the children. The main goal of preschool is to foster the child's social skills and accustom him or her to the group environment. The parents must decide how focused on curriculum they want the school to be. The type of discipline used in the school is also an important factor. Parents should not choose a preschool that uses corporal punishment.

The nurse is assessing the motor skills of a 5-year-old girl. Which finding would cause the nurse to be concerned? A) Can copy a square on another piece of paper B) Can dress and undress herself without help C) Draws a person with three body parts D) Is beginning to tie her own shoelaces

ANS: C Feedback: By the age of 5 years, the child should be able to draw a person with a body and at least six body parts. She should also be able to copy triangles and other geometric patterns and dress and undress herself and should be learning to tie her shoelaces.

The parents of a preschooler express concern to the nurse about their son's new habit of masturbating. Which of the following is an appropriate response to this concern? A) Tell the child in a firm manner that this behavior is not acceptable. B) When the child displays this behavior, place him in a "time-out." C) Treat the action in a matter-of-fact manner emphasizing safety. D) Consult a psychotherapist to determine the reason for this behavior.

ANS: C Feedback: Masturbation is a healthy and natural part of normal preschool development if it occurs in moderation. If the parent overreacts to this behavior, then it may occur more frequently. Masturbation should be treated in a matter-of-fact way by the parent. The child needs to learn certain rules about this activity: nudity and masturbation are not acceptable in public. The child should also be taught safety: no other person can touch the private parts unless it is the parent, doctor, or nurse checking to see when something is wrong.

A nurse is caring for a 4-year-old girl. The mother says that the girl is afraid of cats and dogs and does not like to go to the playground anymore because she wants to avoid the dogs that are often being walked at the park. What should the nurse tell the mother? A) "It is best to avoid the playground until she outgrows the fear." B) "She needs to face her fears head-on; take her to the park as much as possible." C) "Acknowledge her fear and help her develop a strategy for dealing with it." D) "Try to minimize her fears and insist that she go to the park."

ANS: C Feedback: Preschoolers have vivid imaginations and experience a variety of fears. It is best to acknowledge the fear, rather than minimize it, and then collaborate with the child on strategies for dealing with the fear. Avoiding the playground will not address the child's fears. Forcing the child to face her fear without enlisting her input to help deal with the fear does not teach. It is also important for the mother to find out if an incident involving cats and dogs occurred without her knowledge.

The nurse is supervising lunch time for children on a pediatric ward. Which of the following observations is considered abnormal for this age group? A) The child has a full set of primary teeth. B) The child has no difficulty chewing and swallowing meat. C) The child uses his fingers and refuses to use a fork. D) The child is a picky eater.

ANS: C Feedback: The preschool child has learned to use utensils fairly effectively to feed himself or herself, has a full set of primary teeth, and is able to chew and swallow competently. Preschool children may be picky eaters. They may eat only a limited variety of foods or foods prepared in certain ways and may not be very willing to try new things.

The nurse is providing teaching about car safety to the parents of a 5-year-old girl who weighs 45 pounds. What should the nurse instruct the parents to do? A) "Place her in a booster seat with lap and shoulder belts in the front seat." B) "Place her in the back seat with the lap and shoulder belts in place." C) "Place her in a forward-facing car seat with a harness and top tether." D) "Place her in a booster seat with lap and shoulder belts in the back seat."

ANS: D Feedback: A child who weighs between 40 and 80 pounds should ride in a booster seat that utilizes both the lap and shoulder belts in the back seat. When a child is large enough to sit up straight with the knees bent at the front edge of the seat, then he or she may sit directly on the seat of the car with lap or shoulder belt securely and appropriately attached. The back seat of the car is the safest place for a child to ride. A forward-facing car seat with harness and top tether is for a preschooler who weighs less than 40 pounds.

The mother of a 4-year-old boy tells the nurse that her son occasionally wets his pants during the day. How should the nurse respond? A) "Is there a family history of diabetes?" B) "Suddenly having accidents can be a sign of diabetes." C) "That's normal; don't worry about it." D) "Tell me about the circumstances when this occurs."

ANS: D Feedback: Bladder control is present in 4- and 5-year-olds, but an occasional accident may occur, particularly in stressful situations or when the child is absorbed in an interesting activity. The nurse needs to ask an open-ended question to determine the circumstances when the child has had accidents. Simply telling the mother that it is normal does not address the mother's concerns. The nurse does need to gather more information, because accidents in a previously potty-trained child can be a sign of diabetes.

Which activity would the nurse least likely include as exemplifying the preconceptual phase of Piaget's preoperational stage? A) Displays of animism B) Use of active imaginations C) Understanding of opposites D) Beginning questioning of parents' values

ANS: D Feedback: In the intuitive phase of Piaget's preoperational stage, the child begins to question parents' values. Animism, active imaginations, and an understanding of opposites would characterize the preconceptual phase of Piaget's preoperational stage.

The nurse is developing a nursing care plan for a hospitalized 6-year-old. Which of the following behaviors would warrant nursing intervention? A) The child pretends he is talking to an imaginary friend when the nurse addresses the child. B) The child states that her fairy godmother is going to come and take her home. C) The child starts talking about his grandmother and then quickly changes the subject to a new toy he received. D) The child does not want to play games with other children on the hospital ward.

ANS: D Feedback: The preschooler begins to plan activities, make up games, and initiate activities with others. Not wanting to play games with other children is a sign of a developmental delay and nursing intervention is recommended. The preschooler often has an imaginary friend who serves as a creative way for the preschooler to sample different activities and behaviors and practice conversational skills. Through make-believe and magical thinking, preschool children satisfy their curiosity about differences in the world around them. The preschooler uses trXANSduction when reasoning: he or she extrapolates from a particular situation to another, even though the events may be unrelated.

The nurse of a preschool child is helping parents develop a healthy meal plan for their child. Which of the following nutritional requirements for this age group should the nurse consider? A) The 3- to 5-year-old requires 300 to 500 mg calcium and 10 mg iron daily. B) The 3-year-old should consume 10 mg dietary fiber daily. C) The 4- to 8-year-old requires 15 mg dietary fiber per day. D) The typical preschooler requires about 85 kcal per kg of body weight.

ANS: D Feedback: The typical preschooler requires about 85 kcal per kg of body weight. The 3- to 5-year-old requires 500 to 800 mg calcium and 10 mg iron daily. The 3-year-old should consume 19 mg dietary fiber daily, while the 4- to 8-year-old requires 25 mg dietary fiber per day.

Empathy

Ability to identify with client feeling.

What are common characteristics of violent families regardless of the type of abuse that exists

Abuse of power and control Alcohol and other drug abuse Intergenerational transmission Social isolation Feedback: Research studies have identified some common characteristics of violent families regardless of the type of abuse that exists. They include social isolation, abuse of power and control, alcohol and other drug abuse, intergenerational transmission. The victim does not instigate abuse.

The nurse is consulting with a child life specialist (CLS) to help minimize the stress of hospitalization for a child. What services would the CLS provide?

Activities to support normal growth and development Grief and bereavement support Emergency room interventions for children and families Feedback: The CLS would provide activities to support normal growth and development, grief and bereavement support, and emergency room interventions for children and families. The CLS would also provide nonmedical preparation for tests, surgeries, and other medical procedures; support during medical procedures; and outpatient consultation with families.

Adaptive development

Adaptive development-refers to the acquisition of a range of skills that enable independence at home and in the community. Adaptive skills are learned and include self-care activities such as dressing/undressing, eating/feeding, toileting, and grooming; management of one's immediate environment and functional behaviors with the community such as crossing the street, going to the store, and following rules of politeness when interacting with others

The nurse is explaining a discharge plan to the parents of an infant being discharged from the hospital. Which of the following characteristics regarding adult learning should the nurse incorporate into her plan?

Adults are problem focused. Adults are problem focused and task oriented; they learn best when they perceive there is a gap in their knowledge base and want information and skills to fill the gap. Adults are self-directed; they value independence and want to learn on their own terms. Adults want an immediate need satisfied; they learn best at a time when learning meets an immediate need. Adults value past experiences and beliefs; they bring an accumulated wealth of experiences to each health care encounter.

Lorazepam (Ativan)

Alcohol withdrawal 2-4 mg every 2-4 hours PRN Monitor vital signs and global assessments for effectiveness; may cause dizziness or drowsiness

Chlordiazepoxide (Librium)

Alcohol withdrawal 50-100 mg, repeat in 2-4 hours if necessary; not to exceed 300 mg/day Monitor vital signs and global assessments for effectiveness; may cause dizziness or drowsiness

A client with a history of heavy alcohol use, whose last drink was 24 hours ago, is seen in the emergency department. The client is oriented but is tremulous, weak, and sweaty and has some gastrointestinal (GI) symptoms. Which of the following is typical of these symptoms?

Alcohol withdrawal syndrome Withdrawal from alcohol produces shakiness, weakness, diaphoresis, and GI symptoms. These are not symptoms of continuing intoxication. Delirium tremens produce hypertension, delusions, hallucinations, and agitated behavior. Wernicke-Korsakoff syndrome is a type of dementia caused by long-term, excessive alcohol intake that results in a chronic thiamine or vitamin B6 deficiency.

Categories of drugs

Alcohol, Sedatives/Hypnotics/Anxiolytics, Stimulants, Cannabis, Opioids, Hallucinogens, Inhalants

The nurse is implementing care for a hospitalized toddler. What communication technique would the nurse use with the child to reflect the child's developmental level?

Allow the child extra time to complete thoughts. When working with toddlers and preschoolers, the nurse should allow them time to complete their thoughts. Though language acquisition at this age is exponential, it often takes longer for the young child to find the right words, particularly in response to a query. Infants communicate nonverbally and often through play. School-age children need simple but honest and straightforward responses, and nurses should be nonjudgmental with adolescents to avoid alienating them and to keep lines of communication open.

The nurse is administering a liquid medication to a 3-year-old using an oral syringe. Which action would be most appropriate?

Allow the child time to swallow the medication in between amounts. When using an oral syringe to administer liquid medications, give the drug slowly in small amounts and allow the child to swallow before placing more medication in the mouth. The syringe is directed toward the posterior side of the mouth. The toddler or young preschooler may enjoy helping by squirting the medication into his or her mouth.

Revolving door effect

Although people with mental illness have shorter hospital stays, they are admitted more frequently.

Which characteristic of the abuser should the nurse look for when completing the family assessment of a victim on intimate partner violence?

An ability to feel remorse for the abuse Feedback: An abusive husband often believes his wife belongs to him (like property) and becomes increasingly violent and abusive if she shows any sign of independence, such as getting a job or threatening to leave. Typically, the abuser has strong feelings of inadequacy and low self-esteem as well as poor problem-solving and social skills. He is emotionally immature, needy, irrationally jealous, and possessive. By bullying and physically punishing the family, the abuser often experiences a sense of power and control. Therefore, the violent behavior often is rewarding and boosts his self-esteem. A typical pattern of abuse exists: Usually, the initial episode of battering or violence is followed by a period of the abuser expressing regret, apologizing, and promising it will never happen again.

The nurse is teaching a new mother about the drastic growth and developmental changes her infant will experience in the first year of life. Which of the following describes a developmental milestone occurring in infancy? A) By 6 months of age the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. B) Most infants triple their birthweight by 4 to 6 months of age and quadruple their birthweight by the time they are 1 year old. C) The head circumference increases rapidly during the first 6 months: the average increase is about 1 inch per month. D) The heart triples in size over the first year of life; the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.

Ans: A Feedback: By 6 months of age the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. Most infants double their birthweight by 4 to 6 months of age and triple their birthweight by the time they are 1 year old. The head circumference increases rapidly during the first 6 months: the average increase is about 0.6 inch (1.5 cm) per month. The heart doubles in size over the first year of life. As the cardiovascular system matures, the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.

A new mother expresses concern to the nurse that her baby is crying and grunting when passing stool. What is the nurse's best response to this observation? A) "This is normal behavior for infants unless the stool passed is hard and dry." B) "This is normal behavior for infants due to the immaturity of the gastrointestinal system." C) "This indicates a blockage in the intestine and must be reported to the physician." D) "This is normal behavior for infants unless the stool passed is black or green."

Ans: A Feedback: Due to the immaturity of the gastrointestinal system, newborns and young infants often grunt, strain, or cry while attempting to have a bowel movement. This is not of concern unless the stool is hard and dry. Stool color and texture may change depending on the foods that the infant is ingesting. Iron supplements may cause the stool to appear black or very dark green.

The nurse observing toddlers in a day care center notes that they may be happy and pleasant one moment and overreact to limit setting the next minute by throwing a tantrum. What is the focus of the toddler's developmental task that is driving this behavior? A) The need for separation and control B) The need for love and belonging C) The need for safety and security D) The need for peer approval

Ans: A Feedback: Emotional development in the toddler years is focused on separation and individuation. The focus in infancy is on love and belonging, and the need for peer approval occurs in the adolescent. Safety and security are concerns in all levels of development, but not the primary focus.

After teaching a group of parents about language development in toddlers, which of the following if stated by a member of the group indicates successful teaching? A) "When my 3-year-old asks 'why?' all the time, this is completely normal." B) "A 15-month-old should be able to point to his eyes when asked to do so." C) "At age 2 years, my son should be able to understand things like under or on." D) "An 18-month-old would most likely use words and gestures to communicate."

Ans: A Feedback: Language development occurs rapidly in a toddler. By age 3 years, the child asks "why?" Pointing to named body parts is characteristic of a 2-year-old. Understanding concepts such as on, under, or in is typical of a 3-year-old. A 1-year-old would communicate with words and gestures.

The nurse in a community clinic is caring for a 6-month-old boy and his mother. Which of the following is the priority intervention to promote adequate growth? A) Monitoring the child's weight and height B) Encouraging a more frequent feeding schedule C) Assessing the child's current feeding pattern D) Recommending higher-calorie solid foods

Ans: A Feedback: Monitoring the child's weight and height is the priority intervention to promote adequate growth. Encouraging a more frequent feeding schedule, assessing the child's current feeding pattern, and recommending higher-calorie solid foods are interventions when the nursing diagnosis is that nutrition level does not meet body requirements.

The nurse is describing the maturation of various organ systems during toddlerhood to the parents. Which would the nurse correctly include in this description? A) Myelinization of the brain and spinal cord is complete at about 24 months. B) Alveoli reach adult numbers by 3 years of age. C) Urine output in a toddler typically averages approximately 30 mL per hour. D) Toddlers typically have strong abdominal muscles by the age of 2.

Ans: A Feedback: Myelinization of the brain and spinal cord continues to progress and is complete around 24 months of age. Alveoli reach adult numbers usually around the age of 7. Urine output in a toddler typically averages 1 mL per kg per hour. Abdominal musculature in a toddler is weak, resulting in a pot-bellied appearance.

For which of the following children would nonopioid analgesics be recommended? A) A child with juvenile arthritis B) A child with end-stage cancer C) A child with a broken arm D) A child with severe postoperative pain

Ans: A Feedback: Nonopioid analgesics may be used to treat mild to moderate pain, often for conditions such as arthritis; joint, bone, and muscle pain; headache; dental pain; and menstrual pain. Opioid analgesics are typically used for moderate to severe pain as can occur with cancer, broken bones, and postoperative healing.

Prior to administering morphine to a 10-year-old child, the nurse reviews the adverse effects of the drug. Which system is primarily affected by the drug causing most of the adverse effects? A) Central nervous system B) Peripheral nervous system C) Digestive system D) Musculoskeletal system

Ans: A Feedback: Opioid agonists, such as morphine, are associated with numerous adverse effects, resulting primarily from their depressant action on the central nervous system.

The nurse is preparing to administer a topical anesthetic for a 10-year-old girl with a chin laceration. The nurse would expect to apply which of the following as ordered in preparation for sutures? A) TAC (tetracaine, epinephrine, cocaine B) Iontophoretic lidocaine C) EMLA D) Vapocoolant spray

Ans: A Feedback: TAC (tetracaine, epinephrine, cocaine) is commonly used for lacerations that require suturing. The agent can be applied directly to the wound with a cotton ball or swab for 20 to 30 minutes until the area is numb. EMLA and iontophoretic lidocaine are applied to intact skin, not to open wounds or lacerations. A vapocoolant spray, which should not be applied over a wound, is only effective for 1 to 2 minutes.

The nurse is interviewing a 3-year-old girl who tells the nurse: "Want go potty." The parents tell the nurse that their daughter often speaks in this type of broken speech. What would be the nurse's appropriate response to this concern? A) "This is a normal, common speech pattern in the 3-year-old and is called telegraphic speech." B) "This is considered a developmental delay in the 3-year-old and we should consult a speech therapist." C) "This is a condition known as echolalia and can be corrected if you work with your daughter on language skills." D) "This is a condition known as stuttering and it is a normal pattern of speech development in the toddler."

Ans: A Feedback: Telegraphic speech is common in the 3-year-old. Telegraphic speech refers to speech that contains only the essential words to get the point across, much like a telegram. In telegraphic speech the nouns and verbs are present and are verbalized in the appropriate order. Echolalia (repetition of words and phrases without understanding) normally occurs in toddlers younger than 30 months of age. "Why" and "what" questions dominate the older toddler's language. Stuttering usually has its onset at between 2 and 4 years of age. It occurs more often in boys than in girls. About 75% of all cases of stuttering resolve within 1 to 2 years after they start.

The parents of a 1-year-old girl, both of whom have perfect teeth, are concerned about their child getting dental caries. Which is the best advice the nurse can provide? A) Tell the parents to limit the child's eating to meal and snack times. B) Urge the parents to take the child to a dentist for a check-up. C) Advise the parents to reduce carbohydrates in the child's diet. D) Advise the parents to use fluoride toothpaste.

Ans: A Feedback: Telling the parents to limit eating to meal and snack times is the best advice for preventing dental caries. This reduces the amount of exposure the child's teeth have to food. Urging them to take the child to see a dentist is sound advice but doesn't suggest actions they can take now to prevent caries. Carbohydrates react with oral bacteria to cause caries, but they should not be reduced from the diet. Avoiding fluoridated toothpaste may help prevent fluorosis.

The nurse is assessing the pain of a postoperative newborn. The nurse measures the infant's facial expression, body movement, sleep, verbal or vocal ability, consolability, and response to movements and touch. Which behavioral assessment tool is being used by the nurse? A) Riley Infant Pain Scale B) Pain Observation Scale for Young Children C) CRIES Scale for Neonatal Postoperative Pain Assessment D) FLACC Behavioral Scale for Postoperative Pain in Young Children

Ans: A Feedback: The Riley Infant Pain Scale measures six parameters: facial expression, body movement, sleep, verbal or vocal ability, consolability, and response to movements and touch. The Pain Observation Scale for Young Children (POCIS) measures seven parameters: facial expression, cry, breathing, torso, arms and fingers, legs and toes, and state of arousal. The CRIES tool assesses five parameters: cry, oxygen required for saturation levels less than 95%, increased vital signs, facial expression, and sleeplessness. The FLACC tool measures five parameters: facial expression, legs, activity, cry, and consolability.

The nurse is caring for a 7-month-old girl during a well-child visit. Which of the following interventions is most appropriate for this child? A) Discussing the type of sippy cup to use B) Advising about increased caloric needs C) Explaining how to prepare table meats D) Describing the tongue extrusion reflex

Ans: A Feedback: The cup may be introduced at 6 to 8 months of age. Old-fashioned sippy cups are preferred compared to the new style. The nurse would not advise about increased caloric needs as caloric needs drop at this age. Transition to table meat will not take place until age 10 to 12 months. Tongue extrusion reflex has disappeared at age 4 to 6 months.

The nurse is providing anticipatory guidance to the mother of a 9-month-old girl during a well-baby visit. Which of the following topics would be most appropriate? A) Advising how to create a toddler-safe home B) Warning about small objects left on the floor C) Cautioning about putting the baby in a walker D) Telling about safety procedures during baths

Ans: A Feedback: The most appropriate topic for this mother would be advising her on how to create a toddler-safe home. The child will very soon be pulling herself up to standing and cruising the house. This will give her access to areas yet unexplored. Warning about small objects left on the floor, telling about safety procedures during baths, and cautioning about using baby walkers would no longer be anticipatory guidance as the child has passed these stages.

The nurse is teaching the parents of an overweight 18-month-old girl about diet. Which intervention will be most effective for promoting proportionate growth? A) Remove high-calorie, low-nutrient foods from the diet. B) Ensure 30 minutes of unstructured activity per day. C) Avoid sharing your snacks and candy with the child. D) Reduce the amount of high-fat food the child eats.

Ans: A Feedback: The most effective intervention will be to remove high-calorie, low-nutrient foods from the diet in order to reduce the number of calories and increase the nutritional value. Exercise is also important, but a child this age should have 30 minutes of structured physical activity plus several hours of unstructured physical activity per day. The parents should set an example for good eating habits. Dietary fat should not be restricted for an 18-month-old child because it is necessary for nervous system development.

The parent of a 6-month old infant asks the nurse for advice about his son's thumb sucking. What would be the nurse's best response to this parent? A) "Thumb sucking is a healthy self-comforting activity." B) "Thumb sucking leads to the need for orthodontic braces." C) "Caregivers should pay special attention to the thumb sucking to stop it." D) "Thumb sucking should be replaced with the use of a pacifier."

Ans: A Feedback: Thumb sucking is a healthy self-comforting activity. Infants who suck their thumbs or pacifiers often are better able to soothe themselves than those who do not. Studies have not shown that sucking either thumbs or pacifiers leads to the need for orthodontic braces unless the sucking continues well beyond the early school-age period. The infant who has become attached to thumb sucking should not have additional attention drawn to the issue, as that may prolong thumb sucking. Pacifiers should not be used to replace thumb sucking as this habit will also need to be discouraged as the child grows.

The nurse is watching toddlers at play. Which of the following normal behaviors would the nurse observe? A) Toddlers engage in parallel play. B) Toddlers engage in solitary play. C) Toddlers engage in cooperative play. D) Toddlers do not engage in play outside the home.

Ans: A Feedback: Toddlers typically play alongside another child (parallel play) rather than cooperatively. Infants engage in solitary play.

The nurse is providing teaching to the parents of a newborn prior to a heelstick. The nurse is describing the procedure and recommending various methods for the parents to help comfort their baby. Which of the following statements by the parents indicates a need for further teaching? A) "It's better if we are not in the room for this." B) "We can use kangaroo care before and after." C) "We hope you are using a very tiny needle." D) "We can offer him nonnutritive sucking to calm him."

Ans: A Feedback: Unless contraindicated, the parents should be encouraged to be present before, during, and after the procedure to provide comforting support to the child. Kangaroo care, small-gauge needles, and nonnutritive sucking are other methods to provide atraumatic care

The nurse is researching behavioral-cognitive pain relief strategies to use on a 5-year-old child with unrelieved pain. Which of the following methods might the nurse choose? Select all answers that apply. A) Relaxation B) Distraction C) Biofeedback D) Thought stopping E) Massage F) Sucking

Ans: A, B, C, D Feedback: Common behavioral-cognitive strategies include relaxation, distraction, imagery, biofeedback, thought stopping, and positive self-talk. Sucking and massage are examples of biophysical interventions.

The nurse caring for infants in the neonatal intensive care unit (NICU) relies on the use of behavioral and physiologic indicators for determining pain. Which of the following examples are behavioral indicators? Select all answers that apply. A) The infant grimaces. B) The infant's heart rate is elevated. C) The infant flails his arms and legs. D) The infant's respiratory rate is elevated. E) The infant is crying uncontrollably. F) The infant's oxygen saturation is low.

Ans: A, C, E Feedback: In preterm and term newborns, behavioral and physiologic indicators are used for determining pain. Behavioral indicators include facial expression, body movements, and crying. Physiologic indicators include changes in heart rate, respiratory rate, blood pressure, oxygen saturation levels, vagal tone, palmar sweating, and plasma cortisol or catecholamine levels (American Academy of Pediatrics, 2010; Henry, Haubold, & Dobrzykowski, 2004).

The nurse caring for newborns knows that infants exhibit phenomenal increases in their gross motor skills over the first 12 months of life. Which of the following statements accurately describe the typical infant's achievement of these milestones? Select all answers that apply. A) At 1 month the infant lifts and turns the head to the side in the prone position. B) At 2 months the infant lifts head and looks around. C) At 6 months the infant pulls to stand up. D) At 7 months the infant sits alone with some use of hands for support. E) At 9 months the infant crawls with the abdomen off the floor. F) At 12 months the infant walks independently.

Ans: A, D, E, F Feedback: At 1 month the infant lifts and turns the head to the side in the prone position. At 7 months the infant sits alone with some use of hands for support. At 9 months the infant crawls with the abdomen off the floor. At 12 months the infant walks independently. At 4 months the infant lifts the head and looks around. At 10 months the infant pulls to stand up.

5. The nurse is assessing the respiratory system of a newborn. Which of the following anatomic differences place the infant at risk for respiratory compromise? Select all answers that apply. A) The nasal passages are narrower. B) The trachea and chest wall are less compliant. C) The bronchi and bronchioles are shorter and wider. D) The larynx is more funnel shaped. E) The tongue is smaller. F) There are significantly fewer alveoli.

Ans: A, D, F Feedback: In comparison with the adult, in the infant, the nasal passages are narrower, the trachea and chest wall are more compliant, the bronchi and bronchioles are shorter and narrower, the larynx is more funnel shaped, the tongue is larger, and there are significantly fewer alveoli. These anatomic differences place the infant at higher risk for respiratory compromise. The respiratory system does not reach adult levels of maturity until about 7 years of age.

The nurse is assessing the respiratory system of a newborn. Which of the following anatomic differences place the infant at risk for respiratory compromise? Select all answers that apply. A) The nasal passages are narrower. B) The trachea and chest wall are less compliant. C) The bronchi and bronchioles are shorter and wider. D) The larynx is more funnel shaped. E) The tongue is smaller. F) There are significantly fewer alveoli.

Ans: A, D, F Feedback: In comparison with the adult, in the infant, the nasal passages are narrower, the trachea and chest wall are more compliant, the bronchi and bronchioles are shorter and narrower, the larynx is more funnel shaped, the tongue is larger, and there are significantly fewer alveoli. These anatomic differences place the infant at higher risk for respiratory compromise. The respiratory system does not reach adult levels of maturity until about 7 years of age.

When the nurse is assessing a child's pain, which of the following is most important? A) Obtaining a pain rating from the child with each assessment B) Using the same tool to assess the child's pain each time C) Documenting the child's pain assessment D) Asking the parents about the child's pain tolerance

Ans: B Feedback: Although obtaining a pain rating, documenting the assessment, and asking the child's parents about the pain are important, the most important aspect of pain assessment is to use the same tool each time so that appropriate comparisons can be made and effective interventions can be planned and implemented. Consistency allows the most accurate assessment of the child's pain.

Which reflex, if found in a 4-month-old infant, would cause the nurse to be concerned? A) Plantar grasp B) Step C) Babinski D) Neck righting

Ans: B Feedback: Appropriate appearance and disappearance of primitive reflexes, along with the development of protective reflexes, indicates a healthy neurologic system. The step reflex is a primitive reflex that appears at birth and disappears at 4 to 8 weeks of age. The plantar grasp reflex is a primitive reflex that appears at birth and disappears at about the age of 9 months. The Babinski reflex is a primitive reflex that appears at birth and disappears around the age of 12 months. The neck righting reflex is a protective reflex that appears around the age of 4 to 6 months and persists.

The nurse is caring for a child who is complaining of chronic pain. Which of the following is the priority nursing assessment? A) How the pain impacts the child's and family's stress level B) The pain's history, onset, intensity, duration, and location C) The child's and parents' feeling of anxiety and depression D) The child's cognitive level and emotional response

Ans: B Feedback: Assessment of the child's pain is key; it is the priority assessment and is the only answer that focuses on the child's physiologic need. Assessment of how the pain impacts the child's and family's stress, feelings of anxiety, hopelessness, and depression, as well as the child's cognitive level and emotional response, are secondary after the pain is explored.

The nurse is assessing a 2-year-old boy who has missed some developmental milestones. Which finding will point to the cause of motor skill delays? A) The mother is suffering from depression. B) The child is homeless and has no toys. C) The mother describes an inadequate diet. D) The child is unperturbed by a loud noise.

Ans: B Feedback: Children develop through play, so a child without any toys may have trouble developing the motor skills appropriate to his age. Maternal depression is a risk factor for poor cognitive development. Inadequate diet will cause growth deficiencies. A child who does not respond to a loud noise probably has hearing loss, which will lead to a language deficit.

5. The nurse is observing a 24-month-old boy in a day care center. Which finding suggests delayed motor development? A) The child has trouble undressing himself. B) The child is unable to push a toy lawnmower. C) The child is unable to unscrew a jar lid. D) The child falls when he bends over.

Ans: B Feedback: Children with normal motor development are able to push toys with wheels at 24 months of age. He won't be ready to undress himself, unscrew a jar lid, or bend over without falling until about 36 months of age.

The student nurse is learning about the effects of heat and cold when used in a pain management plan. Which of the following accurately describes one of these effects? A) Cold results in vasodilation. B) Cold alters capillary permeability. C) Heat results in vasoconstriction. D) Heat decreases blood flow to the area

Ans: B Feedback: Cold results in vasoconstriction and alters capillary permeability, leading to a decrease in edema at the site of the injury. Heat results in vasodilation and increases blood flow to the area.

During a health history, the nurse explores the sleeping habits of a 3-yearold boy by interviewing his parents. Which of the following statements from the parents reflects a recommended guideline for promoting healthy sleep in this age group? A) "Our son sleeps through the night, and we insist that he takes two naps a day." B) "We keep a strict bedtime ritual for our son, which includes a bath and bedtime story." C) "Our son still sleeps in a crib because we feel it is the safest place for him at night." D) "Our son occasionally experiences night walking so we allow him to stay up later when this happens."

Ans: B Feedback: Consistent bedtime rituals help the toddler prepare for sleep; the parent should be advised to choose a bedtime and stick to it as much as possible. The nightly routine might include a bath followed by reading a story. A typical toddler should sleep through the night and take one daytime nap. Most children discontinue daytime napping at around 3 years of age. When the crib becomes unsafe (that is, when the toddler becomes physically capable of climbing over the rails), then he or she must make the transition to a bed. Attention during night waking should be minimized so that the toddler receives no reward for being awake at night.

The nurse tells a joke to a 12-year-old to distract him from a painful procedure. What pain management technique is the nurse using? A) Relaxation B) Distraction C) Imagery D) Thought stopping

Ans: B Feedback: Distraction involves having the child focus on another stimulus, thereby attempting to shield him from pain. Humor has been demonstrated to be an effective distracting technique for pain management.

The nurse is teaching the parents of a 2-year-old toddler methods of dealing with their child's "negativism." Based on Erokson's theory of development, which of the following would be an appropriate intervention for this child? A) Discourage solitary play; encourage playing with other children. B) Encourage the child to pick out his own clothes. C) Use "time-outs" whenever the child says "no" inappropriately. D) Encourage the child to take turns when playing games.

Ans: B Feedback: Erikson defines the toddler period as a time of autonomy versus shame and doubt. It is a time of exerting independence. Allowing the child to choose his own clothes helps him to assert his independence. Negativism—always saying "no"—is a normal part of healthy development and is occurring as a result of the toddler's attempt to assert his or her independence. It should not be punished with "time-outs." The toddler should be encouraged to play alone and with other children. Toddlers cannot take turns in games until age 3.

The nurse is educating a first-time mother who has a 1-week-old boy. Which of the following is the most accurate anticipatory guidance? A) Describing the effect of neonatal teeth on breastfeeding B) Explaining that the stomach holds less than 1 ounce C) Informing that fontanels will close by 6 months D) Telling that the step reflex persists until the child walks

Ans: B Feedback: Explaining that the child's stomach holds less than 1 ounce gives the mother a reason for frequent, small feedings and is the most helpful and accurate anticipatory guidance. Telling that the step reflex persists until the child walks and informing that fontanels will close by 6 months are inaccurate. The step reflex disappears at about 2 months and fontanels close between 12 and 18 months. Neonatal teeth are highly unusual and need no explanation unless they occur.

The nurse is explaining the effects of heat application for pain relief. Which of the following would the nurse be likely to include as an effect? A) Increased blood flow to the area B) Increased pressure on nociceptive fibers C) Possible release of endogenous opioids D) Altered capillary permeability

Ans: B Feedback: Heat causes an increase in blood flow. This alters capillary permeability, leading to a reduction in swelling and pressure on nociceptive fibers. Heat also may trigger the release of endogenous opioids, which mediate the pain response.

The nurse is providing anticipatory guidance to a mother of a 5-month-old boy about introducing solid foods. Which statement by the mother indicates that effective teaching has occurred? A) "I'll start with baby oatmeal cereal mixed with low-fat milk." B) "The cereal should be a fairly thin consistency at first." C) "I can puree the meat that we are eating to give to my baby." D) "Once he gets used to the cereal, then we'll try giving him a cup."

Ans: B Feedback: Iron-fortified rice cereal mixed with a small amount of formula or breast milk to a fairly thin consistency is typically the first solid food used. As the infant gets older, a thicker consistency is appropriate. Strained, pureed, or mashed meats may be introduced at 10 to 12 months of age. A cup is typically introduced at 6 to 8 months of age regardless of what or how much solid food is being consumed.

The parents of a 2-year-old girl are frustrated by the frequent confrontations they have with their child. Which is the best anticipatory guidance the nurse can offer them? A) "Respond in a calm but firm manner." B) "You need to adhere to various routines." C) "Put her in time-out when she misbehaves." D) "It's important to toddler-proof your home."

Ans: B Feedback: Making expectations known through everyday routines helps to avoid confrontations. This helps the child know what to expect and how to behave. It is the best guidance to give these parents. Calm response and time-out are effective ways to discipline, but do not help to prevent confrontations. Toddler-proofing the house doesn't eliminate all the opportunities for confrontation.

When instructing the parents of a toddler about appropriate nutrition, which of the following would the nurse recommend? A) About 12 to 16 ounces of fruit juice per day B) Approximately 16 to 24 ounces of milk per day C) Fat intake of 30% to 40% of total calories D) An average of 10 to 12 grams of fiber per day

Ans: B Feedback: Milk intake should be limited to 16 to 24 ounces per day, with fruit juice limited to 4 to 6 ounces per day. A toddler's total fat intake should be 20% to 30% of total calories. The daily recommended fiber intake is 19 grams.

11. At which age would the nurse expect to find the beginning of object permanence? A) 1 month B) 4 months C) 8 months D) 12 months

Ans: B Feedback: Object permanence begins to develop between 4 and 7 months of age and is solidified by approximately age 8 months. By age 12 months, the infant knows he or she is separate from the parent or caregiver.

At which age would the nurse expect to find the beginning of object permanence? A) 1 month B) 4 months C) 8 months D) 12 months

Ans: B Feedback: Object permanence begins to develop between 4 and 7 months of age and is solidified by approximately age 8 months. By age 12 months, the infant knows he or she is separate from the parent or caregiver.

A new mother shows the nurse that her baby grasps her finger when she touches the baby's palm. How might the nurse respond to this information? A) "This is a primitive reflex known as the plantar grasp." B) "This is a primitive reflex known as the palmar grasp." C) "This is a protective reflex known as rooting." D) "This is a protective reflex known as the Moro reflex."

Ans: B Feedback: Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. During the palmar grasp, the infant reflexively grasps when the palm is touched. The plantar grasp occurs when the infant reflexively grasps with the bottom of the foot when pressure is applied to the plantar surface. The root reflex occurs when the infant's cheek is stroked and the infant turns to that side, searching with mouth. The Moro reflex is displayed when with sudden extension of the head, the arms abduct and move upward and the hands form a "C."

The nurse is counseling the mother of a newborn who is concerned about her baby's constant crying. What teaching would be appropriate for this mother? A) Carrying the baby may increase the length of crying. B) Reducing stimulation may decrease the length of crying. C) Using vibration, white noise, or swaddling may increase crying. D) Using a swing or car ride may increase the incidence of crying episodes.

Ans: B Feedback: Prolonged crying leads to increased stress among caregivers. Reducing stimulation may decrease the length of crying, and carrying the infant more may be helpful. Some infants respond to the motion of an infant swing or a car ride. Vibration, white noise, or swaddling may also help to decrease fussing in some infants. Parents should try one intervention at a time, taking care not to stimulate the infant excessively in the process of searching for solutions.

The nurse is caring for a 4-week-old girl and her mother. Which of the following is the most appropriate subject for anticipatory guidance? A) Promoting the digestibility of breast milk B) Telling how and when to introduce rice cereal C) Describing root reflex and latching on D) Advising how to choose a good formula

Ans: B Feedback: Telling the mother how to introduce rice cereal is the most appropriate subject for anticipatory guidance. Since this mother is already breast- or bottle-feeding her baby, educating her about these subjects would not inform her about what to expect in the next phase of development.

The nurse is assessing a 4-month-old boy during a scheduled visit. Which of the following findings might suggest a developmental problem? A) The child does not coo or gurgle. B) The child does not babble or laugh. C) The child never squeals or yells. D) The child does not say dada or mama.

Ans: B Feedback: The fact that the child does not babble or laugh might suggest a developmental problem. At 4 to 5 months of age most children are making simple vowel sounds, laughing aloud, doing raspberries, and vocalizing in response to voices. The child should have developed past cooing or gurgling, but is too young to squeal, yell, or say dada or mama.

The nurse is teaching good sleep habits for toddlers to the mother of a 2-year-old boy. Which response indicates the mother understands sleep requirements for her son? A) "I'll put him to bed at 7 p.m., except Friday and Saturday." B) "He needs 13 hours of sleep per day including his nap." C) "I need to put the side down on the crib so he can get out." D) "His father can give him a horseback ride into his bed."

Ans: B Feedback: The mother understands her child needs 13 hours of sleep and one nap per day. Routines, such as the same bedtime every night, promote good sleep. However, a horseback ride to bed may cause problems because it may not provide a calming transition from play to sleep. A bath and reading a book would be better. If the child can climb out of a crib, he needs to be in a youth bed or regular bed to avoid injury.

The nurse is teaching a new mother about the development of sensory skills in her newborn. Which of the following would alert the mother to a sensory deficit in her child? A) The newborn's eyes wander and occasionally are crossed. B) The newborn does not respond to a loud noise. C) The newborn's eyes focus on near objects. D) The newborn becomes more alert with stroking when drowsy.

Ans: B Feedback: Though hearing should be fully developed at birth, the other senses continue to develop as the infant matures. The newborn should respond to noises. Sight, smell, taste, and touch all continue to develop after birth. The newborn's eyes wander and occasionally cross, and the newborn is nearsighted, preferring to view objects at a distance of 8 to 15 inches. Holding, stroking, rocking, and cuddling calm infants when they are upset and make them more alert when they are drowsy.

The nurse observes an infant interacting with his parents. Which of the following are normal social behavioral developments for this age group? Select all answers that apply. A) Around 5 months the infant may develop stranger anxiety. B) Around 2 months the infant exhibits a first real smile. C) Around 3 months the infant smiles widely and gurgles when interacting with the caregiver. D) Around 3 months the infant will mimic the parent's facial movements, such as sticking out the tongue. E) Around 3 to 6 months of age the infant may enjoy socially interactive games such as patty-cake and peek-a-boo. F) Separation anxiety may also start in the last few months of infancy.

Ans: B, C, D, F Feedback: The infant exhibits a first real smile at age 2 months. By about 3 months of age the infant will start an interaction with a caregiver by smiling widely and possibly gurgling. The 3- to 4-month-old will also mimic the parent's facial movements, such as widening the eyes and sticking out the tongue. Separation anxiety may also start in the last few months of infancy. Around the age of 8 months the infant may develop stranger anxiety. At 6 to 8 months of age the infant may enjoy socially interactive games such as patty-cake and peek-a-boo.

The nurse is helping parents prepare a healthy meal plan for their toddler. Which of the following guidelines for promoting nutrition should be followed when planning meals? Select all answers that apply. A) The child younger than 2 years of age should have his or her fat intake restricted. B) Extending breastfeeding into toddlerhood is believed to be beneficial to the child. C) Weaning from the bottle should occur by 6 to 12 months of age. D) Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. E) The toddler requires an average intake of 500 mg calcium per day. F) Toddlers tend to have the highest daily iron intake of any age group.

Ans: B, D, E Feedback: Extending breastfeeding into toddlerhood is believed to be beneficial to the child as it is known to help prevent obesity. Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. The toddler requires an average intake of 500 mg calcium per day. The child younger than 2 years of age should not have his or her fat intake restricted, but this does not mean that unhealthy foods such as sweets should be eaten liberally. Weaning from the bottle should occur by 12 to 15 months of age. Prolonged bottle-feeding is associated with the development of dental caries. It is important for toddlers to consume adequate amounts of iron since they tend to have the lowest daily iron intake of any age group.

The nurse is helping a new mother prepare for breastfeeding her infant. During which of the following newborn states of consciousness would the nurse recommended attempting the feeding? A) Light sleep B) Drowsiness C) Quiet alert state D) Active alert state

Ans: C Feedback: A normal newborn will ordinarily move through six states of consciousness: (1) deep sleep: the infant lies quietly without movement; (2) light sleep: the infant may move a little while sleeping and may startle to noises; (3) drowsiness: eyes may close; the infant may be dozing; (4) quiet alert state: the infant's eyes are open wide and the body is calm; (5) active alert state: the infant's face and body move actively; and (6) crying: the infant cries or screams and the body moves in a disorganized fashion. The quiet alert state is the optimal state in which to breastfeed an infant.

The pediatric nurse is planning quiet activities for hospitalized 18-month-olds. Which of the following would be an appropriate activity for this age group? A) Painting by number B) Putting shapes into appropriate holes C) Stacking blocks D) Using crayons to color in a coloring book

Ans: C Feedback: At 18 months the child can stack four blocks. The 24-month-old can paint (but not by number), scribble, and color, and put round pegs into holes.

The nurse is teaching a new mother the proper techniques for breastfeeding her newborn. Which of the following is a recommended guideline that should be implemented? A) Wash the hands and breasts thoroughly prior to breastfeeding. B) Stroke the nipple against the baby's chin to stimulate wide opening of the baby's mouth. C) Bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola. D) When finished the mother can break the suction by firmly pulling the baby's mouth away from the nipple.

Ans: C Feedback: Before each breastfeeding session, mothers should wash their hands, but it is not necessary to wash the breast in most cases. The mother should then stroke the nipple against the baby's cheek to stimulate opening of the mouth and bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola When the infant is finished feeding, the mother can break the suction by inserting her finger into the baby's mouth.

The nurse is preparing a child for a lumbar puncture. How far ahead of the procedure should the nurse apply the EMLA cream? A) 30 minutes B) 1 hour C) 3 hours D) 4 hours

Ans: C Feedback: For a deeper procedure such as a lumbar puncture, the nurse needs to apply the cream 2 to 3 hours before the procedure. For a superficial procedure, the EMLA cream should be applied at least 1 hour before the procedure.

The nurse measures the head circumference of a 6-month-old infant. Which measurement would the nurse interpret as most appropriate? A) 33 cm B) 35 cm C) 43.5 cm D) 47 cm

Ans: C Feedback: Head circumference increases rapidly during the first 6 months. In a 6-month-old it is typically 42 to 44.5 cm (16.5 to 17.5 in); at birth it is usually 33 to 35 cm (13 to 14 in); and at 1 year of age it is usually 45 to 47.5 cm (17.7 to 18.7 in).

The nurse is testing the sensory development of a toddler brought to the clinic for a well visit. Which of the following might alert the nurse to a potential problem with the child's sensory development? A) The toddler places the nurse's stethoscope in his mouth. B) The toddler's vision tests at 20 over 50 in both eyes C) The toddler does not respond to commands whispered in his ear. D) The toddler's taste discrimination is not at adult levels yet.

Ans: C Feedback: Hearing should be at the adult level, as infants are ordinarily born with hearing intact. Therefore, the toddler should hear commands whispered in his ear. Toddlers examine new items by feeling them, looking at them, shaking them to hear what sound they make, smelling them, and placing them in their mouths. Toddler vision continues to progress and should be 20 over 50 to 20 over 40 in both eyes. Though taste discrimination is not completely developed, toddlers may exhibit preferences for certain flavors of foods.

The nurse is assessing a 12-month-old boy with an English-speaking father and a Spanish-speaking mother. The boy does not say mama or dada yet. Which of the following is the priority intervention? A) Performing a developmental evaluation of the child B) Encouraging the parents to speak English to the child C) Asking the mother if the child uses Spanish words D) Referring the child to a developmental specialist

Ans: C Feedback: Infants in bilingual families may use some words from each language. Therefore, the priority intervention in this situation would be to ask the mother if the child uses Spanish words. There is not enough evidence to warrant performing a developmental evaluation or referring the child to a developmental specialist. Encouraging the parents to speak English to the child is unnecessary if the child is progressing with Spanish first.

The nurse is assessing a 3-year-old boy's development during a well-child visit. Which response by the child indicates the need for further assessment? A) He says a swear word when he hurts himself playing. B) He says "pew" when his sister has soiled her diaper. C) He laughs when his brother cries getting vaccinated. D) He constantly asks "why?" whenever he is told a fact.

Ans: C Feedback: Laughing when his brother cries when being vaccinated indicates that the child hasn't yet developed a sense of empathy or that there may be psychosocial issues, such as sibling rivalry, that should be assessed. The child may repeat a word even if it is out of context. This is called echolalia. Older toddlers have a well-developed sense of smell and will comment if they don't like a smell. The incessant "why" is very common to toddlers' speech.

The nurse is performing a health assessment of a 3-month-old Black American boy. For what condition should this infant be monitored based on his race? A) Jaundice B) Iron deficiency C) Lactose intolerance D) Gastroesophageal reflux disease (GERD)

Ans: C Feedback: Many dietary practices are affected by culture, both in the types of food eaten and in the approach to progression of infant feeding. Some ethnic groups tend to be lactose intolerant (particularly blacks, Native Americans, and Asians); therefore, alternative sources of calcium must be offered. Jaundice, iron deficiency, and GERD are not seen at a significantly higher rate in African American infants.

The nurse is caring for a child who is experiencing pain related to chemotherapy treatment. Which of the following is a behavioral factor that might affect the child's pain experience? A) Knowledge of the therapy B) Fear about the outcome of therapy C) Participation in normal routine activities D) Ability to identify pain triggers

Ans: C Feedback: Participation in normal routine activities is a behavior factor. Knowledge of the therapy and ability to identify pain triggers are cognitive factors. Fear about the outcome of therapy is an emotional factor. Situational factors involve factors or elements that interact with the child and his or her current situation involving the experience of pain.

The nurse is providing anticipatory guidance to a mother to help promote healthy sleep for her 3-week old baby. Which of the following recommended guidelines might be included in the teaching plan? A) Place the baby on a soft mattress with a firm flat pillow for the head. B) Place the head of the bed near the window to provide fresh air, weather permitting. C) Place the baby on his or her back when sleeping. D) If the baby sleeps through the night, wake him or her up for the night feeding.

Ans: C Feedback: Sudden infant death syndrome (SIDS) has been associated with prone positioning of newborns and infants, so the infant should be placed to sleep on the back. The baby should sleep on a firm mattress without pillows or comforters. The baby's bed should be placed away from air conditioner vents, open windows, and open heaters. By 4 months of age night waking may occur, but the infant should be capable of sleeping through the night and does not require a night feeding.

The nurse is providing guidance after observing a mother interact with her negative 2-year-old boy. For which interaction will the nurse advise the mother that she is handling the negativism properly? A) Telling the child to stop tearing pages from magazines B) Asking the child if he would please quit throwing toys C) Telling the child firmly that we don't scream in the office D) Saying, "Please come over here and sit in this chair. OK?"

Ans: C Feedback: Telling the child firmly that we don't scream in the office gets the point across to the child that his behavior is unacceptable while role modeling appropriate communication. Telling the child to stop tearing up magazines does not give him direction for appropriate behavior. Asking the child if he would quit throwing toys gives him an opportunity to say "no," and is the same as asking "OK?" at the end of a direction.

The nurse is performing a physical assessment of a 3-year-old girl. Which of the following would be a concern for the nurse? A) The toddler gained 4 pounds in weight since last year. B) The toddler gained 3 inches in height since last year. C) The toddler's anterior fontanel is not fully closed. D) The circumference of the child's head increased 1 inch since last year.

Ans: C Feedback: The anterior fontanel should be closed by the time the child is 18 months old. The average toddler weight gain is 3 to 5 pounds per year. Length and height increases by an average of 3 inches per year. Head circumference increases about 1 inch from when the child is between 1 and 2 years of age, and then increases an average of a half-inch per year until age 5.

The nurse is examining a 10-month-old boy who was born 10 weeks early. Which of the following findings is cause for concern? A) The child has doubled his birthweight. B) The child exhibits plantar grasp reflex. C) The child's head circumference is 19.5 inches. D) No primary teeth have erupted yet.

Ans: C Feedback: The child's head size is large for his adjusted age (7.5 months), which would be cause for concern. Birth weight doubles by about 6 months of age. Plantar grasp reflex does not disappear until 9 months adjusted age. Primary teeth may not erupt until 8 months adjusted age.

A nurse is providing teaching to the mother of an adolescent girl about how to manage menstrual pain nonpharmacologically. Which of the following statements by the mother indicates a need for further teaching? A) "I need to help her learn techniques to distract her, card games, for example." B) "I need to be able to identify the subtle ways she shows pain." C) "I need to follow these instructions exactly for them to work properly." D) "I need to encourage her to practice and utilize these techniques."

Ans: C Feedback: The mother does not need to follow the instructions exactly; she needs to review the methods and modify them in a way that works best for her daughter. The other statements are correct.

The nurse has applied EMLA cream as ordered. How does the nurse assess that the cream has achieved its purpose? A) Assess the skin for redness. B) Note any blanching of skin. C) Lightly tap the area where the cream is. D) Gently poke the child with a needle.

Ans: C Feedback: The nurse should verify that sensation is absent by lightly tapping or scratching the area. Blanching or redness indicates that the medication has penetrated the skin adequately but does not indicate that sensation is absent. Using a needle to poke the skin would likely frighten the child.

The nurse is teaching an 8-year-old child and his family how to manage cancer pain using nonpharmacologic methods. Which of the following parent statements signifies successful child teaching? A) "I will avoid using descriptive words like pinching, pulling, or heat." B) "I will not use positive reinforcement until the technique is perfected." C) "I will begin using the technique before he experiences pain." D) "I will be honest and tell him that the procedure will hurt a lot."

Ans: C Feedback: The parents should begin using the technique chosen before the child experiences pain or when the child first indicates he is anxious about, or beginning to experience, pain. The parents should use descriptive terms like pushing, pulling, pinching, or heat and avoid overly descriptive or judgmental statements such as, "This will really hurt a lot" or "This will be terrible." They should offer praise, positive reinforcement, hugs, and support for using the technique even when it was not effective.

Which of the following would the nurse expect to find in an 18-month-old? A) Standing on tiptoes B) Pedaling a tricycle C) Climbing stairs with assistance D) Carrying a large toy while walking

Ans: C Feedback: Toddlers continue to progress with motor skills. An 18-month-old should be able to climb stairs with assistance. A 24-month-old should be able to stand on his or her tiptoes and carry a large toy while walking. A 36-month-old would be able to pedal a tricycle.

The nurse is teaching parents interventions appropriate to the emotional development of their toddlers. Which of the following is a recommended intervention for this age group? A) Remove children's security blankets at this stage to help them assert their autonomy. B) Distract toddlers from exploring their own body parts, particularly their genitals. C) Do not blame toddlers for aggressive behavior; instead, point out the results of their behavior. D) Offer toddlers many choices to foster control over their environment.

Ans: C Feedback: Toddlers should not be blamed for their aggressive behavior; adults can assist the toddler in building empathy by pointing out when someone is hurt and explaining what happened. Adults should allow toddlers to rely upon a security item to self-soothe as this is a function of autonomy and is viewed as a sign of a nurturing environment, rather than one of neglect. Toddlers may question parents about the difference between male and female body parts and may begin to explore their own genitals. This is normal behavior in this age group. Offering limited choices is one way of allowing toddlers some control over their environment and helping them to establish a sense of mastery.

The nurse is administering pain medication for a child with continuous pain from internal injuries. Which of the following methods would be ordered to dispense the medication? A) Administer the medication PRN (as needed). B) Administer the mediation when pain has peaked. C) Administer the medication around the clock at timed intervals. D) Administer the medication when the child complains of pain.

Ans: C Feedback: With any medication administered for pain management, the timing of administration is vital. Timing depends on the type of pain. For continuous pain, the current recommendation is to administer analgesia around the clock at scheduled intervals to achieve the necessary effect. As-needed or PRN dosing is not recommended for continuous pain. This method can lead to inadequate pain relief because of the delay before the drug reaches its peak effectiveness. For pain that can be predicted or considered temporary, such as with a procedure, analgesia is administered so that the peak action of the drug matches the time of the painful event. It is not recommended to wait until the child complains of pain because therapeutic levels will be difficult to reach at this point.

The nurse is counseling the parents of a 9-year-old boy who is receiving morphine for postoperative pain. Which of the following statements from the nurse accurately reflects the pain experience in children? A) "You can expect that your child will tell you when he is experiencing pain." B) "Your child will learn to adapt to the pain he is experiencing." C) "Your child will experience more adverse effects to narcotics than adults." D) "It is very rare that children become addicted to narcotics."

Ans: D Feedback: Addiction to narcotics when used in children is very rare. Often children deny pain to avoid a painful situation or procedure, embarrassment, or loss of control. Repeated exposure to pain or painful procedures can result in an increase in behavioral manifestations. The risk of adverse effects of narcotic analgesics is the same for children as for adults.

A 6-month-old girl weighs 14.7 pounds during a scheduled check-up. Her birth weight was 8 pounds. Which of the following is the priority nursing intervention? A) Talking about solid food consumption B) Discouraging daily fruit juice intake C) Increasing the number of breastfeedings D) Discussing the child's feeding patterns

Ans: D Feedback: Assessing the current feeding pattern and daily intake is the priority intervention. Talking about solid food consumption may not be appropriate for this child yet. Discouraging daily fruit juice intake or increasing the number of breastfeedings may not be necessary until the situation is assessed.

The nurse is promoting a healthy diet to guide a mother when feeding her 2-week-old girl. Which of the following is the most effective anticipatory guidance? A) Encouraging breastfeeding until the sixth month B) Advocating iron supplements with bottle-feeding C) Advising fluid intake per feeding of 5 or 6 ounces D) Discouraging the addition of fruit juice to the diet

Ans: D Feedback: Discouraging the addition of fruit juice to the child's diet is the most effective anticipatory guidance. Fruit juice can displace important nutrients from breast milk or formula. Encouraging breastfeeding until the sixth month is only halfway to the Healthy People goal of breastfeeding for the first year. Advising fluid intake per feeding of 5 or 6 ounces is too much for this neonate, but is typical for an infant 4 to 6 months of age. Advocating iron supplements with bottle-feeding is unnecessary so long as the formula is fortified with iron.

The nurse is teaching the parents of a 2-year-old girl how to deal with common toddler situations. Which is the best advice? A) Discipline the child for regressive behavior. B) Scold the child for public thumb sucking. C) Tell the older sibling to not act like a baby. D) Have the child help clean up a bowel accident.

Ans: D Feedback: Having the child help clean up a bowel accident is the best advice. Toddlers should never be punished for bowel or bladder "accidents," but gently reminded about toileting. Regressive behavior is best ignored, while appropriate behavior should be praised. Telling the older sibling to not act like a baby is a negative approach. It would be better to have the child be mother's helper. Calmly telling the child that thumb sucking is something that is done at home is better than scolding the child.

The nurse is conducting a pain assessment of a 10-year-old boy who has been taking acetaminophen for chronic knee pain. The assessment indicates that the recommended dose is no longer providing adequate relief. What is the appropriate nursing action? A) Increase the dosage of the acetaminophen. B) Tell the child he is experiencing the ceiling effect. C) Use guided imagery to help his pain. D) Obtain an order for a different medication.

Ans: D Feedback: Increasing the dose of the acetaminophen will not help his pain because he has reached as high a dose of that medication that will work. This is known as the ceiling effect, but explaining that to him will not help his pain. Guided imagery is not the best therapy for his pain, so the physician needs to order a different medication to manage his pain.

A mother is concerned about her infant's spitting up. Which suggestion would be most appropriate? A) "Put the infant in an infant seat after eating." B) "Limit burping to once during a feeding." C) "Feed the same amount but space out the feedings." D) "Keep the baby sitting up for about 30 minutes afterward."

Ans: D Feedback: Keeping the baby upright for 30 minutes after the feeding, burping the baby at least two or three times during feedings, and feeding smaller amounts on a more frequent basis may help to decrease spitting up. Positioning the infant in an infant seat compresses the stomach and is not recommended.

The neonatal nurse assesses newborns for iron-deficiency anemia. Which of the following newborns is at highest risk for this disorder? A) A postterm newborn B) A term newborn with jaundice C) A newborn born to a diabetic mother D) A premature newborn

Ans: D Feedback: Maternal iron stores are transferred to the fetus throughout the last trimester of pregnancy. Infants born prematurely miss all or at least a portion of this iron store transfer, placing them at increased risk for iron-deficiency anemia compared with term infants. An infant having jaundice, having been born to a mother with diabetes, or have been born postterm does not significantly place the infant at risk for iron-deficiency anemia.

Pentazocine is prescribed for a child with moderate pain. The nurse identifies this drug as an example of which type? A) Nonsteroidal anti-inflammatory drug (NSAID B) Prostaglandin inhibitor C) Opioid D) Mixed opioid agonist-antagonist

Ans: D Feedback: Pentazocine is classified as a mixed opioid agonist-antagonist. Ibuprofen, ketorolac, and naproxen are examples of NSAIDs that inhibit prostaglandin synthesis. Morphine, codeine, and fentanyl are examples of opioids.

The nurse is providing discharge teaching regarding formula preparation for a new mother. Which of the following guidelines would the nurse include in the teaching plan? A) Always wash bottles and nipples in hot soapy water and rinse well; do not wash them in the dishwasher. B) Store tightly covered ready-to-feed formula can after opening in refrigerator for up to 24 hours. C) Warm bottle of formula by placing bottle in a container of hot water, or microwaving formula. D) Do not add cereal to the formula in the bottle or sweeten the formula with honey.

Ans: D Feedback: Proper formula preparation includes the following: wash nipples and bottles in hot soapy water and rinse well or run nipples and bottles through the dishwasher; store tightly covered ready-to-feed formula can after opening in refrigerator for up to 48 hours; after mixing concentrate or powdered formula, store tightly covered in refrigerator for up to 48 hours; do not reheat and reuse partially used bottles; throw away the unused portion after each feeding; do not add cereal to the formula in the bottle; do not sweeten formula with honey; warm formula by placing bottle in a container of hot water; and do not microwave formula.

The nurse is developing a teaching plan for toddler safety to present at a parenting seminar. Which of the following are safety interventions that the nurse should address? A) Encourage parents to enroll toddlers in swimming classes to avoid the need for constant supervision around water. B) Advise parents to keep pot handles on stoves turned outward to avoid accidental burns. C) Encourage parents to smoke only in designated rooms in the house or outside the house. D) Advise parents to use a forward-facing car seat with harness straps and a clip, placed in the backseat of the car.

Ans: D Feedback: Safety is of prime concern throughout the toddler period. The safest place for the toddler to ride is in the back seat of the car. Parents should use the appropriate size and style of car seat for the child's weight and age as required by the state. At a minimum, all children over 20 pounds and up to 40 pounds should be in a forward-facing car seat with harness straps and a clip. Parents who want to enroll a toddler in a swimming class should be aware that a water safety skills class would be most appropriate. However, even toddlers who have completed a swimming program still need constant supervision in the water. Pot handles on stoves should be turned inward to avoid accidental burn. Nurses should counsel parents to stop smoking (optimal), but if they continue smoking never to smoke inside the home or car with children present.

The nurse emphasizes that a toddler younger than the age of 18 months should never be spanked primarily for which reason? A) Spanking in a child this age predisposes the child to a pro-violence attitude. B) The child will become resentful and angry, leading to more outbursts. C) Spanking demonstrates a poor model for problem-solving skills. D) There is an increased risk for physical injury in this age group.

Ans: D Feedback: Spanking should never be used with toddlers younger than 18 months of age because there is an increased possibility of physical injury. Although spanking or other forms of corporal punishment lead to a pro-violence attitude, create resentment and anger in the child, and are a poor model for learning effective problem-solving skills, the risk of physical injury in this age group is paramount.

The nurse is performing a cognitive assessment of a 2-year-old. Which of the following behaviors would alert the nurse to a developmental delay in this area? A) The child cannot say name, age, and gender. B) The child cannot follow a series of two independent commands. C) The child has a vocabulary of 40 to 50 words. D) The child does not point to named body parts.

Ans: D Feedback: The 2-year-old can point to named body parts and has a vocabulary of 40 to 50 words. At 30 months old a child can follow a series of two independent commands and at 3 years old a child can say name, age, and gender.

The nurse is using the acronym QUESTT to assess the pain of a child. Which of the following is an accurate descriptor of this process? A) Question the child's parents. B) Understand the child's pain level. C) Establish a caring relationship with the child. D) Take the cause of pain into account when intervening

Ans: D Feedback: The acronym QUESTT stands for the following: Question the child. Use a reliable and valid pain scale. Evaluate the child's behavior and physiologic changes to establish a baseline and determine the effectiveness of the intervention. The child's behavior and motor activity may include irritability and protection as well as withdrawal of the affected painful area. Secure the parent's involvement. Take the cause of pain into account when intervening. Take action.

The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which guidance will be most helpful for toilet teaching? A) Telling them either one may demonstrate toilet use B) Assuring them that bladder control occurs first C) Telling them that curiosity is a sure sign of readiness D) Advising them to use praise, not scolding

Ans: D Feedback: The most helpful guidance for toilet teaching is to urge the parents to use only praise, but never to scold, throughout the process. It is best for the same-sex parent to demonstrate toilet use. Bowel control will occur first. It may take additional months for nighttime bladder control to be achieved. Curiosity is a sign of readiness for toilet teaching, but by no means a sure sign.

Which tool would be the least appropriate scale for the nurse to use when assessing a 4-year-old child's pain? A) FACES pain rating scale B) Oucher pain rating scale C) Poker chip tool D) Numeric pain intensity scale

Ans: D Feedback: The numeric pain intensity scale can be used with children as young as 5 years of age, but the preferred minimum age for using this tool is 7 years. The FACES and Oucher pain rating scales and the poker chip tool are appropriate pain assessment tools for a 4-year-old.

The nurse is monitoring a child who has received epidural analgesia with morphine. The nurse is careful to monitor for which of the following adverse effects of the medication? A) Epidural hematoma B) Arachnoiditis C) Spinal headache D) Respiratory depression

Ans: D Feedback: The nurse needs to monitor for signs of respiratory depression, a potential adverse effect of the opioid medication. Epidural hematoma, arachnoiditis, and spinal headache are potential adverse effects of the insertion of the epidural catheter.

The nurse is caring for a toddler who is in Piaget's sensorimotor stage of cognitive development. Which of the following tasks would the nurse expect the toddler to be able to perform? A) Completing puzzles with four pieces B) Winding up a mechanical toy C) Playing make-believe with dolls D) Knowing which are his or her toys

Ans: D Feedback: The toddler in Piaget's sensorimotor stage of cognitive development (18 to 24 months) understands requests, is capable of following simple directions, and has a sense of ownership (knowing which toys are his). The other tasks are accomplished by the child in the preoperational stage (2 to 7 years).

The nurse is providing instructions to a mother on how to use thought stopping to help her child deal with anxiety and fear associated with frequent painful injections. Which of the following statements indicates the mother understands the technique? A) "We will imagine that we are on the beach in Florida." B) "We can talk about our favorite funny movie and laugh." C) "She can let her body parts go limp, working from head to toe." D) "We'll repeat 'quick stick, feel better, go home soon' several times

Ans: D Feedback: Thought stopping is a technique that involves the use of short, concise phrases of positive ideas. Doing so helps to promote the child's sense of control. Imagining a favorite beach in Florida is using imagery. Talking about a favorite funny movie involves humor. Letting body parts go limp is a relaxation technique.

The nurse is designing a nursing care plan for a toddler with lymphoma, who is hospitalized for treatment. Which of the following is a priority intervention that the nurse should include in this child's nursing plan? A) Limiting visitors to scheduled visiting hours B) Planning physical therapy for the child C) Introducing the toddler to other toddlers in the unit D) Monitoring the toddler for developmental delays

Ans: D Feedback: When the toddler is hospitalized, growth and development may be altered. The toddler's primary task is establishing autonomy, and the toddler's focus is mobility and language development. The nurse caring for the hospitalized toddler must use knowledge of normal growth and development to be successful in interactions with the toddler, promote continued development, and recognize delays. Parents should be encouraged to stay with the toddler to avoid separation anxiety. Planning activities and socialization of the toddler is important, but the priority intervention is monitoring for, and addressing, developmental delays that may occur in the hospital.

The nurse uses the FLACC behavioral scale to assess a 6-year-old's level of postoperative pain and obtains a score of 9. The nurse interprets this to indicate that the child is experiencing: A) Little to no pain B) Mild pain C) Moderate pain D) Severe pain

Ans: D Feedback: With the FLACC behavioral scale, five parameters are measured and scored as 0, 1, or 2. They are then totaled to achieve a maximum score of 10. The higher the score, the greater the pain. A score of 9 indicates severe pain.

The nurse is choosing foods for a toddler's diet that are high in vitamin A. Which of the following could be added to the menu? Select all answers that apply. A) Applesauce B) Avocados C) Broccoli D) Sweet potatoes E) Spinach F) Carrots

Ans: D, E, F Feedback: Foods that are high in vitamin A include apricots, cantaloupe, carrots, mangos, spinach and dark greens, and sweet potatoes. Applesauce is high in fiber, and avocados and broccoli are high in folate.

The nurse is preparing a class for a group of adolescents about promoting safety. Which of the following would the nurse plan to include as the leading cause of adolescent injuries? A) Car accidents B) Firearms C) Water D) Fires

Ans: A Feedback: Although firearms, water, and fires all pose a risk for injury for adolescents, most adolescent injuries are due to motor vehicle crashes.

The nurse is caring for a 7-year-old girl who is scheduled for a hernia repair and is very scared. Which of the following fears would she also most likely have at this age? A) Fear of being kidnapped B) Fear of cutting her finger C) Fear of sudden loud noises D) Fear of the neighbor's dog

Ans: A Feedback: At this age, the child will be fearful of being kidnapped. She should have outgrown her fears of harm to her body, noises, and dogs, all of which are typical preschooler fears.

After teaching the parents of a 9-year-old girl about safety, which statement indicates the need for additional teaching? A) "She can ride in the front seat of the car once she is 10 years old." B) "We need to buy her a helmet so she can ride her scooter." C) "She should ride her bike with the traffic on the side of the road." D) "We signed her up for swim lesions at the local community center."

Ans: A Feedback: Children younger than 12 years of age must sit in the back seat of the car. Laws in most states require helmets for riding bicycles and scooters. When riding a bike, the child should ride on the side of the road traveling with the traffic. Children should know how to swim. If swimming skills are limited, the child must wear a life preserver at all times.

The nurse explains to parents of school-age children that according to Kohlberg's theory of moral development, their child is at the conventional stage of moral development. What is the motivation for school-age children to follow rules? A) They follow rules out of a sense of being a "good person." B) They follow rules out of fear of being punished. C) They follow rules in order to receive praise from caretakers. D) They follow rules because it is in their nature to do so.

Ans: A Feedback: During the school-age years, the child's sense of morality is constantly being developed. According to Kohlberg, the school-age child is at the conventional stage of moral development. The 7- to 10-year-old usually follows rules out of a sense of being a "good person." He or she wants to be a good person to his or her parents, friends, and teachers and to himself or herself.

The nurse observing toddlers in a day care center notes that they may be happy and pleasant one moment and overreact to limit setting the next minute by throwing a tantrum. What is the focus of the toddler's developmental task that is driving this behavior? A) The need for separation and control B) The need for love and belonging C) The need for safety and security D) The need for peer approval

Ans: A Feedback: Emotional development in the toddler years is focused on separation and individuation. The focus in infancy is on love and belonging, and the need for peer approval occurs in the adolescent. Safety and security are concerns in all levels of development, but not the primary focus.

The nurse knows that the school-age child is in Erikson's stage of industry versus inferiority. Which of the following is the best example of a school-ager working toward accomplishing this developmental task? A) The child signs up for after-school activities. B) The child performs his bedtime preparations autonomously. C) The child becomes aware of the opposite sex. D) The child is developing a conscience.

Ans: A Feedback: Erikson (1963) describes the task of the school-age years to be a sense of industry versus inferiority. During this time, the child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community, which develops his or her cognitive and social skills. Achieving independence is a task of the preschooler who also is developing a conscience at that age. Awareness of the opposite sex occurs in, but is not the focus of, the school-age child.

The mother of a 14-year-old girl complains to the nurse that her daughter is moody, shuts herself in her room, and fights with her younger sister. Which of the following comments is most valuable to the mother? A) "Calmly talk to her about your concerns." B) "This is normal for her age." C) "She may be hanging with a bad crowd." D) "Set some rules for family etiquette."

Ans: A Feedback: Getting the mother and daughter talking and sharing information is the most valuable advice. Telling the mother that this is normal does nothing for the family situation. Setting rules will alienate the child. Suggesting an underlying problem can cause a rift between the mother and daughter.

The mother of a 7-year-old girl tells the school nurse that her child is deathly afraid of going to school. What would be the best intervention the nurse could suggest in this situation? A) Return the child to school and investigate the cause of the fear. B) Have the child stay home from school until any issues causing this fear are resolved. C) Investigate a new school for the child to attend that the child will not be afraid of. D) Tell the child that privileges will be taken away if she does not return to school.

Ans: A Feedback: It is important to investigate specific causes of school refusal/school phobia and take appropriate action. The parents should return the child to school, investigate the cause of the fear, support the child, collaborate with teachers, and praise success in school attendance. This is not a situation for punishment, and changing schools would not solve the child's school phobia.

After teaching a group of parents about language development in toddlers, which of the following if stated by a member of the group indicates successful teaching? A) "When my 3-year-old asks 'why?' all the time, this is completely normal." B) "A 15-month-old should be able to point to his eyes when asked to do so." C) "At age 2 years, my son should be able to understand things like under or on." D) "An 18-month-old would most likely use words and gestures to communicate."

Ans: A Feedback: Language development occurs rapidly in a toddler. By age 3 years, the child asks "why?" Pointing to named body parts is characteristic of a 2-year-old. Understanding concepts such as on, under, or in is typical of a 3-year-old. A 1-year-old would communicate with words and gestures.

The parents of a 4-year-old who is a picky eater ask the nurse what foods to include in their child's diet to provide adequate iron consumption. Which of the following foods would the nurse recommend? A) Cooked lentils B) Whole milk C) Oranges D) Sweet potatoes

Ans: A Feedback: Lentils are a good source of iron. Whole milk, oranges, and sweet potatoes are good sources of calcium.

When providing anticipatory guidance to parents about lying during the preschool period, which of the following would the nurse emphasize? A) "You need to determine the reason for lying before punishing the child." B) "Lying typically occurs because the child is afraid of being punished." C) "The misbehavior is usually more serious than the lying itself." D) "It is okay to become angry when dealing with the child's lying."

Ans: A Feedback: Lying is common in preschool children and occurs for a variety of reasons, such as fearing punishment, getting carried away by imagination, or imitating what another person has done. Regardless, the parent should ascertain the reason for the lying before punishing the child. The child also needs to learn that the lying is usually far worse than the misbehavior. Parents need to remain calm and serve as a role model of an even temper.

The nurse is describing the maturation of various organ systems during toddlerhood to the parents. Which would the nurse correctly include in this description? A) Myelinization of the brain and spinal cord is complete at about 24 months. B) Alveoli reach adult numbers by 3 years of age. C) Urine output in a toddler typically averages approximately 30 mL/hour. D) Toddlers typically have strong abdominal muscles by the age of 2.

Ans: A Feedback: Myelinization of the brain and spinal cord continues to progress and is complete around 24 months of age. Alveoli reach adult numbers usually around the age of 7. Urine output in a toddler typically averages 1 mL/kg/hour. Abdominal musculature in a toddler is weak, resulting in a pot-bellied appearance.

When observing a group of preschoolers at play in the clinic waiting room, which type of play would the nurse be least likely to note? A) Parallel play B) Cooperative play C) Dramatic play D) Fantasy play

Ans: A Feedback: Parallel play is associated with toddlers. Cooperative, dramatic, and fantasy play are commonly used by preschoolers.

The nurse is conducting a well-child assessment for a 5-year-old boy in preparation for kindergarten. The boy's grandmother is his primary caregiver because the boy's mother has suffered from depression and substance abuse issues. The nurse understands that the child is at increased risk for which developmental problem? A) Lack of social and emotional readiness for school B) Stuttering C) Speech and language delays D) Fine motor skills delay

Ans: A Feedback: Risk factors for lack of social and emotional readiness for school include insecure attachment in the early years, maternal depression, parental substance abuse, and low socioeconomic status.

The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally happy and outgoing 5-year-old sister is acting sad and withdrawn. The nurse understands that due to her developmental stage, the girl is at risk of which of the following? A) Viewing her baby sister's illness as her fault B) Harming the baby C) Experiencing clinical depression D) Creating an imaginary friend to cope with the situation

Ans: A Feedback: Since the preschool child is facing the psychosocial task of initiative versus guilt, it is natural for the child to experience guilt when something goes wrong. The child may have a strong belief that if someone is ill or dying, he or she may be at fault and the illness or death is punishment. It is less likely that the girl would be at risk of harming the baby or experiencing clinical depression as a result of the baby's illness. The child may create an imaginary friend to cope with the illness, but would not withdraw or express sadness as a result of the imaginary friend.

The nurse is helping the parents and their underweight adolescent collaborate on planning a healthy menu. Of which of the following nutritional requirements of adolescents should the nurse be aware? A) Teenagers have a need for increased calories, zinc, calcium, and iron for growth. B) Teenage girls who are active require about 1,800 calories per day. C) Teenage boys who are active require between 2,000 and 2,500 calories per day. D) Adolescents require about 1,000 to 1,200 mg of calcium each day.

Ans: A Feedback: Teenagers have a need for increased calories, zinc, calcium, and iron for growth. However, the number of calories needed for adolescence depends on the teen's age and activity level as well as growth patterns. Teenage girls who are active require about 2,200 calories per day. Teenage boys who are active require between 2,500 and 3,000 calories per day. Adolescents require about 1,200 to 1,500 mg of calcium each day.

The nurse is interviewing a 3-year-old girl who tells the nurse: "Want go potty." The parents tell the nurse that their daughter often speaks in this type of broken speech. What would be the nurse's appropriate response to this concern? A) "This is a normal, common speech pattern in the 3-year-old and is called telegraphic speech." B) "This is considered a developmental delay in the 3-year-old and we should consult a speech therapist." C) "This is a condition known as echolalia and can be corrected if you work with your daughter on language skills." D) "This is a condition known as stuttering and it is a normal pattern of speech development in the toddler."

Ans: A Feedback: Telegraphic speech is common in the 3-year-old. Telegraphic speech refers to speech that contains only the essential words to get the point across, much like a telegram. In telegraphic speech the nouns and verbs are present and are verbalized in the appropriate order. Echolalia (repetition of words and phrases without understanding) normally occurs in toddlers younger than 30 months of age. "Why" and "what" questions dominate the older toddler's language. Stuttering usually has its onset at between 2 and 4 years of age. It occurs more often in boys than in girls. About 75% of all cases of stuttering resolve within 1 to 2 years after they start.

The parents of a 1-year-old girl, both of whom have perfect teeth, are concerned about their child getting dental caries. Which is the best advice the nurse can provide? A) Tell the parents to limit the child's eating to meal and snack times. B) Urge the parents to take the child to a dentist for a check-up. C) Advise the parents to reduce carbohydrates in the child's diet. D) Advise the parents to use fluoride toothpaste.

Ans: A Feedback: Telling the parents to limit eating to meal and snack times is the best advice for preventing dental caries. This reduces the amount of exposure the child's teeth have to food. Urging them to take the child to see a dentist is sound advice but doesn't suggest actions they can take now to prevent caries. Carbohydrates react with oral bacteria to cause caries, but they should not be reduced from the diet. Avoiding fluoridated toothpaste may help prevent fluorosis.

The nurse teaches parents of adolescents that adolescents need the support of parents and nurses to facilitate healthy lifestyles. Which of the following should be a priority focus of this guidance? A) Reducing risk-taking behavior B) Promoting adequate physical growth C) Maximizing learning potential D) Teaching personal hygiene routines

Ans: A Feedback: The adolescent experiences drastic changes in the physical, cognitive, psychosocial, and psychosexual areas. With this rapid growth during adolescence, the development of secondary sexual characteristics, and interest in the opposite sex, the adolescent needs the support and guidance of parents and nurses to facilitate healthy lifestyles and to reduce risk-taking behaviors. Promoting physical growth, maximizing learning potential, and teaching hygiene are secondary to reducing risky behavior.

The nurse is explaining to parents that the preschooler's developmental task is focused on the development of initiative rather than guilt. Which of the following is a priority intervention the nurse might recommend for parents of preschoolers to stimulate initiative? A) Reward the child for initiative in order to build self-esteem. B) Change the routine of the preschooler often to stimulate initiative. C) Do not set limits on the preschooler's behavior as this results in low self-esteem. D) As a parent, decide how and with whom the child will play.

Ans: A Feedback: The building of self-esteem continues throughout the preschool period. It is of particular importance during these years, as the preschooler's developmental task is focused on the development of initiative rather than guilt. A sense of guilt will contribute to low self-esteem, whereas a child who is rewarded for his or her initiative will have increased self-confidence. Routine and ritual continue to be important throughout the preschool years, as they help the child to develop a sense of time as well as provide the structure for the child to feel safe and secure. Also, consistent limits provide the preschooler with expectation and guidance. Giving children opportunities to decide how and with whom they want to play also helps them develop initiative.

The nurse is performing an annual check-up for an 8-year-old child. Compared to the previous assessment of this child, which of the following characteristics would most likely be observed? A) Breathing is diaphragmatic. B) Pulse rate is increased. C) Secondary sex characteristics are present. D) Blood pressure has reached adult level.

Ans: A Feedback: The child's respiratory system is maturing, so abdominal breathing has been replaced by diaphragmatic breathing. Pulse rate will decrease, rather than increase, during this time. Secondary sex characteristics will not appear until the late school-age years. Blood pressure will not reach the adult level until adolescence.

The nurse is teaching the parents of an overweight 18-month-old girl about diet. Which intervention will be most effective for promoting proportionate growth? A) Remove high-calorie, low-nutrient foods from the diet. B) Ensure 30 minutes of unstructured activity per day. C) Avoid sharing your snacks and candy with the child. D) Reduce the amount of high-fat food the child eats.

Ans: A Feedback: The most effective intervention will be to remove high-calorie, low-nutrient foods from the diet in order to reduce the number of calories and increase the nutritional value. Exercise is also important, but a child this age should have 30 minutes of structured physical activity plus several hours of unstructured physical activity per day. The parents should set an example for good eating habits. Dietary fat should not be restricted for an 18-month-old child because it is necessary for nervous system development.

During a health check-up without his parents, a 17-year-old tells the nurse he is gay. Which of the following approaches should the nurse take? A) "Tell me what makes you think you are gay." B) "This puts you in an at-risk category." C) "We need to talk about safe sex." D) "You're not gay; you're confused."

Ans: A Feedback: The nurse needs to get more information from the teenager (assessment) before making any comment and then proceed in a sensitive and caring way. Comments about being at risk or needing to know about safe sex are negative and should be replaced with health promotion comments. Denying the statement shows the teenager that you are not an ally.

The nurse is caring for a 5-year-old girl posttonsillectomy. The girl looks out the window and tells the nurse that it is raining and says, "The sky is crying because it is sad that my throat hurts." The nurse understands that the girl is demonstrating which mental process? A) Magical thinking B) Centration C) Transduction D) Animism

Ans: A Feedback: The nurse understands that the girl is demonstrating magical thinking. Magical thinking is a normal part of preschool development. The preschool-age child believes her thoughts to be all-powerful. Transduction is reasoning by viewing one situation as the basis for another situation whether or not they are truly causally linked. Animism is attributing life-like qualities to inanimate objects. Centration is focusing on one aspect of a situation while neglecting others.

The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration? A) A less discriminating sense of taste B) A lack of fully developed hearing C) Visual acuity that has not fully developed D) A less discriminating sense of touch

Ans: A Feedback: The young preschooler may have a less discriminating sense of taste than the older child, making him or her at increased risk for accidental ingestion. A less discriminating sense of touch and developing visual acuity would not increase the risk. Hearing is intact at birth and it does not increase the child's risk for accidental ingestion.

A mother brings her 6-year-old son in for a check-up because the child is complaining of stomachaches. It is the beginning of the school year. Which of the following might the mother also mention? A) The child cries before going to school. B) The child made friends the first day of school. C) The child fights with siblings more often. D) The child loves the crowds in the lunchroom.

Ans: A Feedback: This child has a slow-to-warm-up temperament. The child may also be crying before going to school. Making friends the first day of school and enjoying the crowds in the lunchroom are typical of a child with an easy temperament. Irritability is typical of a child with a difficult temperament.

The nurse is watching toddlers at play. Which of the following normal behaviors would the nurse observe? A) Toddlers engage in parallel play. B) Toddlers engage in solitary play. C) Toddlers engage in cooperative play. D) Toddlers do not engage in play outside the home.

Ans: A Feedback: Toddlers typically play alongside another child (parallel play) rather than cooperatively. Infants engage in solitary play.

The nurse is assessing the psychosocial development of a preschooler. Which of the following are normal activities characteristic of the preschooler? Select all answers that apply. A) Plans activities and makes up games B) Initiates activities with others C) Acts out roles of other people D) Engages in parallel play with peers E) Classifies or groups objects by their common elements F) Understands relationships among objects

Ans: A, B, C Feedback: The many activities of the preschooler include beginning to plan activities, making up games, initiating activities with others, and acting out the roles of other people (real and imaginary). Toddlers engage in parallel play; preschoolers engage in cooperative play. School-age children classify or group objects by common elements and understand relationships among objects.

The nurse is caring for preschoolers in a day care center. Of which of the following developmental milestones of this age group should the nurse be aware? Select all answers that apply. A) Counting 10 or more objects B) Correctly naming at least four colors C) Understanding the concept of time D) Knowing everyday objects E) Understanding the differences of others F) Forming concepts as logical as an adult's

Ans: A, B, C, D Feedback: The child in the intuitive phase can count 10 or more objects, correctly name at least four colors, and better understand the concept of time, and he or she knows about things that are used in everyday life, such as appliances, money, and food. The preschooler forms concepts that are not as complete or as logical as the adult's, and tolerates others' differences but doesn't understand them.

The school nurse providing school health screenings knows that the 7- to 11-year-old is in Piaget's stage of concrete operational thoughts. Which of the following should this age group accomplish when developing operations? Select all answers that apply. A) Ability to assimilate and coordinate information about the world from different dimensions B) Ability to see things from another person's point of view and think through an action C) Ability to use stored memories of past experiences to evaluate and interpret present situations D) Ability to think about a problem from all points of view, ranking the possible solutions while solving the problem E) Ability to think outside of the present and incorporate into thinking concepts that do exist as well as concepts that might exist F) Ability to understand the principle of conservation—that matter does not change when its form changes

Ans: A, B, C, F Feedback: Piaget's stage of cognitive development for the 7- to 11-year-old is the period of concrete operational thoughts. In developing concrete operations, the child is able to assimilate and coordinate information about the world from different dimensions. He or she is able to see things from another person's point of view and think through an action, anticipating its consequences and the possibility of having to rethink the action. The school-age child is able to use stored memories of past experiences to evaluate and interpret present situations. Also, during concrete operational thinking, the school-age child develops an understanding of the principle of conservation—that matter does not change when its form changes. According to Piaget, the adolescent progresses from a concrete framework of thinking to an abstract one in the formal operational period. During this period, the adolescent is able to think about a problem from all points of view, ranking the possible solutions while solving the problem. The adolescent also develops the ability to think outside of the present; that is, he or she can incorporate into thinking concepts that do exist as well as concepts that might exist. His or her thinking becomes logical, organized, and consistent.

The nurse is teaching the parents of a 4-year-old boy about the normal maturations of the child's organs during the preschool years and their effect on body functions. Which of the following statements accurately describe these changes? Select all answers that apply. A) Myelination of the spinal cord allows for bowel and bladder control to be complete in most children by age 3 years. B) The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult number at about 7 years of age. C) Heart rate increases and blood pressure decreases slightly during the preschool years; an innocent heart murmur may be heard upon auscultation. D) The bones continue to increase in length and the muscles continue to strengthen and mature; however, the musculoskeletal system is still not fully mature. E) The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average preschooler. F) The urethra remains long in both boys and girls, making them more susceptible to urinary tract infections than adults.

Ans: A, B, D, E Feedback: Most of the body systems have matured by the preschool years. Myelination of the spinal cord allows for bowel and bladder control to be complete in most children by age 3 years. The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult number at about 7 years of age. The bones continue to increase in length and the muscles continue to strengthen and mature. However, the musculoskeletal system is still not fully mature. The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average preschooler. The 4-year-old generally has adequate bowel control. Heart rate decreases and blood pressure increases slightly during the preschool years. An innocent heart murmur may be heard upon auscultation. The urethra remains short in both boys and girls, making them more susceptible to urinary tract infections than adults.

The school nurse is helping parents choose books for their preschoolers. What literacy skills present in the preschooler would the nurse consider when making choices? Select all answers that apply. A) Preschoolers enjoy books with pictures that tell stories. B) Preschoolers like stories with repeated phrases as they help keep their attention. C) Preschoolers like stories that describe experiences different from their own. D) Preschoolers demonstrate early literacy skills by reciting stories or portions of books. E) Preschoolers may retell the story from the book, pretend to read books, and ask questions about the story. F) Preschoolers do not have enough focus and expanded attention to notice when a page is skipped during reading.

Ans: A, B, D, E Feedback: Preschoolers enjoy books with pictures that tell stories. Stories with repeated phrases help to keep the child's attention. Also, children like stories that describe experiences similar to their own. The preschool child demonstrates early literacy skills by reciting stories or portions of books. He or she also may retell the story from the book, pretend to read books, and ask questions about the story. The preschool child has enough focus and expanded attention to notice when a page is skipped during reading and will call it to the parent's attention.

When assessing adolescents for health risks, the nurse must keep in mind the factors related to the prevalence of adolescent injuries. Which of the following accurately describe these factors? Select all answers that apply. A) Increased physical growth B) Insufficient psychomotor coordination C) Tiredness, lack of energy D) Lack of impulsivity E) Peer pressure F) Inexperience

Ans: A, B, E, F Feedback: Influencing factors related to the prevalence of adolescent injuries include increased physical growth, insufficient psychomotor coordination for the task, abundance of energy, impulsivity, peer pressure, and inexperience. Impulsivity, inexperience, and peer pressure may place the teen in a vulnerable situation between knowing what is right and wanting to impress peers. On the other hand, teens have a feeling of invulnerability, which may contribute to negative outcomes.

The school nurse is teaching parents risk factors for suicide in adolescents. Which of the following would the nurse discuss? Select all answers that apply. A) Mental health changes B) History of previous suicide attempt C) Higher socioeconomic status D) Greatly improved school performance E) Family disorganization F) Substance abuse

Ans: A, B, E, F Feedback: Suicide is the third leading cause of death in adolescents 15 to 19 years of age. Risk factors for suicide include mental health changes, history of previous suicide attempt, family disorganization, and substance abuse. Other risk factors include poor school performance, crowded conditions/housing, low socioeconomic status, limited parental supervision, single-parent families/both parents in workforce, access to guns or cars, drug or alcohol use, low self-esteem, racism, peer or gang pressure, and aggression.

The school nurse is conducting a seminar for parents of adolescents on how to communicate with teenagers. Which of the following guidelines might the nurse recommend? Select all answers that apply. A) Talk face to face and be aware of body language. B) Ask questions to see why he or she feels that way. C) Do not give praise unless the adolescent deserves it. D) Speak to your child as an authority figure, not an equal. E) Don't admit that you make mistakes. F) Don't pretend you know all the answers.

Ans: A, B, F Feedback: In order to improve communication with teenagers, the parents should talk face to face and be aware of body language, ask questions to see why the teenager feels that way, not pretend they know all the answers, give praise and approval to the teenager often, speak to him or her as an equal (not talk down to him or her), and admit that they do make mistakes.

After assessing a 10-year-old girl, the nurse documents the appearance of breast buds, identifying this as which of the following? A) Menarche B) Thelarche C) Puberty D) Tanner stage 5

Ans: B Feedback: "Thelarche" is the term used to describe breast budding. Menarche refers to the first menstrual period. Puberty refers to the biological changes that occur during adolescence. Tanner stage 5 involves maturation of the breast tissue to adult configuration.

Based on Erikson's developmental theory, which of the following is the major developmental task of the adolescent? A) Gaining independence B) Finding an identity C) Coordinating information D) Mastering motor skills

Ans: B Feedback: According to Erikson, it is during adolescence that teenagers achieve a sense of identity. The toddler developed a sense of trust in infancy and is ready to give up dependence and to assert his or her sense of control and autonomy. The psychosocial task of the preschool years is establishing a sense of initiative versus guilt by mastering skills. In the school-age years the child develops concrete operations and is able to assimilate and coordinate information about the world from different dimensions.

The school nurse is preparing a program on sexuality and birth control for a class of 14- to 16-year-olds. Which of the following behaviors will have the most influence on how the information is presented? A) Teens are adjusting to new body images. B) Adolescents tend to take risks. C) Teenagers are able to think in the abstract. D) Adolescents understand that actions have consequences.

Ans: B Feedback: Adolescents are risk takers. This tendency enables them to overcome common sense and their own better judgment. Although adolescents are capable of abstract thinking and understand that actions have consequences, they are not yet committed to these attributes. Changing body image would not have significant influence on the presentation.

When providing anticipatory guidance to a group of parents with school-aged children, which of the following would the nurse describe as the most important aspect of social interaction? A) School B) Peer relationships C) Family D) Temperament

Ans: B Feedback: Although school, family, and temperament are important influences on social interaction, peer relationships at this time provide the most important social interaction for school-age children.

The nurse is talking with a chatty 7-year-old girl during her regular check-up. Which of the following behaviors would the child also be expected to exhibit? A) Showing no interest in what the nurse sees in her ears B) Explaining what is right and what is wrong C) Demonstrating independence from her mother D) Showing no concern when the nurse hurts her own finger

Ans: B Feedback: At this age, behavior is seen by the child as either completely right or wrong. The child will almost surely want to know why the nurse looks in her ears. The child depends heavily on parents for support and encouragement at this age. This is a time when children gain empathy, so the child would show concern for the nurse's injury.

The nurse is assessing a 2-year-old boy who has missed some developmental milestones. Which finding will point to the cause of motor skill delays? A) The mother is suffering from depression. B) The child is homeless and has no toys. C) The mother describes an inadequate diet. D) The child is unperturbed by a loud noise.

Ans: B Feedback: Children develop through play, so a child without any toys may have trouble developing the motor skills appropriate to his age. Maternal depression is a risk factor for poor cognitive development. Inadequate diet will cause growth deficiencies. A child who does not respond to a loud noise probably has hearing loss, which will lead to a language deficit.

The nurse is observing a 24-month-old boy in a day care center. Which finding suggests delayed motor development? A) The child has trouble undressing himself. B) The child is unable to push a toy lawnmower. C) The child is unable to unscrew a jar lid. D) The child falls when he bends over.

Ans: B Feedback: Children with normal motor development are able to push toys with wheels at 24 months of age. He won't be ready to undress himself, unscrew a jar lid, or bend over without falling until about 36 months of age.

During a health history, the nurse explores the sleeping habits of a 3-yearold boy by interviewing his parents. Which of the following statements from the parents reflects a recommended guideline for promoting healthy sleep in this age group? A) "Our son sleeps through the night, and we insist that he takes two naps a day." B) "We keep a strict bedtime ritual for our son, which includes a bath and bedtime story." C) "Our son still sleeps in a crib because we feel it is the safest place for him at night." D) "Our son occasionally experiences night walking so we allow him to stay up later when this happens."

Ans: B Feedback: Consistent bedtime rituals help the toddler prepare for sleep; the parent should be advised to choose a bedtime and stick to it as much as possible. The nightly routine might include a bath followed by reading a story. A typical toddler should sleep through the night and take one daytime nap. Most children discontinue daytime napping at around 3 years of age. When the crib becomes unsafe (that is, when the toddler becomes physically capable of climbing over the rails), then he or she must make the transition to a bed. Attention during night waking should be minimized so that the toddler receives no reward for being awake at night.

The nurse is teaching the parents of a 9-year-old girl about the socialization that is occurring in their child through school contacts. Which of the following information would the nurse include in her teaching plan? A) Teachers are the most influential people in the development of the school-age child's social network. B) Continuous peer relationships provide the most important social interaction for school-age children. C) Parents should establish norms and standards that signify acceptance or rejection. D) A characteristic of school-age children is their formation of groups with no rules and values involved.

Ans: B Feedback: Continuous peer relationships provide the most important social interaction for school-age children. Peer and peer-group identification are most essential to the socialization of the school-age child. Peer groups establish norms and standards that signify acceptance or rejection. Valuable lessons are learned from interactions with children their own age. A characteristic of school-age children is their formation of groups with rules and values.

The parents of a 5-year-old boy tell the nurse that their son is having frequent episodes of night terrors. Which of the following statements would indicate that the boy is having nightmares instead of night terrors? A) "It usually happens about an hour after he falls asleep." B) "He will tell us about what happened in his dream." C) "He is completely unaware that we are there." D) "When we try to comfort him, he screams even more."

Ans: B Feedback: During a nightmare, a child will have a memory of the occurrence and may remember the dream and talk about it later. With night terrors, the child has no memory of the event. The other statements are indicative of night terrors.

Which of the following would the nurse most likely find in a 10-year-old child in the period of concrete operational thought? A) Participation in abstract thinking B) Ability to classify similar objects C) Problem solving via the scientific method D) Ability to make independent decisions

Ans: B Feedback: During the period of concrete operational thought, children are able to classify or group objects based on their common elements. Abstract thinking, problem solving via the scientific method, and independent decision making are higher-level functions, typically seen in adolescents.

The nurse is teaching the parents of a 2-year-old toddler methods of dealing with their child's "negativism." Based on Erokson's theory of development, which of the following would be an appropriate intervention for this child? A) Discourage solitary play; encourage playing with other children. B) Encourage the child to pick out his own clothes. C) Use "time-outs" whenever the child says "no" inappropriately. D) Encourage the child to take turns when playing games.

Ans: B Feedback: Erikson defines the toddler period as a time of autonomy versus shame and doubt. It is a time of exerting independence. Allowing the child to choose his own clothes helps him to assert his independence. Negativism—always saying "no"—is a normal part of healthy development and is occurring as a result of the toddler's attempt to assert his or her independence. It should not be punished with "time-outs." The toddler should be encouraged to play alone and with other children. Toddlers cannot take turns in games until age 3.

The nurse is performing a physical assessment of a 10-year-old boy. The nurse notes that during last year's check-up the child weighed 80 pounds. According to average growth for this age group, what would be his expected current weight? A) 83 pounds B) 85 pounds C) 87 pounds D) 89 pounds

Ans: B Feedback: From 6 to 12 years of age, an increase of 4 to 6 pounds (2 to 3 kg) per year in weight is expected.

The nurse is performing a physical examination of an 11-year-old girl. Which of the following observations would be expected? A) The child has not gained weight since last year. B) The child has grown 3 inches since last year. C) The child breathes abdominally. D) The child's third molars are about to erupt.

Ans: B Feedback: From 6 to 12 years of age, children grow an average of 2 inches (5 cm) per year, increasing their height by at least 1 foot. An increase of 4 to 6 pounds (2 to 3 kg) per year in weight is expected. Abdominal breathing is typical of a preschooler and would have disappeared several years earlier. The third molars do not erupt until late adolescence.

The nurse is teaching the parents of a 12-year-old boy about appropriate approaches when raising an adolescent. Which of the following comments should be included in the discussion? A) "Find out if his friends are worthy of him." B) "Try to be open to his views." C) "Maintain a firm set of rules." D) "Remind him that he is still your little boy."

Ans: B Feedback: It is most important to be open to the child's views. This will encourage the child to consider parental concerns and promote communication. Being judgmental about his friends will make the child defensive about his choice of friends. Rules need to be flexible so they can apply to new situations. Avoid condescension. The child will appreciate being treated like a young man.

The school nurse is performing a physical examination on a 13-year-old boy who is on the soccer team. Which of the following is a physical quality that develops during these early adolescent years? A) Coordination B) Endurance C) Speed D) Accuracy

Ans: B Feedback: It is usually during early adolescence that teenagers begin to develop endurance. Their concentration has increased so they can follow complicated instructions. Coordination can be a problem because of the uneven growth spurts. During middle adolescence, speed and accuracy increase while coordination also improves.

The parents of a 2-year-old girl are frustrated by the frequent confrontations they have with their child. Which is the best anticipatory guidance the nurse can offer them? A) "Respond in a calm but firm manner." B) "You need to adhere to various routines." C) "Put her in time-out when she misbehaves." D) "It's important to toddler-proof your home."

Ans: B Feedback: Making expectations known through everyday routines helps to avoid confrontations. This helps the child know what to expect and how to behave. It is the best guidance to give these parents. Calm response and time-out are effective ways to discipline, but do not help to prevent confrontations. Toddler-proofing the house doesn't eliminate all the opportunities for confrontation.

When instructing the parents of a toddler about appropriate nutrition, which of the following would the nurse recommend? A) About 12 to 16 ounces of fruit juice per day B) Approximately 16 to 24 ounces of milk per day C) Fat intake of 30% to 40% of total calories D) An average of 10 to 12 grams of fiber per day

Ans: B Feedback: Milk intake should be limited to 16 to 24 ounces per day, with fruit juice limited to 4 to 6 ounces per day. A toddler's total fat intake should be 20% to 30% of total calories. The daily recommended fiber intake is 19 grams.

The school nurse knows that dating is a milestone for adolescents. Which of the following statements accurately describes a trend in teen dating? A) Most late adolescents spend more time in activities with mixed-sex groups, such as dances and parties, than they do dating as a couple. B) Most teens have been involved in at least one romantic relationship by middle adolescence. C) Teens that date frequently report slightly lower levels of self-esteem and decreased autonomy. D) Homosexual behavior as a teen usually indicates that the adolescent will maintain a homosexual orientation.

Ans: B Feedback: Most teens have been involved in at least one romantic relationship by middle adolescence. Most early adolescents spend more time in activities with mixed-sex groups, such as dances and parties, than they do dating as a couple. Teens who date frequently report slightly higher levels of self-esteem and increased autonomy. Homosexual behavior as a teen does not necessarily indicate that the adolescent will maintain a homosexual orientation.

The nurse is providing anticipatory guidance for parents of a preschooler regarding sex education. Which of the following is a recommended guideline when dealing with this issue? A) Be prepared to thoroughly cover a topic before the child asks about it. B) Before answering questions, find out what the child thinks about the subject. C) Expand upon the topic when answering questions to prevent further confusion. D) Provide a less than honest response to shelter the child from knowledge that is too advanced.

Ans: B Feedback: Preschoolers are very inquisitive and want to learn about everything around them; therefore, they are very likely to ask questions about sex and where babies come from. Before attempting to answer questions, parents should try to find out first what the child is really asking and what the child already thinks about that subject. Then they should provide a simple, direct, and honest answer. The child needs only the information that he or she is requesting.

The nurse is providing anticipatory guidance for parents of a school-age child on teaching the dangers of drugs and alcohol. Which of the following advice might be helpful for these parents? A) School-age children are not ready to absorb information that deals with drugs and alcohol. B) School-age children can think critically to interpret messages seen in advertising, media, and sports. C) Parents must prevent their child from being exposed to messages that are in conflict with their values. D) Discussions with children need to be based on facts and focused on the past and future.

Ans: B Feedback: School-age children can be taught how to think critically to interpret messages seen in advertising, media, sports, and entertainment personalities. School-age children are ready to absorb information that deals with drugs and alcohol and may be exposed to messages that are in conflict with their parents' values regarding smoking and alcohol. This may occur at school and cannot be prevented. Discussions with children need to be based on facts and focused on the present.

. The school nurse is conducting vision screening for a 7-year-old girl and documents the condition "amblyopia." What would the nurse tell the parents about this condition? A) "Amblyopia is an uncorrected refractive error of the eye." B) "Amblyopia is reduced vision in an eye that has not been adequately used during early development." C) "Amblyopia is a malalignment of the eye, which occurs at birth." D) "Amblyopia is a clouding of the lens of the eye caused by trauma to the eye."

Ans: B Feedback: Some problems frequently identified in school-age children include amblyopia (lazy eye), uncorrected refractive errors or other eye defects, and malalignment of the eyes (called strabismus). Amblyopia is reduced vision in an eye that has not been adequately used during early development. Inadequate use can result from conditions such as strabismus, being cross-eyed, or one eye being more nearsighted, farsighted, or astigmatic than the other eye. Amblyopia is the leading cause of visual impairment in children (National Eye Institute, 2008) and if untreated can result in vision loss.

The school nurse is conducting vision screening for a 7-year-old girl and documents the condition "amblyopia." What would the nurse tell the parents about this condition? A) "Amblyopia is an uncorrected refractive error of the eye." B) "Amblyopia is reduced vision in an eye that has not been adequately used during early development." C) "Amblyopia is a malalignment of the eye, which occurs at birth." D) "Amblyopia is a clouding of the lens of the eye caused by trauma to the eye."

Ans: B Feedback: Some problems frequently identified in school-age children include amblyopia (lazy eye), uncorrected refractive errors or other eye defects, and malalignment of the eyes (called strabismus). Amblyopia is reduced vision in an eye that has not been adequately used during early development. Inadequate use can result from conditions such as strabismus, being cross-eyed, or one eye being more nearsighted, farsighted, or astigmatic than the other eye. Amblyopia is the leading cause of visual impairment in children (National Eye Institute, 2008) and if untreated can result in vision loss.

The parents of an 11-year-old child ask the nurse for suggestions to promote good nutrition for their child. Which response by the nurse would be most appropriate? A) "Be sure to limit protein to one meal every day." B) "Use whole-grain or enriched breads and cereals." C) "Have eggs on the average of once a week." D) "Eat dark green leafy vegetables about twice a week."

Ans: B Feedback: The American Heart Association's dietary recommendations to promote good nutrition include using whole-grain or enriched breads and cereals, having a good-quality protein with every meal, and eating eggs approximately four times per week and dark green leafy or deep yellow vegetables at least four times per week.

The nurse is conducting a well-child examination of a 5-year-old girl, who was 40 inches tall at her last examination at age 4. Which of the following height measurements would be within the normal range of growth expected for a preschooler? A) 41 inches B) 43 inches C) 45 inches D) 47 inches

Ans: B Feedback: The average preschool-age child will grow 2.5 to 3 inches (6.5 to 7.8 cm) per year. The average 3-year-old is 37 inches tall (96.2 cm), the average 4-year-old is 40.5 inches tall (103.7 cm), and the average 5-year-old is 43 inches tall (118.5 cm).

. The nurse knows that barriers to the adolescent's health and successful achievement of the tasks of adolescence exist. Which of the following is the major barrier to health for this population? A) Cultural B) Socioeconomic C) Marital status D) Racial

Ans: B Feedback: The major barrier to the adolescent's health and successful achievement of the tasks of adolescence is socioeconomic status. Adolescents at a lower socioeconomic level are at higher risk for developing health care problems and risk-taking behaviors; this may be due to their inability to access health care and to obtain needed services. In caring for adolescents, the nurse should also recognize the influence of their culture, ethnicity, and race upon them.

The nurse is teaching good sleep habits for toddlers to the mother of a 2-year-old boy. Which response indicates the mother understands sleep requirements for her son? A) "I'll put him to bed at 7 p.m., except Friday and Saturday." B) "He needs 13 hours of sleep per day including his nap." C) "I need to put the side down on the crib so he can get out." D) "His father can give him a horseback ride into his bed."

Ans: B Feedback: The mother understands her child needs 13 hours of sleep and one nap per day. Routines, such as the same bedtime every night, promote good sleep. However, a horseback ride to bed may cause problems because it may not provide a calming transition from play to sleep. A bath and reading a book would be better. If the child can climb out of a crib, he needs to be in a youth bed or regular bed to avoid injury.

The mother of a 5-year-old boy calls the nurse and seeks advice on how to assist the child with the recent death of his paternal grandfather. The boy keeps asking when his grandpa is coming back. How should the nurse respond? A) "It is best to just ignore this and to not respond to his questions." B) "This is normal; children his age do not understand the permanence of death." C) "You have to keep repeating that his grandfather is never coming back." D) "He will eventually figure this out on his own."

Ans: B Feedback: The nurse needs to remind the mother that preschoolers do not completely understand the concept of death or its permanence. Telling the mother that it is best to ignore the boy's questions or that the boy will eventually figure this out on his own does not teach. Repeating that the grandfather is not coming back does not consider the developmental stage of the child and is inappropriate.

The nurse is counseling parents of a picky eater on how to promote healthy eating habits in their child. Which of the following interventions would be appropriate advice? A) Allow the child to pick out his or her own foods for meals. B) Present the food matter-of-factly and allow the child to choose what to eat. C) Offer high-fat snacks if the child does not eat to get him or her to eat something. D) Offer the child a special treat if he or she eats all the food on the plate.

Ans: B Feedback: The parents should maintain a matter-of-fact approach, offer the meal or snack, and then allow the child to decide how much of the food, if any, he or she is going to eat. High-fat, nutrient-poor snacks should not be substituted for healthy foods just to coax the child to "eat something." If the preschooler is growing well, then the pickiness is not a cause for concern. A larger concern may be the negative relationship that can develop between the parent and child relating to mealtime. The more the parent coaxes, cajoles, bribes, and threatens, the less likely the child is to try new foods or even eat the ones he or she likes that are served. The child should be offered a healthy diet, with foods from all groups over the course of the day as recommended by the U.S. Department of Agriculture.

The parents of a 4-year-old ask the nurse when their child will be able to differentiate right from wrong and develop morals. What would be the best response of the nurse? A) "The preschooler has no sense of right and wrong." B) "The preschooler is developing a conscience." C) "The preschooler sees morality as internal to self." D) "The preschooler's morals are their own, right or wrong."

Ans: B Feedback: The preschool child can understand the concepts of right and wrong and is developing a conscience. Preschool children see morality as external to themselves; they defer to power (that of the adult). The child's moral standards are those of their parents or other adults who influence them, not necessarily their own.

. Which food suggestion would be most appropriate for the mother of a preschooler to ensure an adequate intake of calcium? A) Spinach B) White beans C) Enriched bread D) Fortified cereal

Ans: B Feedback: To ensure an adequate intake of calcium, the nurse should suggest white beans, because 1 ounce of dried white beans when cooked provides 160 mg of calcium. Spinach, enriched bread, and fortified cereal are good sources of iron.

The nurse assesses the spirituality of an adolescent. Which of the following are normal moral and spiritual milestones in this age group? Select all answers that apply. A) Adolescents will base their actions on the avoidance of punishment and the attainment of pleasure. B) Adolescents develop their own set of morals and values and question the status quo. C) Adolescents undergo the process of developing their own set of morals at different rates. D) Adolescents are more interested in the spiritualism of their religion than in the actual practices of their religion. E) Adolescents can understand the concepts of right and wrong and are developing a conscience. F) Adolescents are able to understand and incorporate into their behavior the concept of the "golden rule."

Ans: B, C, D Feedback: It is during the adolescent years that teenagers develop their own set of values and morals at different rates. At the beginning of this stage, teenagers begin to question the status quo. The majority of their choices are based on emotions while they are questioning societal standards. Adolescents also begin to question their formal religious practices. As they progress through adolescence, teenagers become more interested in the spiritualism of their religion than in the actual practices of their religion. The toddler will base his or her actions on the avoidance of punishment and the attainment of pleasure. The preschool child can understand the concepts of right and wrong and is developing a conscience. The school-age child is able to understand and incorporate into his behavior the concept of the "golden rule."

The pediatric nurse is aware of the maturation of organ systems in the school-age child. Which of the following accurately describe these changes? Select all answers that apply. A) The brain grows very slowly during the school-age years and growth is complete by the time the child is 12 years of age. B) Respiratory rates decrease, abdominal breathing disappears, and respirations become diaphragmatic in nature. C) The school-age child's blood pressure increases and the pulse rate decreases, and the heart grows more slowly during the middle years. D) The school-age child experiences more gastrointestinal upsets compared with earlier years since the stomach capacity increases. E) Bladder capacity increases, but varies among individual children, and girls generally have a greater bladder capacity than boys. F) Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics.

Ans: B, C, E, F Feedback: Respiratory rates decrease, abdominal breathing disappears, and respirations become diaphragmatic in nature. The school-age child's blood pressure increases and the pulse rate decreases. The heart grows more slowly during the middle years and is smaller in size in relation to the rest of the body than at any other development stage. Bladder capacity increases, but varies among individual children. Girls generally have a greater bladder capacity than boys. Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics. The brain and skull grow very slowly during the school-age years. Brain growth is complete by the time the child is 10 years of age. The school-age child experiences fewer gastrointestinal upsets compared with earlier years. Stomach capacity increases, which permits retention of food for longer periods of time.

The nurse is helping parents prepare a healthy meal plan for their toddler. Which of the following guidelines for promoting nutrition should be followed when planning meals? Select all answers that apply. A) The child younger than 2 years of age should have his or her fat intake restricted. B) Extending breastfeeding into toddlerhood is believed to be beneficial to the child. C) Weaning from the bottle should occur by 6 to 12 months of age. D) Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. E) The toddler requires an average intake of 500 mg calcium per day. F) Toddlers tend to have the highest daily iron intake of any age group.

Ans: B, D, E Feedback: Extending breastfeeding into toddlerhood is believed to be beneficial to the child as it is known to help prevent obesity. Adequate calcium intake and appropriate exercise lay the foundation for proper bone mineralization. The toddler requires an average intake of 500 mg calcium per day. The child younger than 2 years of age should not have his or her fat intake restricted, but this does not mean that unhealthy foods such as sweets should be eaten liberally. Weaning from the bottle should occur by 12 to 15 months of age. Prolonged bottle-feeding is associated with the development of dental caries. It is important for toddlers to consume adequate amounts of iron since they tend to have the lowest daily iron intake of any age group.

The parents of a preschooler ask the nurse to help them choose a preschool for their child. Which of the following are recommended guidelines and goals for choosing a preschool? Select all answers that apply. A) The main goal of preschool is to improve reading and writing skills and readiness for entering into grade school. B) When selecting a preschool the parent may want to consider the accreditation of the school and the teachers' qualifications. C) The teachers should decide how focused on curriculum the school should be for each individual student. D) The parent should observe the classroom, evaluating the environment, noise level, and sanitary practices. E) The type of discipline used in the school is also an important factor. Parents should choose a preschool that uses corporal punishment. F) The parent should observe the classroom to determine how the children interact with each other and how the teachers interact with the children.

Ans: B, D, F Feedback: When selecting a preschool the parent may want to consider the accreditation of the school, the teachers' qualifications, and recommendations of other parents. The parent should observe the classroom, evaluating the environment, noise level, and sanitary practices, as well as how the children interact with each other and how the teachers interact with the children. The main goal of preschool is to foster the child's social skills and accustom him or her to the group environment. The parents must decide how focused on curriculum they want the school to be. The type of discipline used in the school is also an important factor. Parents should not choose a preschool that uses corporal punishment.

The pediatric nurse is planning quiet activities for hospitalized 18-month-olds. Which of the following would be an appropriate activity for this age group? A) Painting by number B) Putting shapes into appropriate holes C) Stacking blocks D) Using crayons to color in a coloring book

Ans: C Feedback: At 18 months the child can stack four blocks. The 24-month-old can paint (but not by number), scribble, and color, and put round pegs into holes.

The nurse has seen a 15-year-old girl and a 16-year-old boy during health surveillance visits. Which of the following physical characteristics would be seen in both teenagers? A) Decreased respiratory rates of 15 to 20 breaths per minute B) Eruption of last four molars C) Increased shoulder, chest, and hip widths D) Fully functioning sweat and sebaceous glands

Ans: C Feedback: Both teenagers are in the middle state of adolescence, which is marked by an increase in shoulder, chest, and hip widths. Decreased respiratory rate occurs in early adolescence, as do fully functioning sweat and sebaceous glands. Eruption of the last four molars occurs in late adolescence.

The nurse is assessing the motor skills of a 5-year-old girl. Which finding would cause the nurse to be concerned? A) Can copy a square on another piece of paper B) Can dress and undress herself without help C) Draws a person with three body parts D) Is beginning to tie her own shoelaces

Ans: C Feedback: By the age of 5 years, the child should be able to draw a person with a body and at least six body parts. She should also be able to copy triangles and other geometric patterns and dress and undress herself and should be learning to tie her shoelaces.

The nurse is discussing ways to promote discipline with parents who are becoming increasingly frustrated with their teenager. Which of the following would the nurse identify as most important? A) Establish rules and expectations. B) Collaborate to determine consequence. C) Make your responses consistent. D) Explain the rules to the adolescent.

Ans: C Feedback: Consistency and predictability are the cornerstones of discipline. Establishing rules and expectations, collaborating to determine the consequences, and explaining the rules are all important, but they are not as important as being consistent.

When describing the various changes that occur in organ systems during adolescence, which of the following would the nurse include? A) Significant increase in brain size B) Ossification completed later in girls C) Decrease in heart rate D) Decrease in activity of sebaceous glands

Ans: C Feedback: During adolescence, the heart rate decreases while the systolic blood pressure increases. Brain growth continues, but the size of the brain does not increase significantly. Ossification is more advanced in girls and occurs at an earlier age. Sebaceous gland activity increases during adolescence.

The nurse is testing the sensory development of a toddler brought to the clinic for a well visit. Which of the following might alert the nurse to a potential problem with the child's sensory development? A) The toddler places the nurse's stethoscope in his mouth. B) The toddler's vision tests at 20/50 in both eyes C) The toddler does not respond to commands whispered in his ear. D) The toddler's taste discrimination is not at adult levels yet.

Ans: C Feedback: Hearing should be at the adult level, as infants are ordinarily born with hearing intact. Therefore, the toddler should hear commands whispered in his ear. Toddlers examine new items by feeling them, looking at them, shaking them to hear what sound they make, smelling them, and placing them in their mouths. Toddler vision continues to progress and should be 20/50 to 20/40 in both eyes. Though taste discrimination is not completely developed, toddlers may exhibit preferences for certain flavors of foods.

The nurse is promoting learning and school attendance to an 11-year-old girl. Which of the following factors will affect the child's attitude most? A) Her parents' values and desires B) The dramatic changes to her body C) Peer group behaviors and attitudes D) Desire for attention from boys

Ans: C Feedback: In this age group, children have a strong desire to conform to their peer group and to be accepted. It is important to know the peer group's attitude about school and learning. Early adolescence marks the beginning of separation from the family, including its values and desires. Physiologic changes and sexual attraction would not have significant or lasting influence in this matter.

During a health maintenance visit, a 15-year-old girl mentions that she is not happy with how overweight she is. Which of the following approaches is best for the nurse to take? A) "Good observation. Let's talk about diet and exercise." B) "Don't worry; you are within the weight and height guidelines." C) "What specifically have you been noticing?" D) "Tell me about your parents. Are they overweight?"

Ans: C Feedback: It is best to find out what caused the teenager to make the comment so that you can work with her about the issue. This is an assessment and must be done first. Launching into a lecture on diet and exercise will be of no value if the teenager wants to talk about dealing with snide comments from her peers. Telling the teenager she is statistically in the normal range for weight and height may close the conversation prematurely. The focus is on the teenager, not her parents. Obtaining that information would be important, but not at this time.

The nurse is performing risk assessments on adolescents in the school setting. Which one of the following teens should the nurse screen for hypertension? A) An Asian female B) A white male C) An African American male D) A Jewish male

Ans: C Feedback: It is important for the nurse to recognize the ethnic background of each adolescent. Research has shown that certain ethnic groups are at higher risk for certain diseases. For example, adolescent African Americans are at higher risk for developing hypertension.

The nurse is assessing a 3-year-old boy's development during a well-child visit. Which response by the child indicates the need for further assessment? A) He says a swear word when he hurts himself playing. B) He says "pew" when his sister has soiled her diaper. C) He laughs when his brother cries getting vaccinated. D) He constantly asks "why?" whenever he is told a fact.

Ans: C Feedback: Laughing when his brother cries when being vaccinated indicates that the child hasn't yet developed a sense of empathy or that there may be psychosocial issues, such as sibling rivalry, that should be assessed. The child may repeat a word even if it is out of context. This is called echolalia. Older toddlers have a well-developed sense of smell and will comment if they don't like a smell. The incessant "why" is very common to toddlers' speech.

The parents of a preschooler express concern to the nurse about their son's new habit of masturbating. Which of the following is an appropriate response to this concern? A) Tell the child in a firm manner that this behavior is not acceptable. B) When the child displays this behavior, place him in a "time-out." C) Treat the action in a matter-of-fact manner emphasizing safety. D) Consult a psychotherapist to determine the reason for this behavior.

Ans: C Feedback: Masturbation is a healthy and natural part of normal preschool development if it occurs in moderation. If the parent overreacts to this behavior, then it may occur more frequently. Masturbation should be treated in a matter-of-fact way by the parent. The child needs to learn certain rules about this activity: nudity and masturbation are not acceptable in public. The child should also be taught safety: no other person can touch the private parts unless it is the parent, doctor, or nurse checking to see when something is wrong.

The school nurse is performing health assessments on students in middle school. Of which of the following developmental milestones should the nurse be aware? A) Height in girls increases rapidly after menarche and usually ceases immediately after menarche. B) Boys' growth spurt usually begins between the ages of 8 and 14 years and ends between the ages of 131/2 and 171/2 years. C) Peak height velocity (PHV) occurs at approximately 12 years of age in girls or about 6 to 12 months after menarche. D) Boys reach PHV and peak weight velocity (PWV) at about 16 years of age.

Ans: C Feedback: PHV occurs at approximately 12 years of age in girls or about 6 to 12 months after menarche. Height in girls increases rapidly after menarche and usually ceases 2 to 21/2 years after menarche. Boys' growth spurt occurs later than girls' and usually begins between the ages of 101/2 and 16 years and ends sometime between the ages of 131/2 and 171/2 years. Boys reach PHV at about 14 years of age. PWV occurs about 6 months after menarche in girls and at about 14 years of age in boys.

The nurse is providing suggestions to a female adolescent about foods to help meet her nutritional requirements for iron. Which food would the nurse suggest as a good source of iron? A) Broccoli B) Yogurt C) Peanut butter D) White beans

Ans: C Feedback: Peanut butter is a good source of iron. Broccoli, yogurt, and white beans are good sources of calcium.

A nurse is caring for a 4-year-old girl. The mother says that the girl is afraid of cats and dogs and does not like to go to the playground anymore because she wants to avoid the dogs that are often being walked at the park. What should the nurse tell the mother? A) "It is best to avoid the playground until she outgrows the fear." B) "She needs to face her fears head-on; take her to the park as much as possible." C) "Acknowledge her fear and help her develop a strategy for dealing with it." D) "Try to minimize her fears and insist that she go to the park."

Ans: C Feedback: Preschoolers have vivid imaginations and experience a variety of fears. It is best to acknowledge the fear, rather than minimize it, and then collaborate with the child on strategies for dealing with the fear. Avoiding the playground will not address the child's fears. Forcing the child to face her fear without enlisting her input to help deal with the fear does not teach. It is also important for the mother to find out if an incident involving cats and dogs occurred without her knowledge.

The nurse is providing guidance after observing a mother interact with her negative 2-year-old boy. For which interaction will the nurse advise the mother that she is handling the negativism properly? A) Telling the child to stop tearing pages from magazines B) Asking the child if he would please quit throwing toys C) Telling the child firmly that we don't scream in the office D) Saying, "Please come over here and sit in this chair. OK?"

Ans: C Feedback: Telling the child firmly that we don't scream in the office gets the point across to the child that his behavior is unacceptable while role modeling appropriate communication. Telling the child to stop tearing up magazines does not give him direction for appropriate behavior. Asking the child if he would quit throwing toys gives him an opportunity to say "no," and is the same as asking "OK?" at the end of a direction.

1. The nurse is performing a physical assessment of a 3-year-old girl. Which of the following would be a concern for the nurse? A) The toddler gained 4 pounds in weight since last year. B) The toddler gained 3 inches in height since last year. C) The toddler's anterior fontanel is not fully closed. D) The circumference of the child's head increased 1 inch since last year.

Ans: C Feedback: The anterior fontanel should be closed by the time the child is 18 months old. The average toddler weight gain is 3 to 5 pounds per year. Length/height increases by an average of 3 inches per year. Head circumference increases about 1 inch from when the child is between 1 and 2 years of age, and then increases an average of a half-inch per year until age 5.

The nurse is using the formula for bladder capacity to measure the bladder capacity of a 9-year-old girl. What number would the nurse document for this measurement? A) 9 ounces B) 10 ounces C) 11 ounces D) 12 ounces

Ans: C Feedback: The formula for bladder capacity is age in years plus 2 ounces. Therefore, the bladder capacity of the 9-year-old would be 11 ounces.

The nurse has determined that an 8-year-old girl is at risk for being overweight. Which of the following interventions would be a priority prior to developing the care plan? A) Determining the need for additional caloric intake B) Asking the parents who they want to work with the child C) Interviewing the parents about their eating habits D) Discussing the influence of peers on the child's diet

Ans: C Feedback: The nurse would need to find out what the parents' eating habits are like. It would not be necessary to determine the need for additional caloric intake. Developing a multidisciplinary plan is an intervention for a child with growth and development problems. Discussing the influence of peers is an intervention used for preventing injury.

The nurse is counseling the parents of a 10-year-old child who was caught stealing at school. Which of the following topics should the nurse cover? A) Having the child return the property in front of his or her class B) Discussing ways for the child to save face C) Finding out what is currently going on at home D) Reminding the child daily that stealing is wrong

Ans: C Feedback: The parents need to understand the child's behavior. The reason for stealing at age 10 may be that the child wants the item or is trying to impress peers, or it may be a sign of anxiety. More information is needed before the nurse can effectively work with the family. The parents should work together with the child to decide how the item will be returned. The child will lose face but gain integrity by returning the stolen item. Reminding the child about stealing on a daily basis may ruin the child's self-esteem.

The nurse is supervising lunch time for children on a pediatric ward. Which of the following observations is considered abnormal for this age group? A) The child has a full set of primary teeth. B) The child has no difficulty chewing and swallowing meat. C) The child uses his fingers and refuses to use a fork. D) The child is a picky eater.

Ans: C Feedback: The preschool child has learned to use utensils fairly effectively to feed himself or herself, has a full set of primary teeth, and is able to chew and swallow competently. Preschool children may be picky eaters. They may eat only a limited variety of foods or foods prepared in certain ways and may not be very willing to try new things.

The nurse is teaching parents to plan nutritional meals for their son who is overweight. Which of the following guidelines might the nurse include in the teaching plan? A) School-age children with an average body weight of 20 to 35 kg need approximately 90 calories per kilogram daily. B) The average water requirement for a school-age child per 24 hours ranges from 2,000 to 2,500 mL per day. C) The school-age child needs 28 g of protein and 800 mg of calcium for maintenance of growth and good nutrition. D) In the school-age child, calories needed to sustain weight increase, while the appetite decreases.

Ans: C Feedback: The school-age child needs 28 g of protein and 800 mg of calcium for maintenance of growth and good nutrition. School-age children with an average body weight of 20 to 35 kg need approximately 70 calories per kilogram daily (1,400 to 2,100 calories per day). The average water requirement per 24 hours ranges from 1,800 to 2,200 mL per day. Growth, body composition, and body shape remain constant during the late school-age years. Needed calories decrease while the appetite increases.

The nurse is assessing the gross motor skills of an 8-year-old boy. Which of the following interview questions would facilitate this assessment? A) "Do you like to do puzzles?" B) "Do play any instruments?" C) "Do you participate in any sports?" D) "Do you like to construct models?"

Ans: C Feedback: To assess the gross motor skills of school-age children, the nurse should ask questions about participation in sports and after-school activities. For fine motor skills, the nurse could ask questions about band membership, constructing models, and writing skills.

Which of the following would the nurse expect to find in an 18-month-old? A) Standing on tiptoes B) Pedaling a tricycle C) Climbing stairs with assistance D) Carrying a large toy while walking

Ans: C Feedback: Toddlers continue to progress with motor skills. An 18-month-old should be able to climb stairs with assistance. A 24-month-old should be able to stand on his or her tiptoes and carry a large toy while walking. A 36-month-old would be able to pedal a tricycle.

The nurse is teaching parents interventions appropriate to the emotional development of their toddlers. Which of the following is a recommended intervention for this age group? A) Remove children's security blankets at this stage to help them assert their autonomy. B) Distract toddlers from exploring their own body parts, particularly their genitals. C) Do not blame toddlers for aggressive behavior; instead, point out the results of their behavior. D) Offer toddlers many choices to foster control over their environment.

Ans: C Feedback: Toddlers should not be blamed for their aggressive behavior; adults can assist the toddler in building empathy by pointing out when someone is hurt and explaining what happened. Adults should allow toddlers to rely upon a security item to self-soothe as this is a function of autonomy and is viewed as a sign of a nurturing environment, rather than one of neglect. Toddlers may question parents about the difference between male and female body parts and may begin to explore their own genitals. This is normal behavior in this age group. Offering limited choices is one way of allowing toddlers some control over their environment and helping them to establish a sense of mastery.

The nurse is providing teaching about car safety to the parents of a 5-year-old girl who weighs 45 pounds. What should the nurse instruct the parents to do? A) "Place her in a booster seat with lap and shoulder belts in the front seat." B) "Place her in the back seat with the lap and shoulder belts in place." C) "Place her in a forward-facing car seat with a harness and top tether." D) "Place her in a booster seat with lap and shoulder belts in the back seat."

Ans: D Feedback: A child who weighs between 40 and 80 pounds should ride in a booster seat that utilizes both the lap and shoulder belts in the back seat. When a child is large enough to sit up straight with the knees bent at the front edge of the seat, then he or she may sit directly on the seat of the car with lap/shoulder belt securely and appropriately attached. The back seat of the car is the safest place for a child to ride. A forward-facing car seat with harness and top tether is for a preschooler who weighs less than 40 pounds.

The mother of a 4-year-old boy tells the nurse that her son occasionally wets his pants during the day. How should the nurse respond? A) "Is there a family history of diabetes?" B) "Suddenly having accidents can be a sign of diabetes." C) "That's normal; don't worry about it." D) "Tell me about the circumstances when this occurs."

Ans: D Feedback: Bladder control is present in 4- and 5-year-olds, but an occasional accident may occur, particularly in stressful situations or when the child is absorbed in an interesting activity. The nurse needs to ask an open-ended question to determine the circumstances when the child has had accidents. Simply telling the mother that it is normal does not address the mother's concerns. The nurse does need to gather more information, because accidents in a previously potty-trained child can be a sign of diabetes.

The school nurse is teaching parents about the effects of bullying on school children. Which of the following accurately describes this developmental concern? A) Children who bully are those who report themselves as being lonely and having difficulty in forming friendships. B) Children who are bullied are reported to have low self-esteem, poor grades, and poor interpersonal skills. C) In general, about 20% of all children attending school are frightened and afraid most of the day. D) Both boys and girls are bullied; boys usually bully boys and use force more often.

Ans: D Feedback: Both boys and girls are bullied; boys usually bully boys and use force more often. Bullied children are those who report themselves as being lonely and having difficulty in forming friendships. The children who perform the bullying are those children who are reported to have low self-esteem, poor grades, and poor interpersonal skills. In general, about 10% of all children attending school are frightened and afraid most of the day.

Two working parents are discussing with the school nurse the possibility of their 12-year-old girl going home alone after school. Which of the following suggestions should the nurse make? A) Provide entertainment until the parents come home. B) Allow the child to go to a friend's house. C) Teach her how to take a message if someone calls. D) Purchase caller ID for the phone.

Ans: D Feedback: Having caller ID allows the child to answer the phone if Mom or Dad calls while ignoring all other calls. Rather than entertaining the child, this would be a better time for homework, age-appropriate chores, and limited entertainment. If the child goes to a friend's house, it should be prearranged between the parents, not spur of the moment. It is safer if the child does not answer the phone instead of taking a message.

The nurse is promoting nutrition to a 13-year-old boy who is overweight. Which of the following comments should the nurse expect to include in the discussion? A) "You need to go on a low-fat diet." B) "Eat what your parents eat." C) "Go out for a sport at school." D) "Keep a food diary."

Ans: D Feedback: Having the boy keep a detailed food diary for 1 week will determine current patterns of eating. This can then be used to show him how to make small changes with results, especially if eating is done before periods of inactivity such as before going to bed or when he is bored. Speaking and thinking in terms of diet are negative and can lead to poor body image. If the parents have poor eating habits, telling the child to eat what his parents eat could be bad advice. The child could too easily choose the wrong sport or do poorly. It is best to offer solutions with more variety.

The nurse is teaching the parents of a 2-year-old girl how to deal with common toddler situations. Which is the best advice? A) Discipline the child for regressive behavior. B) Scold the child for public thumb sucking. C) Tell the older sibling to not act like a baby. D) Have the child help clean up a bowel accident.

Ans: D Feedback: Having the child help clean up a bowel accident is the best advice. Toddlers should never be punished for bowel or bladder "accidents," but gently reminded about toileting. Regressive behavior is best ignored, while appropriate behavior should be praised. Telling the older sibling to not act like a baby is a negative approach. It would be better to have the child be mother's helper. Calmly telling the child that thumb sucking is something that is done at home is better than scolding the child.

Which activity would the nurse least likely include as exemplifying the preconceptual phase of Piaget's preoperational stage? A) Displays of animism B) Use of active imaginations C) Understanding of opposites D) Beginning questioning of parents' values

Ans: D Feedback: In the intuitive phase of Piaget's preoperational stage, the child begins to question parents' values. Animism, active imaginations, and an understanding of opposites would characterize the preconceptual phase of Piaget's preoperational stage.

The school nurse is planning to teach a segment on smoking during the freshman health classes. The nurse is aware that this needs to be a forum rather than a lecture. Which of the following techniques will also help deliver a "don't smoke" message? A) Showing a command of the facts on smoking B) Speaking with a tone of authority C) Keeping your personal experiences out of it D) Listening to all comments nonjudgmentally

Ans: D Feedback: It is very important to listen to the students' comments without judgment to avoid creating a resistance to information. Spouting too many facts too often and taking on an authoritative tone will show the audience that their opinions don't matter. Using personal experiences and admitting mistakes you have made can be helpful to communication.

The school nurse knows that school-age children are developing metalinguistic awareness. Which of the following is an example of this skill? A) The child enjoys reading books. B) The child enjoys conversations with peers. C) The child enjoys speaking on the phone. D) The child enjoys telling jokes.

Ans: D Feedback: Language skills continue to accelerate during the school-age years. School-age children develop metalinguistic awareness—an ability to think about language and comment on its properties. This enables them to enjoy jokes and riddles due to their understanding of double meanings and play on words and sounds.

The school nurse is preparing a talk on the influence of the media on school-age children to present at the next PTO meeting. Which of the following facts might the nurse include in the introduction? A) Children in the United States spend about 6 hours a day either watching TV or playing video games. B) A child will see 2,000 murders by the end of grade school and 20,000 commercials a year. C) A school-age child cannot determine what is real from what is fantasy; therefore, TV and video games can lead to aggressive behavior. D) Parents should limit television watching and video-game playing to 2 hours per day.

Ans: D Feedback: Parents should limit television watching and video-game playing to 2 hours per day. Children in the United States spend about 4 hours a day either watching TV or playing video games. A child will see 8,000 murders by the end of grade school and 40,000 commercials a year. Although school-age children can determine what is real from what is fantasy, research has shown that this amount of time in front of the TV—watching it or playing video games—can lead to aggressive behavior, less physical activity, and altered body image.

During a well-child check-up, the parents of a 9-year-old boy tell the nurse that their son's friends told him that soccer is a stupid game, and now he wants to play baseball. Which comment by the nurse best explains the effects of peer groups? A) "The child's best friends will continue playing soccer." B) "The children will cheer for each other regardless of the sport being played." C) "Your child will rarely talk to you about his friends." D) "Acceptance by friends, especially of the same sex, is very important at this age."

Ans: D Feedback: Peer relationships, especially of the same sex, are very important and can influence the child's relationship with his parents. They can provide enough support that he can risk parental conflict and stand his ground about playing soccer. At this age, peer groups are made up of the child's best friends, and they happen to be playing baseball. Peer groups have rules and take up sides against the soccer player. Peers are an authority, so the child will let his parents know their opinions.

The nurse is developing a teaching plan for toddler safety to present at a parenting seminar. Which of the following are safety interventions that the nurse should address? A) Encourage parents to enroll toddlers in swimming classes to avoid the need for constant supervision around water. B) Advise parents to keep pot handles on stoves turned outward to avoid accidental burns. C) Encourage parents to smoke only in designated rooms in the house or outside the house. D) Advise parents to use a forward-facing car seat with harness straps and a clip, placed in the backseat of the car.

Ans: D Feedback: Safety is of prime concern throughout the toddler period. The safest place for the toddler to ride is in the back seat of the car. Parents should use the appropriate size and style of car seat for the child's weight and age as required by the state. At a minimum, all children over 20 pounds and up to 40 pounds should be in a forward-facing car seat with harness straps and a clip. Parents who want to enroll a toddler in a swimming class should be aware that a water safety skills class would be most appropriate. However, even toddlers who have completed a swimming program still need constant supervision in the water. Pot handles on stoves should be turned inward to avoid accidental burn. Nurses should counsel parents to stop smoking (optimal), but if they continue smoking never to smoke inside the home or car with children present.

The nurse is preparing a presentation for a local parent-teacher organization about the growth and development of school-age children. Which of the following would the nurse include? A) Boys mature much more quickly than girls of the same age during this time. B) From 6 to 12 years of age, children grow an average of 4 inches per year. C) The child's body size is in direct correlation with his or her maturity level. D) Secondary sex characteristics are often embarrassing for both sexes.

Ans: D Feedback: Secondary sex characteristics are often a source of embarrassment for both sexes because preadolescent boys and girls do not want to be different from their peers of the same or opposite sex. In the later school years, girls begin to surpass boys in both height and weight. During this time, children grow an average of 2 inches (5 cm) per year. Physical maturity is not necessarily associated with emotional or social maturity.

The adolescent continues to develop self-concept and self-esteem. Which of the following is most important to a teen's self-esteem? A) Strong authority figures B) Spirituality C) Morals and values D) Body image

Ans: D Feedback: Self-concept and self-esteem are tied to body image many times. Adolescents who perceive their body as being different than peers or as less than ideal may view themselves negatively. Sexual characteristics are important to the adolescent's self-concept and body image. Authority figures, spirituality, and morals and values play a role in development of self-esteem, but body image is most influential in the development of self-concept/self-esteem.

The nurse emphasizes that a toddler younger than the age of 18 months should never be spanked primarily for which reason? A) Spanking in a child this age predisposes the child to a pro-violence attitude. B) The child will become resentful and angry, leading to more outbursts. C) Spanking demonstrates a poor model for problem-solving skills. D) There is an increased risk for physical injury in this age group.

Ans: D Feedback: Spanking should never be used with toddlers younger than 18 months of age because there is an increased possibility of physical injury. Although spanking or other forms of corporal punishment lead to a pro-violence attitude, create resentment and anger in the child, and are a poor model for learning effective problem-solving skills, the risk of physical injury in this age group is paramount.

The parents of an 8-year-old boy are interested in promoting learning through reading to their son. Which of the following suggestions by the nurse would best promote this goal? A) Have the parents choose what he should read initially. B) Tell the child to read instead of watching TV with his parents. C) Tell the parents that reading is for the child to do by himself. D) Take the child to the library to check out some books.

Ans: D Feedback: Taking the child to the library can be a positive start to the reading experience. It is best to let the librarian recommend books that will be appropriate for the child, but let the child choose from recommended materials. Set an example by reading instead of watching TV while the child is not in bed. Reading to the child is a valuable parent-child activity that can expose the child to classic works that are beyond the child's present reading ability.

The nurse is performing a cognitive assessment of a 2-year-old. Which of the following behaviors would alert the nurse to a developmental delay in this area? A) The child cannot say name, age, and gender. B) The child cannot follow a series of two independent commands. C) The child has a vocabulary of 40 to 50 words. D) The child does not point to named body parts.

Ans: D Feedback: The 2-year-old can point to named body parts and has a vocabulary of 40 to 50 words. At 30 months old a child can follow a series of two independent commands and at 3 years old a child can say name, age, and gender.

The nurse is performing an assessment of the reproductive system of a 17-year-old girl. Which of the following would alert the nurse to a developmental delay in this girl? A) Areola and papilla separate from the contour of the breast B) Mature distribution and coarseness of pubic hair C) Developed breast tissue D) Occurrence of first menstrual period

Ans: D Feedback: The first menstrual period usually begins between the ages of 9 and 15 years (average 12.8 years). Breast budding (thelarche) occurs at approximately ages 9 to 11 years and is followed by the growth of pubic hair.

The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which guidance will be most helpful for toilet teaching? A) Telling them either one may demonstrate toilet use B) Assuring them that bladder control occurs first C) Telling them that curiosity is a sure sign of readiness D) Advising them to use praise, not scolding

Ans: D Feedback: The most helpful guidance for toilet teaching is to urge the parents to use only praise, but never to scold, throughout the process. It is best for the same-sex parent to demonstrate toilet use. Bowel control will occur first. It may take additional months for nighttime bladder control to be achieved. Curiosity is a sign of readiness for toilet teaching, but by no means a sure sign.

A mother calls the school nurse and is concerned because her 13-year-old daughter's friends wear heavy makeup and black clothes. Which of the following is the best advice for the mother? A) "This can lead to piercings and tattoos." B) "The teen years are a time for experimenting." C) "Encourage her to socialize with the kids at church." D) "Teen appearance might not accurately reflect their actual values."

Ans: D Feedback: The nurse should inform the mother that the statements adolescents make with their dress and grooming may not indicate what their actual values are. Mentioning piercings and tattoos will only worry the mother more. Minimizing the situation as experimentation is of no value to the mother. Telling the mother to choose her daughter's friends for her will destroy trust between mother and daughter.

The nurse is developing a nursing care plan for a hospitalized 6-year-old. Which of the following behaviors would warrant nursing intervention? A) The child pretends he is talking to an imaginary friend when the nurse addresses the child. B) The child states that her fairy godmother is going to come and take her home. C) The child starts talking about his grandmother and then quickly changes the subject to a new toy he received. D) The child does not want to play games with other children on the hospital ward.

Ans: D Feedback: The preschooler begins to plan activities, make up games, and initiate activities with others. Not wanting to play games with other children is a sign of a developmental delay and nursing intervention is recommended. The preschooler often has an imaginary friend who serves as a creative way for the preschooler to sample different activities and behaviors and practice conversational skills. Through make-believe and magical thinking, preschool children satisfy their curiosity about differences in the world around them. The preschooler uses transduction when reasoning: he or she extrapolates from a particular situation to another, even though the events may be unrelated.

The nurse is caring for a toddler who is in Piaget's sensorimotor stage of cognitive development. Which of the following tasks would the nurse expect the toddler to be able to perform? A) Completing puzzles with four pieces B) Winding up a mechanical toy C) Playing make-believe with dolls D) Knowing which are his or her toys

Ans: D Feedback: The toddler in Piaget's sensorimotor stage of cognitive development (18 to 24 months) understands requests, is capable of following simple directions, and has a sense of ownership (knowing which toys are his). The other tasks are accomplished by the child in the preoperational stage (2 to 7 years).

The nurse of a preschool child is helping parents develop a healthy meal plan for their child. Which of the following nutritional requirements for this age group should the nurse consider? A) The 3- to 5-year-old requires 300 to 500 mg calcium and 10 mg iron daily. B) The 3-year-old should consume 10 mg dietary fiber daily. C) The 4- to 8-year-old requires 15 mg dietary fiber per day. D) The typical preschooler requires about 85 kcal/kg of body weight.

Ans: D Feedback: The typical preschooler requires about 85 kcal/kg of body weight. The 3- to 5-year-old requires 500 to 800 mg calcium and 10 mg iron daily. The 3-year-old should consume 19 mg dietary fiber daily, while the 4- to 8-year-old requires 25 mg dietary fiber per day.

The nurse teaching safety to teens knows that which of the following is the leading cause of death among adolescents? A) Drowning B) Poisoning C) Diseases D) Unintentional injuries

Ans: D Feedback: Unintentional injuries are the leading causes of death in adolescents (U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 2008). Injuries kill more adolescents than all diseases combined, with 46% of injury-related deaths due to motor vehicle accidents (U.S. Department of Health and Human Services, 2007). Unintentional injury accounts for about 48% of adolescent injury deaths, violence and homicide for 15.2%, and suicide for 11.8% of adolescent injury deaths (U.S. Department of Health and Human Services, 2007). Males are more likely than females to die of any type of injury.

The nurse is designing a nursing care plan for a toddler with lymphoma, who is hospitalized for treatment. Which of the following is a priority intervention that the nurse should include in this child's nursing plan? A) Limiting visitors to scheduled visiting hours B) Planning physical therapy for the child C) Introducing the toddler to other toddlers in the unit D) Monitoring the toddler for developmental delays

Ans: D Feedback: When the toddler is hospitalized, growth and development may be altered. The toddler's primary task is establishing autonomy, and the toddler's focus is mobility and language development. The nurse caring for the hospitalized toddler must use knowledge of normal growth and development to be successful in interactions with the toddler, promote continued development, and recognize delays. Parents should be encouraged to stay with the toddler to avoid separation anxiety. Planning activities and socialization of the toddler is important, but the priority intervention is monitoring for, and addressing, developmental delays that may occur in the hospital.

The nurse is choosing foods for a toddler's diet that are high in vitamin A. Which of the following could be added to the menu? Select all answers that apply. A) Applesauce B) Avocados C) Broccoli D) Sweet potatoes E) Spinach F) Carrots

Ans: D, E, F Feedback: Foods that are high in vitamin A include apricots, cantaloupe, carrots, mangos, spinach and dark greens, and sweet potatoes. Applesauce is high in fiber, and avocados and broccoli are high in folate.

After teaching the parents of a 9-year-old girl about safety, which statement indicates the need for additional teaching? A) "She can ride in the front seat of the car once she is 10 years old." B) "We need to buy her a helmet so she can ride her scooter." C) "She should ride her bike with the traffic on the side of the road." D) "We signed her up for swim lesions at the local community center."

Ans:A Feedback: Children younger than 12 years of age must sit in the back seat of the car. Laws in most states require helmets for riding bicycles and scooters. When riding a bike, the child should ride on the side of the road traveling with the traffic. Children should know how to swim. If swimming skills are limited, the child must wear a life preserver at all times.

The nurse knows that the school-age child is in Erikson's stage of industry versus inferiority. Which of the following is the best example of a school-ager working toward accomplishing this developmental task? A) The child signs up for after-school activities. B) The child performs his bedtime preparations autonomously. C) The child becomes aware of the opposite sex. D) The child is developing a conscience.

Ans:A Feedback: Erikson (1963) describes the task of the school-age years to be a sense of industry versus inferiority. During this time, the child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community, which develops his or her cognitive and social skills. Achieving independence is a task of the preschooler who also is developing a conscience at that age. Awareness of the opposite sex occurs in, but is not the focus of, the school-age child.

The school nurse providing school health screenings knows that the 7- to 11-year-old is in Piaget's stage of concrete operational thoughts. Which of the following should this age group accomplish when developing operations? Select all answers that apply. A) Ability to assimilate and coordinate information about the world from different dimensions B) Ability to see things from another person's point of view and think through an action C) Ability to use stored memories of past experiences to evaluate and interpret present situations D) Ability to think about a problem from all points of view, ranking the possible solutions while solving the problem E) Ability to think outside of the present and incorporate into thinking concepts that do exist as well as concepts that might exist F) Ability to understand the principle of conservation—that matter does not change when its form changes

Ans:A, B, C, F Feedback: Piaget's stage of cognitive development for the 7- to 11-year-old is the period of concrete operational thoughts. In developing concrete operations, the child is able to assimilate and coordinate information about the world from different dimensions. He or she is able to see things from another person's point of view and think through an action, anticipating its consequences and the possibility of having to rethink the action. The school-age child is able to use stored memories of past experiences to evaluate and interpret present situations. Also, during concrete operational thinking, the school-age child develops an understanding of the principle of conservation—that matter does not change when its form changes. According to Piaget, the adolescent progresses from a concrete framework of thinking to an abstract one in the formal operational period. During this period, the adolescent is able to think about a problem from all points of view, ranking the possible solutions while solving the problem. The adolescent also develops the ability to think outside of the present; that is, he or she can incorporate into thinking concepts that do exist as well as concepts that might exist. His or her thinking becomes logical, organized, and consistent.

The nurse is performing a physical examination of an 11-year-old girl. Which of the following observations would be expected? A) The child has not gained weight since last year. B) The child has grown 3 inches since last year. C) The child breathes abdominally. D) The child's third molars are about to erupt.

Ans:B Feedback: From 6 to 12 years of age, children grow an average of 2 inches (5 cm) per year, increasing their height by at least 1 foot. An increase of 4 to 6 pounds (2 to 3 kg) per year in weight is expected. Abdominal breathing is typical of a preschooler and would have disappeared several years earlier. The third molars do not erupt until late adolescence.

19. The nurse is teaching parents to plan nutritional meals for their son who is overweight. Which of the following guidelines might the nurse include in the teaching plan? A) School-age children with an average body weight of 20 to 35 kg need approximately 90 calories per kilogram daily. B) The average water requirement for a school-age child per 24 hours ranges from 2,000 to 2,500 mL per day. C) The school-age child needs 28 g of protein and 800 mg of calcium for maintenance of growth and good nutrition. D) In the school-age child, calories needed to sustain weight increase, while the appetite decreases.

Ans:C Feedback: The school-age child needs 28 g of protein and 800 mg of calcium for maintenance of growth and good nutrition. School-age children with an average body weight of 20 to 35 kg need approximately 70 calories per kilogram daily (1,400 to 2,100 calories per day). The average water requirement per 24 hours ranges from 1,800 to 2,200 mL per day. Growth, body composition, and body shape remain constant during the late school-age years. Needed calories decrease while the appetite increases.

The school nurse knows that school-age children are developing metalinguistic awareness. Which of the following is an example of this skill? A) The child enjoys reading books. B) The child enjoys conversations with peers. C) The child enjoys speaking on the phone. D) The child enjoys telling jokes.

Ans:D Feedback: Language skills continue to accelerate during the school-age years. School-age children develop metalinguistic awareness—an ability to think about language and comment on its properties. This enables them to enjoy jokes and riddles due to their understanding of double meanings and play on words and sounds.

During a well-child check-up, the parents of a 9-year-old boy tell the nurse that their son's friends told him that soccer is a stupid game, and now he wants to play baseball. Which comment by the nurse best explains the effects of peer groups? A) "The child's best friends will continue playing soccer." B) "The children will cheer for each other regardless of the sport being played." C) "Your child will rarely talk to you about his friends." D) "Acceptance by friends, especially of the same sex, is very important at this age."

Ans:D Feedback: Peer relationships, especially of the same sex, are very important and can influence the child's relationship with his parents. They can provide enough support that he can risk parental conflict and stand his ground about playing soccer. At this age, peer groups are made up of the child's best friends, and they happen to be playing baseball. Peer groups have rules and take up sides against the soccer player. Peers are an authority, so the child will let his parents know their opinions.

A nurse is promoting the use of family-centered care in a local community clinic. Which of the following are advantages or disadvantages of this type of care provision? Select all answers that apply.

Anxiety is decreased. Communication is improved. Health care costs are increased. When children's health care is provided through a family-centered approach, many positive outcomes are possible, including anxiety is decreased; children are calmer and pain management is enhanced; recovery times are shortened; families' confidence and problem-solving skills are improved; communication between the health care team and the family is also improved, leading to greater satisfaction for both the health care team and health care consumers (families); a decrease in health care costs is seen; and health care resources are used more effectively.

An unconscious client is admitted to the emergency department after a motor vehicle accident. The client's blood alcohol level upon admission was 1.7. The client's family soon arrives, reporting that the client is an uncle who is visiting from out of town. They cannot give much more history other than that he is a "social drinker." After being transported to the unit, the client starts sweating and has elevated vital signs. What information should the nurse request of the family?

Are there other indications that the client may be a heavy drinker? It is important to assess the situation thoroughly and since the client is unconscious, he cannot communicate what is happening to the staff. The best chance for the staff to understand what is going on would be to inquire further of the relatives. If the client is experiencing withdrawal, detoxification needs to be initiated immediately under medical supervision. Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake. Symptoms include coarse hand tremors, sweating, elevated pulse and blood pressure, insomnia, anxiety, and nausea or vomiting. Severe or untreated withdrawal may progress to transient hallucinations, seizures, or delirium—called delirium tremens (DTs). Alcohol withdrawal usually peaks on the second day and is over in about 5 days.

The nurse is assessing an elderly female in the emergency department. There are many bruises present on her body in varying stages of healing. After documenting the bruising in the assessment, what should the nurse do next?

Ask the client when and how the bruises occurred Feedback: The nurse should not assume the bruises were caused by abuse; the client's explanation is an important step in the assessment of potential abuse. A nurse must assess for abuse prior to getting the supervisor and physician involved. Reporting abuse would be initiated after a thorough assessment.

A peer reports for work looking unkempt and disheveled. Her movements are uncoordinated, and her breath smells like mouthwash. Another nurse suspects this peer is intoxicated. What should be the action of the nurse who suspects that a peer is intoxicated?

Ask the peer if she feels alright and express concern. Client safety is a priority; the impaired nurse should not be caring for clients. After client safety is ensured, the nurse should call the supervisor to handle the situation. It is not the nurse's responsibility to give out information on the hospital's employee assistance program. It is not appropriate to ignore the situation.

The nurse is educating a 16-year-old girl who has just been diagnosed with acute myelogenous leukemia. Which of the following statements best demonstrates therapeutic communication?

Assessing the adolescent's emotional status in private Therapeutic communication is goal directed and purposeful. Assessing the child's emotional status in private is goal directed and purposeful. Talking about clothing and shopping is not therapeutic communication unless its purpose is to find head coverings or wigs to mask hair loss and that information was not presented. Discussing the treatment plan for the next few weeks in detail is too much information for someone who has just been diagnosed. Using medical terms when describing the disease does not promote understanding.

The nurse is providing atraumatic care to children in a hospital setting. What are principles of this philosophy of care?

Avoid or reduce painful procedures, Avoid or reduce physical distress, Use core primary nursing. When using atraumatic care, the nurse would avoid or reduce painful procedures, avoid or reduce physical distress, use core primary nursing, maximize parent-child interactions, provide family-centered care, and provide opportunities for control, such as participating in care, attempting to normalize daily schedule, and providing direct suggestions.

A nurse uses the SBAR method to hand off the communication to the healthcare team. Which of the following might be listed under the "B" of the acronym? A) vital signs B) mental status C) patient problem D) further testing

B

What action by the nurse will facilitate the helping relationship during the orientation phase? A) providing assistance to meet activities of daily living B) introducing himself or herself to the patient by name C) designing a specific teaching plan of care D) preparing for termination of the relationship

B

The nurse is teaching the parents of a 9-year-old girl about the socialization that is occurring in their child through school contacts. Which of the following information would the nurse include in her teaching plan? A) Teachers are the most influential people in the development of the school-age child's social network. B) Continuous peer relationships provide the most important social interaction for school-age children. C) Parents should establish norms and standards that signify acceptance or rejection. D) A characteristic of school-age children is their formation of groups with no rules and values involved.

B Ans: Feedback: Continuous peer relationships provide the most important social interaction for school-age children. Peer and peer-group identification are most essential to the socialization of the school-age child. Peer groups establish norms and standards that signify acceptance or rejection. Valuable lessons are learned from interactions with children their own age. A characteristic of school-age children is their formation of groups with rules and values.

When providing anticipatory guidance to a group of parents with school-aged children, which of the following would the nurse describe as the most important aspect of social interaction? A) School B) Peer relationships C) Family D) Temperament

B Feedback: Although school, family, and temperament are important influences on social interaction, peer relationships at this time provide the most important social interaction for school-age children.

The nurse is talking with a chatty 7-year-old girl during her regular check-up. Which of the following behaviors would the child also be expected to exhibit? A) Showing no interest in what the nurse sees in her ears B) Explaining what is right and what is wrong C) Demonstrating independence from her mother D) Showing no concern when the nurse hurts her own finger

B Feedback: At this age, behavior is seen by the child as either completely right or wrong. The child will almost surely want to know why the nurse looks in her ears. The child depends heavily on parents for support and encouragement at this age. This is a time when children gain empathy, so the child would show concern for the nurse's injury.

The nurse is teaching the parents of a 9-year-old girl about the socialization that is occurring in their child through school contacts. Which of the following information would the nurse include in her teaching plan? A) Teachers are the most influential people in the development of the school-age child's social network. B) Continuous peer relationships provide the most important social interaction for school-age children. C) Parents should establish norms and standards that signify acceptance or rejection. D) A characteristic of school-age children is their formation of groups with no rules and values involved.

B Feedback: Continuous peer relationships provide the most important social interaction for school-age children. Peer and peer-group identification are most essential to the socialization of the school-age child. Peer groups establish norms and standards that signify acceptance or rejection. Valuable lessons are learned from interactions with children their own age. A characteristic of school-age children is their formation of groups with rules and values.

Which of the following would the nurse most likely find in a 10-year-old child in the period of concrete operational thought? A) Participation in abstract thinking B) Ability to classify similar objects C) Problem solving via the scientific method D) Ability to make independent decisions

B Feedback: During the period of concrete operational thought, children are able to classify or group objects based on their common elements. Abstract thinking, problem solving via the scientific method, and independent decision making are higher-level functions, typically seen in adolescents.

The nurse is performing a physical assessment of a 10-year-old boy. The nurse notes that during last year's check-up the child weighed 80 pounds. According to average growth for this age group, what would be his expected current weight? A) 83 pounds B) 85 pounds C) 87 pounds D) 89 pounds

B Feedback: From 6 to 12 years of age, an increase of 4 to 6 pounds (2 to 3 kg) per year in weight is expected.

The nurse is performing a physical examination of an 11-year-old girl. Which of the following observations would be expected? A) The child has not gained weight since last year. B) The child has grown 3 inches since last year. C) The child breathes abdominally. D) The child's third molars are about to erupt.

B Feedback: From 6 to 12 years of age, children grow an average of 2 inches (5 cm) per year, increasing their height by at least 1 foot. An increase of 4 to 6 pounds (2 to 3 kg) per year in weight is expected. Abdominal breathing is typical of a preschooler and would have disappeared several years earlier. The third molars do not erupt until late adolescence.

The nurse is providing anticipatory guidance for parents of a school-age child on teaching the dangers of drugs and alcohol. Which of the following advice might be helpful for these parents? A) School-age children are not ready to absorb information that deals with drugs and alcohol. B) School-age children can think critically to interpret messages seen in advertising, media, and sports. C) Parents must prevent their child from being exposed to messages that are in conflict with their values. D) Discussions with children need to be based on facts and focused on the past and future.

B Feedback: School-age children can be taught how to think critically to interpret messages seen in advertising, media, sports, and entertainment personalities. School-age children are ready to absorb information that deals with drugs and alcohol and may be exposed to messages that are in conflict with their parents' values regarding smoking and alcohol. This may occur at school and cannot be prevented. Discussions with children need to be based on facts and focused on the present.

The school nurse is conducting vision screening for a 7-year-old girl and documents the condition "amblyopia." What would the nurse tell the parents about this condition? A) "Amblyopia is an uncorrected refractive error of the eye." B) "Amblyopia is reduced vision in an eye that has not been adequately used during early development." C) "Amblyopia is a malalignment of the eye, which occurs at birth." D) "Amblyopia is a clouding of the lens of the eye caused by trauma to the eye."

B Feedback: Some problems frequently identified in school-age children include amblyopia (lazy eye), uncorrected refractive errors or other eye defects, and malalignment of the eyes (called strabismus). Amblyopia is reduced vision in an eye that has not been adequately used during early development. Inadequate use can result from conditions such as strabismus, being cross-eyed, or one eye being more nearsighted, farsighted, or astigmatic than the other eye. Amblyopia is the leading cause of visual impairment in children (National Eye Institute, 2008) and if untreated can result in vision loss.

The parents of an 11-year-old child ask the nurse for suggestions to promote good nutrition for their child. Which response by the nurse would be most appropriate? A) "Be sure to limit protein to one meal every day." B) "Use whole-grain or enriched breads and cereals." C) "Have eggs on the average of once a week." D) "Eat dark green leafy vegetables about twice a week."

B Feedback: The American Heart Association's dietary recommendations to promote good nutrition include using whole-grain or enriched breads and cereals, having a good-quality protein with every meal, and eating eggs approximately four times per week and dark green leafy or deep yellow vegetables at least four times per week.

The nurse is teaching the student nurse the physiology involved in pain transmission. Which of the following statements accurately describes a physiologic event in the nervous system related to pain transmission? Select all answers that apply. A) Thermal stimulation may involve the release of mediators, such as histamine, prostaglandins, leukotrienes, or bradykinin. B) When nociceptors are activated by noxious stimuli, the stimuli are converted to electrical impulses that are relayed to the spinal cord and brain. C) Myelinated A-delta fibers are large fibers that conduct the impulse at very rapid rates; unmyelinated small C fibers transmit the impulse slowly. D) Once in the dorsal horn of the spinal cord, the nerve fibers divide and then cross to the opposite side and rise upward to the thalamus. E) The point at which the person first feels the highest intensity of the painful stimulus is termed the pain threshold. F) Peripheral sensitization allows the nerve fibers to react to a stimulus that is of lower intensity than would be needed to cause pain.

B, C, D, F Feedback: When nociceptors are activated by noxious stimuli, the stimuli are converted to electrical impulses that are relayed along the peripheral nerves to the spinal cord and brain. Myelinated A-delta fibers are large fibers that conduct the impulse at very rapid rates; unmyelinated small C fibers transmit the impulse slowly. Once in the dorsal horn of the spinal cord, the nerve fibers divide and then cross to the opposite side and rise upward to the thalamus. Peripheral sensitization allows the nerve fibers to react to a stimulus that is of lower intensity than would be needed to cause pain. Chemical stimulation may involve the release of mediators, such as histamine, prostaglandins, leukotrienes, or bradykinin. The point at which the person first feels the lowest intensity of the painful stimulus is termed the pain threshold.

The pediatric nurse is aware of the maturation of organ systems in the school-age child. Which of the following accurately describe these changes? Select all answers that apply. A) The brain grows very slowly during the school-age years and growth is complete by the time the child is 12 years of age. B) Respiratory rates decrease, abdominal breathing disappears, and respirations become diaphragmatic in nature. C) The school-age child's blood pressure increases and the pulse rate decreases, and the heart grows more slowly during the middle years. D) The school-age child experiences more gastrointestinal upsets compared with earlier years since the stomach capacity increases. E) Bladder capacity increases, but varies among individual children, and girls generally have a greater bladder capacity than boys. F) Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics.

B, C, E, F Feedback: Respiratory rates decrease, abdominal breathing disappears, and respirations become diaphragmatic in nature. The school-age child's blood pressure increases and the pulse rate decreases. The heart grows more slowly during the middle years and is smaller in size in relation to the rest of the body than at any other development stage. Bladder capacity increases, but varies among individual children. Girls generally have a greater bladder capacity than boys. Prepubescence typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics. The brain and skull grow very slowly during the school-age years. Brain growth is complete by the time the child is 10 years of age. The school-age child experiences fewer gastrointestinal upsets compared with earlier years. Stomach capacity increases, which permits retention of food for longer periods of time.

Termination Phase

Begins when the conclusion of the initial agreement in acknowledged.

When interviewing the family members of a client being treated for substance abuse problems, which behavior would alert the nurse to the possibility of codependency?

Blaming themselves for the family's problems Feedback: Self-blame is an example of maladaptive coping or codependent behavior. The other choices do not correlate with codependency behaviors.

Naltrexone (ReVia, Trexan)

Blocks the effects of opiates; reduces alcohol cravings 350 mg/week, divided into three doses for opiate-blocking effect; 50 mg/day for up to 12 weeks for alcohol cravings Client may not respond to narcotics used to treat cough, diarrhea, or pain; take with food or milk; may cause headache, restlessness, or irritability

What is the goal of the nurse in a helping relationship with a patient? A) to provide hands-on physical care B) to ensure safety while caring for the patient C) to assist the patient to identify and achieve goals D) to facilitate the patient's interactions with others

C

The nurse is using the formula for bladder capacity to measure the bladder capacity of a 9-year-old girl. What number would the nurse document for this measurement? A) 9 ounces B) 10 ounces C) 11 ounces D) 12 ounces

C Feedback: The formula for bladder capacity is age in years plus 2 ounces. Therefore, the bladder capacity of the 9-year-old would be 11 ounces.

The nurse has determined that an 8-year-old girl is at risk for being overweight. Which of the following interventions would be a priority prior to developing the care plan? A) Determining the need for additional caloric intake B) Asking the parents who they want to work with the child C) Interviewing the parents about their eating habits D) Discussing the influence of peers on the child's diet

C Feedback: The nurse would need to find out what the parents' eating habits are like. It would not be necessary to determine the need for additional caloric intake. Developing a multidisciplinary plan is an intervention for a child with growth and development problems. Discussing the influence of peers is an intervention used for preventing injury.

The nurse is counseling the parents of a 10-year-old child who was caught stealing at school. Which of the following topics should the nurse cover? A) Having the child return the property in front of his or her class B) Discussing ways for the child to save face C) Finding out what is currently going on at home D) Reminding the child daily that stealing is wrong

C Feedback: The parents need to understand the child's behavior. The reason for stealing at age 10 may be that the child wants the item or is trying to impress peers, or it may be a sign of anxiety. More information is needed before the nurse can effectively work with the family. The parents should work together with the child to decide how the item will be returned. The child will lose face but gain integrity by returning the stolen item. Reminding the child about stealing on a daily basis may ruin the child's self-esteem.

The nurse is teaching parents to plan nutritional meals for their son who is overweight. Which of the following guidelines might the nurse include in the teaching plan? A) School-age children with an average body weight of 20 to 35 kg need approximately 90 calories per kilogram daily. B) The average water requirement for a school-age child per 24 hours ranges from 2,000 to 2,500 mL per day. C) The school-age child needs 28 g of protein and 800 mg of calcium for maintenance of growth and good nutrition. D) In the school-age child, calories needed to sustain weight increase, while the appetite decreases.

C Feedback: The school-age child needs 28 g of protein and 800 mg of calcium for maintenance of growth and good nutrition. School-age children with an average body weight of 20 to 35 kg need approximately 70 calories per kilogram daily (1,400 to 2,100 calories per day). The average water requirement per 24 hours ranges from 1,800 to 2,200 mL per day. Growth, body composition, and body shape remain constant during the late school-age years. Needed calories decrease while the appetite increases.

The nurse is assessing the gross motor skills of an 8-year-old boy. Which of the following interview questions would facilitate this assessment? A) "Do you like to do puzzles?" B) "Do play any instruments?" C) "Do you participate in any sports?" D) "Do you like to construct models?"

C Feedback: To assess the gross motor skills of school-age children, the nurse should ask questions about participation in sports and after-school activities. For fine motor skills, the nurse could ask questions about band membership, constructing models, and writing skills.

COPE model

C: Creativity Help the family overcome obstacles to carrying out health care management and learning how to generate alternatives. O: Optimism Help the family caregivers learn how to view the caregiving situation with confidence. P: Planning Help the family learn how to plan for future problems and how to develop contingency plans that reduce uncertainty. E: Expert Information Help the family learn how to obtain expert information from health care providers about what to do in specific situations. This information empowers caregivers by encouraging them to develop plans for solving caregiving problems.

Hypervolemic Patient

CHF, renal failure, cirrhosis

Cannabis: Intoxication and Overdose, Withdrawal and Detoxification

Cannabis begins to act less than 1 minute after inhalation. Peak effects usually occur in 20 to 30 minutes and last at least 2 to 3 hours. Users report a high feeling similar to that with alcohol, lowered inhibitions, relaxation, euphoria, and increased appetite. Symptoms of intoxication include impaired motor coordination, inappropriate laughter, impaired judgment and short-term memory, and distortions of time and perception. Anxiety, dysphoria, and social withdrawal may occur in some users. Physiologic effects, in addition to increased appetite, include conjunctival injection (bloodshot eyes), dry mouth, hypotension, and tachycardia. Excessive use of cannabis may produce delirium or, rarely, cannabis-induced psychotic disorder, both of which are treated symptomatically. Overdoses of cannabis do not occur No clinically significant withdrawal symptom is identified

Physiologic Effects of Long-Term alcohol use

Cardiac myopathy Wernicke's encephalopathy Korsakoff's psychosis Pancreatitis Esophagitis Hepatitis Cirrhosis Leukopenia Thrombocytopenia Ascites

Working phase

Care provided a client after interventions and until discharge. During this phase, the nurse and client explore and develop solutions that are enacted and evaluated in subsequent interactions.

Psychosocial Abuse Indicators in Elderly

Change in elder's general mood or usual behavior Isolated from previous friends or family Sudden lack of contact from other people outside the elder's home Helplessness Hesitance to talk openly Anger or agitation Withdrawal or depression

Goals During Hospitalization of Peds Patients

Child will be prepared, Child will experience little or no separation, Child will maintain sense of control, Child will exhibit decreased fear of bodily injury

Biologic Factors of Alcoholism

Children of alcoholics are more likely to become alcoholics.

The nurse knows that effective communication with children and their parents is critical to providing atraumatic quality nursing care. Which of the following statements accurately describes the communication patterns of children?

Children rely more on nonverbal communication and silence. Children often use fewer words than adults and may rely more on nonverbal communication and silence. Communication patterns can vary greatly from one child to the next. Some children are very talkative, while others are quiet. Parents more often require neutral communication (i.e., verbal communication that is related to assessing and solving problems), whereas children more often desire affective communication (establishment of rapport and trust, giving comfort).

What groups could benefit most from prevention programs?

Children, prior to first use. Feedback: Poor outcomes have been associated with an earlier age at onset and longer periods of substance use. Children who have not yet used substances may be easily influenced because of their age and the fact that they have not already become addicted. Adults who have already engaged in substance abuse will not benefit as greatly from prevention programs as will children. Older adults will not benefit as greatly from prevention programs as will children. Infants will not benefit from prevention programs as they do not have self-efficacy.

During an assessment of a newly admitted client the nurse asks the client many questions. The nurse begins the assessment by asking " how many times have you been hospitalized this year for your back pain? " This is an example of what type of question?

Closed question

Cognitive development

Cognitive development-related to sensory reception, processing, and use of information. These processes underlie learning, understanding, problem solving, reasoning, and remembering. Cognitive abilities enable moral and spiritual development.

Communication development

Communication-Speech is the expression of language. The 3 components of speech are articulation, voice, and fluency. Language is a set of rules shared by a group of people that allows the communication of thoughts, ideas, and emotions. Receptive language function is the ability to understand what others say. Expressive language function is the ability to express completely one's own thoughts, ideas, and emotions.

Additional steps prior to giving an IVP med?

Compatibility, rate of admin, need to be diluted?

A nurse is attempting to improve her communication skills. What are appropriate therapeutic communication skills?

Control the tone of the voice to avoid hidden messages. - Conversation skills involve controlling the tone of one's voice that what is intended is conveyed and there is no hidden message. Periods of silence allow for reflection. Cliches should be avoided, and the conversation should be flexible.

Three trends of mental health care in the US?

Cost containment and managed care, population diversity, community based care

Basic-level functions Psychiatric nursing

Counseling Milieu therapy Self-care activities Psychobiologic interventions Health teaching Case management Health promotion, maintenance

The nurse is conducting an assessment of a high school track athlete. He tells the nurse he is experiencing pain along his outer thigh. He describes it as tight, achy, and tender, particularly after he runs. The nurse understands that he is most likely experiencing what kind of pain? A) Cutaneous B) Neuropathic C) Visceral D) Deep somatic

D Feedback: Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones. It can be localized or diffuse and is usually described as dull, aching, or cramping with tenderness. It can also be due to overuse injuries commonly experienced by athletes. Cutaneous pain usually involves the skin and is described as sharp or burning. Neuropathic pain is due to a malfunctioning of the peripheral nervous system and is described as burning or tingling. Visceral pain is pain that develops within organs.

The school nurse is teaching parents about the effects of bullying on school children. Which of the following accurately describes this developmental concern? A) Children who bully are those who report themselves as being lonely and having difficulty in forming friendships. B) Children who are bullied are reported to have low self-esteem, poor grades, and poor interpersonal skills. C) In general, about 20% of all children attending school are frightened and afraid most of the day. D) Both boys and girls are bullied; boys usually bully boys and use force more often.

D Feedback: Both boys and girls are bullied; boys usually bully boys and use force more often. Bullied children are those who report themselves as being lonely and having difficulty in forming friendships. The children who perform the bullying are those children who are reported to have low self-esteem, poor grades, and poor interpersonal skills. In general, about 10% of all children attending school are frightened and afraid most of the day.

Two working parents are discussing with the school nurse the possibility of their 12-year-old girl going home alone after school. Which of the following suggestions should the nurse make? A) Provide entertainment until the parents come home. B) Allow the child to go to a friend's house. C) Teach her how to take a message if someone calls. D) Purchase caller ID for the phone.

D Feedback: Having caller ID allows the child to answer the phone if Mom or Dad calls while ignoring all other calls. Rather than entertaining the child, this would be a better time for homework, age-appropriate chores, and limited entertainment. If the child goes to a friend's house, it should be prearranged between the parents, not spur of the moment. It is safer if the child does not answer the phone instead of taking a message.

The school nurse knows that school-age children are developing metalinguistic awareness. Which of the following is an example of this skill? A) The child enjoys reading books. B) The child enjoys conversations with peers. C) The child enjoys speaking on the phone. D) The child enjoys telling jokes.

D Feedback: Language skills continue to accelerate during the school-age years. School-age children develop metalinguistic awareness—an ability to think about language and comment on its properties. This enables them to enjoy jokes and riddles due to their understanding of double meanings and play on words and sounds.

The school nurse is preparing a talk on the influence of the media on school-age children to present at the next PTO meeting. Which of the following facts might the nurse include in the introduction? A) Children in the United States spend about 6 hours a day either watching TV or playing video games. B) A child will see 2,000 murders by the end of grade school and 20,000 commercials a year. C) A school-age child cannot determine what is real from what is fantasy; therefore, TV and video games can lead to aggressive behavior. D) Parents should limit television watching and video-game playing to 2 hours per day.

D Feedback: Parents should limit television watching and video-game playing to 2 hours per day. Children in the United States spend about 4 hours a day either watching TV or playing video games. A child will see 8,000 murders by the end of grade school and 40,000 commercials a year. Although school-age children can determine what is real from what is fantasy, research has shown that this amount of time in front of the TV—watching it or playing video games—can lead to aggressive behavior, less physical activity, and altered body image.

During a well-child check-up, the parents of a 9-year-old boy tell the nurse that their son's friends told him that soccer is a stupid game, and now he wants to play baseball. Which comment by the nurse best explains the effects of peer groups? A) "The child's best friends will continue playing soccer." B) "The children will cheer for each other regardless of the sport being played." C) "Your child will rarely talk to you about his friends." D) "Acceptance by friends, especially of the same sex, is very important at this age."

D Feedback: Peer relationships, especially of the same sex, are very important and can influence the child's relationship with his parents. They can provide enough support that he can risk parental conflict and stand his ground about playing soccer. At this age, peer groups are made up of the child's best friends, and they happen to be playing baseball. Peer groups have rules and take up sides against the soccer player. Peers are an authority, so the child will let his parents know their opinions.

The nurse is preparing a presentation for a local parent-teacher organization about the growth and development of school-age children. Which of the following would the nurse include? A) Boys mature much more quickly than girls of the same age during this time. B) From 6 to 12 years of age, children grow an average of 4 inches per year. C) The child's body size is in direct correlation with his or her maturity level. D) Secondary sex characteristics are often embarrassing for both sexes.

D Feedback: Secondary sex characteristics are often a source of embarrassment for both sexes because preadolescent boys and girls do not want to be different from their peers of the same or opposite sex. In the later school years, girls begin to surpass boys in both height and weight. During this time, children grow an average of 2 inches (5 cm) per year. Physical maturity is not necessarily associated with emotional or social maturity.

The parents of an 8-year-old boy are interested in promoting learning through reading to their son. Which of the following suggestions by the nurse would best promote this goal? A) Have the parents choose what he should read initially. B) Tell the child to read instead of watching TV with his parents. C) Tell the parents that reading is for the child to do by himself. D) Take the child to the library to check out some books.

D Feedback: Taking the child to the library can be a positive start to the reading experience. It is best to let the librarian recommend books that will be appropriate for the child, but let the child choose from recommended materials. Set an example by reading instead of watching TV while the child is not in bed. Reading to the child is a valuable parent-child activity that can expose the child to classic works that are beyond the child's present reading ability.

Diagnostic and Statistical Manual of Mental Disorders

DSM: Taxonomy of American Psychiatric Association Purposes: Standardize nomenclature, language Identify defining characteristics or symptoms Assist in identifying underlying causes

The nurse contacts a child life specialist (CLS) to work with children on a pediatric ward. What is the primary goal of the CLS?

Decrease anxiety and fear during hospitalization and painful procedures The CLS is a specially trained individual who provides programs that prepare children for hospitalization, surgery, and other procedures that could be painful (Child Life Council, 2010a, 2010b). The goal of the CLS is to decrease the anxiety and fear while improving and encouraging understanding and cooperation of the child. The CLS may use distraction techniques and act as a liaison, but that is not the primary goal of the CLS role. The CLS does not perform medical procedures.

A client in treatment for drug abuse makes the statement, "I am a winner. You all are the losers because you can't beat this on your own." What common characteristic of persons addicted to drugs is revealed in this statement?

Defending against a negative self-concept Clients generally have low self-esteem, which they may express directly or to cover with grandiose behavior. They do not feel adequate to cope with life and stress without the substance and often are uncomfortable around others when not using. They often have difficulty identifying and expressing true feelings.

Community mental health movement (1950s)

Deinstitutionalization Legislation for disability income Changes in commitment laws

The nurse is caring for a 4-year-old boy with Ewing sarcoma who is scheduled for a computed axial tomography (CAT) scan tomorrow. Which of the following is the best example of therapeutic communication?

Describing what it is like to get a CAT scan using words he understands Describing what it is like to get a CAT scan using age-appropriate words is the best example of therapeutic communication. It is goal-directed, focused, and purposeful communication. Using family-familiar words and soft words is a good teaching technique. Telling him how cool he looks in his baseball cap and pajamas is not goal-directed communication. Telling the child he will get a shot when he wakes up could keep him awake all night.

A nurse is designing a teaching program for individuals who have recently immigrated to the United States from Iraq. Which of the following considerations is necessary for culturally competent patient teaching?

Develop written materials in the patient's native language.

The nurse is teaching the student nurse how to communicate effectively with children. Which one of the following methods would the nurse recommend?

Direct questions and explanations to the child. To communicate effectively with children, the nurse should direct questions and explanations to the child; position self at the child's level; allow the child to remain near the parent if needed, so the child can remain comfortable and relaxed; and use the child's or family's terms for body parts and medical care when possible.

A student appears very nervous on the first day of clinical in a psychiatric setting. The student reviews the instructor's guidelines and appropriately takes which of the following actions?

Discusses the anxious feelings with the instructor Builds rapport with the patient before asking personal questions Consults the instructor if a shocking situation arises

General criteria for diagnosis of a Mental illness:

Dissatisfaction with characteristics, abilities, accomplishments Ineffective or unsatisfying relationships Dissatisfaction with one's place in the world Ineffective coping with life events Lack of personal growth

Cautions when IVP

Don't mix 2 drugs in syringe, label all syringes, give push meds with instructor. Don't throw away vial until checked by instructor.

Associated with moral treatment of the mentally ill

Dorothea Dix

Stimulants ( amphetamine, Cocaine)

Drugs that stimulate or excite the CNS and have limited clinical use.

A nurse who is discharging a patient is terminating the helping relationship. Which of the following actions might the nurse perform in this phase? Select all that apply. A) making formal introductions B) making a contract regarding the relationship C) providing assistance to achieve goals D) helping patient perform activities of daily living E) examining goals of relationship for achievement F) helping patient establish helping relationship with another nurse

E,F

A nurse teaching a new mother how to bathe her infant uses the acronym TEACH to maximize the effectiveness of the teaching plan. Which of the following are guidelines based on this acronym?

Edit patient information. Act on every teaching moment. Clarify often.

Which of the following is a standard of professional performance?

Education Education is a standard of professional performance. Other standards of professional performance include the quality of practice, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, and leadership. Assessment, planning, and implementation are components of the nursing process, not standards of professional performance.

Created classification of mental disorders according to symptoms

Emil Kraeplin

Warning signs of relationship violence

Emotionally abuses you (insults, makes belittling comments, or acts sulky or angry when you initiate an idea or activity) Tells you with whom you may be friends or how you should dress, or tries to control other elements of your life Talks negatively about women in general Gets jealous for no reason Drinks heavily, uses drugs, or tries to get you drunk Acts in an intimidating way by invading your personal space such as standing too close or touching you when you don't want him to Cannot handle sexual or emotional frustration without becoming angry Does not view you as an equal: sees himself as smarter or socially superior Guards his masculinity by acting tough Is angry or threatening to the point that you have changed your life or yourself so you won't anger him Goes through extreme highs and lows: is kind one minute, cruel the next Berates you for not getting drunk or high, or not wanting to have sex with him Is physically aggressive, grabbing and holding you, or pushing and shoving

A family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. What quality should the nurse use in this situation?

Empathy- empathy helps the nurse to provide effective care without being emotionally distraught.

A nurse is caring for a terminally ill client whose death is imminent. The nurse has developed a close relationship with the family. What is an appropriate intervention?

Encourage family discussions of feelings.

What is defined as an advanced-level function in the practice area of psychiatric mental health nursing?

Evaluation Advanced-level functions are psychotherapy, prescriptive authority, consultation and liaison, evaluation, and program development and management. Case management, counseling, and health teaching are basic-level functions in the practice area of psychiatric mental health nursing.

Self-Awareness Issues

Everyone has unique or different values, ideas, and beliefs. Possible conflict between personal values/beliefs, those of client Need to accept differences; view each client as worthwhile regardless of opinions or lifestyle Self-awareness through reflection

A nurse is caring for a patient who is visually impaired. Which of the following is a recommended guideline for communication with this patient?

Explain reason for touching patient before doing so.

When assessing a client's nonverbal communication, the nurse will assess which part of the body as the most expressive?

Facial expressions- the face is the most expressive part of the body. Eye contact, the lack of eye contact, posture, gesture , and silence are other methods of nonverbal communication.

What is the best explanation for why family violence tends to occur over multiple generations of families?

Family violence may be perpetuated between generations of families by role modeling and social learning. Feedback: The intergenerational transmission process shows that patterns of violence are perpetuated from one generation to the next through role modeling and social learning. Not all persons exposed to family violence, however, become abusive or violent as adults.

A nurse has just administered medication via an orogastric tube. What is the priority nursing action following administration?

Flush the tube. After administration, the nurse should flush the tube to maintain patency and ensure that the entire amount of medication has been given. The tube should be checked prior to administering the medication. It is not necessary to retape the tube following administration. It is not appropriate to remove the tube unless it has been specifically ordered.

Developmental Assessment: Older Adults

Focus on functional assessment/ability Assessment of an individual's ability to carry out basic activities of daily living and instrumental activities of daily living B (basic)ADLs: Hygiene, toileting, eating, and ambulating I(instrumental)ADLs: Needed to function independently. Preparing meals, shopping, taking medications, traveling within community, maintaining finances With serious mental/physical disease or injury, adult is assessed for emotional regression because of frequency of regression to an earlier level of emotional expression

Possible Physical Abuse indicators in Elderly

Frequent, unexplained injuries accompanied by a habit of seeking medical assistance from various locations Reluctance to seek medical treatment for injuries or denial of their existence Disorientation or grogginess indicating misuse of medications Fear or edginess in the presence of family member or caregiver (Videbeck 206) Videbeck, Sheila. Psychiatric-Mental Health Nursing, 6th Edition. Wolters Kluwer Health, 09/2013. VitalBook file.

A nurse who is preparing to administer an injection to the client states " this injection will not be painful". This is an example of what type of communication technique?

Giving false reassurances.

A client with alcohol dependence is admitted to the hospital with pancreatitis. Which intervention should be included in the client's plan of care?

Glucometer checks b.i.d. Pancreatitis can cause elevated serum glucose levels. The other choices are not necessarily appropriate.

Intoxication and Overdose: Hallucinogen

Hallucinogen intoxication is marked by several maladaptive behavioral or psychologic changes: anxiety, depression, paranoid ideation, ideas of reference, fear of losing one's mind, and potentially dangerous behavior such as jumping out a window in the belief that one can fly (Jones, 2009). Physiologic symptoms include sweating, tachycardia, palpitations, blurred vision, tremors, and lack of coordination. PCP intoxication often involves belligerence, aggression, impulsivity, and unpredictable behavior. Toxic reactions to hallucinogens (except PCP) are primarily psychologic; overdoses as such do not occur. These drugs are not a direct cause of death, although fatalities have occurred from related accidents, aggression, and suicide. Treatment of toxic reactions is supportive. Psychotic reactions are managed best by isolation from external stimuli; physical restraints may be necessary for the safety of the client and others. PCP toxicity can include seizures, hypertension, hyperthermia, and respiratory depression. Medications are used to control seizures and blood pressure. Cooling devices such as hyperthermia blankets are used, and mechanical ventilation is used to support respirations (Lehne, 2009).

The nurse is choosing a vein to insert a peripheral IV for a 2-year-old child. Which of the following sites would be appropriate?

Hand veins Feet veins Forearm veins Scalp veins Peripheral IV therapy sites commonly include the hands, feet, and forearms. In infants up to about the age of 9 months, the scalp veins may be used. Central IV therapy usually is administered through a large vein, such as the subclavian, femoral, or jugular vein or the vena cava.

Therapeutic nurse-client relationship

Hildegard Peplau

Causes of Speed Shock

IV med administered too quickly, Toxic effects related to medication being infused

Infiltration

IV slips out of vein, fluid leaks from previous IV puncture site.

A nurse is caring for a 14-year-old with a gastrostomy tube. The girl has skin breakdown and irritation at the insertion site. Which of the following would be the most appropriate method to clean and secure the gastrostomy tube?

If any drainage is present, use a presplit 2 × 2 and place it loosely around the site. Skin around the gastrostomy or jejunostomy insertion site may become irritated from movement of the tube, moisture, leakage of stomach or intestinal contents, or the adhesive device holding the tube in place. Keeping the skin clean and dry is important and will help prevent most of these problems. If any drainage is present, a presplit 2 × 2 can be placed loosely around the site and changed when soiled. If no drainage is present, the nurse should not place a dressing as it can cause undue pressure and trap moisture, leading to skin irritation. Preventing movement of the tube helps reduce skin irritation; however, the tube should be able to move slightly in and out of the child's stomach.

A young woman telephones the emergency department and loudly tells the nurse, "I've been raped! Please help me!" What is the priority for the nurse to determine?

If the client was in a safe place, her condition, and if transportation is available Feedback: If the client is injured, she may need immediate medical attention; if she is in a safe place, she can talk to the nurse on the phone. All other questions can wait until the client's safety is ensured.

A 42-year-old male patient recovering from a MI is having difficulty following the care plan to stop smoking and exercise. What is the nurse's best response to this patient?

Ignore the behavior and recommend a behavior modification program.

The nurse is teaching the student nurse the factors that affect the pharmacodynamics of the drugs they are administering. Which of the following is a factor affecting this property of drugs?

Immature body systems Although a drug's mechanism of action is the same in any individual, the physiologic immaturity of some body systems in a child can affect a drug's pharmacodynamics (behavior of the medication at the cellular level). The child's age, weight, body surface area, and body composition also can affect the drug's pharmacokinetics (movement of drugs throughout the body via absorption, distribution, metabolism, and excretion).

Psychologic Factors of Alcoholism

In addition to the genetic links to alcoholism, family dynamics are thought to play a part. Children of alcoholics are four times as likely to develop alcoholism (Schuckit, 2009a,b) compared with the general population. Some theorists believe that inconsistency in the parent's behavior, poor role modeling, and lack of nurturing pave the way for the child to adopt a similar style of maladaptive coping, stormy relationships, and substance abuse. Others hypothesize that even children who abhorred their family lives are likely to abuse substances as adults because they lack adaptive coping skills and cannot form successful relationships. Some people use alcohol as a coping mechanism or to relieve stress and tension, increase feelings of power, and decrease psychologic pain. High doses of alcohol, however, actually increase muscle tension and nervousness

Mental health and mental illness

In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. Feedback: What one society may view as acceptable and appropriate behavior, another society may see that as maladaptive, and inappropriate. Mental health and mental illness are difficult to define precisely. In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. Persons who engage in fantasies may be mentally healthy, but the inability to distinguish reality from fantasy is an individual factor that may contribute to mental illness.

Dorothea Dix

In the US, began a crusade to reform the treatment of mental illness. Instrumental in opening 32 state hospitals that offered asylum to the suffering.

Possible Indicators of Self Neglect in Elderly

Inability to manage personal finances, such as hoarding, squandering, or giving away money while not paying bills Inability to manage activities of daily living, such as personal care, shopping, or housework Wandering, refusing needed medical attention, isolation, and substance use Failure to keep needed medical appointments Confusion, memory loss, and unresponsiveness Lack of toilet facilities, or living quarters infested with animals or vermin

Which of the following strategies might a nurse use to increase compliance with teaching?

Include the patient and family as partners.

Healthy People 2020 objectives:

Increase number of people identified, diagnosed, treated, helped to live healthier lives Decrease rates of suicide, homelessness Increase employment for those with serious mental illness Provide more services for incarcerated persons with mental health problems

Ideas for increasing the number of people receiving treatment for mental illness

Increased community-based clinics; increased screening for mental illness in primary care settings; screening identified high-risk populations; improved mental health parity in insurance coverage; increased services in jails, prisons, and other institutional settings.

What are some reasons for why substance abuse must be addressed?

Increasing numbers of infants are suffering the physiologic and emotional consequences of prenatal exposure to alcohol or drugs. Chemical abuse results in increased violence. Drug abuse costs business and industry an estimated 102 billion annually. Alcohol abuse is a too frequent cause of or contributor to death. Feedback: Increasing numbers of infants are suffering the physiologic and emotional consequences of prenatal exposure to alcohol or drugs. Chemical abuse results in increased violence. Drug abuse costs business and industry an estimated $102 billion annually. Alcohol abuse is a too frequent cause of or contributor to death. Substance use/abuse and related disorders are a national health proble

Nursing interventions to help with children's loss of control:

Infants: Provide consistent care Toddlers: maintain consistent routine Toddlers often have security objects such as a stuffed animal that help them feel safe and secure Preschoolers: need adequate preparation to unfamiliar experiences, fear bodily injury School-aged: provide schoolwork, social Adolescents: same as schoolage, privacy

Promotion of Normal development in Atraumatic Care

Infants: oral-motor development Toddlers: encourage mobility & exploration, language development Preschoolers: assistance with self-care School-aged: socialization, provision of games & tasks for mastery Adolescents: increased independence in managing own care

Assessing for Pain in Children:

Infants: watch facial expression, FLACC Toddlers: grimace, clench teeth, restless Preschoolers: can locate pain, use face scale, fear bodily injury & mutilation, literal School-aged: fear disability & death, pain is punishment, "magical quality" of germs, can use faces scale Adolescents: use same pain scale as adults

The nurse is caring for a 6-year-old child who has multisystem trauma due to a motor vehicle accident. The child is receiving total parenteral nutrition (TPN). Which of the following is a recommended nursing intervention for children on TPN?

Initially, check blood glucose levels frequently, such as every 4 to 6 hours, to evaluate for hyperglycemia. Initially, the nurse should check blood glucose levels frequently, such as every 4 to 6 hours, to evaluate for hyperglycemia. Throughout TPN therapy, the nurse should be vigilant in monitoring the infusion rate, and report any changes in the infusion rate to the physician or nurse practitioner immediately. Adjustments may be made to the rate, but only as ordered by the physician or nurse practitioner. If for any reason the TPN infusion is interrupted or stops, the nurse should begin an infusion of a 10% dextrose solution at the same infusion rate as the TPN. TPN can be administered continuously over a 24-hour period, or after initiation it may be given on a cyclic basis, such as over a 12-hour period during the night.

The nurse is implementing interventions to prevent physical stressors for a 9-year-old child receiving chemotherapy in the hospital. Which of the following is an example of using atraumatic care for this child?

Insert a saline lock if the child will require multiple doses of parenteral medications. The nurse should insert a saline lock if the child will require multiple doses of parenteral medications. During painful or invasive procedures, the nurse should avoid traditional restraint or "holding down" of the child and use alternative positioning such as "therapeutic hugging." If therapeutic hugging is not an option, the nurse could have the parent stand near the child's head to provide comfort. The nurse should also use numbing techniques for blood draws or IV insertion.

The family of a patient in a burn unit asks the nurse for information. The nurse sits with the family and discusses their concerns. What type of communication is this?

Interpersonal

Intimate partner violence can exist with former partners.

Intimate partner violence is the mistreatment or misuse of one person by another in the context of an emotionally intimate relationship. The relationship may be spousal, between partners, boyfriend, girlfriend, or an estranged relationship. Ninety to ninety-five percent of domestic violence victims are women. By deduction, this means that 5% to 10% of domestic violence victims are men. The abuse can be emotional or psychological, physical, sexual, or a combination (which is common). All abuse is harmful.

Intoxication and Overdose of Stimulants

Intoxication from stimulants develops rapidly; effects include the high or euphoric feeling, hyperactivity, hypervigilance, talkativeness, anxiety, grandiosity, hallucinations, stereotypic or repetitive behavior, anger, fighting, and impaired judgment. Physiologic effects include tachycardia, elevated blood pressure, dilated pupils, perspiration or chills, nausea, chest pain, confusion, and cardiac dysrhythmias. Overdoses of stimulants can result in seizures and coma; deaths are rare (McCann & Ricourte, 2009). Treatment with chlorpromazine (Thorazine), an antipsychotic, controls hallucinations, lowers blood pressure, and relieves nausea

The nurse is administering immunizations to children in a neighborhood clinic. Which of the following is the most frequent route of administration?

Intramuscular

The nurse is explaining to the student nurse the therapeutic effects of total parenteral nutrition (TPN). Which of the following accurately describes the use of TPN?

It is a highly concentrated solution of carbohydrates, electrolytes, vitamins, and minerals. TPN is a highly concentrated solution of carbohydrates, electrolytes, vitamins, and minerals. TPN provides all nutrients to meet a child's needs. It is delivered via central venous access to allow rapid dilution of hypertonic solution. It is usually used in a child with a nonfunctioning gastrointestinal (GI) tract, such as a congenital or acquired GI disorder; a child with severe failure to thrive or multisystem trauma or organ involvement; and preterm newborns.

The nurse is coleading a family therapy group for clients and families of drug-addicted individuals. The family of a cocaine addict is angry and cannot understand why the client cannot just stop using. The nurse guides the group to discuss their understanding of the nature of addiction. Which statements would the nurse identify as an accurate understanding of the nature of addiction? Select all that apply.

It is a medical illness that is progressive. Relapses and remissions are part of the illness. Alcoholism (and other substance abuse) often is called a family illness. All those who have a close relationship with a person who abuses substances suffer emotional, social, and sometimes physical anguish. Client and family members need facts about the substance, its effects, and recovery. The nurse must dispel myths and misconceptions such as, "It's a matter of will power," "I can't be an alcoholic if I only drink beer or if I only drink on weekends," "I can learn to use drugs socially," or "I'm okay now; I could handle using once in a while."

Which characteristic of the 12-step program distinguishes it from other programs?

It is a self-help group that does not necessarily use health professionals as leaders. Feedback: Alcoholics Anonymous (AA) was founded in the 1930s by alcoholics. This self-help group developed the 12-step program model for recovery, which is based on the philosophy that total abstinence is essential and that alcoholics need the help and support of others to maintain sobriety. Regular attendance at meetings is emphasized.

First school of nursing to include psychiatric?

Johns Hopkins in 1913

A nurse is working with a client who has a history of repeated abusive intimate relationships. The nurse has difficulty understanding why a woman would repeatedly enter into relationships with abusive partners. When working with this client, the nurse can best maintain a therapeutic relationship through which approaches?

Keeping focused on the client's feelings about her life situation Feedback: Nurses may believe that a woman who stays in an abusive relationship might deserve or enjoy the abuse or that abuse between husband and wife is private. The nurse may also feel horror or revulsion. Because clients often watch for the nurse's reaction, containing these feelings and focusing on the client's needs are important. The nurse must be prepared to listen to the client's story, no matter how disturbing, and support and validate the client's feelings with comments such as "That must have been terrifying" or "Sounds like you were afraid for your life." The nurse must remember that he or she cannot fix or change things; the nurse's role is to listen and convey acceptance and support for the client.

Community based care for mental illness

Lack of appropriate number of community mental health centers to provide services Development of community support programs Availability, quality of services highly variable Inaccurate anticipation of extent of people's needs Despite flaws, positive aspects making them preferable for treatment

The nurse is caring for a 14-year-old boy with an osteosarcoma. Which of the following communication techniques would be least effective for him? A) Letting him choose juice or soda to take pills B) Seeking the teenager's input on all decisions C) Discussing the benefits of chemotherapy with him D) Avoiding undue criticism of noncompliance

Letting him choose juice or soda to take pills Letting the child choose juice or soda to take pills is the least effective communication technique for an adolescent. It may provide some sense of control, but is not as effective as seeking his input on all care decisions, including him during discussions of the benefits of chemotherapy, and avoiding undue criticism of noncompliance.

Findings of Speed Shock

Lightheadedness, chest pain/discomfort, palpitations, shock, cardiac arrest.

First american Psych nurse

Linda Richards

Goals of IV fluid therapy

Maintain/regain fluid, electrolyte balance. Medium for delivery of medications.

Disulfiram (Antabuse)

Maintains abstinence from alcohol 500 mg/day for 1-2 weeks, then 250 mg/day Teach client to read labels to avoid products with alcohol

Methadone (Dolophine)

Maintains abstinence from heroin Up to 120 mg/day for maintenance May cause nausea and vomiting

Levomethadyl (Orlaam)

Maintains abstinence from opiates 60-90 mg three times a week for maintenance Do not take drug on consecutive days; take-home doses are not permitted

Buprenorphine/naloxone (Suboxone)

Maintains abstinence from opiates and decreases opiate cravings 4/1 mg-24/6 mg daily for maintenance May cause orthostatic hypotension, sedation; avoid CNS depressants

Federal legislation for commitment laws?

Making it more difficult to commit people for mental health treatment against their will. Feedback: Commitment laws changed in the early 1970s, making it more difficult to commit people for mental health treatment against their will. Deinstitutionalization accomplished the release of individuals from long-term stays in state institutions. Deinstitutionalization also had negative effects in that some mentally ill persons are subjected to the revolving door effect, which may limit care for mentally ill persons.

The first training of nurses to work with persons with mental illness was in 1882 in what state?

Massachusetts. The first training for nurses to work with persons with mental illess was in 1882 at McLean hospital in Belmont, MA

What is true about mental illness?

Mental illness can cause significant distress, impaired functioning, or both. Individuals suffering from mental illness are usually able to cope effectively with daily life. Individuals suffering from mental illness may experience dissatisfaction with relationships and self. Feedback: Mental illness can cause significant distress, impaired functioning, or both. Mental illness may be related to individual, interpersonal, or social/cultural factors. Excessive dependency on or withdrawal from relationships are interpersonal factors that relate to mental illness. Individuals suffering from mental illness can feel overwhelmed with daily life. Individuals suffering from mental illness may experience dissatisfaction with relationships and self.

A nurse is exploring treatment options with a client addicted to heroin. Which information regarding the use of methadone is important for the nurse to include?

Methadone will meet the physical need for opiates without producing cravings for more. Methadone, a potent synthetic opiate, is used as a substitute for heroin in some maintenance programs. The client takes one daily dose of methadone, which meets the physical need for opiates but does not produce cravings for more. Methadone does not produce the high associated with heroin. The client has essentially substituted his or her addiction to heroin for an addiction to methadone; however, methadone is safer because it is legal, controlled by a physician, and available in tablet form. The client avoids the risks of intravenous drug use, the high cost of heroin (which often leads to criminal acts), and the questionable content of street drugs.

The nurse is administering a crushed tablet to an 18-month-old infant. Which of the following is a recommended guideline for this intervention?

Mix the crushed tablet with a small amount of applesauce. if a tablet or capsule is the only oral form available for children younger than 6 years, it needs to be crushed or opened and mixed with a pleasant-tasting liquid or a small amount (generally no more than a tablespoon) of a nonessential food such as applesauce. The crushed tablet or inside of a capsule may taste bitter, so it should never be mixed with formula or other essential foods. Otherwise, the child may associate the bitter taste with the food and later refuse to eat it.

A client is admitted for a drug overdose with a Barbiturate? Which is the priority nursing action when planning care for this client?

Monitor respiratory function. CNS depressants depress respiratory functioning. Answer choices A, B, and C would not be priority nursing actions in this situation.

Current state of mental illness

More than 26% of Americans aged 18 years and older have diagnosable mental disorder (NIMH, 2008) 15 million adults, 4 million children and adolescents with impaired daily activities Economic burden exceeds that by all types of cancer Leading cause of disability in the United States and Canada for those 15 to 44 years of age Increasing number of both adults and children/adolescents are being treated for mental illness. Treatment still lagging in homeless and those with substance abuse problems

ADDICTION RESEARCH FOUNDATION CLINICAL INSTITUTE WITHDRAWAL ASSESSMENT FOR ALCOHOL, REVISED (CIWA-AR)

NAUSEA AND VOMITING—Ask "Do you feel sick to your stomach? Have you vomited?" Observation. 0 no nausea and no vomiting 1 mild nausea with no vomiting 2 3 4 intermittent nausea with dry heaves 5 6 7 constant nausea, frequent dry heaves, and vomiting TREMOR—Arms extended and fingers spread apart. Observation. 0 no tremor 1 not visible, but can be felt fingertip to fingertip 2 3 4 moderate, with patient's arms extended 5 6 7 severe, flapping tremors PAROXYSMAL SWEATS—Observation. 0 no sweat visible 1 barely perceptible sweating, palms moist 2 3 4 beads of sweat obvious on forehead 5 6 7 drenching sweats ANXIETY—Ask, "Do you feel nervous?" Observation. 0 no anxiety, at ease 1 mildly anxious 2 3 4 moderately anxious, or guarded, so anxiety is inferred 5 6 7 equivalent to acute panic states as seen in severe delirium or acute psychotic reactions AGITATION—Observation. 0 normal activity 1 somewhat more than normal activity 2 3 4 moderately fidgety and restless 5 6 7 paces back and forth during most of the interview, or constantly thrashes about TACTILE DISTURBANCES—Ask, "Have you any itching, pins and needles sensations, any burning, any numbness or do you feel bugs crawling on or under your skin?" Observation. 0 none 1 very mild itching, pins and needles, burning or numbness 2 mild itching, pins and needles, burning or numbness 3 moderate itching, pins and needles, burning or numbness 4 moderately severe hallucinations 5 severe hallucinations 6 extremely severe hallucinations 7 continuous hallucinations AUDITORY DISTURBANCES—Ask, "Are you more aware of sounds around you? Are they harsh? Do they frighten you? Are you hearing anything that is disturbing to you? Are you hearing things you know are not there?" Observation. 0 not present 1 very mild harshness or ability to frighten 2 mild harshness or ability to frighten 3 moderate harshness or ability to frighten 4 moderately severe hallucinations 5 severe hallucinations 6 extremely severe hallucinations 7 continuous hallucinations VISUAL DISTURBANCES—Ask, "Does the light appear too bright? Is its color different? Does it hurt your eyes? Are you seeing anything that is disturbing to you? Are you seeing things you know are not there?" Observation. 0 not present 1 very mild sensitivity 2 mild sensitivity 3 moderate sensitivity 4 moderately severe hallucinations 5 severe hallucinations 6 extremely severe hallucinations 7 continuous hallucinations HEADACHE, FULLNESS IN HEAD—Ask, "Does your head feel different? Does it feel like there is a band around your head?" Do not rate for dizziness or light-headedness. Otherwise, rate severity. Observation. 0 not present 1 very mild 2 mild 3 moderate 4 moderately severe 5 severe 6 very severe 7 extremely severe ORIENTATION AND CLOUDING OF SENSORIUM—Ask, "What day is this? Where are you? Who am I?" Observation. 0 oriented and can do serial additions 1 cannot do serial additions or is uncertain about date 2 disoriented for date by no more than two calendar days 3 disoriented for date by more than two calendar days 4 disoriented for place and/or person Maximum Possible Score 67

The nurse is involved in a community education program for new parents and plans to include information on child abuse. The nurse will teach the parents that the most common form of child abuse is ?

Neglect. Feedback: Sixty-four percent of child maltreatment victims suffered neglect; 16% were physically abused; 8.8% were sexually abused; 6.6% were psychologically or emotionally abused; and 2.2% were medically neglected. Also, 15% suffered "other" types of maltreatment such as abandonment, physical threats, and congenital drug addiction.

Withdrawal and Detoxification: Hallucinogens

No withdrawal syndrome has been identified for hallucinogens, although some people have reported a craving for the drug. Hallucinogens can produce flashbacks, which are transient recurrences of perceptual disturbances like those experienced with hallucinogen use. These episodes occur even after all traces of the hallucinogen are gone and may persist for a few months up to 5 years.

Small group

Nurses with 2 or more individuals.

Which is included in Healthy People 2020 objectives?

One of the Healthy People 2020 objectives is to increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives. It may not be possible to decrease the incidence of mental illness. At this time, the focus is on ensuring that persons with mental illness are receiving needed treatment. It may not be possible or desirable to provide mental health services only in the community.

The nurse is assessing a client's risk factors for developing a substance abuse disorder. What family characteristics would the nurse identify as a significant risk?

One parent is an alcoholic. Feedback: The strongest indication of risk factors comes from studies that indicate children of alcoholic parents are four times as likely to develop alcoholism that of nonalcoholic parents. Some theorists also believe that inconsistency in the parent's behavior, poor role modeling, and lack of nurturing pave the way for the child to adopt a similar style of maladaptive coping, stormy relationships, and substance abuse. Others hypothesize that even children who abhorred their family lives are likely to abuse substances as adults because they lack adaptive coping skills and cannot form successful relationships. Urban areas where drugs and alcohol are readily available also have high crime rates, high unemployment, and substandard school systems that contribute to high rates of cocaine and opioid use and low rates of recovery.

What are common behavioral and emotional responses to abuse?

One third of abusive men are likely to have come from violent homes. Women who grew up in violent homes are 50% more likely to expect or accept violence in their own relationships. Dependency on the abuser is a common trait found in victims of domestic violence. It is critical for the nurse to demonstrate acceptance after hearing about the abuse so that the victim may begin to gain self-acceptance. Feedback: One third of abusive men are likely to have come from violent homes. Women who grew up in violent homes are 50% more likely to expect or accept violence in their own relationships. Dependency on the abuser is a common trait found in victims of domestic violence. The victim may believe that he or she caused the abuse, but this is not accurate. It is critical for the nurse to demonstrate acceptance after hearing about the abuse so that the victim may begin to gain self-acceptance.

What is true of treatment of people with mental illness in the United States today?

Only 25% of people needing mental health services are receiving those services. Only one in four (25%) adults needing mental health care receives the needed services. Substance abuse issues cannot be dealt with in the 3 to 5 days typical for admissions in the current managed care environment. Money saved by states when state hospitals were closed has not been transferred to community programs and support. Although people with severe and persistent mental illness have shorter hospital stays, they are admitted to hospitals more frequently. In some cities, emergency department visits for acutely disturbed persons have increased by 400% to 500%.

A male client has always prided himself in maintaining good health and is consequently shocked at his recent diagnosis of diabetes. The nurse has asked the client " How do you think your diabetes is going to affect your lifestyle?" The nurse has utilized what interviewing technique?

Open Ended Question- allows for a wide range of responses and encourages free verbalization, characteristics of a useful open-ended question.

Intoxication and Overdose of Opiods

Opioid intoxication develops soon after the initial euphoric feeling; symptoms include apathy, lethargy, listlessness, impaired judgment, psychomotor retardation or agitation, constricted pupils, drowsiness, slurred speech, and impaired attention and memory. Severe intoxication or opioid overdose can lead to coma, respiratory depression, pupillary constriction, unconsciousness, and death. Administration of naloxone (Narcan), an opioid antagonist, is the treatment of choice because it reverses all signs of opioid toxicity. Naloxone is given every few hours until the opioid level drops to nontoxic; this process may take days

Opioid withdrawal and detoxification

Opioid withdrawal develops when drug intake ceases or decreases markedly, or it can be precipitated by the administration of an opioid antagonist. Initial symptoms are anxiety, restlessness, aching back and legs, and cravings for more opioids (Strain et al., 2009). Symptoms that develop as withdrawal progresses include nausea, vomiting, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, and insomnia. Symptoms of opioid withdrawal cause significant distress, but do not require pharmacologic intervention to support life or bodily functions. Short-acting drugs such as heroin produce withdrawal symptoms in 6 to 24 hours; the symptoms peak in 2 to 3 days and gradually subside in 5 to 7 days. Longer-acting substances such as methadone may not produce significant withdrawal symptoms for 2 to 4 days, and the symptoms may take 2 weeks to subside. Methadone can be used as a replacement for the opioid, and the dosage is then decreased over 2 weeks. Substitution of methadone during detoxification reduces symptoms to no worse than a mild case of flu (Lehne, 2006). Withdrawal symptoms such as anxiety, insomnia, dysphoria, anhedonia, and drug craving may persist for weeks or months.

The nurse is using verbal skills to explain the nursing care plan to parents of a 10-year-old child with cancer. Which of the following describes a guideline the nurse should follow to provide appropriate verbal communication?

Paraphrase the child's or parent's feelings to demonstrate empathy. General guidelines for appropriate verbal communication include the following: paraphrase the child's or parent's feelings to demonstrate empathy, use open-ended questions that do not restrict the child's or parent's answers, redirect the conversation to maintain focus, and demonstrate active listening by using the child's or family's own words.

According to Rosenstock, which of the following are health beliefs critical for patient motivation? Select all that apply.

Patients view themselves as susceptible to the disease in question. Patients view the disease as a serious threat. Patients believe there are actions they can take to reduce the probability of contracting the disease.

The person who wanted asylum to be a safe refuge

Phillipe Pinel or William Dukes

Physical development

Physical-growth and changes in body tissues and organ systems and the resultant changes in body proportions. Physical change is bilateral and symmetrical, progressing in direction cephalocaudally (head to tail) and proximodistally (midline to periphery). Progresses from gross motor to fine motor skills via a process called refinement. Gross motor skills use large muscles to do such things as sit, stand, walk, run, maintain balance, and change positions. Fine motor skills involve the use of small muscles in a very precise manner. These include using hands to eat, draw, dress, play, and write.

Possible Neglect Indicators in Elderly

Poor personal hygiene Lack of needed medications or therapies Dirt, fecal or urine smell, or other health hazards in the elder's living environment Rashes, sores, or lice on the elder The elder has an untreated medical condition or is malnourished or dehydrated not related to a known illness Inadequate material items, such as clothing, blankets, furniture, and television

Which are general warning signs of substance abuse that a nurse should be alert for in coworkers?

Poor work performance, frequent absenteeism, unusual behavior, slurred speech, isolation from peers General warning signs of abuse include poor work performance, frequent absenteeism, unusual behavior, slurred speech, and isolation from peers. Physicians, dentists, and nurses have far higher rates of dependence on controlled substances, than other professionals of comparable educational achievement. One reason is thought to be the ease of obtaining controlled substances. Health-care professionals also have higher rates of alcoholism than the general population.

Social Risks to Development

Poverty, parenting difficulty, abuse/neglect, environmental exposure to toxins, adverse living conditions

Birth Risk

Prematurity, LBW, birth trauma, CP

Thiamine (vitamin B1)

Prevents or treats Wernicke-Korsakoff syndrome in alcoholism 100 mg/day Teach client about proper nutrition

Signs of Separation Anxiety

Protest: loud, demanding cries, rejects comfort measures Despair: lies on abdomen, flat facial expression, weight loss, insomnia, loss of developmental skills Denial or Detachment: silent expressionless child, deterioration of developmental milestones, may have trouble forming close relationships

The community health nurse meets with the family members of an elderly client. The nurse includes what in the following in the plan of care as a preventive measure to guard against elder abuse?

Provide the primary caregiver with additional resources to meet the elder's needs Feedback: Elder abuse may develop gradually as the burden of care exceeds the caregiver's physical or emotional resources. Relieving the caregiver's stress and providing additional resources may help to correct the abusive situation and keep the caregiving relationship intact.

Advanced level functions, Psychiatric nursing

Psychotherapy Prescriptive authority for drugs Consultation, liaison Evaluation

Drugs used to treat mental illness

Psychotropic drugs.

Hildegard Peplau

Published books that described the therapeutic nurse-client relationship and wrote about anxiety. Interpersonal Relations in Nursing.

QUESTT

Question the child ,Use pain rating scales, Evaluate behavior and physiological changes, Secure the parents' involvement, take into consideration: Cause of pain, Take action and evaluate results.

Common Myths about rape

Rape is about having sex. When a woman submits to rape, she really wants it to happen. Women who dress provocatively are asking for trouble. Some women like rough sex but later call it rape. Once a man is aroused by a woman, he cannot stop his actions. Walking alone at night is an invitation for rape. Rape cannot happen between persons who are married. Rape is exciting for some women. Rape occurs only between heterosexual couples. If a woman has an orgasm, it can't be rape. Rape usually happens between strangers. Rape is a crime of passion. Rape happens spontaneously.

Advantages of IV Fluid therapy

Rapid onset, Precise control of dose, reduce discomfort, irritation

A client is being discharged on disulfiram (Antabuse). Which instruction for Antabuse should the client receive?

Read products labels carefully to avoid all products containing alcohol. The client must avoid a wide variety of products that contain alcohol such as cough syrup, lotions, mouthwash, perfume, aftershave, vinegar, and vanilla and other extracts. The client must read product labels carefully, because any product containing alcohol can produce symptoms. Ingestion of alcohol may cause unpleasant symptoms for 1 to 2 weeks after the last dose of disulfiram.

A young mother asks the nurse in a pediatric office for information about safety, diet, and immunizations for her baby. Which nursing diagnosis would be appropriate for this patient?

Readiness for Enhanced Parenting

A nurse suspects a coworker is signing out narcotics for clients and is using them herself. Which action should be taken by the nurse who has these suspicions?

Report the observations to the supervisor. Nurses have an ethical responsibility to report suspicious behavior to a supervisor and, in some states, a legal obligation as defined in the state's nurse practice act. Nurses should not try to handle such situations alone by warning the coworker; this often just allows the coworker to continue to abuse the substance without suffering any repercussions.

A student is developing a teaching plan for her assigned patient. The student wants to teach the patient about what symptoms to report after chemotherapy. What would the student need to do first?

Review information available in writing and on the Internet.

Student Concerns and Psychiatric-Mental Health Clinical Experience

Saying the wrong thing Knowing what to do Being rejected or not talking to the student Asking personal questions Handling bizarre, inappropriate, or sexually aggressive behavior Handling feeling unsafe

A community health nurse is planning a substance abuse prevention program. Which group would be the best target audience for the nurse to plan a program?

School age children in an afterschool program. Feedback: Forty-three percent of all Americans have been exposed to alcoholism in their families. Children of alcoholics are four times more likely than the general population to develop problems with alcohol. Many adult people in treatment programs as adults report having had their first drink of alcohol as a young child, when they were younger than age 10. With the increasing rates of use being reported among young people today, this problem could spiral out of control unless great strides can be made through programs for prevention, early detection, and effective treatment.

SAFE

Screening/Assessment, Afraid/abused, friends/Family, Emergency plan

Intrapersonal

Self Talk

Stressors of Hospitalization

Separation anxiety, loss of control, bodily injury and pain

WARNING SIGNS OF ABUSED /NEGLECTED Children

Serious injuries such as fractures, burns, or lacerations with no reported history of trauma Delay in seeking treatment for a significant injury Child or parent giving a history inconsistent with severity of injury, such as a baby with contrecoup injuries to the brain (shaken baby syndrome) that the parents claim happened when the infant rolled off the sofa Inconsistencies or changes in the child's history during the evaluation by either the child or the adult Unusual injuries for the child's age and level of development, such as a fractured femur in a 2-month-old or a dislocated shoulder in a 2-year-old High incidence of urinary tract infections; bruised, red, or swollen genitalia; tears or bruising of rectum or vagina Evidence of old injuries not reported, such as scars, fractures not treated, and multiple bruises that parent/caregiver cannot explain adequately

A coherent elderly woman has been financially and emotionally abused by her adult children for the past several years, but has failed to report the abuse to anyone. What is the most likely reason that the woman neglects to report the abuse?

She is emotionally close to her children and does not want to bring them harm. Feedback: Elders are often reluctant to report abuse, even when they can, because the abuse usually involves family members whom the elder wishes to protect. Victims also often fear losing their support and being moved to an institution.

A young female immigrant presents in the rural health clinic with facial bruising and a fractured nose. The client is reluctant to give details of the nature of her injuries. What should be considered when providing care to this client?

She may fear deportation if she seeks public assistance. Battered immigrant women face legal, social, and economic problems different from US citizens who are battered and from people of other cultural, racial, and ethnic origins who are not battered: The battered woman may come from a culture that accepts domestic violence. She may believe she has less access to legal and social services than do US citizens. If she is not a citizen, she may be forced to leave the United States if she seeks legal sanctions against her husband or attempts to leave him. She is isolated by cultural dynamics that do not permit her to leave her husband; economically, she may be unable to gather the resources to leave, work, or go to school. Language barriers may interfere with her ability to call 911, learn about her rights or legal options, and obtain shelter, financial assistance, or food. The nurse must treat the whole person and encourage the client to share the details in order to protect the client's safety and well-being.

What is meant by the term " revolving door effect" in mental health care?

Shorter and more frequents hospital stays for persons with severe and persistent mental illness. The revolving door effect refers to shorter, but more frequent, hospital stays. Clients are quickly discharged into the community where services are not adequate; without adequate community services, clients become acutely ill and require rehospitalization. The revolving door effect does not refer to flexible treatment settings for mentally ill. Even though hospitalization is more expensive than outpatient treatment, if utilized appropriately could result in stabilization and less need for emergency department visits and/or rehospitalization. The revolving door effect does not relate to the incidence of severe mental illness.

Findings for Fluid Overload

Shortness of breath, intake greater than output, increases BP, pulse, respiratory rate. Crackles in lungs on auscultation. Neck vein distention. Extremity edema.

The nurse is incorporating nonverbal communication with verbal communication when explaining the treatment plan for a child with juvenile diabetes. Which of the following should the nurse do to communicate effectively with this family?

Sit opposite the family and lean forward slightly. Guidelines for appropriate nonverbal communication include the following: sit opposite the family and lean forward slightly; relax: maintain an open posture, with the arms uncrossed; maintain eye contact; and nod your head to demonstrate interest.

A nurse is using motivational interviewing to find out why a patient refuses to participate in the recommended rehabilitation program. Which of the following is an example of using the skill of reflective listening to help motivate this patient?

So, you feel that you are not ready to start a program this week...?

Social/emotional development

Social/emotional-pertains to personality, emotion, and behavior. Involves interacting with others; having relationships with family, friends, and teachers; and cooperating and responding to the feelings of others. Also called maintaining emotional control.

ANA' standards of practice for psychiatric-mental health nursing

Some aspects of Standard 5: Implementation may only be carried out by psychiatric-mental health advanced practice nurses. Prescriptive authority is used by psychiatric-mental health advanced practice registered nurses in accordance with state and federal laws and regulations. Standards 5D-G are advanced practice interventions and may be performed only by the psychiatric-mental health advanced practice registered nurse. Psychiatric-mental health registered nurses may provide milieu therapy according to Standard 5C. This is not restricted to psychiatric-mental health advanced practice nurses.

Which of the following is a standard of practice?

Standards of practice include assessment, diagnosis, outcomes identification, planning, implementation, coordination of care, health teaching and health promotion, and milieu therapy. The standards of professional performance include quality of practice, education, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, and leadership.

What neurochemical influence is a probable cause of substance abuse?

Stimulation of dopamine pathways in the brain. Feedback: Neurochemical influences on substance use patterns have been studied primarily in animal research (Jaffe & Anthony, 2005). The ingestion of mood-altering substances stimulates dopamine pathways in the limbic system, which produces pleasant feelings or a "high" that is a reinforcing, or positive, experience.

SAFE Questions

Stress/Safety: What stress do you experience in your relationships? Do you feel safe in your relationships? Should I be concerned for your safety? Afraid/Abused: Have there been situations in your relationships where you have felt afraid? Has your partner ever threatened or abused you or your children? Have you ever been physically hurt or threatened by your partner? Are you in a relationship like that now? Has your partner ever forced you to engage in sexual intercourse that you did not want? People in relationships/marriages often fight; what happens when you and your partner disagree? Friends/Family: Are your friends aware that you have been hurt? Do your parents or siblings know about this abuse? Do you think you could tell them, and would they be able to give you support? Emergency plan: Do you have a safe place to go and the resources you (and your children) need in an emergency? If you are in danger now, would you like help in locating a shelter? Would you like to talk to a social worker/a counselor/me to develop an emergency plan? (Videbeck 201)

The nurse is preparing to administer insulin to a diabetic child. Which of the following would be the recommended route for this administration?

Subcutaneous Subcutaneous (SQ) administration distributes medication into the fatty layers of the body. It is used primarily for insulin administration, heparin, and certain immunizations, such as MMR. Intradermal administration is used primarily for tuberculosis screening and allergy testing. Intramuscular administration is used to administer certain medications, such as many immunizations. Insulin is not administered orally.

Acamprosate (Campral)

Suppresses alcohol cravings 666 mg three times daily Monitor for diarrhea, vomiting, flatulence, and pruritis

Clonidine (Catapres)

Suppresses opiate withdrawal symptoms 0.1 mg every 6 hours PRN Take blood pressure before each dose; withhold if client is hypotensive

What guideline should a nurse use when choosing what position in relation to a client to be in during a verbal interaction?

Take note of the client's cues when choosing a position and act on these cues. Preferences regarding space and territory vary greatly.

The nurse is assessing the factors contributing to the well-being of a newly admitted client. What would the nurse identify as having a positive impact on the individual's mental status?

The ability to effectively manage stress. Rationale: Individual factors influencing mental health include biologic makeup, autonomy, independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience or hardiness, sense of belonging, reality orientation, and coping or stress management abilities. Interpersonal factors such as intimacy and a balance of separateness and connectedness are both needed for good mental health, and therefore a healthy person would need others for companionship. A family history of mental illness could relate to the biologic makeup of an individual, which may have a negative impact on an individual's mental health, as well as a negative impact on an individual's interpersonal and social-cultural factors of health. Total self-reliance is not possible, and a positive social/cultural factor is access to adequate resources.

What are common reasons why abused women remain with the abusive partner?

The abused person is personally and financially dependent on the abuser. The abused person has low self-esteem and defines her success as a person by the ability to make the relationship work. The abused person believes that she is unable to function without her husband. The abused person is afraid that the abuser will kill her if she tries to leave. Feedback: Dependency is the trait most commonly found in abused wives who stay with their husbands. Women often cite personal and financial dependency as a reason why they find leaving an abusive relationship extremely difficult. The victim may suffer from low self-esteem and defines her success as a person by her ability to remain loyal to her marriage and "make it work." Some women internalize the criticism they receive and mistakenly believe they are to blame. Women also fear their abuser will kill them if they try to leave. An abuser often has feelings of low self-esteem and poor problem-solving and social skills and may interpret any attempts at defense or any behavior of the abused person as abuse of the perpetrator.

Cultural Considerations for Abuse.

The battered woman may come from a culture that accepts domestic violence. She may believe she has less access to legal and social services than do U.S. citizens. If she is not a citizen, she may be forced to leave the United States if she seeks legal sanctions against her husband or attempts to leave him. She is isolated by cultural dynamics that do not permit her to leave her husband; economically, she may be unable to gather the resources to leave, work, or go to school. Language barriers may interfere with her ability to call 911, learn about her rights or legal options, and obtain shelter, financial assistance, or food.

What behaviors would first alert the school nurse or teacher to suspect sexual abuse in a 7-year-old child?

The child tells sexually explicit stories to peers. Feedback: Children who have sexual knowledge not expected at their age have often been sexually abused. A child who has been sexually abused by an adult may feel more comfortable with peers than with adults. Learning problems, shyness, and wearing dirty and threadbare clothing may be related to many situations other than sexual abuse.

The nurse is collecting assessment data on a client who is suspected to be a victim of violence. Which assessment data would support the suspicion that the client is a victim of abuse?

The client has few friends. There is a moderate amount of alcohol use in the home. The client reports that the father was abusive during childhood. Feedback: One characteristic of violent families is social isolation. Members of these families keep to themselves and usually do not invite others into the home or tell them what is happening. If the client reports that the father was abusive during childhood, that would support the suspicion that the client is a victim of abuse. The abusive family member almost always holds a position of power and control over the victim. The abuser exerts not only physical power but also economic and social control. Substance abuse, especially alcoholism, has been associated with family violence.

The nurse is caring for a 16-year-old boy with a history of sexual abuse. What might the nurse expect to assess with this client?

The client will experience long-term emotional trauma. Feedback: Nightmares and flashbacks are common in people who were abused as children regardless of their current age. The client may have ill effects irrespective of the age. The client will likely have low self-esteem. The client will likely have difficulty relating to anyone, including the nurse.

The nurse is discussing the principles of 12-step programs for recovery with a client. What statement is consistent with the principles of 12-step programs?

The client will need to abstain from all substances for successful recovery. Feedback: Alcoholics Anonymous (AA) developed the 12-step program model for recovery, which is based on the philosophy that total abstinence is essential and that alcoholics need the help and support of others to maintain sobriety. Key slogans reflect the ideas in the 12 steps, such as "one day at a time" (approach sobriety one day at a time), "easy does it" (don't get frenzied about daily life and problems), and "let go and let God" (turn your life over to a higher power).

Warning Indicators from caregiver of elderly

The elder is not given opportunity to speak for self, to have visitors, or to see anyone without the presence of the caregiver Attitudes of indifference or anger toward the elder Blaming the elder for his or her illness or limitations Defensiveness Conflicting accounts of elder's abilities, problems, and so forth Previous history of abuse or problems with alcohol or drugs

The nurse uses family-centered care to care for children in a pediatric office. Upon what concept is family-centered care based?

The family is the constant in the child's life and the primary source of strength. Family-centered care involves a partnership between the child, family, and health care providers in planning, providing, and evaluating care. Family-centered care enhances parents' and caregivers' confidence in their own skills and also prepares children and young adults for assuming responsibility for their own health care needs. It is based on the concept that the family is the constant in the child's life and the primary source of strength and support for the child.

Linda Richards

The first american psychiatric nurse. Believed that "the mentally sick should be cared for as the physically sick".

Orientation phase

The first phase of therapeutic work and involves signing of formal contracts. This helps the client to develop more insight and control over his or her own behavior

The nurse is talking with the friend of a client with alcoholism. The friend tells the nurse that his relationship with the client was codependent and enabling. What is an example of codependent behavior?

The friend called the client every night to make sure he got home safely and went looking for him if he was not at home. Feedback: Codependent behavior appears helpful on the surface but actually prolongs the drinking behavior. The other choices are not examples of codependent behavior.

A school nurse is educating a group of adolescent girls about rape and sexual assault. The nurse evaluates the students' understanding when they report which of the following as a high-risk factor regarding the incidence of rape?

The highest incidence of rape occurs in adolescents and young adult women. Feedback: Only 20% of rapes are committed by strangers. A phenomenon called date rape (acquaintance rape) may occur on a first date, on a ride home from a party, or when the two people have known each other for some time. It is more prevalent near college and university campuses. The highest incidence is in girls and women 16 to 24 years of age. Rape most commonly occurs in a woman's neighborhood, often inside or near her home. Most rapes are premeditated.

The pediatric nurse is caring for a 15-month-old child recently admitted to the hospital for a fractured femur. What data obtained during the assessment would raise the nurse's suspicion that the child has suffered physical abuse?

The injury occurring several days before the parents sought treatment Feedback: Warning signs of abused/neglected children include serious injuries such as fractures, burns, or lacerations with no reported history of trauma; delay in seeking treatment for a significant injury; the child or a parent giving a history inconsistent with severity of injury; inconsistencies or changes in the child's history during the evaluation by either the child or the adult; unusual injuries for the child's age and level of development, such as a fractured femur in a 2-month-old or a dislocated shoulder in a 2-year-old; high incidence of urinary tract infections; bruised, red, or swollen genitalia; tears or bruising of the rectum or vagina; and evidence of old injuries not reported, such as scars, fractures not treated, and multiple bruises that the parent/caregiver cannot explain adequately.

The nurse is administering Tylenol PRN to a 9-year-old child on the pediatric ward of the hospital. Which of the following reflect nursing actions that follow the rules of the "eight rights" of pediatric medication administration?

The nurse checks the documented time of the last dosage administered. The nurse calculates the dosage according to the child's weight. The nurse explains the therapeutic effects of the medication to the child and parents. Feedback: Following the "right patient" rule, the nurse checks the documented time of the last dosage administered. For the "right dose," the nurse calculates the dosage according to the child's weight. For the "right to be educated," the nurse explains the therapeutic effects of the medication to the child and parents. To ensure the "right patient," the nurse confirms the child's identity and then checks with the caregivers for further identification. To administer at the "right time," the nurse gives the medication within 20 to 30 minutes of the ordered time, and to protect the child's "right to refuse," the nurse respects the child's or parents' option to refuse.

A client is readmitted to the detox unit for the fourth time in 3 years. The nurse states in the morning report, "Not again! Why should we keep trying to help this guy? He obviously doesn't want it." What does this statement reflect?

The nurse lacks the self-awareness to work effectively with this addicted client. Many clients experience periodic relapses. For some, being sober is a lifelong struggle. The nurse may become cynical or pessimistic when clients return for multiple attempts at substance use treatment. Such thoughts as "he deserves health problems if he keeps drinking" or "she should expect to get hepatitis or HIV infection if she keeps doing intravenous drugs" are signs that the nurse has some self-awareness problems that prevent him or her from working effectively with clients and their families. It is not appropriate to assume that the nurse is trying to conceal his or her own addictions.

Which reasons make it necessary for the nurse to examine his or her beliefs and attitudes about substance abuse?

The nurse may be overly harsh and critical of the client. The nurse may unknowingly act out old family roles and engage in enabling behavior. The nurse or close friends and family of the nurse may abuse substances. The nurse may have different attitudes about various substances of abuse Feedback: The nurse must examine his or her beliefs and attitudes about substance abuse. A history of substance abuse in the nurse's family can strongly influence his or her interaction with clients. The nurse may be overly harsh and critical. Conversely, the nurse may unknowingly act out old family roles and engage in enabling behavior. Examining one's own substance use or use by close friends and family may be difficult and unpleasant but is necessary if the nurse is to have therapeutic relationships with clients. The nurse also might have different attitudes about various substances of abuse. Health-care professionals also have higher rates of alcoholism than the general population. With the pervasive nature of substance abuse nationally, odds are great that nurses and other health professionals have been affected by substance abuse in their lives.

Working Phase of helping relationship

The patient will actively participate in the relationship. The patient will cooperate in activities that work toward achieving mutually acceptable goals. The patient will express feelings and concerns to the nurse.

Orientation phase of helping relationship

The patient will call the nurse by name. The patient will accurately describe the roles of the participants in the relationship. The patient and nurse will establish an agreement about: Goals of the relationship Location, frequency, and length of the contacts Duration of the relationship

Termination phase of helping relationship

The patient will participate in identifying the goals accomplished or the progress made toward goals. The patient will verbalize feelings about the termination of the relationship.

What are typical characteristics of the perpetrator of intimate partner abuse

The perpetrator often believes that the partner is his own property. The perpetrator is often irrationally jealous, even of his own children. The perpetrator is emotionally immature and needy. The perpetrator often believes that the partner is his own property. The perpetrator is often irrationally jealous, even of his own children if the partner pays any attention to them. The perpetrator is emotionally immature and needy. The perpetrator does not respect his partner because if he did, he would not believe that the partner is his own property to do with as he wishes. The perpetrator wants to maintain control over his partner and is therefore not intimidated by the partner but by the thought of the partner not being available.

The legislation enacted in 1963 was largely responsible for which of the following shifts in care for the mentally ill?

The widespread use of community-based services

The nurse is working in the emergency department with a woman who was raped 1 hour ago.What is most important for the nurse to remember when planning care?

The woman may feel threatened by some of the procedures. Feedback: Many of the examination procedures, such as a pelvic exam, may cause the woman to feel violated again. The client needs emotional support and evidence collection as well as physical care. It would not be appropriate for the nurse to make decisions for this client.

Hildegard Peplary is best known for writing on

Therapeautic nurse-client relatioship

The nurse is preparing a child and his family for a lumbar puncture. Which of the following would be a primary intervention instituted by the CLS to keep the child safe?

Therapeutic hugging Therapeutic hugging (a holding position that promotes close physical contact between the child and a parent or caregiver) may be used for certain procedures or treatments where the child must remain still. Alternatively, distraction or stimulation (such as with a toy) can help to gain the child's cooperation, but therapeutic hugging would be used to keep the child safe during the procedure. Therapeutic touch is an energy therapy used to promote healing and decrease anxiety and stress and is not related to safety.

Withdrawal and Detoxification: Inhalants

There are no withdrawal symptoms or detoxification procedures for inhalants as such, although frequent users report psychologic cravings. People who abuse inhalants may suffer from persistent dementia or inhalant-induced disorders such as psychosis, anxiety, or mood disorders even if the inhalant abuse ceases. These disorders are all treated symptomatically

A client has been admitted to the inpatient unit after using inhalants recently. Which is an antidote to treat inhalant toxicity?

There is no antidote There is no antidote or specific medication to treat inhalant toxicity. Ativan, Narcan, and Antabuse are not used to treat inhalant toxicity.

Sedatives, Hypnotics, Anxiolytics

This class of drugs includes all central nervous system depressants: barbiturates, nonbarbiturate hypnotics, and anxiolytics, particularly benzodiazepines. Benzodiazepines and barbiturates are the most frequently abused drugs in this category (Ciraulo & Sarid-Segal, 2009). The intensity of the effect depends on the particular drug. The effects of the drugs, symptoms of intoxication, and withdrawal symptoms are similar to those of alcohol. In the usual prescribed doses, these drugs cause drowsiness and reduce anxiety, which is the intended purpose. Intoxication symptoms include slurred speech, lack of coordination, unsteady gait, labile mood, impaired attention or memory, and even stupor and coma. Benzodiazepines alone, when taken orally in overdose, are rarely fatal, but the person is lethargic and confused. Treatment includes gastric lavage followed by ingestion of activated charcoal and a saline cathartic; dialysis can be used if symptoms are severe (Lehne, 2013). The client's confusion and lethargy improve as the drug is excreted. Barbiturates, in contrast, can be lethal when taken in overdose. They can cause coma, respiratory arrest, cardiac failure, and death. Treatment in an intensive care unit is required using lavage or dialysis to remove the drug from the system and to support respiratory and cardiovascular function.

. A female college student comes to the counseling center and tells the nurse she is afraid of her boyfriend. She states, "He is so jealous and overprotective; he wants to know where I am and who I'm with every minute." What is most likely true of the situation?

This is characteristic of the tension-building phase of the violence cycle. Feedback: In tension building, the abuser attempts to establish complete control over all the person's actions. It is more appropriate for the nurse to listen to the client, rather than to judge whether the client is overreacting. This may or may not require a restraining order. The student's boyfriend is insecure and needs reassurance, but that is not the only concern.

After administering eye drops to a child, the nurse applies gentle pressure to the inside corner of the eye at the nose for which reason?

To enhance systemic absorption C) To ensure the medication stays in the eye Punctal pressure, or gentle pressure to the inside corner of the eye at the nose, helps to slow systemic absorption and ensure that the medication stays in the eye. Having the head lower than the body aids in dispersing the medication over the cornea. Placing the heel of the hand on the child's forehead and then retracting the lower lid helps to stabilize it.

A diabetes nurse educator is teaching a patient, newly diagnosed with diabetes, about his disease process, diet, exercise, and medications. What is the goal of this teaching?

To help the patient develop self care abilities

A client reports drinking one to two drinks when drinking behavior first began. Now the client reports drinking at least 6 drinks with every episode in order to have a good time. Which term best describes this phenomenon?

Tolerance. Feedback: As the person continues to drink, he or she often develops a tolerance for alcohol; that is, he or she needs more alcohol to produce the same effect. Intoxication is use of a substance that results in maladaptive behavior. Withdrawal syndrome refers to the negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreases. Substance dependence also includes problems associated with addiction such as tolerance, withdrawal, and unsuccessful attempts to stop using the substance.

When describing the differences affecting the pharmacokinetics of drugs administered to children, which of the following would the nurse include?

Topical drugs are absorbed more quickly in young children than adults. Topical absorption of drugs is increased in infants and young children because the stratum corneum is thinner and well hydrated. The absorption of oral drugs is slowed by slower gastric emptying, increased intestinal motility, a proportionately larger small intestine surface area, high gastric pH, and decreased lipase and amylase secretion. The absorption of drugs given intramuscularly or subcutaneously is erratic and may be decreased.

The nurse is helping a 14-year old boy who has asthma to administer medication via an inhaler. Which of the following describes a developmentally appropriate nursing intervention for this child?

Treat the adolescent as an adult when explaining the use of the inhaler. The adolescent is developing a sense of identity and the nurse should foster this by approaching him in the same manner as adults, with respect and sensitivity to his needs. The nurse would involve the parents of children younger than school age in the actual administration of medications and reward the school-age child to enhance cooperation if necessary. Toddlers and preschoolers would benefit from handling and playing with equipment prior to use.

What is the priority of the Healthy People 2020 objectives for mental health?

Treatment of mental illness. The objectives are to increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives. The objectives also strive to decrease rates of suicide and homelessness, to increase employment among those with serious mental illness, and to provide more services both for juveniles and for adults who are incarcerated and have mental health problems

Folic acid (folate)

Treats nutritional deficiencies 1-2 mg/day Teach client about proper nutrition; urine may be dark yellow

Cyanocobalamin (vitamin B12)

Treats nutritional deficiencies 25-250"μg/day Teach client about proper nutrition

Acronym TEACH

Tune into the patient, Edit patient informaton, Act on every teaching moment, Clarify often, Honor the patient as a partner in the education process

Why would a student use the DSM?

Understand the reason for the admission and the nature of psychiatric illnesses.

Possible Material Abuse Indicators Elderly

Unpaid bills Standard of living below the elder's means Sudden sale or disposal of the elder's property/possessions Unusual or inappropriate activity in bank accounts Signatures on checks that differ from the elder's Recent changes in will or power of attorney when the elder is not capable of making those decisions Missing valuable belongings that are not just misplaced Lack of television, clothes, or personal items that are easily affordable Unusual concern by the caregiver over the expense of the elder's treatment when it is not the caregiver's money being spent

The nurse is caring for a child who is receiving total parenteral nutrition (TPN) for failure to thrive. Which of the following nursing actions might the nurse take to prevent complications from this therapy?

Use occlusive dressings and chlorhexidine-impregnated sponge (Biopatch) dressings. The nurse should use occlusive dressings and chlorhexidine-impregnated sponge (Biopatch) dressings to help prevent infection. The nurse should always follow agency or institution policy and procedures, adhere to strict aseptic technique when caring for the catheter and administering TPN, ensure that the system remains a closed system at all times, and secure all connections and clamp the catheter or have the child perform the Valsalva maneuver during tubing and cap changes.

Atraumatic Care

Use of interventions that eliminate or minimize psychological and physical distress that is experienced by children and their families in the health care system.

Developmental ages

Used to decribe developmental progress, stated as age and is determined by the standardized measurements of body size, motor function, psychosocial function, and performance on mental and aptitude tests.

The nurse is preparing to administer an intramuscular injection to an 8-month-old infant. Which site would the nurse select?

Vastus lateralis The preferred injection site in infants is the vastus lateralis muscle. An alternative site is the rectus femoris. The dorsogluteal site is not used in children until the child has been walking for at least 1 year. The deltoid muscle is used as a site in children after the age of 4 or 5 years.

The nurse is preparing to administer medication to a child with a gastrostomy tube in place. Which of the following is a recommended guideline for this procedure?

Verify proper tube placement prior to instilling medication. Crush tablets and mix with warm water to prevent tube occlusion. Open up capsules and mix the contents with warm water. Flush the tube with water after administering medications. The correct procedure includes the following: checking proper tube placement prior to instilling medication, crushing tablets and mixing with warm water to prevent tube occlusion, opening up capsules and mixing the contents with warm water, and flushing the tube with water after administering medications. The nurse should give liquid medications directly into the tube and mix powdered medications well with warm water first.

Cycle of Abuse

Violence, honeymoon period, tension building

The National Patient Safety Foundation recently collaborated with the Partnership for Clear Health Communication (2007) to create awareness of the need for improved health literacy and developed the "Ask Me 3" tool. Which of the following is an "Ask Me 3" question? Select all that apply.

What is my main problem? What do I need to do? Why is it important for me to do this?

Withdrawal and Detoxification of Stimulants

Withdrawal from stimulants occurs within a few hours to several days after cessation of the drug and is not life threatening. Marked dysphoria is the primary symptom and is accompanied by fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, and psychomotor retardation or agitation. Marked withdrawal symptoms are referred to as "crashing"; the person may experience depressive symptoms, including suicidal ideation, for several days. Stimulant withdrawal is not treated pharmacologically.

June Mellow

Wrote " Nursing Therapy" which described her approach of focusing on client's psychosocial needs and strength.

inhalant

a diverse group of drugs including anesthetics, nitrates, and organic solvents that are inhaled for their effects

Inhalants

a diverse group of drugs that include anesthetics, nitrates, and organic solvents that are inhaled for their effects. The most common substances in this category are aliphatic and aromatic hydrocarbons found in gasoline, glue, paint thinner, and spray paint. Less frequently used halogenated hydrocarbons include cleaners, correction fluid, spray can propellants, and other compounds containing esters, ketones, and glycols. Most of the vapors are inhaled from a rag soaked with the compound, from a paper or plastic bag, or directly from the container. Inhalants can cause significant brain damage, peripheral nervous system damage, and liver disease.

A nursing faculty member is teaching a class of second-degree students who have an average age of 32. What is important to remember when teaching adult learners?

a focus on the immediate application of new material

codependence

a maladaptive coping pattern on the part of family members or others that results from a prolonged relationship with the person who uses substances

polysubstance abuse

abuse of more than one substance

tapering

administering decreasing doses of a medication leading to discontinuation of the drug

Substance abuse, especially ______ , has been associated with family violence

alcoholism

blackout

an episode during which the person continues to function but has no conscious awareness of his or her behavior at the time or any later memory of the behavior; usually associated with alcohol consumption

One of the unforeseen effects of the movement toward community mental health services is

an increased number of admissions to available hospital services. Although people with severe and persistent mental illness have shorter hospital stays, they are admitted to hospitals more frequently. Although deinstitutionalization reduced the number of public hospital beds by 80%, the number of admissions to those beds correspondingly increased by 90%. The number of individuals with mental illness did not change.

Opiods

are popular drugs of abuse because they desensitize the user to both physiologic and psychologic pain and induce a sense of euphoria and well-being. Opioid compounds include both potent prescription analgesics such as morphine, meperidine (Demerol), codeine, hydromorphone, oxycodone, methadone, oxymorphone, hydrocodone, and propoxyphene as well as illegal substances such as heroin and normethadone. People who abuse opioids spend a great deal of their time obtaining the drugs; they often engage in illegal activity to get them. Health-care professionals who abuse opioids often write prescriptions for themselves or divert prescribed pain medication for clients to themselves.

Hallucinogens

are substances that distort the user's perception of reality and produce symptoms similar to psychosis, including hallucinations (usually visual) and depersonalization. Hallucinogens also cause increased pulse, blood pressure, and temperature; dilated pupils; and hyperreflexia. Examples of hallucinogens are mescaline, psilocybin, lysergic acid diethylamide, and "designer drugs" such as Ecstasy. PCP, developed as an anesthetic, is included in this section because it acts similarly to hallucinogens.

Warning signs of motor development problems in infant:

arms and legs are stiff or floppy, child cannot support head at 3-4 months, child reaches with one hand only, child cannot sit with assistance at 6 months, does not crawl by 12 months, cannot stand supported at 12 months.

A nurse is writing learning outcomes for a patient recovering from severe burns. Which of the following verbs would be good choices to use when preparing outcomes related to learning how to change dressings?

assembles demonstrates

HEADSS

assess home, education, activities, drugs, sex, and suicide

Maturation

associated with the process of aging, enables cells to function or operate at a higher level.

Hospitals established by Dorothea Dix were designed to be

asylums

The major problems with large state institutions are

attendants were accused of abusing the residents. clients were geographically isolated from family and community. Clients were often far removed from the local community, family, and friends because state institutions were usually in rural or remote settings. Choices B and D were not major problems associated with large state instructions.

NPO Patient, surgical patient, euvolemic

awaiting surgery or unsafe swallow.

12-step program

based on the philosophy that total abstinence is essential and that alcoholics need the help and support of others to maintain sobriety

Object Permanence

begins to develop 4-7 months, solidified by 8 months..If an infant sees an object, he will search for it in the last place he saw it , knowing it still exists.

Severe allergic reaction findings

bronchospasm, wheexing, shortness of breath. Severe hypotension, tachycardia, respiratory/cardiac arrest.

Treatment for severe allergic reaction

call rapid response team, initiate oxygen therapy, elevate head of bed ( 45 degrees unless hypotensive= 10 degrees) . Stop medication infusion, infuse .9% NaCl 30ml/hr. Anticipate administering epinephrine, dipheyhydramine. Perform emergency measures as necessary.

substance abuse

can be defined as using a drug in a way that is inconsistent with medical or social norms and despite negative consequences

What word or phrase best describes an effective counselor?

caring

Differentiation

cells and structures become specialized.

Developmental arrest

cessation of one or more phases of development before it reaches normal completion, when this occurs in utero, a congenital anomaly results.

Signs of chemical incompatibility in IV

changes in molecular structure or pharmacological properties; may or may not be physically observable.

Warning signs of social/emotional development problems in infant

child does not smile at people at 3 months of age; child refuses to cuddle; child does not seem to enjoy people; child shows no interest in peek-a-boo at 8 months of age.

Rick factors for late onset substance abuse in elders

chronic illness that causes pain, long term use of prescription medication, life stress, loss, social isolation, grief, depression, abundance of discretionary time and money.

Health Status Risks to Development

chronic illness, injuries, multiple/prolonged hospitalizations

Power Reassurance or Opportunity rapist

commits rape when opportunity presents itself, often during the commission of another crime. keeps souvenirs, thinks victim " liked it"

Bolus

concentrated medication or solution given rapidly over a short period of timedrip.

opioid

controlled drugs; often abused because they desensitize the user to both physiologic and psychological pain and induce a sense of euphoria and well-being; some are prescribed for analgesic effects but others are illegal in the United States

Positive regard

conveying genuine care to clients without passing any negative judgement.

Period of enlightenment

creation of asylums, moral treatment.

denial

defense mechanism; clients may deny directly having any problems or may minimize the extent of problems or actual substance use

The goal of the 1963 Community Mental Health Centers Act was to

deinstitutionalize state hospitals. The 1963 Community Mental Health Centers Act intimated the movement toward treating those with mental illness in a less restrictive environment. This legislation resulted in the shift of clients with mental illness from large state institutions to care based in the community.

Deinstitutionalization

deliberate shift from institutional care in state hospitals to community facilities.

A mother of a toddler wants to learn how to do CPR. What teaching strategy would be most effective in helping her learn?

demonstration

Power assertive rapist

desires to dominate and control the victim. May cruise bars or the internet to obtain victims. Acts macho, may repeat with same victim

Medications sometimes given for off label use of decreasing craving for cocaine

disulfiram, modafinil (anti-narcoleptic), propranolol( a b-blocker), Topomax (anti convulsant)

controlled substance

drug classified under the Controlled Substances Act; includes opioids, stimulants, benzodiazepines, anabolic steroids, cannabis derivatives, psychedelics, and sedatives

stimulant drugs

drugs that stimulate or excite the central nervous system

Adequate pain relief leads to

earlier mobilization , shortened hospital stays, reduced costs.

What term describes a nurse who is sensitive to the patient's feelings but remains objective enough to help the patient achieve positive outcomes?

empathic

Mental health parity laws ensure

equality in equal coverage for mental illness.

What is the most critical element of documentation of teaching?

evidence that learning has occurred

Helping relationship

exists among people who provide and receive assistance in meeting human needs. It sets the climate for the participants to move towards common goals. It is dynamic, it is purposeful and time limited with specific goals.

A nurse refers a patient with a new colostomy to a support group. This nurse is practicing which of the following aims of nursing?

facilitating coping

Treatment of extravasation

facility policy

Congruence

feelings that match the expressions of the client

Linda Richards

first American psychiatric nurse

Johns Hopkins

first school of nursing to include psychiatric nursing course (1913)

Developing a teaching plan is comparable to what other nursing activity?

formulating a nursing care plan.

Findings of allergic reaction

generalized urticaria, hives, itching

Prenatal Risk

genetic, congenital, prenatal exposure to illicit drugs and/or alcohol

Development is the result of

genetics, environmental factors, culture, and family values

Three processes in development

growth, differentiation, and maturation

Developmental Infographic

http://indulgy.com/post/H9mTbm533/the-milestones-of-a-childs-development-b

Cause of allergic reaction

hypersensitivity to medication

Reflection statement

identifying the main emotional themes

When is the best time to evaluate one's own teaching effectiveness?

immediately after a teaching session

substance dependence

includes problems associated with addiction, such as tolerance, withdrawal, and unsuccessful attempts to stop using the substance

Growth

increase in size and weight, ie Growth and weight chart

Organization communication

individuals and groups within an organization communicate to achieve established goals.

Warning signs of language development problems in infant:

infant does not make sounds at 4 months of age; infant does not laugh or squeal by 6 months of age; infant does not babble by 8 months of age; infant does not use single words with meaning at 12 months of age (mama, dada).

Phlebitis

inflammation of a vein

Causes of Fluid Overload

infusion at a rate client can't tolerate. Those at risks are older adults, infants, children, and those with heart failure.

Intoxication and Overdose: Inhalants

inhalant intoxication involves dizziness, nystagmus, lack of coordination, slurred speech, unsteady gait, tremor, muscle weakness, and blurred vision. Stupor and coma can occur. Significant behavioral symptoms are belligerence, aggression, apathy, impaired judgment, and inability to function. Acute toxicity causes anoxia, respiratory depression, vagal stimulation, and dysrhythmias. Death may occur from bronchospasm, cardiac arrest, suffocation, or aspiration of the compound or vomitus (Sakai & Crowley, 2009). Treatment consists of supporting respiratory and cardiac functioning until the substance is removed from the body. There are no antidotes or specific medications to treat inhalant toxicity.

The nurse and PT discuss the schedule and goals for a patient. This is what type of communication?

interpersonal- 2 or more people with the goal to exchange messages.

The nurse at a university health services clinic has been asked to meet with a freshman class of women about warning signs of relationship violence. The nurse points out what danger signs the students should be alert for in a date?

is excessively jealous Feedback: Warning signs of relationship violence include gets jealous for no reason; tells you with whom you may be friends or how you should dress, or tries to control other elements of your life; does not view you as an equal: sees himself as smarter or socially superior; is angry or threatening to the point that you have changed your life or yourself so you would not anger him.

Risks of IV fluid therapy

local reactions like phlebitis, infiltration and/or extravasation and systemic reactions like speed shock, fluid overload, catheter embolism, allergy

Manage care is designed to

maintain a balance between the quality and costs of health care.

Causes of phlebitis

mechanical- excessively large catheter or leaving a catheter in too long (2-3 days) Chemical- infusion of irritating solutions

A client diagnosed with a mild anxiety disorder has been referred to treatment in a community mental health center. Treatment most likely provided at the center includes

medical management of symptoms. Community mental health centers focus on rehabilitation, vocational needs, education, and socialization, as well as on management of symptoms and medication. Daily therapies, constant supervision, and stabilization require a more acute care inpatient setting.

When communicating with clients, the nurse should recognize that what factor will most likely pose a barrier?

medical terminology- another filter is the particular language system into which the person is socialized. Nurses are socialized into health care or medical jargon. To effectively educate and communicate, the nurse should limit medical jargon.

Mental illness includes disorders that affect

mood, behavior, thinking.

What patient characteristic is important to assess when using the health belief model as the framework for teaching?

motivation to learn

The primary purpose of the Community Mental Health Center Act of 1963 was

moving patients to their home community for treatment.

spontaneous remission

natural recovery that occurs without treatment of any kind

Interpersonal Communication

occurs between two or more people with a goal to exchange messages.

Infiltration findings

pallor, swelling, pain

What is the primary focus of communication during the nurse-patient relationship?

patient and patient needs

3 Critical development areas to consider when developing a teaching plan

physical maturation and abilities, psychosocial development and cognitive capacities

5 categories of Development

physical, social/emotional, cognitive, communication, adaptive

Before the period of the enlightenment, treatment of the mentally ill included:

placing the mentally ill on display for the public's amusement. In 1775, visitors at St. Mary's of Bethlehem were charged a fee for viewing and ridiculing the mentally ill, who were seen as animals, less than human. Custodial care was not often provided as persons who were considered harmless were allowed to wander in the countryside or live in rural communities, and more dangerous lunatics were imprisoned, chained, and starved. In early Christian times, primitive beliefs and superstitions were strong. The mentally ill were viewed as evil or possessed. Priests performed exorcisms to rid evil spirits, and in the colonies, witch hunts were conducted with offenders burned at the stake. It was not until the period of enlightenment when persons who were mentally ill were offered asylum as a safe refuge or haven offering protection at institutions.

Hypovolemic Patient

pneumonia, sepsis, hemorrhage, gastroenteritis

Signs of substance abuse in health professionals

poor work performance, frequent absenteeism, unusual behavior, slurred speech, isolation from peers. Incorrect drug counts Excessive controlled substances listed as wasted or contaminated Reports by clients of ineffective pain relief from medications, especially if relief had been adequate previously Damaged or torn packaging on controlled substances Increased reports of "pharmacy error" Consistent offers to obtain controlled substances from pharmacy Unexplained absences from the unit Trips to the bathroom after contact with controlled substances Consistent early arrivals at or late departures from work for no apparent reason

Developmental level

position of an individual in the sequence of development

DSM Classification allows the...

practitioner to identify all factors that relate to a patient's condition: Major psychiatric disorders Medical conditions Psychosocial and environmental problems

A nurse in a neighborhood clinic is conducting educational sessions on weight loss. What aim of nursing is met by these educational programs?

preventing illness

A woman has just presented at the emergency department after being raped. The initial nursing action would be to

provide emotional support. Feedback: In the emergency setting, the nurse is an essential part of the team in providing emotional support to the victim. The nurse should allow the woman to proceed at her own pace and not rush her through any interview or examination procedures. Giving back to the victim as much control as possible is important. Ways to do so include allowing her to make decisions, when possible, about whom to call, what to do next, what she would like done, and so on.

The creation of asylums during the 1800s was meant to

provide food and shelter for the mentally ill. Feedback: The asylum was meant to be a safe haven with food, shelter, and humane treatment for the mentally ill. Asylums were not used to improve treatment of mental disorders or to punish mentally ill people who were believed to be possessed. The asylum was not created to remove the dangerously mentally ill from the community.

A significant change in the treatment of people with mental illness occurred in the 1950s when

psychotropic drugs became available for use. Feedback: the development of psychotropic drugs, or drugs used to treat mental illenss, began in the 1950s

Why IVP?

rapid onset, improved serum drug concentrations, able to administer when NPO, IM painful, some drugs can only be given IV, loading dose.

flushing

reddening of the face and neck as a result of increased blood flow

Signs of Phlebitis

redness, swelling, discomfort at sight. Redness, heat, firmness along vein.

withdrawal syndrome

refers to the negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreases

Findings of IV catheter embolism

reflect location where embolism lodges. Pain proximal to IV insertion site. Shortness of breath, cyanosis, tachycardia. Other signs of shock

Treatment of IV catheter embolism

remove IV catheter. Inspect for damage to tip. Apply tourniquet above insertion site. Notify provider. Anticipate obtaining X-ray.

National League for Nursing (1950)

requiring schools to include psychiatric nursing experience

The appropriate action for a student nurse who says the wrong thing is to

restate it by saying, "That didn't come out right. What I meant was..." No one magic phrase can solve a client's problems; likewise, no single statement can significantly worsen them. Listening carefully, showing genuine interest, and caring about the client are extremely important. A nurse who possesses these elements but says something that sounds out of place can simply restate it by saying, "That didn't come out right. What I meant was..." Pretending that the student nurse did not say it, stating that it was a joke, and ignoring the error are not likely to help the student nurse build and maintain credibility with the client.

Children lose control over their:

routine, body, basic decisions loss of school (boredom), ability to socialize.

Sigmund Freud

scientific study and treatment of mental illness

Intrapersonal Communication

self talk, communication within a person.

A nurse is interviewing a client for the establishment of long term care insurance. During the interview, the nurse asks questions regarding the client's past medical history. The nurse is the

sender- a person or group with a purpose for the communication

The nurse consults the DSM to

serve as a guide for client assessment

Developmental milestones

set of functional skills or age-specific tasks that most children can complete at a certain age range; provide basis for developmental assessment; serve as major markers in tracking the emergence of motor, social, cognitive, and language skills

Causes of IV catheter embolism

shearing off portion of IV catheter. Catheter damaged during insertion. Excessive force.

An elderly patient is very stressed about who will care for his pets while he is hospitalized for a fall that caused a fractured hip and hospitalization. What type of counseling would the nurse conduct?

short term

McLean Hospital, Belmont, MA

site of first training for nurses to work with persons with mental illness

Treatment for Fluid overload

slow infusion rate of IV fluids, elevate head of bed, administer oxygen, notify provider for diuretic, document findings.

Characteristics of violent families

social isolation, abuse of power and control, alcohol and other drug abuse, intergenerational transmission process.

Treatment of Infiltration

stop IV, remove cannula

Treatment of Speed Shock

stop med, change IV to isotonic solution, notify provider, treat effects, monitor vital signs.

Treatment of allergic reaction

stop medication being infused. Replace IV tubing, infuse .9% NaCl 30ml/hour. Notify provider and anticipate administering epinephrine.

Treatment of phlebitis

stop treatment, remove IV Cathether, change vein. Warm compress. Document and monitor.

hallucinogen

substances that distort the user's perception of reality and produce symptoms similar to psychosis including hallucinations (usually visual) and depersonalization

designer drugs

synthetic substances made by altering existing medications or formulating new ones not yet controlled by the FDA; amphetamine-like effects, some also have hallucinogenic effects; called club drugs

Speed Shock

systemic reaction when IV is administered to rapidly, causing blood levels to rise to possibly toxic levels

dual diagnosis

the client with both substance abuse and another psychiatric illness

tolerance

the need for increased amount of a substance to produce the same effect

detoxification

the process of safely withdrawing from a substance

Atraumatic Care

therapeutic care that minimizes or eliminates the psychological and physical distress experienced by children and their families in the health care system.

Signs of therapeutic incompatibility in IV

therapeutic effect of a drug altered (increased or decreased) by another.

H. Peplau:

therapeutic nurse-client relationship; interpersonal dimension (foundation for current practice)

Developmental tasks

unique sets of skills and competencies that need to be mastered at each developmental stage in order for the individual to cope with the environment. Age related developmental expectancies or norms are always based on an age range, never an exact point in time when specific skills will be achieved

intoxication

use of a substance that results in maladaptive behavior

A new graduate nurse has accepted a staff position at an inpatient mental health facility. The graduate nurse can expect to be responsible for basic-level functions, including

using effective communication skills. Basic-level functions include counseling, milieu therapy, self-care activities, psychobiologic interventions, health teaching, case management, and health promotion and maintenance. Advanced-level functions include psychotherapy, prescriptive authority for drugs, consultation and liaison, evaluation, program development and management, and clinical supervision.

Extravasation findings

varying tissue damage

tolerance break

very small amounts of a substance will produce intoxication

Extravasation

vesicant medication leaks outside infiltrated IV

Signs of physical incompatibility in IV

visible precipitation

Anger excitement/Sadistic rapist

wants to hurt/kill victim, acts out fantasies, compulsive in appearance, carries a rape kit, learns better ways to stalk.

Anger retaliation rapist

wants to punish victims, hates women, often causes substantial injury, sees self as masculine and action oriented, voiced hatred for women over perceived injustice.

Warning signs of sensory development problems in infant:

young infant does not respond to loud noises; child does not focus on a near object; infant does not start to make sounds or babble by 4 months of age; infant does not turn to locate sound at age 4 months; infant crosses eyes most of the time at age 6 months.