Peds Exam 1 Flashcards
What is the primary disadvantage associated with outpatient and day facility care?
a.
Increased cost
b.
Increased risk of infection
c.
Lack of physical connection to the hospital
d.
Longer separation of the child from family
ANS: C
Outpatient and day facility care do not provide extended care; therefore, a child requiring extended care must be transferred to the hospital, causing increased stress to the child and parents. Outpatient care decreases cost and reduces the risk of infection. Outpatient care also minimizes separation of the child from family.
Which should the nurse expect for a toddler’s language development at age 18 months? a. Vocabulary of 25 words b. Increasing level of comprehension c. Use of phrases d. Approximately one third of speech understandable
ANS: B
During the second year of life, level of comprehension and understanding of speech increases and is far greater than the child’s vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages. The 18-month-old child has a vocabulary of 10 or more words. At this age, the child does not use one-word sentences or phrases. The child has a limited vocabulary of single words that are comprehensible.
The nurse must do a heel stick on an ill neonate to obtain a blood sample. Which procedure is recommended to facilitate this? a. Apply cool, moist compresses. c. Elevate the foot for 5 minutes. b. Apply a tourniquet to the ankle. d. Wrap foot in a warm washcloth.
ANS: D
Before the blood sample is taken, the heel is heated with warm moist compresses for 5 to 10 minutes to dilate the blood vessels in the area. Cooling causes vasoconstriction, making blood collection more difficult. A tourniquet is used to constrict superficial veins. It will have an insignificant effect on capillaries. Elevating the foot will decrease the blood in the foot available for collection.
Which demonstrates the school-age child’s developing logic in the stage of concrete operations (select all that apply)?
a.
The school-age child is able to recognize that he can be a son, brother, or nephew at the same time.
b.
The school-age child understands the principles of adding, subtracting, and reversibility.
c.
The school-age child understands the principles of adding, subtracting, and reversibility.
d.
The school-age child has thinking that is characterized by egocentrism and animism.
ANS: A, B, C The school-age child understands that the properties of objects do not change when their order, form, or appearance does. Conservation occurs in the concrete operations stage. Comprehension of class inclusion occurs as the school-age child’s logic increases. The child begins to understand that a person can be in more than one class at the same time. This is characteristic of concrete thinking and logical reasoning. The school-age child is able to understand principles of adding, subtracting, and the process of reversibility, which occurs in the stage of concrete operations. Thinking that is characterized by egocentrism and animism occurs in the intuitive thought stage, not the concrete operations stage of development.
A nurse is performing an assessment on a school-age child. Which findings suggest the child is receiving an excess of vitamin A (Select all that apply)? a. Delayed sexual development b. Edema c. Pruritus d. Jaundice e. Paresthesia
ANS: A, C, D
Excess vitamin A can cause delayed sexual development, pruritus, and jaundice. Edema is seen with excess sodium. Paresthesia occurs with excess riboflavin.
The nurse is doing a prehospitalization orientation for Kayla, age 7, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that Kayla will not be able to talk because of an endotracheal tube but that she will be able to talk when it is removed. This explanation is: a. Unnecessary. b. The surgeon’s responsibility. c. Too stressful for a young child. d. An appropriate part of the child’s preparation.
ANS: D
This is a necessary part of preoperative preparation that will help reduce the anxiety associated with surgery. If the child wakes and is not prepared for the inability to speak, she will be even more anxious. It is a joint responsibility of nursing, medical staff, and child life personnel. This is a necessary component of preparation that will help reduce the anxiety associated with surgery.
The school nurse has been asked to begin teaching sex education in the 5th grade. The nurse should recognize that:
a.
Children in 5th grade are too young for sex education.
b.
Children should be discouraged from asking too many questions.
c.
Correct terminology should be reserved for children who are older.
d.
Sex can be presented as a normal part of growth and development.
ANS: D
When sex information is presented to school-age children, sex should be treated as a normal part of growth and development. Fifth graders are usually 10 to 11 years old. This age is not too young to speak about physiologic changes in their bodies. They should be encouraged to ask questions. Preadolescents need precise and concrete information.
The nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident. Which statement by the adolescent would be expected about separation anxiety?
a.
“I wish my parents could spend the night with me while I am in the hospital.”
b.
“I think I would like for my siblings to visit me but not my friends.”
c.
“I hope my friends don’t forget about visiting me.”
d.
“I will be embarrassed if my friends come to the hospital to visit.”
ANS: C
Loss of peer-group contact may pose a severe emotional threat to an adolescent because of loss of group status; friends visiting is an important aspect of hospitalization for an adolescent and would be very reassuring. Adolescents may welcome the opportunity to be away from their parents. The separation from siblings may produce reactions from difficulty coping to a welcome relief.
A nurse is planning care for a hospitalized toddler in the preoperational thinking stage. Which characteristics should the nurse expect in this stage (select all that apply)? a. Concrete thinking b. Egocentrism c. Animism d. Magical thinking e. Ability to reason
ANS: B, C, D
The characteristics of preoperational thinking that occur for the toddler include egocentrism (views everything in relation to self), animism (believes that inert objects are alive), and magical thinking (believes that thinking something causes that event). Concrete thinking is seen in school-age children and ability to reason is seen with adolescents.
The parents of a newborn say that their toddler “hates the baby . . . he suggested that we put him in the trash can so the trash truck could take him away.” The nurse’s best reply is:
a.
“Let’s see if we can figure out why he hates the new baby.”
b.
“That’s a strong statement to come from such a small boy.”
c.
“Let’s refer him to counseling to work this hatred out. It’s not a normal response.”
d.
“That is a normal response to the birth of a sibling. Let’s look at ways to deal with this.”
ANS: D
The arrival of a new infant represents a crisis for even the best-prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. The nurse should work with parents on ways to involve the toddler in the newborn’s care and help focus attention on the toddler. The toddler does not hate the infant. This is an expected response to the changes in routines and attention that affect the toddler. This is a normal response. The toddler can be provided with a doll to tend to its needs when the parent is performing similar care for the newborn.
Pacifiers can be extremely dangerous because of the frequency of use and the intensity of the infant’s suck. In teaching parents about appropriate pacifier selection, the nurse should explain that a pacifier should have which characteristics (select all that apply)? a. Easily grasped handle b. One-piece construction c. Ribbon or string to secure to clothing d. Soft, pliable material e. Sturdy, flexible material
ANS: A, B, E
A good pacifier should be easily grasped by the infant. One-piece construction is necessary to avoid having the nipple and guard separate. The material should be sturdy and flexible. An attached ribbon or string and soft, pliable material are not characteristics of a good pacifier.
The nurse must check vital signs on a 2-year-old boy who is brought to the clinic for his 24-month checkup. Which criteria should the nurse use in determining the appropriate-size blood pressure cuff (Select all that apply)?
a.
The cuff is labeled “toddler.”
b.
The cuff bladder width is approximately 40% of the circumference of the upper arm.
c.
The cuff bladder length covers 80% to 100% of the circumference of the upper arm.
d.
The cuff bladder covers 50% to 66% of the length of the upper arm.
ANS: B, C
Research has demonstrated that cuff selection with a bladder width that is 40% of the arm circumference will usually have a bladder length that is 80% to 100% of the upper arm circumference. This size cuff will most accurately reflect measured radial artery pressure. The name of the cuff is a representative size that may not be suitable for any individual child. Choosing a cuff by limb circumference more accurately reflects arterial pressure than choosing a cuff by length.
Which comments indicate that the mother of a toddler needs further teaching about dental care?
a.
“We use well water so I give my toddler fluoride supplements.”
b.
“My toddler brushes his teeth with my help.”
c.
“My child will not need a dental checkup until his permanent teeth come in.”
d.
“I use a small nylon bristle brush for my toddler’s teeth.”
ANS: C
Children should first see the dentist 6 months after the first primary tooth erupts and no later than age 30 months. Toddlers need fluoride supplements when they use a water supply that is not fluorinated. Toddlers also require supervision with dental care. The parent should finish brushing areas not reached by the child. A small nylon bristle brush works best for cleaning toddlers’ teeth.
In providing anticipatory guidance to parents whose child will soon be entering kindergarten, which is a critical factor in preparing a child for kindergarten entry?
a.
The child’s ability to sit still
b.
The child’s sense of learned helplessness
c.
The parent’s interactions and responsiveness to the child
d.
Attending a preschool program
ANS: C
Interactions between the parent and child are an important factor in the development of academic competence. Parental encouragement and support maximize a child’s potential. The child’s ability to sit still is important to learning; however, parental responsiveness and involvement are more important factors. Learned helplessness is the result of a child feeling that he or she has no effect on the environment and that his or her actions do not matter. Parents who are actively involved in a supportive learning environment will demonstrate a more positive approach to learning. Preschool and day care programs can supplement the developmental opportunities provided by parents at home, but they are not critical in preparing a child for entering kindergarten.
A 2-year-old child is being admitted to the hospital for possible bacterial meningitis. When preparing for a lumbar puncture, the nurse’s best action is to:
a.
Prepare child for conscious sedation during the test.
b.
Set up a tray with equipment the same size as for adults.
c.
Reassure the parents that the test is simple, painless, and risk free.
d.
Apply EMLA to puncture site 15 minutes before procedure.
ANS: A
Because of the urgency of the child’s condition, conscious sedation should be used for the procedure. Pediatric spinal trays have smaller needles than do adult trays. Reassuring the parents that the test is simple, painless, and risk free is incorrect information. A spinal tap does have associated risks, and analgesia will be given for the pain. EMLA (a eutectic mixture of local anesthetics) should be applied approximately 60 minutes before the procedure. The emergency nature of the spinal tap precludes its use.
A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, “Wait a minute,” and, “I’m not ready.” The nurse should recognize that:
a.
This is normal behavior for a school-age child.
b.
This behavior is usually not seen past the preschool years.
c.
The child thinks the nurse is punishing her.
d.
The child has successfully manipulated the nurse in the past.
ANS: A
This school-age child is attempting to maintain control. The nurse should provide the girl with structured choices about when the IV will be inserted. This can be characteristic behavior when an individual needs to maintain some control over a situation. The child is trying to have some control in the hospital experience.
Where in the health history should the nurse describe all details related to the chief complaint? a. Past history c. Present illness b. Chief complaint d. Review of systems
ANS: C
The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. The focus of the present illness is on all factors relevant to the main problem, even if they have disappeared or changed during the onset, interval, and present. Past history refers to information that relates to previous aspects of the child’s health, not to the current problem. The chief complaint is the specific reason for the child’s visit to the clinic, office, or hospital. It does not contain the narrative portion describing the onset and progression. The review of systems is a specific review of each body system.
The most effective way to clean a toddler’s teeth is for the:
a.
Child to brush regularly with toothpaste of his or her choice.
b.
Parent to stabilize the chin with one hand and brush with the other.
c.
Parent to brush the mandibular occlusive surfaces, leaving the rest for the child.
d.
Parent to brush the front labial surfaces, leaving the rest for the child.
ANS: B
For young children, the most effective cleaning of teeth is done by the parents. Different positions can be used if the child’s back is to the adult. The adult should use one hand to stabilize the chin and the other to brush the child’s teeth. The child can participate in brushing, but for a thorough cleaning adult intervention is necessary.
An adolescent boy tells the nurse that he has recently had homosexual feelings. The nurse’s response should be based on knowledge that:
a.
This indicates that the adolescent is homosexual.
b.
This indicates that the adolescent will become homosexual as an adult.
c.
The adolescent should be referred for psychotherapy.
d.
The adolescent should be encouraged to share his feelings and experiences.
ANS: D
These adolescents are at increased risk for health-damaging behaviors, not because of the sexual behavior itself, but because of society’s reaction to the behavior. The nurse’s first priority is to give the young man permission to discuss his feelings about this topic, knowing that the nurse will maintain confidentially, appreciate his feelings, and remain sensitive to his need to talk it. In recent studies among self-identified gay, lesbian, and bisexual adolescents, many of the adolescents report changing their self-labels one or more times during their adolescence.
The nurse should expect the anterior fontanel to close at age: a. 2 months c. 6 to 8 months b. 2 to 4 months d. 12 to 18 months
ANS: D
Ages 2 through 8 months are too early. The expected closure of the anterior fontanel occurs between ages 12 and 18 months; if it closes at these earlier ages, the child should be referred for further evaluation.
When is a child with chickenpox considered to be no longer contagious? a. When fever is absent c. 24 hours after lesions erupt b. When lesions are crusted d. 8 days after onset of illness
ANS: B
When the lesions are crusted, the chickenpox is no longer contagious. This may be a week after onset of disease. The child is still contagious once the fever has subsided and after the lesions erupt, and may or may not be contagious any time after 6 days as long as all lesions are crusted over.
Which toys should a nurse provide to promote imaginative play for a 3-year-old hospitalized child (select all that apply)? a. Plastic telephone b. Hand puppets c. Jigsaw puzzle (100 pieces) d. Farm animals and equipment e. Jump rope
ANS: A, B, D
To promote imaginative play for a 3-year-old child, the nurse should provide: dress-up clothes, dolls and dollhouses, housekeeping toys, play-store toys, telephones, farm animals and equipment, village sets, trains, trucks, cars, planes, hand puppets, and medical kits. A 100-piece jigsaw puzzle and a jump rope would be appropriate for a young, school-age child but not a 3-year-old child.
Which statement accurately describes physical development during the school-age years?
a.
The child’s weight almost triples.
b.
A child grows an average of 2 inches per year.
c.
Few physical differences are apparent among children at the end of middle childhood.
d.
Fat gradually increases, which contributes to the child’s heavier appearance.
ANS: B
In middle childhood, growth in height and weight occur at a slower pace. Between the ages of 6 and 12 years, children grow 2 inches per year. In middle childhood, children’s weight will almost double; they gain 3 kg/year. At the end of middle childhood, girls grow taller and gain more weight than boys. Children take on a slimmer look with longer legs in middle childhood.
Which statement regarding childhood morbidity is the most accurate? a. Morbidity does not vary with age. b. Morbidity is not distributed randomly. c. Little can be done to improve morbidity. d. Unintentional injuries do not have an effect on morbidity.
ANS: B
Morbidity is not distributed randomly in children. Increased morbidity is associated with certain groups of children, including children living in poverty and those who were low birth weight. Morbidity does vary with age. The types of illnesses in children are different for each age group. Morbidity can be decreased with interventions focused on groups with high morbidity and on decreasing unintentional injuries, which also affect morbidity.
An appropriate intervention to encourage food and fluid intake in a hospitalized child is to:
a.
Force child to eat and drink to combat caloric losses.
b.
Discourage participation in noneating activities until caloric intake is sufficient.
c.
Administer large quantities of flavored fluids at frequent intervals and during meals.
d.
Give high-quality foods and snacks whenever child expresses hunger.
ANS: D
Small, frequent meals and nutritious snacks should be provided for the child. Favorite foods such as peanut butter and jelly sandwiches, fruit yogurt, cheese, pizza, and macaroni and cheese should be available. Forcing a child to eat only meets with rebellion and reinforces the behavior as a control mechanism. Large quantities of fluid may decrease the child’s hunger and further inhibit food intake.
A parent of an infant with colic tells the nurse, “All this baby does is scream at me; it is a constant worry.” The nurse’s best action is:
a.
Encourage parent to verbalize feelings.
b.
Encourage parent not to worry so much.
c.
Assess parent for other signs of inadequate parenting.
d.
Reassure parent that colic rarely lasts past age 9 months.
ANS: A
Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parent’s anxieties. The nurse should reassure the parent that he or she is not doing anything wrong. The infant with colic is experiencing spasmodic pain that is manifested by loud crying, in some cases up to 3 hours each day. Telling the parent that it will eventually go away does not help him or her through the current situation.
A clinic nurse is planning a teaching session about childhood obesity prevention for parents of school-age children. The nurse should include which associated risk of obesity in the teaching plan? a. Type I diabetes c. Celiac disease b. Respiratory disease d. Type II diabetes
ANS: D
Childhood obesity has been associated with the rise of type II diabetes in children. Type I diabetes is not associated with obesity and has a genetic component. Respiratory disease is not associated with obesity, and celiac disease is the inability to metabolize gluten in foods and is not associated with obesity.
What type of breath sound is normally heard over the entire surface of the lungs, except for the upper intrascapular area and the area beneath the manubrium? a. Vesicular c. Adventitious b. Bronchial d. Bronchovesicular
ANS: A
Vesicular breath sounds are heard over the entire surface of lungs, with the exception of the upper intrascapular area and the area beneath the manubrium. Bronchial breath sounds are heard only over the trachea near the suprasternal notch. Adventitious breath sounds are not usually heard over the chest. These sounds occur in addition to normal or abnormal breath sounds. Bronchovesicular breath sounds are heard over the manubrium and in the upper intrascapular regions where trachea and bronchi bifurcate.
A nurse is caring for a child in Droplet Precautions. Which instructions should the nurse give to the unlicensed assistive personnel caring for this child (Select all that apply)?
a.
Wear gloves when entering the room.
b.
Wear an isolation gown when entering the room.
c.
Place the child in a special air handling and ventilation room.
d.
A mask should be worn only when holding the child.
e.
Wash your hands upon exiting the room.
ANS: A, B, E
Droplet transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person with large-particle droplets (>5 mm) containing microorganisms generated from a person who has a clinical disease or who is a carrier of the microorganism. Droplets are generated from the source person primarily during coughing, sneezing, or talking and during procedures such as suctioning and bronchoscopy. Gloves, gowns, and a mask should be worn when entering the room. Hand washing when exiting the room should be done with any patient. Because droplets do not remain suspended in the air, special air handling and ventilation are not required to prevent droplet transmission.
Which screening tests should the school nurse perform for the adolescent (select all that apply)? a. Glucose b. Vision c. Hearing d. Cholesterol e. Scoliosis
ANS: B, C, E
The school nurse should perform vision, hearing, and scoliosis screening tests according to the school district’s required schedule. Glucose and cholesterol screening would be performed in the medical clinic setting.
Katie, 4 years old, is admitted to outpatient surgery for removal of a cyst on her foot. Her mother puts the hospital gown on her, but Katie is crying because she wants to leave on her underpants. The most appropriate nursing action is to:
a.
Allow her to wear her underpants.
b.
Discuss with her mother why this is important to Katie.
c.
Ask her mother to explain to her why she cannot wear them.
d.
Explain in a kind, matter-of-fact manner that this is hospital policy.
ANS: A
It is appropriate for the child to leave her underpants on. This allows her some measure of control during the foot surgery. The mother should not be required to make the child more upset. Katie is too young to understand what hospital policy means.
Which behavior by parents or teachers will best assist the child in negotiating the developmental task of industry?
a.
Identifying failures immediately and asking the child’s peers for feedback
b.
Structuring the environment so the child can master tasks
c.
Completing homework for children who are having difficulty in completing assignments
d.
Decreasing expectations to eliminate potential failures
ANS: B
The task of the caring teacher or parent is to identify areas in which a child is competent and to build on successful experiences to foster feelings of mastery and success. Structuring the environment to enhance self-confidence and to provide the opportunity to solve increasingly more complex problems will promote a sense of mastery. Asking peers for feedback reinforces the child’s feelings of failure. When teachers or parents complete children’s homework for them, it sends the message that they do not trust the children to do a good job. Providing assistance and suggestions and praising their best efforts are more appropriate. Decreasing expectations to eliminate failures will not promote a sense of achievement or mastery.
The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse’s response should be based on knowledge that this is:
a.
Unacceptable because of the risk of sudden infant death syndrome (SIDS).
b.
Unacceptable because it does not encourage achievement of developmental milestones.
c.
Unacceptable to encourage fine motor development.
d.
Acceptable to encourage head control and turning over.
ANS: D
These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs and then be placed on their abdomens when awake to enhance development of milestones such as head control. The face-down position while awake and positioning on the back for sleep are acceptable because they reduce risk of SIDS and allow achievement of developmental milestones. These position changes encourage gross motor, not fine motor, development.
A nurse is working in a clinic that serves a culturally diverse population of children. The nurse should plan care, understanding that the following complementary and alternative practices may be used by this patient population (Select all that apply):
a.
Seeking another doctor’s opinion
b.
Seeking advice from a curandero or curandera
c.
Using acupuncture or acupressure as a therapy
d.
Consulting an herbalist
e.
Consulting a kahuna
ANS: B, C, D, E The curandero (male) or curandera (female) of the Mexican-American community is believed to have healing powers that are a gift from God. The Asian family may consult an herbalist, knowledgeable in medicines, or perhaps a specialized practitioner of Asian therapies, including acupuncture (insertion of needles) or acupressure (application of pressure). Native Hawaiians consult kahunas and practice ho’oponopono to heal family imbalance or disputes. The nurse may encounter use of these practices. Consulting another doctor would not be a complementary or alternative practice expected in a culturally diverse population.
Latasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What will help her most in her adjustment to the hospital?
a.
Explain hospital schedules such as mealtimes.
b.
Use terms such as “honey” and “dear” to show a caring attitude.
c.
Explain when parents can visit and why siblings cannot come to see her.
d.
Orient her parents, because she is young, to her room and hospital facility.
ANS: A
School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for experiences that are unavoidable. The nurse should refer to the child by the preferred name. Telling the child about all of the limitations of visiting does not help her adjust to the hospital. At the age of 8 years, the child and parents should be oriented to the environment.
Which statement is correct about childhood obesity?
a.
Heredity is an important factor in the development of obesity.
b.
Childhood obesity in the United States is decreasing.
c.
Childhood obesity is the result of inactivity.
d.
Childhood obesity can be attributed to an underlying disease in most cases.
ANS: A
Heredity is an important fact that contributes to obesity. Identical twins reared apart tend to resemble their biologic parents to a greater extent than their adoptive parents. It is difficult to distinguish between hereditary and environmental factors. The rate of childhood obesity has increased so dramatically that it has now reached epidemic proportions. Inactivity is an important contributing factor; however, obesity is the result of a combination of a number of other factors. Fewer than 5% of all cases of obesity can be linked to underlying disease.
The nurse is performing an assessment on a child and notes the presence of Koplik's spots. In which communicable disease are Koplik's spots present? a. Rubella c. Chickenpox (varicella) b. Measles (rubeola) d. Exanthema subitum (roseola)
ANS: B
Koplik’s spots are small, irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before systemic rash. Koplik’s spots are not present with rubella, varicella, or roseola.
A 3-year-old girl was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guideline concerning adoption should the nurse use in planning her response?
a.
Telling the child is an important aspect of their parental responsibilities.
b.
The best time to tell the child is between ages 7 and 10 years.
c.
It is not necessary to tell the child who was adopted so young.
d.
It is best to wait until the child asks about it.
ANS: A
It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the child’s identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to keep third parties from telling the children before the parents have had the opportunity.
A 2-year-old child has been returned to the nursing unit after an inguinal hernia repair. Which pain assessment tool should the nurse use to assess this child for the presence of pain? a. FACES pain rating tool c. Oucher scale b. Numeric scale d. FLACC tool
ANS: D
A behavioral pain tool should be used when the child is preverbal or does not have the language skills to express pain. The FLACC (face, legs, activity, cry, consolability) tool should be used with a 2-year-old child. The FACES, numeric, and Oucher scales are all self-report pain rating tools. Self-report measures are not sufficiently valid for children younger than 3 years of age because many children are not able to self-report their pain accurately.
By what age do the head and chest circumferences generally become equal? a. 1 month c. 1 to 2 years b. 6 to 9 months d. 2.5 to 3 years
ANS: C
Head circumference begins larger than chest circumference. Between ages 1 and 2 years, they become approximately equal. Head circumference is larger than chest circumference at ages 1 month and 6 to 9 months. Chest circumference is larger than head circumference at age 2.5 to 3 years.
What heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? a. S1, S2 c. Murmur b. S3, S4 d. Physiologic splitting
ANS: C
Murmurs are the sounds that are produced in the heart chambers or major arteries from the back-and-forth flow of blood. S1 is the closure of the tricuspid and mitral valves, and S2 is the closure of the pulmonic and aortic valves, and both are considered normal heart sounds. S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If heard, medical evaluation is required. Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding.
The school nurse tells adolescents in the clinic that confidentiality and privacy will be maintained unless a life-threatening situation arises. This practice is:
a.
Not appropriate in a school setting.
b.
Never appropriate because adolescents are minors.
c.
Important in establishing trusting relationships.
d.
Suggestive that the nurse is meeting his or her own needs.
ANS: C
Health professionals who work with adolescents should consider the adolescents’ increasing independence and responsibility while maintaining privacy and ensuring confidentiality. However, circumstances may occur in which they are not able to maintain confidentiality, such as self-destructive behavior or maltreatment by others. Confidentiality and privacy are necessary to facilitate trust with this age group. The nurse must be aware of the limits placed on confidentiality by local jurisdiction.
Developmentally, most children at age 12 months:
a.
Use a spoon adeptly.
b.
Relinquish the bottle voluntarily.
c.
Eat the same food as the rest of the family.
d.
Reject all solid food in preference to the bottle.
ANS: C
By age 12 months, most children are eating the same food that is prepared for the rest of the family. Using a spoon usually is not mastered until age 18 months. The parents should be engaged in weaning a child from a bottle if that is the source of liquid. Toddlers should be encouraged to drink from a cup at the first birthday and weaned totally by 14 months. The child should be weaned from a milk/formula-based diet to a balanced diet that includes iron-rich sources of food.
During examination of a toddler’s extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is:
a.
Abnormal and requires further investigation.
b.
Abnormal unless it occurs in conjunction with knock-knee.
c.
Normal if the condition is unilateral or asymmetric.
d.
Normal because the lower back and leg muscles are not yet well developed.
ANS: D
Lateral bowing of the tibia (bowlegged) is common in toddlers when they begin to walk, not an abnormal finding. It usually persists until all of their lower back and leg muscles are well developed. Further evaluation is needed if it persists beyond ages 2 to 3 years, especially in African-American children.
The nurse must assess 10-month-old infant. The infant is sitting on the father’s lap and appears to be afraid of the nurse and of what may happen next. Which initial action by the nurse would be most appropriate?
a.
Initiate a game of peek-a-boo.
b.
Ask the father to place the infant on the examination table.
c.
Undress the infant while he is still sitting on his father’s lap.
d.
Talk softly to the infant while taking him from his father.
ANS: A
Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done while the child is on the father’s lap. The nurse should have the father undress the child as needed for the examination.
An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler isto: a. Provide for privacy. b. Encourage parents to room in. c. Explain procedures and routines. d. Encourage contact with children the same age.
ANS: B
A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room in as much as possible. Maintaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents. Contact with same-aged children would not substitute for having the parents present.
The nurse is teaching a mother how to perform chest physiotherapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To enable the mother to perform percussion, the nurse should instruct her to:
a.
Cover the skin with a shirt or gown before percussing.
b.
Strike the chest wall with a flat-hand position.
c.
Percuss over the entire trunk anteriorly and posteriorly.
d.
Percuss before positioning for postural drainage.
ANS: A
For postural drainage and percussion, the child should be dressed in a light shirt to protect the skin and placed in the appropriate postural drainage positions. The chest wall is struck with a cupped-hand, not a flat-hand, position. The procedure should be done over the rib cage only. Positioning precedes the percussion.
The nurse is preparing a 12-year-old girl for a bone marrow aspiration. She tells the nurse that she wants her mother with her “like before.” The most appropriate nursing action is to:
a.
Grant her request.
b.
Explain why this is not possible.
c.
Identify an appropriate substitute for her mother.
d.
Offer to provide support to her during the procedure.
ANS: A
The parents’ preferences for assisting, observing, or waiting outside the room should be assessed, as well as the child’s preference for parental presence. The child’s choice should be respected. If the mother and child are agreeable, the mother is welcome to stay. An appropriate substitute for the mother is necessary only if the mother does not wish to stay. Support is offered to the child regardless of parental presence.
Which behavior suggests appropriate psychosocial development in the adolescent?
a.
The adolescent seeks validation for socially acceptable behavior from older adults.
b.
The adolescent is self-absorbed and self-centered and has sudden mood swings.
c.
Adolescents move from peers and enjoy spending time with family members.
d.
Conformity with the peer group increases in late adolescence.
ANS: B
During adolescence, energy is focused within. Adolescents concentrate on themselves in an effort to determine who they are or who they will be. Adolescents are likely to be impulsive and impatient. Parents often describe their teenager as being “self-centered” or “lazy.” The peer group validates acceptable behavior during adolescence. Adolescents move from family and enjoy spending time with peers. Adolescents also spend time alone; they need this time to think and concentrate on themselves. Conformity becomes less important in late adolescence.
Because of their striving for independence and productivity, which age-group of children is particularly vulnerable to events that may lessen their feeling of control and power? a. Infants c. Preschoolers b. Toddlers d. School-age children
ANS: D
When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurp individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that lessen their control and power. Infants, toddlers, and preschoolers, although affected by loss of power, are not as significantly affected as are school-age children.
By what age would the nurse expect that most children could understand prepositional phrases such as “under,” “on top of,” “beside,” and “in back of”? a. 18 months c. 3 years b. 24 months d. 4 years
ANS: D
At 4 years, children can understand directional phrases. Children 18 to 24 months and 3 years of age are too young.
Which term best describes the emotional attitude that one’s own ethnic group is superior to others? a. Culture c. Superiority b. Ethnicity d. Ethnocentrism
ANS: D
Ethnocentrism is the belief that one’s way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of one’s ethnic group are superior to those of others. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perception and judgments. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. Superiority is the state or quality of being superior; it does not include ethnicity.
Latasha is a breastfed infant being seen in the clinic for her 6-month checkup. Her mother tells the nurse that Latasha recently began to suck her thumb. The best nursing intervention is to:
a.
Recommend that the mother substitute a pacifier for Latasha’s thumb.
b.
Assess Latasha for other signs of sensory deprivation.
c.
Reassure the mother that this is very normal at this age.
d.
Suggest that the mother breastfeed Latasha more often to satisfy sucking needs.
ANS: C
Sucking is an infant’s chief pleasure, and she may not be satisfied by bottle-feeding or breastfeeding alone. During infancy and early childhood, there is no need to restrict nonnutritive sucking. Dental damage does not appear to occur unless the use of the pacifier or finger persists after age 4 to 6 years. The nurse should explore with the mother her feelings about pacifier vs. thumb. This is a normal behavior to meet nonnutritive sucking needs. No data support that Latasha has sensory deprivation.
A 17-year-old tells the nurse that he is not having sex because it would make his parents very angry. This response indicates that the adolescent has a developmental lag in which area? a. Cognitive development c. Psychosocial development b. Moral development d. Psychosexual development
ANS: B
The appropriate moral development for a 17-year-old would include evidence that the teenager has internalized a value system and does not depend on parents to determine right and wrong behaviors. Adolescents who remain concrete thinkers may never advance beyond conformity to please others and avoid punishment. Cognitive development is related to moral development, but it is not the pivotal point in determining right and wrong behaviors. Identity formation is the psychosocial development task. Energy is focused within the adolescent, who exhibits behavior that is self-absorbed and egocentric. Although a task during adolescence is the development of a sexual identity, the teenager’s dependence on the parents’ sanctioning of right or wrong behavior is more appropriately related to moral development.
With the goal of preventing plagiocephaly, the nurse should teach new parents to:
a.
Place the infant prone for 30 to 60 minutes per day.
b.
Buy a soft mattress.
c.
Allow the infant to nap in the car safety seat.
d.
Have the infant sleep with the parents.
ANS: A
Prevention of positional plagiocephaly may begin shortly after birth by implementing prone positioning or “tummy time” for approximately 30 to 60 minutes per day when the infant is awake. Soft mattresses or sleeping with parents (co-sleeping) are not recommended because they put the infant at a higher risk for a sudden infant death incident. To prevent plagiocephaly, prolonged placement in car safety seats should be avoided.
The nurse is taking a health history on an adolescent. What best describes how the chief complaint should be determined?
a.
Ask for a detailed listing of symptoms.
b.
Ask the adolescent, “Why did you come here today?”
c.
Use what the adolescent says to determine, in correct medical terminology, what the problem is.
d.
Interview the parent away from the adolescent to determine the chief complaint.
ANS: B
The chief complaint is the specific reason for the child’s visit to the clinic, office, or hospital. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. A listing of symptoms will make it difficult to determine the chief complaint. The adolescent should be prompted to tell which symptom caused him or her to seek help at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention at this time.
A dose of oxycodone (OxyContin) 2 mg/kg has been ordered for a child weighing 33 lb. The nurse should administer ______ milligrams of OxyContin. (Record your answer as a whole number.)
ANS:
30
The child’s weight is divided by 2.2 to obtain the weight in kilograms.
Kilograms in weight are then multiplied by the prescribed 2 mg.
33 lb/2.2 = 15 kg.
15 kg × 2 mg = 30 mg.
A nurse is planning care for a 7-year-old child hospitalized with osteomyelitis. Which activities should the nurse plan to bring from the playroom for the child (select all that apply)? a. Paper and some paints b. Board games c. Jack-in-the-box d. Stuffed animals e. Computer games
ANS: A, B, E
School-age children become fascinated with complex board, card, or computer games that they can play alone, with a best friend, or with a group. They also enjoy sewing, cooking, carpentry, gardening, and creative activities such as painting. Jack-in-the-box and stuffed animals would be appropriate for a toddler or preschool child.
A young child from Mexico is hospitalized for a serious illness. The father tells the nurse that “the child is being punished by God for being bad.” The nurse should recognize this as:
a.
A health belief common in this culture.
b.
An early indication of potential child abuse.
c.
A misunderstanding of the family’s common beliefs.
d.
A belief common when fortune tellers have been used.
ANS: A
A common health belief in the Mexican-American cultural group is that health is controlled by the environment, fate, and the will of God. This comment has no relation to child abuse. The father would not misunderstand the family’s beliefs. This is a cultural belief. Mexicans may use the services of curanderos (healers), not fortune tellers.
A nurse in the emergency department is assessing a 5-year-old child with symptoms of pneumonia and a fever of 102° F. Which intervention can the nurse implement to promote a sense of control for the child?
a.
None, this is an emergency and the child should not participate in care.
b.
Allow the child to hold the digital thermometer while taking the child’s blood pressure.
c.
Ask the child if it is OK to take a temperature in the ear.
d.
Have parents wait in the waiting room.
ANS: B
The nurse should allow the child to hold the digital thermometer while taking the child’s blood pressure. Unless an emergency is life threatening, children need to participate in their care to maintain a sense of control. Because emergency departments are frequently hectic, there is a tendency to rush through procedures to save time. However, the extra few minutes needed to allow children to participate may save many more minutes of useless resistance and uncooperativeness during subsequent procedures. The child may not give permission, if asked, for a procedure that is necessary to be performed. It is better to give choices such as, “Which ear do you want me to do your temperature in?” instead of, “Can I take your temperature?” Parents should remain with their child to help with decreasing the child’s anxiety.
Which statement best describes a child who is abused by the parent(s)?
a.
Unintentionally contributes to the abusing situation
b.
Belongs to a low socioeconomic population
c.
Is healthier than the nonabused siblings
d.
Abuses siblings in the same way as child is abused by the parent(s)
ANS: A
A child’s temperament, position in the family, additional physical needs, activity level, or degree of sensitivity to parental needs unintentionally contributes to the abusing situation. Socioeconomic status is an environmental characteristic. This child is less likely to be abused than one who is premature, disabled, or very young. The abused child does not in turn abuse his or her siblings.
A critically ill child has hyperthermia. The parents ask the nurse to give an antipyretic such as acetaminophen (Tylenol). The nurse should explain that antipyretics:
a.
May cause malignant hyperthermia.
b.
May cause febrile seizures.
c.
Are of no value in treating hyperthermia.
d.
Are of limited value in treating hyperthermia.
ANS: C
Unlike with fever, antipyretics are of no value in hyperthermia because the set point is already normal. Cooling measures are used instead. Malignant hyperthermia is a genetic myopathy that is triggered by anesthetic agents. Antipyretic agents do not have this effect. Antipyretics do not cause seizures and are of no value in hyperthermia.
A child is receiving total parenteral nutrition (TPN; hyperalimentation). At the end of 8 hours, the nurse observes the solution and notes that 200 mL/8 hr is being infused rather than the ordered amount of 300 mL/8 hr. The nurse should adjust the rate so that how much will infuse during the next 8 hours? a. 200 mL c. 350 mL b. 300 mL d. 400 mL
ANS: B
The TPN infusion rate should not be increased or decreased without the practitioner being informed because alterations in rate can cause hyperglycemia or hypoglycemia. The infusion rate should be reset to the prescribed flow rate.
The school nurse is discussing testicular self-examination with adolescent boys. Why is this important?
a.
Epididymitis is common during adolescence.
b.
Asymptomatic sexually transmitted diseases may be present.
c.
Testicular tumors during adolescence are generally malignant.
d.
Testicular tumors, although usually benign, are common during adolescence.
ANS: C
Tumors of the testes are not common, but when manifested in adolescence, they are generally malignant and demand immediate evaluation. Epididymitis is not common in adolescence. Asymptomatic sexually transmitted disease would not be evident during testicular self-examination. The focus of this examination is on testicular cancer. Testicular tumors are most commonly malignant.
The mother of a 14-month-old child is concerned because the child’s appetite has decreased. The best response for the nurse to make to the mother is:
a.
“It is important for your toddler to eat three meals a day and nothing in between.”
b.
“It is not unusual for toddlers to eat less.”
c.
“Be sure to increase your child’s milk consumption, which will improve nutrition.”
d.
“Giving your child a multivitamin supplement daily will increase your toddler’s appetite.”
ANS: B
Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age-group. Physiologically, growth slows and appetite decreases during the toddler period. Milk consumption should not exceed 16 to 24 oz daily. Juice should be limited to 4 to 6 oz per day. Increasing the amount of milk will only further decrease solid food intake. Supplemental vitamins are important for all children, but they do not increase appetite.
A nurse is reviewing hormone changes that occur during adolescence. The hormone that is responsible for the growth of beard, mustache, and body hair in the male is: a. Estrogen. c. Androgen. b. Pituitary hormone. d. Progesterone.
ANS: C
Beard, mustache, and body hair on the chest, upward along the linea alba, and sometimes on other areas (e.g., back and shoulders) appears in males and is androgen dependent. Estrogen and progesterone are produced by the ovaries in the female and do not contribute to body hair appearance in the male. The pituitary hormone does not have any relationship to body hair appearance in the male.
An important nursing consideration when performing a bladder catheterization on a young boy is to:
a.
Use clean technique, not Standard Precautions.
b.
Insert 2% lidocaine lubricant into the urethra.
c.
Lubricate catheter with water-soluble lubricant such as K-Y Jelly.
d.
Delay catheterization for 20 minutes while anesthetic lubricant is absorbed.
ANS: B
The anxiety, fear, and discomfort experienced during catheterization can be significantly decreased by preparing the child and parents, selecting the correct catheter, and using appropriate insertion technique. Generous lubrication of the urethra before catheterization and use of lubricant containing 2% lidocaine may reduce or eliminate the burning and discomfort associated with this procedure. Catheterization is a sterile procedure, and Standard Precautions for body-substance protection should be followed. Water-soluble lubricants do not provide appropriate local anesthesia. Catheterization should be delayed only 2 to 3 minutes. This provides sufficient local anesthesia for the procedure.
Which are characteristic of the physical development of a 30-month-old child (select all that apply)? a. Birth weight has doubled. b. Primary dentition is complete. c. Sphincter control is achieved. d. Anterior fontanel is open. e. Length from birth is doubled.
ANS: B, C
Usually by age 30 months, the primary dentition of 20 teeth is completed, and the child has sphincter control in preparation for bowel and bladder control. A doubling of birth weight, opening of the anterior fontanel, and doubling of length are not characteristic of the physical development of a 30-month-old child.
Which is an important nursing consideration when caring for an infant with failure to thrive?
a.
Establish a structured routine and follow it consistently.
b.
Maintain a nondistracting environment by not speaking to the infant during feeding.
c.
Place the infant in an infant seat during feedings to prevent overstimulation.
d.
Limit sensory stimulation and play activities to alleviate fatigue.
ANS: A
The infant with failure to thrive should have a structured routine that is followed consistently. Disruptions in other activities of daily living can have a great impact on feeding behaviors. Bathing, sleeping, dressing, playing, and feeding are structured. The nurse should talk to the infant by giving directions about eating. This will help the infant maintain focus. Young children should be held while being fed, and older children can sit at a feeding table. The infant should be fed in the same manner at each meal. The infant can engage in sensory and play activities at times other than mealtime.
A child is being discharged from an ambulatory care center after an inguinal hernia repair. Which discharge interventions should the nurse implement (select all that apply)?
a.
Discuss dietary restrictions.
b.
Hold any analgesic medications until the child is home.
c.
Send a pain scale home with the family.
d.
Suggest the parents fill the prescriptions on the way home.
e.
Discuss complications that may occur.
ANS: A, C, E
The discharge interventions a nurse should implement when a child is being discharged from an ambulatory care center should include dietary restrictions, being very specific and giving examples of “clear fluids” or what is meant by a “full liquid diet.” The nurse should give specific information on pain control and send a pain scale home with the family. All complications that may occur after an inguinal hernia repair should be discussed with the parents. The pain medication, as prescribed, should be given before the child leaves the building, and prescriptions should be filled and given to the family before discharge.
The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infant’s stool. The nurse bases her explanation on knowing that:
a.
Children should not be given fibrous foods until the digestive tract matures at age 4 years.
b.
The infant should not be given any solid foods until this digestive problem is resolved.
c.
This is abnormal and requires further investigation.
d.
This is normal because of the immaturity of digestive processes at this age.
ANS: D
The immaturity of the digestive tract is evident in the appearance of the stools. Solid foods are passed incompletely broken down in the feces. An excess quantity of fiber predisposes the child to large, bulky stools. This is a normal part of the maturational process, and no further investigation is necessary.
The weight loss of anorexia nervosa is often triggered by: a. Sexual abuse. c. Independence from family. b. School failure. d. Traumatic interpersonal conflict.
ANS: D
Weight loss may be triggered by a typical adolescent crisis such as the onset of menstruation or a traumatic interpersonal incident; situations of severe family stress such as parental separation or divorce; or circumstances in which the young person lacks personal control, such as being teased, changing schools, or entering college. There may in fact be a history of sexual abuse; however, this is not the trigger. These adolescents are often overachievers who are successful in school, not failures in school. The adolescent is most often enmeshed with his or her family.
Using knowledge of child development, the best approach when preparing a toddler for a procedure is to:
a.
Avoid asking the child to make choices.
b.
Demonstrate the procedure on a doll.
c.
Plan for the teaching session to last about 20 minutes.
d.
Show necessary equipment without allowing child to handle it.
ANS: B
Prepare toddlers for procedures by using play. Demonstrate on a doll, but avoid the child’s favorite doll because the toddler may think the doll is really “feeling” the procedure. In preparing a toddler for a procedure, the child is allowed to participate in care and help whenever possible. Teaching sessions for toddlers should be about 5 to 10 minutes. Use a small replica of the equipment and allow the child to handle it.
In the clinic waiting room, a nurse observes a parent showing an 18-month-old child how to make a tower out of blocks. In this situation the nurse should recognize that:
a.
Blocks at this age are used primarily for throwing.
b.
Toddlers are too young to imitate the behavior of others.
c.
Toddlers are capable of building a tower of blocks.
d.
Toddlers are too young to build a tower of blocks.
ANS: C
This is a good parent-child interaction. The 18-month-old is capable of building a tower of 3 or 4 blocks. The ability to build towers of blocks usually begins at age 15 months. With ongoing development, the child is able to build taller towers. At this age, children imitate others around them and no longer throw blocks.
A nurse is conducting education classes for parents of infants. The nurse plans to discuss sudden infant death syndrome (SIDS). Which risk factors should the nurse include as increasing an infant’s risk of a SIDS incident (select all that apply)? a. Breastfeeding b. Low Apgar scores c. Male sex d. Birth weight in the 50th or higher percentile e. Recent viral illness
ANS: B, C, E
Certain groups of infants are at increased risk for SIDS: those with low birth weight, low Apgar scores, or recent viral illness, and those of male sex. Breastfed infants and infants of average or above-average weight are not at higher risk for SIDS.
The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the nurse do first? a. Introduce himself or herself. c. Explain the purpose of the interview. b. Make the family comfortable. d. Give an assurance of privacy.
ANS: A
The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. During the initial part of the interview the nurse should include general conversation to help make the family feel at ease. Next, the purpose of the interview and the nurse’s role should be clarified. The interview should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality.
The parent of 16-month-old Chris asks, “What is the best way to keep Chris from getting into our medicines at home?” The nurse should advise that:
a.
“All medicines should be locked securely away.”
b.
“The medicines should be placed in high cabinets.”
c.
“Chris just needs to be taught not to touch medicines.”
d.
“Medicines should not be kept in the homes of small children.”
ANS: A
The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. Toddlers can climb by using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize as dangerous all of the different forms of medications that may be available in the home. Teaching them not to touch medicines is not feasible. Many parents require medications for chronic illnesses. They must be taught safe storage for their home and when they visit other homes.
A nurse is planning to use an interpreter during a health history interview of a non-English speaking patient and family. Which nursing care guidelines should the nurse include when using an interpreter (Select all that apply)?
a.
Elicit one answer at a time.
b.
Interrupt the interpreter if the response from the family is lengthy.
c.
Comments to the interpreter about the family should be made in English.
d.
Arrange for the family to speak with the same interpreter, if possible.
e.
Introduce the interpreter to the family.
ANS: A, D, E
When using an interpreter, the nurse should pose questions to elicit only one answer at a time, such as: “Do you have pain?” rather than “Do you have any pain, tiredness, or loss of appetite?” Refrain from interrupting family members and the interpreter while they are conversing. Introduce the interpreter to family and allow some time before the interview for them to become acquainted. Refrain from interrupting family members and the interpreter while they are conversing. Avoid commenting to the interpreter about family members because they may understand some English.
In terms of gross motor development, what would the nurse expect a 5-month-old infant todo? a. Roll from abdomen to back. c. Sit erect without support. b. Roll from back to abdomen. d. Move from prone to sitting position.
ANS: A
Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position.
Which statement is most descriptive of central nervous system stimulants?
a.
They produce strong physical dependence.
b.
They can result in strong psychologic dependence.
c.
Withdrawal symptoms are life threatening.
d.
Acute intoxication can lead to coma.
ANS: B Central nervous system stimulants such as amphetamines and cocaine produce a strong psychologic dependence. This class of drugs does not produce strong physical dependence and can be withdrawn without much danger. Acute intoxication leads to violent, aggressive behavior or psychotic episodes characterized by paranoia, uncontrollable agitation, and restlessness.
What type of family is one in which all members are related by blood? a. Consanguineous c. Family of origin b. Affinal d. Household
ANS: A
A consanguineous family is one of the most common types and consists of members who have a blood relationship. The affinal family is one made up of marital relationships. Although the parents are married, they may each bring children from a previous relationship. The family of origin is the family unit that a person is born into. Considerable controversy has been generated about the newer concepts of families (i.e., communal, single-parent or homosexual families). To accommodate these other varieties of family styles, the descriptive term household is frequently used.
In terms of fine motor development, what could the 3-year-old child be expected to do? a. Tie shoelaces. b. Use scissors or a pencil very well. c. Draw a person with seven to nine parts. d. Copy (draw) a circle.
ANS: D
Three-year-olds are able to accomplish the fine motor skill of drawing a circle. Tying shoelaces, using scissors or a pencil very well, and drawing a person with multiple parts are fine motor skills of 5-year-old children.
Which accomplishment would the nurse expect of a healthy 3-year-old child? a. Jump rope b. Ride a two-wheel bicycle c. Skip on alternate feet d. Balance on one foot for a few seconds
ANS: D
Three-year-olds are able to accomplish the gross motor skill of balancing on one foot. Jumping rope, riding a two-wheel bike, and skipping on alternate feet are gross motor skills of 5-year-old children.
The mean age of menarche in the United States is: a. 11.5 years c. 13.5 years b. 12.5 years d. 14 years
ANS: B
The average age of menarche is 12 years and 4 months in North American girls, with a normal range of 10.5 to 15 years.
The nurse notices that a 10-month-old infant being seen in the clinic is wearing expensive, inflexible, high-top shoes. The nurse should explain that:
a.
Soft and flexible shoes are generally better.
b.
High-top shoes are necessary for support.
c.
Inflexible shoes are necessary to prevent in-toeing and out-toeing.
d.
This type of shoe will encourage the infant to walk sooner.
ANS: A
The main purpose of the shoe is protection. Soft, well-constructed, athletic-type shoes are best for infants and children. High-top shoes are not necessary for support but may be helpful keeping the child’s foot in the shoe. Inflexible shoes can delay walking, aggravate in-toeing and out-toeing, and impede development of the supportive foot muscles.
The nurse is discussing with a parent group the importance of fluoride for healthy teeth. The nurse should recommend that the parents:
a.
Use fluoridated mouth rinses in children older than 1 year.
b.
Have children brush teeth with fluoridated toothpaste unless fluoride content of water supply is adequate.
c.
Give fluoride supplements to breastfed infants beginning at age 1 month.
d.
Determine whether water supply is fluoridated.
ANS: D
The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount. It is difficult to teach this age-group to spit out the mouthwash. Swallowing fluoridated mouthwashes can contribute to fluorosis. Fluoridated toothpaste is still indicated, but very small amounts are used. Fluoride supplementation is not recommended until after age 6 months.
A nurse must do a venipuncture on a 6-year-old child. An important consideration in providing atraumatic care is to:
a.
Use an 18-gauge needle if possible.
b.
If not successful after four attempts, have another nurse try.
c.
Restrain the child only as needed to perform venipuncture safely.
d.
Show the child equipment to be used before procedure.
ANS: C
Restrain the child only as needed to perform the procedure safely; use therapeutic hugging. Use the smallest gauge needle that permits free flow of blood. A two-try-only policy is desirable, in which two operators each have only two attempts. If insertion is not successful after four punctures, alternative venous access should be considered. Keep all equipment out of sight until used.
Tepid water or sponge baths are indicated for hyperthermia in children. The nurse should: a. Add isopropyl alcohol to the water. b. Direct a fan on the child in the bath. c. Stop the bath if the child begins to chill. d. Continue the bath for 5 minutes.
ANS: C
Environmental measures such as sponge baths can be used to reduce temperature if tolerated by the child and if they do not induce shivering. Shivering is the body’s way of maintaining the elevated set point. Compensatory shivering increases metabolic requirements above those already caused by the fever. Ice water and isopropyl alcohol are inappropriate, potentially dangerous solutions. Fans should not be used because of the risk of the child developing vasoconstriction, which defeats the purpose of the cooling measures. Little blood is carried to the skin surface, and the blood remains primarily in the viscera to become heated. The child is placed in a tub of tepid water for 20 to 30 minutes.
A nurse teaches parents that team play is important for school-age children. Which can children develop by experiencing team play (select all that apply)? a. Achieve personal goals over group goals. b. Learn complex rules. c. Experience competition. d. Learn about division of labor.
ANS: B, C, D
Team play helps stimulate cognitive growth because children are called on to learn many complex rules, make judgments about those rules, plan strategies, and assess the strengths and weaknesses of members of their own team and members of the opposing team. Team play can also contribute to children’s social, intellectual, and skill growth. Children work hard to develop the skills needed to become team members, to improve their contribution to the group, and to anticipate the consequences of their behavior for the group. Team play teaches children to modify or exchange personal goals for goals of the group; it also teaches them that division of labor is an effective strategy for attaining a goal.
The nurse has a 2-year-old boy sit in “tailor” position during palpation for the testes. The rationale for this position is that:
a.
It prevents cremasteric reflex.
b.
Undescended testes can be palpated.
c.
This tests the child for an inguinal hernia.
d.
The child does not yet have a need for privacy.
ANS: A
The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity. Undescended testes cannot be predictably palpated. Inguinal hernias are not detected by this method. This position is used for inhibiting the cremasteric reflex. Privacy should always be provided for children.
What is the best action for the nurse to take when a 5-year-old child who requires another 2 days of intravenous (IV) antibiotics cries, screams, and resists having the IV restarted?
a.
Exit the room and leave the child alone until he stops crying.
b.
Tell the child big boys and girls “don’t cry.”
c.
Let the child decide which color arm board to use with the IV.
d.
Administer a narcotic analgesic for pain to quiet the child.
ANS: C
Giving the preschooler some choice and control, while maintaining boundaries of treatment, supports the child’s coping skills. Leaving the child alone robs the child of support when a coping difficulty exists. Crying is a normal response to stress. The child needs time to adjust and support to cope with unfamiliar and painful procedures during hospitalization. Although administration of a topical analgesic is indicated before restarting the child’s IV, a narcotic analgesic is not indicated.
Which statement best describes the infant’s physical development?
a.
Anterior fontanel closes by age 6 to 10 months.
b.
Binocularity is well established by age 8 months.
c.
Birth weight doubles by age 5 months and triples by age 1 year.
d.
Maternal iron stores persist during the first 12 months of life.
ANS: C
Growth is very rapid during the first year of life. The birth weight approximately doubles by age 5 to 6 months and triples by age 1 year. The anterior fontanel closes at age 12 to 18 months. Binocularity is not established until age 15 months. Maternal iron stores are usually depleted by age 6 months.
The earliest age at which a satisfactory radial pulse can be taken in children is: a. 1 year c. 3 years b. 2 years d. 6 years
ANS: B
Satisfactory radial pulses can be used in children older than 2 years. In infants and young children the apical pulse is more reliable. The radial pulse can be used for assessment at ages 3 and 6 years.
The father of 12-year-old Ryan tells the nurse that he is concerned about his son getting “fat.” Ryan’s body mass index for age is at the 60th percentile. The most appropriate nursing action is to:
a.
Reassure the father that Ryan is not “fat.”
b.
Reassure the father that Ryan is just a growing child.
c.
Suggest a low-calorie, low-fat diet.
d.
Explain that this is typical of the growth pattern of boys at this age.
ANS: D
This is a characteristic pattern of growth in preadolescent boys, in which the growth in height has slowed in preparation for the pubertal growth spurt but weight is still gained. This should be reviewed with both the father and Ryan, and a plan should be developed to maintain physical exercise and a balanced diet. Saying that Ryan is not “fat” is false reassurance. His weight is high for his height. Ryan needs to maintain his physical activity. The father is concerned; an explanation is required. A nutritional diet with physical activity should be sufficient to maintain his balance.
Peer victimization is becoming a significant problem for school-age children and adolescents in the United States. Parents should be educated regarding signs that a child is being bullied. These might include (select all that apply):
a.
The child spends an inordinate amount of time in the nurse’s office.
b.
Belongings frequently go missing or are damaged.
c.
The child wants to be driven to school.
d.
School performance improves.
e.
The child freely talks about his or her day.
ANS: A, B, C
Signs that may indicate a child is being bullied are similar to signs of other types of stress and include nonspecific illness or complaints, withdrawal, depression, school refusal, and decreased school performance. Children expressed fear of going to school or riding the school bus, and their belongings often are damaged or missing. Very often, children will not talk about what is happening to them.
Kyle, age 6 months, is brought to the clinic. His parent says, “I think he hurts. He cries and rolls his head from side to side a lot.” This most likely suggests which feature of pain? a. Type c. Duration b. Severity d. Location
ANS: D
The child is displaying a local sign of pain. Rolling the head from side to side and pulling at ears indicate pain in the ear. The child’s behavior indicates the location of the pain. The behavior does not provide information about the type, severity, or duration.
The pediatric nurse understands that nonpharmacologic strategies for pain management:
a.
May reduce pain perception.
b.
Make pharmacologic strategies unnecessary.
c.
Usually take too long to implement.
d.
Trick children into believing they do not have pain.
ANS: A
Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. Nonpharmacologic techniques should be learned before the pain occurs. With severe pain it is best to use both pharmacologic and nonpharmacologic measures for pain control. The nonpharmacologic strategy should be matched with the child’s pain severity and taught to the child before the onset of the painful experience. Some of the techniques may facilitate the child’s experience with mild pain, but the child will still know that discomfort is present.
A nurse is caring for an adolescent hospitalized for cellulitis. The nurse notes that the adolescent experiences many “mood swings” throughout the day. The nurse interprets this behavior as: a. Requiring a referral to a mental health counselor. b. Requiring some further lab testing. c. Normal behavior. d. Related to feelings of depression.
ANS: C
Adolescents vacillate in their emotional states between considerable maturity and childlike behavior. One minute they are exuberant and enthusiastic; the next minute they are depressed and withdrawn. Because of these mood swings, adolescents are frequently labeled as unstable, inconsistent, and unpredictable, but the behavior is normal. The behavior would not require a referral to a mental health counselor or further lab testing. The mood swings do not indicate depression.
A nurse is planning a class on accident prevention for parents of toddlers. Which safety topic is the priority for this class? a. Appropriate use of car seat restraints b. Safety crossing the street c. Helmet use when riding a bicycle d. Poison control numbers
ANS: A
Motor vehicle accidents (MVAs) continue to be the most common cause of death in children older than 1 year; therefore, the priority topic is appropriate use of car seat restraints. Safety crossing the street and bicycle helmet use are topics that should be included for preschool parents but are not priorities for parents of toddlers. Information about poison control is important for parents of toddlers and would be a safety topic to include but is not the priority over the appropriate use of car seat restraints.
An important consideration for the school nurse who is planning a class on bicycle safety is:
a.
Most bicycle injuries involve collision with an automobile.
b.
Head injuries are the major causes of bicycle-related fatalities.
c.
Children should wear bicycle helmets if they ride on paved streets.
d.
Children should not ride double unless the bicycle has an extra-large seat.
ANS: B
The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. Although motor vehicle collisions do cause injuries to bicyclists, most injuries result from falls. The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission. Children should not ride double.
The nurse is completing a health history with a 16-year-old male. He informs the nurse that he has started using smokeless tobacco after he plays baseball. Which information regarding smokeless tobacco would be most correct for the nurse to provide to this teen? a. Not addicting. b. Proven to be carcinogenic. c. Easy to stop using. d. A safe alternative to cigarette smoking.
ANS: B
Smokeless tobacco is a popular substitute for cigarettes and poses serious health hazards to children and adolescents. Smokeless tobacco is associated with cancer of the mouth and jaw. Smokeless tobacco is just as addictive as cigarettes. Although teens believe that it is easy to stop using smokeless tobacco, this is not the case. A popular belief is that smokeless tobacco is a safe alternative to cigarettes; this has been proven incorrect. Half of all teens who use smokeless tobacco agree that it poses significant health risks.
The nurse is assessing parental knowledge of temper tantrums. Which are true statements regarding temper tantrums (select all that apply)?
a.
Temper tantrums are a common response to anger and frustration in toddlers.
b.
Temper tantrums often include screaming, kicking, throwing things, and head banging.
c.
Parents can effectively manage temper tantrums by giving in to the child’s demands.
d.
Children having temper tantrums should be safely isolated and ignored.
e.
Parents can learn to anticipate times when tantrums are more likely to occur.
ANS: A, B, D, E
Temper tantrums are a common response to anger and frustration in toddlers. They occur more often when toddlers are tired, hungry, bored, or excessively stimulated. A nap prior to fatigue or a snack if mealtime is delayed will be helpful in alleviated the times when tantrums are most likely to occur. Tantrums may include screaming, kicking, throwing things, biting themselves, or banging their head. Effective management of tantrums includes safely isolating and ignoring the child. The child should learn that nothing is gained by having a temper tantrum. Giving in to the child’s demands only increases the behavior.
In preparing to give “enemas until clear” to a young child, the nurse should select: a. Tap water. c. Oil retention. b. Normal saline. d. Fleet solution.
ANS: B
Isotonic solutions should be used in children. Saline is the solution of choice. Plain water is not used. This is a hypotonic solution and can cause rapid fluid shift, resulting in fluid overload. Oil-retention enemas will not achieve the “until clear” result. Fleet enemas are not advised for children because of the harsh action of the ingredients. The osmotic effects of the Fleet enema can result in diarrhea, which can lead to metabolic acidosis.
A nurse is caring for an African-American child recently admitted to the hospital. The nurse should be aware of which broad cultural characteristics for this child when planning care (Select all that apply)?
a.
Silence may indicate a lack of trust.
b.
Maintaining constant eye contact may be viewed as aggressive.
c.
Self-care and folk medicine do not play a role in health care.
d.
Illness may be seen as the “will of God.”
e.
No importance is attached to nonverbal behavior.
ANS: A, B, D
A nurse should be aware of the African-American broad cultural characteristics, which include the following: initial eye contact shows respect; maintaining eye contact can be viewed as aggressive, silence may indicate a lack of trust, and illness may be seen as the “will of God.” Self-care and folk medicine are prevalent in this culture, and importance is placed on nonverbal behavior.
What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Separation anxiety c. Fear of bodily injury b. Loss of control d. Fear of pain
ANS: A
The major stress for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age-group.
The nurse is teaching a group of new parents about the experience of role transition. Which statement by a parent indicates a correct understanding of the teaching?
a.
“My marital relationship can have a positive or negative effect on the role transition.”
b.
“If an infant has special care needs, the parents’ sense of confidence in their new role is strengthened.”
c.
“Young parents can adjust to the new role more easily than older parents.”
d.
“A parent’s previous experience with children makes the role transition more difficult.”
ANS: A
If parents are supportive of each other, they can serve as positive influences on establishing satisfying parental roles. When marital tensions alter caregiving routines and interfere with the enjoyment of the infant, the marital relationship has a negative effect. Infants with special care needs can be a significant source of added stress. Older parents are usually more able to cope with the greater financial responsibilities, changes in sleeping habits, and reduced time for each other and other children. Parents who have previous experience with parenting appear more relaxed, have less conflict in disciplinary relationships, and are more aware of normal growth and development.
What is helpful to tell a mother who is concerned about preventing sleep problems in her 2-year-old child?
a.
Have the child always sleep in a quiet, darkened room.
b.
Provide high-carbohydrate snacks before bedtime.
c.
Communicate with the child’s daytime caregiver about eliminating the afternoon nap.
d.
Use a night-light in the child’s room.
ANS: D
The preschooler has a great imagination. Sounds and shadows can have a negative effect on sleeping behavior. Night-lights provide the child with the ability to visualize the environment and decrease the fear felt in a dark room. A dark, quiet room may be scary to a preschooler. High-carbohydrate snacks increase energy and do not promote relaxation. Most 2-year-olds take one nap each day. Many give up the habit by age 3. Insufficient rest during the day can lead to irritability and difficulty sleeping at night.
A parent asks the nurse whether her infant is susceptible to pertussis. The nurse’s response should be based on which statement concerning susceptibility to pertussis?
a.
Neonates will be immune the first few months.
b.
If the mother has had the disease, the infant will receive passive immunity.
c.
Children younger than 1 year seldom contract this disease.
d.
Most children are highly susceptible from birth.
ANS: D
The acellular pertussis vaccine is recommended by the American Academy of Pediatrics beginning at age 6 weeks. Infants are at greater risk for complications of pertussis. The vaccine is not given after age 7 years, when the risks of the vaccine become greater than those of pertussis. The infant is highly susceptible to pertussis, which can be a life-threatening illness in this age-group.
Health beliefs vary among the cultural groups living in the United States. The belief that health is “a state of harmony with nature and the universe” is common in which culture? a. Japanese c. Native American b. African-American d. Hispanic American
ANS: C
Many cultures ascribe attributes of health to natural forces. Many individuals of the Native American culture view health as a state of harmony with nature and the universe. This belief is not consistent with Japanese, African-American, or Hispanic American cultural groups.
A common characteristic of those who sexually abuse children is that they:
a.
Pressure the victim into secrecy.
b.
Are usually unemployed and unmarried.
c.
Are unknown to victims and victims’ families.
d.
Have many victims that are each abused only once.
ANS: A
Sex offenders may pressure the victim into secrecy, regarding the activity as a “secret between us” that other people may take away if they find out. Abusers are often employed upstanding members of the community. Most sexual abuse is committed by men and persons who are well known to the child. Abuse is often repeated with the same child over time. The relationship may start insidiously without the child realizing that sexual activity is part of the offer.
Parents tell the nurse that their 1-year-old son often sleeps with them. They seem unconcerned about this. The nurse’s response should be based on the knowledge that:
a.
Children should not sleep with their parents.
b.
Separation from parents should be completed by this age.
c.
Daytime attention should be increased.
d.
This is a common and accepted practice, especially in some cultural groups.
ANS: D
Co-sleeping or sharing the family bed, in which the parents allow the children to sleep with them, is a common and accepted practice in many cultures. Parents should evaluate the options available and avoid conditions that place the infant at risk. Population-based studies are currently underway; no evidence at this time supports or abandons the practice for safety reasons. This is the age at which children are just beginning to individuate. Increased daytime activity may help decrease sleep problems in general, but co-sleeping is a culturally determined phenomenon.
Which action by the nurse demonstrates use of evidence-based practice (EBP)?
a.
Gathering equipment for a procedure
b.
Documenting changes in a patient’s status
c.
Questioning the use of daily central line dressing changes
d.
Clarifying a physician’s prescription for morphine
ANS: C
The nurse who questions the daily central line dressing change is ascertaining whether clinical interventions result in positive outcomes for patients. This demonstrates evidence-based practice (EBP), which implies questioning why something is effective and whether a better approach exists. Gathering equipment for a procedure and documenting changes in a patient’s status are practices that follow established guidelines. Clarifying a physician’s prescription for morphine constitutes safe nursing care.
Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period? a. Codeine c. Methadone b. Morphine d. Meperidine
ANS: B
The most commonly prescribed medications for PCA are morphine, hydromorphone, and fentanyl. Parenteral use of codeine is not recommended. Methadone is not available in parenteral form in the United States. Meperidine is not used for continuous and extended pain relief.
Which information should the nurse include in teaching parents how to care for a child’s gastrostomy tube at home?
a.
Never turn the gastrostomy button.
b.
Clean around the insertion site daily with soap and water.
c.
Expect some leakage around the button.
d.
Remove the tube for cleaning once a week.
ANS: B
The skin around the tube insertion site should be cleaned with soap and water once or twice daily. The gastrostomy button should be rotated in a full circle during cleaning. Leakage around the tube should be reported to the physician. A gastrostomy tube is placed surgically. It is not removed for cleaning.
The nurse has just collected blood by venipuncture in the antecubital fossa. Which should the nurse do next?
a.
Keep arm extended while applying a bandage to the site.
b.
Keep arm extended, and apply pressure to the site for a few minutes.
c.
Apply a bandage to the site, and keep the arm flexed for 10 minutes.
d.
Apply a gauze pad or cotton ball to the site, and keep the arm flexed for several minutes.
ANS: B
Applying pressure to the site of venipuncture stops the bleeding and aids in coagulation. Pressure should be applied before a bandage is applied.
With the National Center for Health Statistics (NCHS) criteria, which body mass index (BMI)–for-age percentile indicates a risk for being overweight? a. 10th percentile c. 85th percentile b. 9th percentile d. 95th percentile
ANS: C
Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children in the 9th and 10th percentiles are within normal limits. Children who are greater than or equal to the 95th percentile are considered overweight.
The leading cause of death from unintentional injuries in children is: a. Poisoning. c. Motor vehicle–related fatalities. b. Drowning. d. Fire- and burn-related fatalities.
ANS: C
Motor vehicle–related fatalities comprise the leading cause of death in children, as either passengers or pedestrians. Poisoning is the ninth leading cause of death.
Drowning is the second leading cause of death. Fire- and burn-related fatalities are the third leading cause of death.
Which action is most likely to encourage parents to talk about their feelings related to their child’s illness? a. Be sympathetic. c. Use open-ended questions. b. Use direct questions. d. Avoid periods of silence.
ANS: C
Closed-ended questions should be avoided when attempting to elicit parents’ feelings. Open-ended questions require the parent to respond with more than a brief answer. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in the helping relationship. Direct questions may obtain limited information. In addition, the parent may consider them threatening. Silence can be an effective interviewing tool. It allows sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions.
What is an important consideration for the nurse who is communicating with a very young child?
a.
Speak loudly, clearly, and directly.
b.
Use transition objects such as a doll.
c.
Disguise own feelings, attitudes, and anxiety.
d.
Initiate contact with the child when the parent is not present.
ANS: B
Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This facilitates communication with this age child.
Speaking loudly, clearly, and directly tends to increase anxiety in very young children. The nurse must be honest with the child. Attempts at deception lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children.
An appropriate play activity for a 7-month-old infant to encourage visual stimulation is: a. Playing peek-a-boo. c. Imitating animal sounds. b. Playing pat-a-cake. d. Showing how to clap hands.
ANS: A
Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation. Playing pat-a-cake and showing how to clap hands will help with kinesthetic stimulation. Imitating animal sounds will help with auditory stimulation.
When the nurse interviews an adolescent, it is especially important to:
a.
Focus the discussion on the peer group.
b.
Allow an opportunity to express feelings.
c.
Emphasize that confidentiality will always be maintained.
d.
Use the same type of language as the adolescent.
ANS: B
Adolescents, like all children, need an opportunity to express their feelings. Often they will interject feelings into their words. The nurse must be alert to the words and feelings expressed. Although the peer group is important to this age group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently.
Identify the statement that is the most accurate about moral development in the 9-year-old school-age child.
a.
Right and wrong are based on physical consequences of behavior.
b.
The child obeys parents because of fear of punishment.
c.
The school-age child conforms to rules to please others.
d.
Parents are the determiners of right and wrong for the school-age child.
ANS: C
The 7- to 12-year-old child bases right and wrong on a good-boy or good-girl orientation in which the child conforms to rules to please others and avoid disapproval. Children 4 to 7 years of age base right and wrong on consequences, the most important consideration for this age-group. Parents determine right and wrong for the child younger than 4 years of age.
The nurse must suction a child with a tracheostomy. Interventions should include:
a.
Encouraging the child to cough to raise the secretions before suctioning.
b.
Selecting a catheter with a diameter three-fourths as large as the diameter of the tracheostomy tube.
c.
Ensuring that each pass of the suction catheter take no longer than 5 seconds.
d.
Allowing the child to rest after every 5 times the suction catheter is passed.
ANS: C
Suctioning should require not longer than 5 seconds per pass. Otherwise the airway may be occluded for too long. If the child is able to cough up secretions, suctioning may not be indicated. The catheter should have a diameter one-half the size of the tracheostomy tube. If it is too large, it might block the child’s airway. The child is allowed to rest for 30 to 60 seconds after each aspiration to allow oxygen tension to return to normal. Then the process is repeated until the trachea is clear.
Which factor is most important in predisposing toddlers to frequent infections such as otitis media, tonsillitis, and upper respiratory tract infections?
a.
Respirations are abdominal.
b.
Pulse and respiratory rates are slower than those in infancy.
c.
Defense mechanisms are less efficient than those during infancy.
d.
Short, straight internal ear/throat structures and large tonsil/adenoid lymph tissue are present.
ANS: D
Toddlers continue to have the short, straight internal ear canal of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose the toddler to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy.
What describes a toddler’s cognitive development at age 20 months?
a.
Searches for an object only if he or she sees it being hidden
b.
Realizes that “out of sight” is not out of reach
c.
Puts objects into a container but cannot take them out
d.
Understands the passage of time such as “just a minute” and “in an hour”
ANS: B
At this age the child is in the final sensorimotor stage. Children will now search for an object in several potential places, even though they saw only the original hiding place. Children have a more developed sense of objective permanence. They will search for objects even if they have not seen them hidden. Putting an object in a container but being unable to take it out indicates tertiary circular reactions. An embryonic sense of time exists; although toddlers may behave appropriately to time-oriented phrases, their sense of timing is exaggerated.
Although a 14-month-old girl received a shock from an electrical outlet recently, her parents find her about to place a paper clip in another outlet. The best interpretation of this behavior is that:
a.
Her cognitive development is delayed.
b.
This is typical behavior because toddlers are not very developed.
c.
This is typical behavior because of inability to transfer knowledge to new situations.
d.
This is not typical behavior because toddlers should know better than to repeat an act that caused pain.
ANS: C
During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. Her cognitive development is appropriate for her age and represents typical behavior for a toddler. Only some awareness exists of a causal relation between events.
The father of a hospitalized child tells the nurse, “He can’t have meat. We are Buddhist and vegetarians.” The nurse’s best intervention is to:
a.
Order the child a meatless tray.
b.
Ask a Buddhist priest to visit.
c.
Explain that hospital patients are exempt from dietary rules.
d.
Help the parent understand that meat provides protein needed for healing.
ANS: A
It is essential for the nurse to respect the religious practices of the child and family. The nurse should arrange a dietary consultation to ensure that nutritionally complete vegetarian meals are prepared by the hospital kitchen. The nurse should be able to arrange for a vegetarian tray. The nurse should not encourage the child and parent to go against their religious beliefs. Nutritionally complete, acceptable vegetarian meals should be provided.
The appropriate placement of a tongue blade for assessment of the mouth and throat is the: a. The center back area of the tongue. c. Against the soft palate. b. The side of the tongue. d. On the lower jaw.
ANS: B
The side of the tongue is the correct position. It avoids the gag reflex yet allows visualization. Placement on the center back area of the tongue elicits the gag reflex. Against the soft palate and on the lower jaw are not appropriate places for the tongue blade.
A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says that she is completing her schoolwork satisfactorily, but lately she has been somewhat aggressive and stubborn in the classroom. The school nurse should recognize this as:
a.
Signs of stress.
b.
Developmental delay.
c.
A physical problem causing emotional stress.
d.
Lack of adjustment to the school environment.
ANS: A
Signs of stress include stomach pains or headache, sleep problems, bed-wetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. This child is exhibiting signs of stress, not developmental delay, a physical problem, or lack of adjustment.
According to Piaget, the 6-month-old infant would be in what stage of the sensorimotor phase? a. Use of reflexes c. Secondary circular reactions b. Primary circular reactions d. Coordination of secondary schemata
ANS: C
Infants are usually in the secondary circular reaction stage from age 4 months to 8 months. This stage is characterized by a continuation of the primary circular reaction for the response that results. For example, shaking of a rattle is performed to hear the noise of the rattle, not just for shaking. The use of reflexes is primarily during the first month of life. The primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from age 1 month to 4 months. The fourth sensorimotor stage is coordination of secondary schemata. This is a transitional stage in which increasing motor skills enable greater exploration of the environment.
A nurse is recommending strategies to a group of school-age children for prevention of obesity. Which should the nurse include (select all that apply)?
a.
Eat breakfast daily.
b.
Limit fruits and vegetables.
c.
Have frequent family meals with parents present.
d.
Eat frequently at restaurants.
e.
Limit television viewing to 2 hours a day.
ANS: A, C, E
The nurse should counsel school-age children to eat breakfast daily, have mealtimes with family, and limit television viewing to 2 hours a day to prevent obesity. Fruits and vegetables should be consumed in the recommended quantities, and eating at restaurants should be limited.
In terms of gross motor development, what would the nurse expect a 5-month-old infant to do (select all that apply)? a. Roll from abdomen to back. b. Put feet in mouth when supine. c. Roll from back to abdomen. d. Sit erect without support. e. Move from prone to sitting position.
ANS: A, B
Rolling from abdomen to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant. Rolling from back to abdomen is developmentally appropriate for a 6-month-old infant. An 8-month-old infant should be able to sit erect without support. A 10-month-old infant can usually move from a prone to a sitting position.
The nurse is preparing staff in-service education about atraumatic care for pediatric patients. Which intervention should the nurse include?
a.
Prepare the child for separation from parents during hospitalization by reviewing a video.
b.
Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal.
c.
Help the child accept the loss of control associated with hospitalization.
d.
Help the child accept pain that is connected with a treatment or procedure.
ANS: B
Preparing the child for any unfamiliar treatments, controlling pain, allowing privacy, providing play activities for expression of fear and aggression, providing choices, and respecting cultural differences are components of atraumatic care. In providing atraumatic care, the separation of child from parents during hospitalization is minimized. The nurse should promote a sense of control for the child. Preventing and minimizing bodily injury and pain are major components of atraumatic care.
A young adolescent boy tells the nurse he “feels gawky.” The nurse should explain that this occurs in adolescents because:
a.
Growth of the extremities and neck precedes growth in other areas.
b.
Growth is in the trunk and chest.
c.
The hip and chest breadth increases.
d.
The growth spurt occurs earlier in boys than it does in girls.
ANS: A
Growth in length of the extremities and neck precedes growth in other areas, and, because these parts are the first to reach adult length, the hands and feet appear larger than normal during adolescence. Increases in hip and chest breadth take place in a few months, followed several months later by an increase in shoulder width. These changes are followed by increases in length of the trunk and depth of the chest. This sequence of changes is responsible for the characteristic long-legged, gawky appearance of early adolescent children. The growth spurt occurs earlier in girls than in boys.
Which nursing action is the most appropriate when applying a face mask to a child for oxygen therapy?
a.
Set the oxygen flow rate at less than 6 L/min.
b.
Make sure the mask fits properly.
c.
Keep the child warm.
d.
Remove the mask for 5 minutes every hour.
ANS: B
A properly fitting face mask is essential for adequate oxygen delivery. The oxygen flow rate should be greater than 6 L/min to prevent rebreathing of exhaled carbon dioxide. Oxygen delivery through a face mask does not affect body temperature. A face mask used for oxygen therapy is not routinely removed.
Parents need further teaching about the use of car safety seats if they make which statement?
a.
“Even if our toddler helps buckle the straps, we will double-check the fastenings.”
b.
“We won’t start the car until everyone is properly restrained.”
c.
“We won’t need to use the car seat on short trips to the store.”
d.
“We will anchor the car seat to the car’s anchoring system.”
ANS: C
Parents need to be taught to always use the restraint even for short trips. Further teaching is needed if they make this statement. Parents have understood the teaching if they encourage the child to help attach buckles, straps, and shields but always double-check fastenings; do not start the car until everyone is properly restrained; and anchor the car safety seat securely to the car’s anchoring system and apply the harness snugly to the child.
Physiologic measurements in children’s pain assessment are:
a.
The best indicator of pain in children of all ages.
b.
Essential to determine whether a child is telling the truth about pain.
c.
Of most value when children also report having pain.
d.
Of limited value as sole indicator of pain.
ANS: D
Physiologic manifestations of pain may vary considerably and may not provide a consistent measure of pain. Heart rate may increase or decrease. The same signs that may suggest fear, anxiety, or anger also indicate pain. In chronic pain the body adapts, and these signs decrease or stabilize. These signs are of limited value and must be viewed in the context of a pain-rating scale, behavioral assessment, and parental report. When the child states that pain exists, it does. That is the truth.
Which information could be given to the parents of a 12-month-old child regarding appropriate play activities for this age?
a.
Give large push-pull toys for kinesthetic stimulation.
b.
Place cradle gym across crib to facilitate fine motor skills.
c.
Provide child with finger paints to enhance fine motor skills.
d.
Provide stick horse to develop gross motor coordination.
ANS: A
The 12-month-old child is able to pull to a stand and walk holding on or independently. Appropriate toys for a child of this age include large push-pull toys for kinesthetic stimulation. A cradle gym should not be placed across the crib. Finger paints are appropriate for older children. A 12-month-old child does not have the stability to use a stick horse.
Imaginary playmates are beneficial to the preschool child because they: a. Take the place of social interactions. b. Take the place of pets and other toys. c. Become friends in times of loneliness. d. Accomplish what the child has already successfully accomplished.
ANS: C
One purpose of an imaginary friend is to be a friend in time of loneliness. Imaginary friends do not take the place of social interactions but may encourage conversation.
Imaginary friends do not take the place of pets or toys. They accomplish what the child is still attempting, not what has already been accomplished.
A nurse is interviewing the parents of a toddler about use of complementary or alternative medical practices. The parents share several practices they use in their household. Which should the nurse document as complementary or alternative medical practices (select all that apply)?
a.
Use of acetaminophen (Tylenol) for fever
b.
Administration of chamomile tea at bedtime
c.
Hypnotherapy for relief of pain
d.
Acupressure to relieve headaches
e.
Cool mist vaporizer at the bedside for “stuffiness”
ANS: B, C, D
When conducting an assessment, the nurse should inquire about the use of complementary or alternative medical practices. Administration of chamomile tea at bedtime, hypnotherapy for relief of pain, and acupressure to relieve headaches are complementary or alternative medical practices. Using Tylenol for fever relief and a cool mist vaporizer at the bedside to reduce “stuffiness” are not considered complementary or alternative medical practices.
The advantages of the ventrogluteal muscle as an injection site in young children include which of the following (Select all that apply)?
a.
Less painful than vastus lateralis
b.
Free of important nerves and vascular structures
c.
Cannot be used when child reaches a weight of 20 pounds
d.
Increased subcutaneous fat, which increases drug absorption
e.
Easily identified by major landmarks
ANS: A, B, E
Less painful, free of important nerves and vascular structures, and easily identifiable are advantages of the ventrogluteal muscle. The major disadvantage is lack of familiarity by health professionals and controversy over whether the site can be used before weight bearing. Cannot be used when a child is 20 pounds or more and increased subcutaneous fat are not advantages of the ventrogluteal muscle as an injection site in young children.
A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, “I want to go back to work, but I don’t want Eric to suffer because I’ll have less time with him.” The nurse’s most appropriate answer is:
a.
“I’m sure he’ll be fine if you get a good babysitter.”
b.
“You will need to stay home until Eric starts school.”
c.
“You should go back to work so Eric will get used to being with others.”
d.
“Let’s talk about the child care options that will be best for Eric.”
ANS: D
“Let’s talk about the child care options that will be best for Eric” is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. “I’m sure he’ll be fine if you get a good babysitter,” “You will need to stay home until Eric starts school,” and “You should go back to work so Eric will get used to being with others” are directive statements and do not address the effect of her working on Eric.
Motor vehicle injuries are a significant threat to young children. Knowing this, the nurse plans a teaching session with a toddler’s parents on car safety. Which will she teach (select all that apply)?
a.
Secure in a rear-facing, upright, car safety seat.
b.
Place the car safety seat in the rear seat, behind the driver’s seat.
c.
Harness safety straps should be fit snugly.
d.
Place the car safety seat in the front passenger seat equipped with an air bag.
e.
After the age of 2 years, toddlers can be placed in a forward-facing car seat.
ANS: A, C, E
Toddlers younger than 2 years should be secured in a rear-facing, upright, approved car safety seat. After the age of 2 years, a forward-facing car seat can be used. Harness straps should be adjusted to provide a snug fit. The car safety seat should be placed in the middle of the rear seat. Children younger than 13 years should not ride in a front passenger seat that is equipped with an air bag.
A parent asks the nurse about how to respond to negativism in toddlers. The most appropriate recommendation is to: a. Punish the child. b. Provide more attention. c. Ask child not always to say “no.” d. Reduce the opportunities for a “no” answer.
ANS: D
The nurse should suggest to the parent that questions should be phrased with realistic choices rather than “yes” or “no” answers. This provides a sense of control for the toddler and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young to be asked to not always say “no.”
The Vietnamese mother of a child being seen in the clinic avoids eye contact with the nurse. Considering cultural differences, the best explanation for this is that the parent: a. Feels responsible for her child’s illness. b. Feels inferior to nurse. c. Is embarrassed to seek health care. d. Is showing respect for nurse.
ANS: D
In some ethnic groups eye contact is avoided. In the Vietnamese culture an individual may not look directly into the nurse’s eyes as a sign of respect. The nurse providing culturally competent care would recognize that the mother does not feel responsible for her child’s illness, she does not feel inferior to the nurse, and she is not embarrassed to seek health care as reasons for the mother to avoid eye contact with the nurse.
At what age should the nurse expect an infant to begin smiling in response to pleasurable stimuli? a. 1 month c. 3 months b. 2 months d. 4 months
ANS: B
At age 2 months, the infant has a social, responsive smile. A reflex smile is usually present at age 1 month. The 3-month-old can recognize familiar faces. At age 4 months, the infant can enjoy social interactions.
Parents tell the nurse that their toddler daughter eats little at mealtimes, only sits at the table with the family briefly, and wants snacks “all the time.” The nurse should recommend that the parents:
a.
Give her planned, frequent, and nutritious snacks.
b.
Offer rewards for eating at mealtimes.
c.
Avoid snacks so she is hungry at mealtimes.
d.
Explain to her in a firm manner what is expected of her.
ANS: A
Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirement associated with the slower growth rate. Parents should assist the child to develop healthy eating habits. The toddler is often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat nonnutritious foods in response.
The most common cause of death in the adolescent age-group involves: a. Drownings. c. Drug overdoses. b. Firearms. d. Motor vehicles.
ANS: D
The leading cause of all adolescent deaths in the United States is motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but do not cause the majority of deaths.
When introducing hospital equipment to a preschooler who seems afraid, the nurse’s approach should be based on which principle?
a.
The child may think the equipment is alive.
b.
The child is too young to understand what the equipment does.
c.
Explaining the equipment will only increase the child’s fear.
d.
One brief explanation is enough to reduce the child’s fear
ANS: A
Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. The child should be given simple concrete explanations about what the equipment does and how it will feel to the child. Simple, concrete explanations help alleviate the child’s fear. The preschooler will need repeated explanations as reassurance.
What describes moral development in younger school-age children?
a.
The standards of behavior now come from within themselves.
b.
They do not yet experience a sense of guilt when they misbehave.
c.
They know the rules and behaviors expected of them but do not understand the reasons behind them.
d.
They no longer interpret accidents and misfortunes as punishment for misdeeds.
ANS: C
Children who are ages 6 and 7 years know the rules and behaviors expected of them but do not understand the reasons for them. Young children do not believe that standards of behavior come from within themselves but that rules are established and set down by others. Younger school-age children learn standards for acceptable behavior, act according to these standards, and feel guilty when they violate them. Misfortunes and accidents are viewed as punishment for bad acts.
By what age does the posterior fontanel usually close? a. 6 to 8 weeks c. 4 to 6 months b. 10 to 12 weeks d. 8 to 10 months
ANS: A
The bones surrounding the posterior fontanel fuse and close by age 6 to 8 weeks. Ten weeks or longer is too late.
