Lifespan Review_Test 1. All Answers

Lifespan Review_Test 1 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 doubl ...

Lifespan Review_Test 1 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. Growth is very rapid during the first year of life. The birth weight has approximately doubled 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 nurse is assessing a 6-month-old healthy infant who weighed 7 pounds at birth. The nurse should expect the infant to now weigh approximately: a. 10 pounds c. 20 pounds b. 15 pounds d. 25 pounds Birth weight doubles at about age 5 to 6 months. At 6 months a child who weighed 7 pounds at birth would weigh approximately 15 pounds. Ten pounds is too little. The infant would have gone from the 50th percentile at birth to below the 5th percentile. Twenty pounds or more is too much. The infant would have tripled the birth weight at 6 months. The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as: a. A normal finding. b. A questionable finding—infant should be rechecked in 1 month. c. An abnormal finding—indicates need for immediate referral to practitioner. d. An abnormal finding—indicates need for developmental assessment. Because the anterior fontanel normally closes between ages 12 and 18 months, this is a normal finding, and no further intervention is required. 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 The bones surrounding the posterior fontanel fuse and close by age 6 to 8 weeks. Ten weeks or longer is too late. 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. Child should not be given fibrous foods until digestive tract matures at age 4 years. b. Child 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. 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. A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. The nurse should interpret this as: a. Normal development. b. Significant developmental lag. c. Slightly delayed development caused by prematurity. d. Suggestive of a neurologic disorder such as cerebral palsy. This indicates normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. No evidence of neurologic dysfunction is present. In terms of fine motor development, the infant of 7 months should be able to: a. Transfer objects from one hand to the other. b. Use thumb and index finger in crude pincer grasp. c. Hold crayon and make a mark on paper. d. Release cubes into a cup. By age 7 months infants can transfer objects from one hand to the other, crossing the midline. The crude pincer grasp is apparent at about age 9 months. The child can scribble spontaneously at age 15 months. At age 12 months the child can release cubes into a cup. In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? a. Roll from abdomen to back. b. Roll from back to abdomen. c. Sit erect without support. d. Move from prone to sitting position. 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. At which age can most infants sit steadily unsupported? a. 4 months c. 8 months b. 6 months d. 10 months Sitting erect without support is a developmental milestone usually achieved by 8 months. At age 4 months an infant can sit with support. At age 6 months, the infant will maintain a sitting position if propped. By 10 months the infant can maneuver from a prone to a sitting position. By what age should the nurse expect that an infant will be able to pull to a standing position? Most infants can pull themselves to a standing position at age 9 months. Infants who are not able to pull themselves to standing by age 11 to 12 months should be further evaluated for developmental dysplasia of the hip. At 6 months the infant has just obtained coordination of arms and legs. By age 8 months infants can bear full weight on their legs. Any infant who cannot pull to a standing position by age 1 year should be referred for further evaluation. According to Piaget, the 6-month-old infant would be in what stage of the sensorimotor phase? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata 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. Shaking 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. 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. What behavior indicates that an infant has developed object permanence? a. Recognizes familiar face such as mother b. Recognizes familiar object such as bottle c. Actively searches for a hidden object d. Secures objects by pulling on a string During the first 6 months of life infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows that an object exists even when it is not visible. Between ages 8 and 12 weeks infants begin to respond differentially to the mother. They cry, smile, vocalize, and show distinct preference for the mother. This preference is one of the stages that influence the attachment process, but it is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence. The ability to understand cause and effect is part of secondary schema development. Most infants begin to fear strangers at age: a. 2 months c. 6 months b. 4 months d. 12 months Between ages 6 and 8 months fear of strangers and stranger anxiety become prominent and are related to the infant's ability to discriminate between familiar and nonfamiliar people. At age 2 months infants are just beginning to respond differentially to the mother. At age 4 months the infant is beginning the process of separation individuation when the infant begins to recognize self and mother as separate beings. Twelve months is too late and requires referral for evaluation if the child does not fear strangers at this age. The nurse is interviewing the father of 10-month-old Megan. She is playing on the floor when she notices an electrical outlet and reaches up to touch it. Her father says "No" firmly and removes her from near the outlet. The nurse should use this opportunity to teach the father that Megan: a. Is old enough to understand the word "No." b. Is too young to understand the word "No." c. Should already know that electrical outlets are dangerous. d. Will learn safety issues better if she is spanked. By age 10 months children are able to associate meaning with words. The father is using both verbal and physical cues to alert the child to dangerous situations. The child should be old enough to understand the word "No." The 10-month-old is too young to understand the purpose of an electric outlet. The father is using both verbal and physical cues to teach safety measures. Physical discipline should be avoided. Sara, age 4 months, was born at 35 weeks' gestation. She seems to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was term. The nurse should explain that: a. Infants' temperaments are part of their unique characteristics. b. Infants become less difficult if they are not kept on scheduled feedings and structured routines. c. Sara's behavior is suggestive of failure to bond completely with her parents. d. Sara's difficult temperament is the result of painful experiences in the neonatal period. Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant's unique temperament. Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. Sara's temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to Sara's temperament. What 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 kinetic 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. The 12-month-old child is able to pull to a stand and walk holding on or independently. Appropriate toys for this age child include large 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. An appropriate play activity for a 7-month-old infant to encourage visual stimulation is: a. Playing peek-a-boo. b. Playing pat-a-cake. c. Imitating animal sounds. d. Showing how to clap hands. 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 kinetic stimulations. Imitating animal sounds will help with auditory stimulation. The best play activity for a 6-month-old infant to provide tactile stimulation is to: a. Allow to splash in bath. b. Give various colored blocks. c. Play music box, tapes, or CDs. d. Use infant swing or stroller. The feel of the water while the infant is splashing provides tactile stimulation. Various colored blocks provide visual stimulation for a 4- to 6-month-old. Music box, tapes, and CDs provide auditory stimulation. Swings and strollers provide kinesthetic stimulation. 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 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. Latasha is a breastfed infant being seen in the clinic for her 6-month checkup. Her mother tells the nurse that she recently began to suck her thumb. The best nursing intervention is to: a. Recommend that the mother substitute a pacifier for her 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. 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. Austin, age 6 months, has six teeth. The nurse should recognize that this is: a. Normal tooth eruption. b. Delayed tooth eruption. c. Unusual and dangerous. d. Earlier-than-normal tooth eruption. This is earlier than expected. Most infants at age 6 months have two teeth. The average number of teeth in 6-month-old infants is two. Six teeth at 6 months is not delayed; it is early tooth eruption. Although unusual, it is not dangerous. 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. 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. A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should recommend that the infant be given: a. Skim milk. b. Whole cow's milk. c. Commercial iron-fortified formula. d. Commercial formula without iron. For children younger than 1 year the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, iron-fortified commercial formula should be used. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia. When is the best age for solid food to be introduced into the infant's diet? a. 2 to 3 months b. 4 to 6 months c. When birth weight has tripled d. When tooth eruption has started Physiologically and developmentally the 4- to 6-month-old is in a transition period. The extrusion reflex has disappeared, and swallowing is a more coordinated process. In addition, the gastrointestinal tract has matured sufficiently to handle more complex nutrients and is less sensitive to potentially allergenic food. Infants of this age will try to help during feeding. Two to three months is too young. The extrusion reflex is strong, and the child will push food out with the tongue. No research base indicates that the addition of solid food to a bottle has any benefit. Infant birth weight doubles at 1 year. Solid foods can be started earlier. Tooth eruption can facilitate biting and chewing; most infant foods do not require this ability. The parents of a 4-month-old infant tell the nurse that they are getting a microwave oven and will be able to heat the baby's formula faster. The nurse should recommend to: a. Never heat a bottle in a microwave oven. b. Heat only 10 ounces or more. c. Always leave bottle top uncovered to allow heat to escape. d. Shake bottle vigorously for at least 30 seconds after heating. If a microwave is being used, the bottle should be left uncovered. This will allow heat to escape. Bottles can be heated safely in microwave ovens if safe guidelines are followed. No more than 4 ounces should be heated at any one time. The bottle should be inverted 10 times; vigorous shaking is not necessary. 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 knowing 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. 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 under way; no evidence at this time supports or abandons the practice for safety reasons. This is a cultural practice. 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. The parent of 2-week-old Sarah asks the nurse if Sarah needs fluoride supplements because she is exclusively breastfed. The nurse's best response is: a. "She needs to begin taking them now." b. "They are not needed if you drink fluoridated water." c. "She may need to begin taking them at age 6 months." d. "She can have infant cereal mixed with fluoridated water instead of supplements." Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 6 months if the child is not drinking adequate amounts of fluoridated water. The recommendation is to begin supplementation at 6 months. The amount of water that is ingested and the amount of fluoride in the water are considered when supplementation is being considered. A mother tells the nurse that she doesn't want her infant immunized because of the discomfort associated with injections. The nurse should explain that: a. This cannot be prevented. b. Infants do not feel pain as adults do. c. This is not a good reason for refusing immunizations. d. A topical anesthetic, eutectic mixture of local anesthetic (EMLA), can be applied before injections are given. Several topical anesthetic agents can be used to minimize the discomfort associated with immunization injections. These include EMLA and vapor coolant sprays. Pain associated with many procedures can be prevented and minimized by using the principles of atraumatic care. With preparation the injection site can be properly anesthetized to decrease the amount of pain felt by the infant. Infants have the neural pathways to sense pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process. The parents of a 12-month-old child ask the nurse if the child can eat hot dogs. The nurse's reply should be based on knowing that: a. The child is too young to digest hot dogs. b. The child is too young to eat hot dogs safely. c. Hot dogs must be sliced into sections to prevent aspiration. d. Hot dogs must be cut into small, irregular pieces to prevent aspiration. Hot dogs are of a consistency, diameter, and round shape that may cause complete obstruction of the child's airway. If given to young children, the hot dog should be cut into small irregular pieces rather than served whole or in slices. The child's digestive system is mature enough to digest hot dogs. To eat the hot dog safely, the child should be sitting down, and the hot dog should be appropriately cut into irregularly shaped pieces. The clinic is lending a federally approved car seat to an infant's family. The nurse should explain that the safest place to put the car seat is: a. Front facing in back seat. b. Rear facing in back seat. c. Front facing in front seat with airbag on passenger side. d. Rear facing in front seat if an air bag is on the passenger side. The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck. Infants should face the rear from birth to 20 pounds and as close to 1 year of age as possible. The middle of the back seat provides the safest position. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat 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? Choose 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 , 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. In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? Choose 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 f. Adjust posture to reach an object , B Rolling from abdomen to back and placing the feet in the mouth when supine are developmentally appropriate for a 5-month-old infant. 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. Toddlers continue to have the short, straight internal ear canal of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose the toddler to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy. The psychosocial developmental tasks of toddlerhood include: a. Development of a conscience. b. Recognition of sex differences. c. Ability to get along with age mates. d. Ability to withstand delayed gratification. If the need for basic trust has been satisfied, toddlers can give up dependence for control, independence, and autonomy. One of the tasks that the toddler is concerned with is the ability to withstand delayed gratification. Development of a conscience occurs during the preschool years. The recognition of sex differences occurs during the preschool years. The ability to get along with age mates develops during the preschool and school-age years. A parent of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurse's best interpretation of this behavior is that: a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention. Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and the use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old. A 17-month-old child would be expected to be in what stage according to Piaget? a. Trust b. Preoperations c. Secondary circular reaction d. Tertiary circular reaction The 17-month-old is in the fifth stage of the sensorimotor phase: tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Trust is Erikson's first stage. Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. Secondary circular reactions last from about ages 4 to 8 months. 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" 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 able to take it out indicates tertiary circular reactions. An embryonic sense of time exists, although the children may behave appropriately to time-oriented phrases; their sense of timing is exaggerated. 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: 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. 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. Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. The best interpretation of this behavior is that: a. This is typical behavior because toddlers are aggressive. b. This is typical behavior because toddlers are egocentric. c. Toddlers should know that sharing toys is expected of them. d. Toddlers should have the cognitive ability to know right from wrong. Play develops from the solitary play of infancy to the parallel play of toddlers. The toddler plays alongside other children, not with them. This typical behavior of the toddler is not intentionally aggressive. Shared play is not within their cognitive development. Toddlers do not conceptualize shared play. Because the toddler cannot view the situation from the perspective of the other child, it is okay to take the toy. Therefore no right or wrong is associated with taking a toy. Which statement is correct about toilet training? a. Bladder training is usually accomplished before bowel training. b. Wanting to please the parent helps motivate the child to use the toilet. c. Watching older siblings use the toilet confuses the child. d. Children must be forced to sit on the toilet when first learning. Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please the parent by holding on rather than pleasing self by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner. Which characteristic best describes the gross motor skills of a 24-month-old child? a. Skips b. Rides tricycle c. Broad jumps d. Walks up and down stairs The 24-month-old child can go up and down stairs alone with two feet on each step. Skipping and the ability to broad jump are skills acquired at age 3. Tricycle riding is achieved at age 4. 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. 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. 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." 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 care for to tend to its needs when the parent is performing similar care for the newborn A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. The most appropriate recommendation is to: a. Punish the child. b. Leave the child alone until the tantrum is over. c. Ignore the behavior, provided that it is not injurious. d. Explain to child that this is wrong. The parent should be told that the best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common during this age group as the child becomes more independent and increasingly complex tasks overwhelm him or her. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The presence of the parent is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over. A parent asks the nurse about 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. 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 parents of a 2-year-old tell the nurse that they are concerned because the toddler has started to use "baby talk" since the arrival of their new baby. The nurse should recommend that the parents: a. Ignore the "baby talk." b. Explain to the toddler that "baby talk" is for babies. c. Tell the toddler frequently, "You are a big kid now." d. Encourage the toddler to practice more advanced patterns of speech. The baby talk is a sign of regression in the toddler. It should be ignored, while praising the child for developmentally appropriate behaviors. Regression is children's way of saying that they are expressing stress. The parents should not introduce new expectations and should allow the child to master the developmental tasks without criticism. Parents tell the nurse that their toddler daughter eats little at mealtime, only sits at the table with the family briefly, and wants snacks "all the time." 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. 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. A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is: a. A sign that the child is spoiled. b. A way to exert unhealthy control. c. Regression, common at this age. d. Ritualism, common at this age. The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain sameness and reliability. It provides a sense of comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. This does not indicate a child who has unreasonable expectations, but rather normal development. Toddlers use ritualistic behaviors to maintain necessary structure in their lives. This is not regression, which is a retreat from a present pattern of functioning. 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. 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. 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. For young children the most effective cleaning of teeth is by the parents. Different positions can be used if the child's back is to the adult. The adult should use one hand to stabilize the chin and the other to brush the child's teeth. The child can participate in brushing, but for a thorough cleaning adult intervention is necessary. 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. 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. An appropriate recommendation in preventing tooth decay in young children is to: a. Substitute raisins for candy. b. Serve sweets after a meal. c. Use honey or molasses instead of refined sugar. d. Serve sweets between meals. Sweets should be consumed with meals so the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth. Raisins, honey, and molasses are highly cariogenic and should be avoided. The leading cause of death during the toddler period is: a. Injuries. b. Infectious diseases. c. Congenital disorders. d. Childhood diseases. Injuries are the single most cause of death in children ages 1 through 4 years. It is the period of highest death rate from injuries of any childhood age group except adolescence. Infectious and childhood diseases are less common cause of deaths in this age group. Congenital disorders are the second leading cause of death in this age group. Kimberly's parents have been using a rearward-facing convertible car seat since she was born. Most car seats can be safely switched to the forward-facing position when the child weighs: a. 10 pounds c. 30 pounds b. 20 pounds d. 40 pounds Although the transition point for switching to the forward-facing position is defined by the manufacturer, it is generally at 9 kg or 20 pounds. Ten pounds is too small to be safe. The relatively large head of this size child should be in the rear-facing position. It is usually safe to put children who weigh more than 20 pounds in forward-facing convertible safety seats. The nurse recommends to parents that peanuts are not a good snack food for toddlers. The nurse's rationale for this action is: a. They are low in nutritive value. b. They are very high in sodium. c. They cannot be entirely digested. d. They can be easily aspirated. Foreign-body aspiration is common during the second year of life. Although they chew well, this age child may have difficulty with large pieces of food such as meat and whole hot dogs and with hard foods such as nuts or dried beans. Peanuts have many beneficial nutrients but should be avoided because of the risk of aspiration in this age group. The sodium level may be a concern, but the risk of aspiration is more important. Many foods pass through the gastrointestinal tract incompletely digested. This is not necessarily detrimental to the child. 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." 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. This 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. The most fatal type of burn in the toddler age group is: a. Flame burn from playing with matches. b. Scald burn from high-temperature tap water. c. Hot object burn from cigarettes or irons. d. Electric burn from electrical outlets. Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age group. Scald burns from water, hot object burns from cigarettes or irons, and electric burns from outlets are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use. Which is characteristic of physical development of a 30-month-old child? Choose all that apply. a. Birth weight has doubled. b. Primary dentition is complete. c. Sphincter control is achieved. d. Anterior fontanel is open. e. Length from birth is doubled. f. Left- or right-handedness is established. , 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, doubling of length, and handedness orientation are not characteristic of the physical development of a 30-month-old child. What 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 3-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 alternative feet are gross motor skills of 5-year-old children 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. 3-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. In terms of cognitive development the 5-year-old child would be expected to: a. Use magical thinking. b. Think abstractly. c. Understand conservation of matter. d. Be unable to comprehend another person's perspective. Magical thinking is believing that thoughts can cause events. Abstract thought does not develop until school-age years. The concept of conservation is the cognitive task of school-age children ages 5 to 7 years. Five-year-olds cannot understand another's perspective. What is descriptive of the preschooler's understanding of time? a. Has no understanding of time b. Associates time with events c. Can tell time on a clock d. Uses terms like "yesterday" appropriately In a preschooler's understanding time has a relation with events such as, "We'll go outside after lunch." Preschoolers develop an abstract sense of time at age 3 years. Children can tell time on a clock at age 7 years. Children do not fully understand use of time-oriented words until age 6 years. The nurse is caring for a hospitalized 4-year-old boy, Ryan. His parents tell the nurse that they will be back to visit at 6 PM. When Ryan asks the nurse when his parents are coming, the nurse's best response is: a. "They will be here soon." b. "They will come after dinner." c. "Let me show you on the clock when 6 PM is." d. "I will tell you every time I see you how much longer it will be." A 4-year-old understands time in relation to events such as meals. Children perceive "soon" as a very short time. The nurse may lose the child's trust if his parents do not return in the time he perceives as "soon." Children cannot read or use a clock for practical purposes until age 7 years. This answer assumes that the child understands the concept of hours and minutes, which is not developed until age 5 or 6 years. A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was "bad." The nurse's best interpretation of this comment is that it is: a. A sign of stress. b. Common at this age. c. Suggestive of maladaptation. d. Suggestive of excessive discipline at home. Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think that they are directly responsible for events, making them feel guilt for things outside of their control. Children of this age show stress by regressing developmentally or acting out. Maladaptation is unlikely. This comment does not imply excessive discipline at home. In terms of language and cognitive development, a 4-year-old child would be expected to: a. Think in abstract terms. b. Follow simple commands. c. Understand conservation of matter. d. Comprehend another person's perspective. Children ages 3 to 4 years can give and follow simple commands. Children cannot think abstractly at age 4 years. Conservation of matter is a developmental task of the school-age child. A 4-year-old child cannot comprehend another's perspective. Which type of play is most typical of the preschool period? a. Solitary c. Associative b. Parallel d. Team Associative play is group play in similar or identical activities but without rigid organization or rules. Solitary play is that of infants. Parallel play is that of toddlers. School-age children play in teams. 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. One purpose of an imaginary friend is to be a friend in time of loneliness. Imaginary friends do not take the place of social interaction but may encourage conversation. Imaginary friends do not take the place of pets or toys. They accomplish what the child is still attempting, not what has already been accomplished. Which characteristic best describes the language of a 3-year-old child? a. Asks meanings of words b. Follows directional commands c. Can describe an object according to its composition d. Talks incessantly, regardless of whether anyone is listening Because of the dramatic vocabulary increase at this age, 3-year-olds are known to talk incessantly, regardless of whether anyone is listening. A 4- to 5-year-old asks lots of questions and can follow simple directional commands. A 6-year-old can describe an object according to its composition. By what age would the nurse expect that most children could obey 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 At 4 years, children can understand directional phrases. 18 to 24 months and 3 years is too young. A useful skill that the nurse should expect a 5-year-old child to be able to master is to: a. Tie shoelaces. b. Use a knife to cut meat. c. Hammer a nail. d. Make change from a quarter. Tying shoelaces is a fine motor task typical of 5-year-olds. Using a knife to cut meat is a fine motor task of a 7-year-old. Hammering a nail and making change from a quarter are fine motor tasks of an 8- to 9-year-old. The nurse is guiding parents in selecting a day care facility for their child. When making the selection, it is especially important to consider: a. Structured learning environment. b. Socioeconomic status of children. c. Cultural similarities of children. d. Teachers knowledgeable about development. A teacher knowledgeable about development will structure activities for learning. A structured learning environment is not necessary at this age. Socioeconomic status is not the most important factor in selecting a preschool. Preschool is about expanding experiences with others; cultural similarities are not necessary. The parent of a 4-year-old son tells the nurse that the child believes "monsters and boogeyman" are in his bedroom at night. The nurse's best suggestion for coping with this problem is to: a. Insist that the child sleep with his parents until the fearful phase passes. b. Suggest involving the child to find a practical solution such as a night light. c. Help the child understand that these fears are illogical. d. Tell the child frequently that monsters and boogeyman do not exist. A night light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with parents will not get rid of the fears. A 4-year-old is in the preconceptual age and cannot understand logical thought. Preschoolers' fears can best be dealt with by: a. Actively involving them in finding practical methods to deal with the frightening experience. b. Forcing them to confront the frightening object or experience in the presence of their parents. c. Using logical persuasion to explain away their fears and help them recognize how unrealistic the fears are. d. Ridiculing their fears so they understand that there is no need to be afraid. Actively involving the child in finding practical methods to deal with the frightening experience is the best way to deal with fears. Forcing a child to confront fears may make the child more afraid. Preconceptual thought prevents logical understanding. Ridiculing A normal characteristic of the language development of a preschool-age child is: a. Lisp b. Stammering c. Echolalia d. Repetition without meaning Stammering and stuttering are normal dysfluency in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers' language. During the preschool period the emphasis of injury prevention should be placed on: a. Constant vigilance and protection. b. Punishment for unsafe behaviors. c. Education for safety and potential hazards. d. Limitation of physical activities. Education for safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Constant vigilance and protection is not practical at this age since preschoolers are becoming more independent. Punishment may make children scared of trying new things. Limitation of physical activities is not appropriate. Acyclovir (Zovirax) is given to children with chickenpox to: a. Minimize scarring b. Decrease the number of lesions. c. Prevent aplastic anemia. d. Prevent spread of the disease. Acyclovir decreases the number of lesions; shortens duration of fever; and decreases itching, lethargy, and anorexia; however, it does not prevent scarring. Preventing aplastic anemia is not a function of acyclovir. Only quarantine of the infected child can prevent the spread of disease. What may be given to high risk children after exposure to chickenpox to prevent varicella? a. Acyclovir b. Vitamin A c. Diphenhydramine hydrochloride d. Varicella zoster immune globulin (VZIG) VZIG is given to high risk children to help prevent the development of chickenpox. Immune globulin intravenous may also be recommended. Acyclovir is given to immunocompromised children to reduce the severity of symptoms. Vitamin A reduces morbidity and mortality associated with the measles. The antihistamine diphenhydramine is administered to reduce the itching associated with chickenpox. Vitamin A supplementation may be recommended for the young child who has: a. Mumps. c. Measles (rubeola). b. Rubella. d. Erythema infectiosum. Evidence shows that vitamin A decreases morbidity and mortality associated with measles. Vitamin A will not lessen the effects of mumps, rubella or fifth disease. When is a child with chickenpox considered to be no longer contagious? a. When fever is absent b. When lesions are crusted c. 24 hours after lesions erupt d. 8 days after onset of illness 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, after the lesions erupt, and may or may not be contagious any time after 6 days as long as all lesions are crusted over. In which communicable disease are Koplik spots present? a. Rubella b. Measles (rubeola) c. Chickenpox (varicella) d. Exanthema subitum (roseola) Koplik spots are small, irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before systemic rash. Koplik spots are not present with rubella, varicella, or roseola. What 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) 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 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. 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. A 3-month-old infant dies shortly after arrival to the emergency department. The infant has subdural and retinal hemorrhages but no external signs of trauma. The nurse should suspect: a. Unintentional injury. b. Shaken-baby syndrome. c. Sudden infant death syndrome (SIDS). d. Congenital neurologic problem. Shaken-baby syndrome causes internal bleeding but may have no external signs. Violent shaking of the brain results in shearing forces that tears blood vessels and neurons. The baby will then present with subdural hematoma and retinal hemorrhage. This is not the characteristic injury pattern of a baby who has received an unintentional injury. With SIDS the baby usually presents to the emergency department with no signs of life. These findings are inconsistent with a congenital neurologic problem. Strict isolation is required for a child who is hospitalized with (choose all that apply): a. Mumps. b. Chickenpox. c. Exanthema subitum (roseola). d. Erythema infectiosum (fifth disease). e. Parvovirus B19. , B, C, D Childhood communicable diseases requiring strict transmission-based precautions (contact, airborne, droplet) include: diphtheria, chickenpox, measles, mumps, tuberculosis, adenovirus, hemophilus B, mumps, pertussis, plague, streptococcal pharyngitis or scarlet fever. Strict isolation is not required for parvovirus B19. 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. In middle childhood growth in height and weight occur at a slower pace. Between the ages of 6 to 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. Generally the earliest age at which puberty begins is: a. 13 years in girls, 13 years in boys b. 11 years in girls, 11 years in boys c. 10 years in girls; 12 years in boys d. 12 years in girls, 10 years in boys Puberty signals the beginning of the development of secondary sex characteristics. This begins in girls earlier than in boys. Usually a 2-year difference occurs in the age at onset. Girls and boys do not usually begin puberty at the same age; girls usually begin earlier than boys do. What describes the cognitive abilities of school-age children? a. Have developed the ability to reason abstractly b. Become capable of scientific reasoning and formal logic c. Progress from making judgments based on what they reason to making judgments based on what they see d. Have the ability to classify, group and sort, and hold a concept in their minds while making decisions based on that concept In Piaget's stage of concrete operations children have the ability to group and sort and make conceptual decisions. Children cannot reason abstractly until late adolescence. Scientific reasoning and formal logic is a skill of adolescents. Making judgments on what the child sees versus what they reason is not a developmental skill. 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. 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. Which statement characterizes moral development in older school-age children? a. They are able to judge an act by the intentions that prompted it rather than just by the consequences. b. Rules and judgments become more absolute and authoritarian. c. They view rule violations in an isolated context. d. They know the rules but cannot understand the reasons behind them. Older school-age children are able to judge and act by the intentions that prompted the behavior rather than just by the consequences. Rules and judgments become less absolute and authoritarian. Rule violation is likely to be viewed in relation to the total context in which it appears. Both the situation and the morality of the rule itself influence reactions. An 8-year-old girl tells the nurse that she has cancer because God is punishing her for "being bad." She shares her concern that, if she dies, she will go to hell. The nurse should interpret this as being: a. A belief common at this age. b. A belief that forms the basis for most religions. c. Suggestive of excessive family pressure. d. Suggestive of a failure to develop a conscience. Children at this age may view illness or injury as a punishment for a real or imagined mystique. The belief in divine punishment is common at this age. The role of the peer group in the life of school-age children is that it: a. Gives them an opportunity to learn dominance and hostility. b. Allows them to remain dependent on their parents for a longer time. c. Decreases their need to learn appropriate sex roles. d. Provides them with security as they gain independence from their parents. Peer-group identification is an important factor in gaining independence from parents. Through peer relationships children learn ways to deal with dominance and hostility. They also learn how to relate to people in positions of leadership and authority and explore ideas and the physical environment. Peer-group identification helps in gaining independence rather than remaining dependent. A child's concept of appropriate sex roles is influenced by relationships with peers. A group of boys ages 9 and 10 years have formed a "boys-only" club that is open to neighborhood and school friends who have skateboards. This should be interpreted: a. Behavior that encourages bullying and sexism. b. Behavior that reinforces poor peer relationships. c. Characteristic of social development of this age. d. Characteristic of children who later are at risk for membership in gangs. One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. A boys-only club does not have a direct correlation with later gang activity. What is descriptive of the play of school-age children? a. Individuality in play is better tolerated than at earlier ages. b. Knowing the rules of a game gives an important sense of belonging. c. They like to invent games, making up the rules as they go. d. Team play helps children learn the universal importance of competition and winning. Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play children learn about competition and the importance of winning, an attribute highly valued in the United States. What is characteristic of dishonest behavior in children ages 8 to 10 years? a. Cheating during games is now more common. b. Lying results from the inability to distinguish between fact and fantasy. c. They may steal because their sense of property rights is limited. d. They may lie to meet expectations set by others that they have been unable to attain. Older school-age children may lie to meet expectations set by others to which they have been unable to measure up. Cheating usually becomes less frequent as the child matures. In this age group children are able to distinguish between fact and fantasy. Young children may lack a sense of property rights; older children may steal to supplement an inadequate allowance, or it may be an indication of serious problems. 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. 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. Which statement best describes fear in school-age children? a. They are increasingly fearful for body safety. b. Most of the new fears that trouble them are related to school and family. c. They should be encouraged to hide their fears to prevent ridicule by peers. d. Those who have numerous fears need continuous protective behavior by parents to eliminate these fears. During the school-age years children experience a wide variety of fears, but new fears related predominantly to school and family bother children during this time. During the middle-school years children become less fearful of body safety than they were as preschoolers. Parents and other persons involved with children should discuss their fear with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding the fears does not end them and may lead to phobias. The 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. 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. 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. 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. 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. 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. When teaching injury prevention during the school-age years, the nurse should include: a. Teach the need to fear strangers. b. Teach basic rules of water safety. c. Avoid letting children cook in microwave ovens. d. Caution children against engaging in competitive sports. Water safety instruction is an important source of injury prevention at this age. The child should be taught to swim, select safe and supervised places to swim, swim with a companion, check sufficient water depth for diving, and use an approved flotation device. Teach stranger safety, not fearing strangers. This includes not going with strangers, not having personalized clothing in public places, having children tell parents if anyone makes them uncomfortable, and teaching children to say "no" in uncomfortable situations. Teach children safe cooking methods. Caution against engaging in hazardous sports such as those involving trampolines. Turner's syndrome is suspected in an adolescent girl with short stature. This is caused by: a. Absence of one of the X chromosomes. b. Presence of an incomplete Y chromosome. c. Precocious puberty in an otherwise healthy child. d. Excess production of both androgens and estrogens. Turner's syndrome is caused by an absence of one of the X chromosomes. Most girls who have this disorder have one X chromosome missing from all cells. A Y chromosome is not part of the genetic makeup of girls. Puberty is delayed and amenorrhea is a clinical manifestation in girls with Turner's syndrome. These girls often need hormone therapy to increase their levels of these hormones. An important consideration when the nurse is discussing enuresis with the parents of a young child is that: a. Enuresis is more common in girls than in boys. b. Enuresis is neither inherited nor does it have a familial tendency. c. Organic causes that may be related to enuresis should be considered first. d. Psychogenic factors that cause enuresis persist into adulthood. Organic causes that may be related to enuresis should be ruled out before psychogenic factors are considered. Enuresis is more common in boys and has a strong familial tendency. Nocturnal bed-wetting usually ceases long before adulthood. The nurse is assisting the family of a child with a history of encopresis. What should be included in the nurse's discussion with this family? a. Instruct the parents to sit the child on the toilet at twice-daily routine intervals. b. Instruct the parents that the child will probably need to have daily enemas. c. Suggest the use of stimulant cathartics weekly. d. Reassure the family that most problems are resolved successfully, with some relapses during periods of stress. Children may be unaware of a prior sensation and unable to control the urge once it begins. They may be so accustomed to bowel accidents that they are unable to smell or feel it. Family counseling is directed toward reassurance that most problems resolve successfully, although relapses during periods of stress are possible. Constipation is the most common cause of encopresis. This should be corrected, and, if the condition persists, behavioral therapy may be necessary. Relief of fecal impaction does not require daily enemas. Dietary changes are necessary and would be more beneficial that cathartics. A mother calls the school nurse saying that her daughter has developed a school phobia. She has been out of school 3 days. The nurse's recommendations should include: a. Immediately returning the child to school. b. Explaining to the child that this is the last day she can stay home. c. Determining the cause of the phobia before returning child to school. d. Seeking professional counseling before forcing child to return to school. The primary goal is to return the child to school. Parents must be convinced gently but firmly that immediate return is essential and that it is their responsibility to insist on school attendance. Telling the child that this is the last day she can stay home will increase the fear of the child. She must play a role in preparing for her return to school. Beginning with half days might be beneficial. The child may not be able to identify the cause for the phobia. Treatment will depend on the cause if known. Relaxation techniques are commonly used. Professional counseling is usually not necessary to resolve this condition. A characteristic of children with depression is: a. Increased range of affective response. b. Preoccupation with need to perform well in school. c. Change in appetite, resulting in weight loss or gain. d. Tendency to prefer play instead of schoolwork. Physiologic characteristics of children with depression include change in appetite resulting in weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping pattern, insomnia or hypersomnia, and constipation. This child displays a predominantly sad facial expression with absence or diminished range of affective response. The child has lower grades in school, with lack of interest in doing homework or achieving in school. Solitary play, disinterest in play, or a tendency to be alone are more characteristic. A 9-year-old child has just been diagnosed with recurrent abdominal pain (RAP). What should the nurse include in preparing the family for discharge? Choose all that apply. a. "Your child should be on a high-fiber diet." b. "You may give your child a stimulant laxative once a week." c. "You should help your child with bowel training to establish regular bowel habits." d. "Your child may place ice packs on the abdomen when pain occurs." , C A high-fiber diet with possible addition of bulk laxatives is beneficial in children with RAP. Bowel training is recommended to assist the child in establishing regular bowel habits. Giving a child a stimulant laxative once a week and placing ice packs on the abdomen for pain would not be included in discharge teaching for this patient and family. In girls the initial indication of puberty is: a. Menarche. b. Growth spurt. c. Growth of pubic hair. d. Breast development. In most girls the initial indication of puberty is the appearance of breast buds, an event known as the larche. The usual sequence of secondary sexual characteristic development in girls is breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, and abrupt deceleration of linear growth. The mean age of menarche in the United States is: a. 11.5 years c. 13.5 years b. 12.75 years d. 14 years The average age of menarche is 12 years and 9.5 months in North American girls, with a normal range of 10.5 to 15 years. By what age should concerns about pubertal delay be considered in boys? a. 12 to 12.5 years c. 13 to 13.5 years b. 12.5 to 13 years d. 13.5 to 14 years Concerns about pubertal delay in boys should be considered for boys who exhibit no enlargement of the testes or scrotal changes from 13.5 to 14 years. Ages younger than 13.5 years are too young for initial concern. Steve, 14 years old, mentions that he now has to use deodorant but never had to before. The nurse's response should be based on knowledge that: a. Eccrine sweat glands in the axillae become fully functional during puberty. b. Sebaceous glands become extremely active during puberty. c. New deposits of fatty tissue insulate the body and cause increased sweat production. d. Apocrine sweat glands reach secretory capacity during puberty. The apocrine sweat glands, nonfunctional in children, reach secretory capacity during puberty. They secrete a thick substance as a result of emotional stimulation that, when acted on by surface bacteria, becomes highly odoriferous. They are limited in distribution and grow in conjunction with hair follicles in the axilla, genital, anal areas, and others. Eccrine sweat glands are present almost everywhere on the skin and become fully functional and respond to emotional and thermal stimulation. Sebaceous glands become extremely active at this time, especially those on the genitals and the "flush" areas of the body such as face, neck, shoulders, upper back, and chest. This increased activity is important in the development of acne. New deposits of fatty tissue insulate the body and cause increased sweat production is not the etiology of apocrine sweat gland activity. According to Erikson, the psychosocial task of adolescence is developing: a. Intimacy. c. Initiative. b. Identity. d. Independence. Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. Intimacy is the developmental stage for early adulthood. Initiative is the developmental stage for early childhood. Independence is not one of Erikson's developmental stages. According to Piaget the adolescent is in the fourth stage of cognitive development, or period of: a. Formal operations. b. Concrete operations. c. Conventional thought. d. Postconventional thought. Cognitive thinking culminates with capacity for abstract thinking. This stage, the period of formal operations, is Piaget's fourth and last stage. The concrete operations stage usually develops between ages 7 and 11 years. Conventional and postconventional thought refer to Kohlberg's stages of moral development. Which aspect of cognition develops during adolescence? a. Capability to use a future time perspective b. Ability to place things in a sensible and logical order c. Ability to see things from the point of view of another d. Progress from making judgments based on what they see to making judgments based on what they reason Adolescents are no longer restricted to the real and actual. They also are concerned with the possible; they think beyond the present. During concrete operations (between ages 7 and 11 years) children exhibit the ability to place things in a sensible and logical order, the ability to see things from another's point of view, and the ability to make judgments based on what they reason rather than just what they see. Peer relationships become more important during adolescence because: a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents. The peer group serves as a strong support to teenagers, providing them with a sense of belonging and strength and power. During adolescence the parent/child relationship changes from one of protection-dependency to one of mutual affection and quality. Parents continue to play an important role in the personal and health-related decisions. The peer group forms the transitional world between dependence and autonomy. 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. 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 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. 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. Matt, age 14 years, seems to be always eating, although his weight is appropriate for his height. The best explanation for this is: a. This is normal because of increase in body mass. b. This is abnormal and suggestive of future obesity. c. His caloric intake would have to be excessive. d. He is substituting food for unfilled needs. In adolescence nutritional needs are closely related to the increase in body mass. The peak requirements occur in the years of maximal growth. The caloric and protein requirements are higher than at almost any other time of life. This describes the expected eating pattern for young adolescents as long as weight and height are appropriate; obesity is not a concern. Which predisposes the adolescent to feel an increased need for sleep? a. An inadequate diet b. Rapid physical growth c. Decreased activity that contributes to a feeling of fatigue d. The lack of ambition typical of this age group During growth spurts the need for sleep is increased. Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contribute to fatigue. The most common cause of death in the adolescent age-group involves: a. Drownings. b. Firearms. c. Drug overdoses. d. Motor vehicles. 36% of all adolescent deaths in the United States are the result of motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but do not cause the majority of deaths. Which statement is true about smoking in adolescence? a. Smoking is related to other high-risk behaviors. b. Smoking is more common among athletes. c. Smoking is less common when the adolescent's parent(s) smokes. d. Smoking among adolescents is becoming more prevalent. Cigarettes are considered a gateway drug. Teenagers who smoke are 11.4 times more likely to use an illicit drug. Teens who refrain from smoking often have a desire to succeed in athletics. If a parent smokes, it is more likely that the teen will smoke. Cigarette smoking has declined among all groups since the 1990s. An adolescent girl asks the school nurse for advice because she has dysmenorrhea. She says that a friend recommended that she try an over-the-counter nonsteroidal antiinflammatory drug (NSAID). The nurse's response should be based on knowing that: a. Aspirin is the drug of choice for the treatment of dysmenorrhea. b. Over-the-counter NSAIDs are rarely strong enough to provide adequate pain relief. c. NSAIDs are effective because of their analgesic effect. d. NSAIDs are effective because they inhibit prostaglandins, leading to reduction in uterine activity. First-line therapy for adolescents with dysmenorrhea is NSAIDs. This group of drugs blocks the formation of prostaglandins. NSAIDs are the drug of choice for this condition. Aspirin may increase bleeding. In most cases NSAIDs are sufficient to treat the symptoms of dysmenorrhea. They should be started at the first sign of bleeding and taken for 2 to 3 days. NSAIDs are effective because of their antiinflammatory effects. A 14-year-old boy and his parents are concerned about bilateral breast enlargement. The nurse's discussion of this should be based on knowing that: a. This is usually benign and temporary. b. This is usually caused by Klinefelter syndrome. c. Administration of estrogen effectively reduces gynecomastia. d. Administration of testosterone effectively reduces gynecomastia. The male breast responds to hormone changes. Some degree of bilateral or unilateral breast enlargement occurs frequently in boys during puberty. This is not a manifestation of Klinefelter syndrome. Administration of estrogen and testosterone will have no effect on the reduction of breast tissue and may aggravate the condition. 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. 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 psychologic effects of being obese during adolescence include: a. Sexual promiscuity. b. Poor body image. c. Memory has no effect on eating behavior. d. Accurate body image but self-deprecating attitude. Common emotional consequences of obesity include poor body image, low self-esteem, social isolation, and feelings of depression and isolation. Sexual promiscuity is an unlikely effect of obesity. The obese adolescent often substitutes food for affection. Eating behaviors are closely related to memory. Memory and appetite are closely linked and can be modified over time with treatment. Obese adolescents most often have a very poor self-image. Anorexia nervosa may best be described as: a. Occurring most frequently in adolescent males. b. Occurring most frequently in adolescents from lower socioeconomic groups. c. Resulting from a posterior pituitary disorder. d. Resulting in severe weight loss in the absence of obvious physical causes. The etiology of anorexia remains unclear, but a distinct psychologic component is present. The diagnosis is based primarily on psychologic and behavioral criteria. Anorexia nervosa is observed more commonly in adolescent girls and young women. It does not occur most frequently in adolescents from a lower socioeconomic group. In reality, these are often families of means who have high parental expectations for achievement. Anorexia is a psychiatric disorder. The weight loss of anorexia nervosa is often triggered by: a. Sexual abuse. b. School failure. c. Independence from family. d. Traumatic interpersonal conflict. 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 girls are often overachievers who are successful in school, not failures in school. The adolescent is most often enmeshed with his or her family. What is descriptive of bulimia during adolescence? a. Strong sense of control over eating behavior b. Feelings of elation after the binge-purge cycle c. Profound lack of awareness that the eating pattern is abnormal d. Weight that can be normal, slightly above normal, or below normal Individuals with bulimia are of normal or more commonly slightly above normal weight. Those who also restrict their intake can become severely underweight. Behavior related to this eating disorder is secretive, frenzied, and out of control. These cycles are followed by self-deprecating thoughts and a depressed mood. These young women are keenly aware that this eating pattern is abnormal. The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Data collection should include the: a. Mode of administration. b. Actual content of the drug. c. Function the drug plays in the adolescent's life. d. Adolescent's level of interest in rehabilitation. When the drug is questionable or unknown, every effort must be made to determine the type, amount of drug taken, the mode and time of administration, and factors relating to the onset of presenting symptoms. Because the actual content of most street drugs is highly questionable, this information would be difficult to obtain. It is helpful to know the pattern of use but not essential during this emergency. This is an inappropriate time for an evaluation about the level of interest in rehabilitation. An adolescent girl tells the nurse that she is very suicidal. The nurse asks her if she has a specific plan. Asking this should be considered: a. An appropriate part of the assessment. b. Not a critical part of the assessment. c. Suggesting that the adolescent needs a plan. d. Encouraging the adolescent to devise a plan. Routine health assessments of adolescents should include questions that assess the presence of suicidal ideation or intent. Questions such as, "Have you ever developed a plan to hurt yourself or kill yourself" should be part of that assessment. Threats of suicide should always be taken seriously and evaluated. Suggesting that the adolescent needs a plan and encouraging them to devise this plan are inappropriate statements by the nurse. Research has shown that the most successful smoking cessation programs among teens include (choose all that apply): a. Peer-led education and support. b. Information on the long-term effects of smoking. c. Programs including the media. d. School-based programs. e. Information on the immediate effects of smoking. , C, D, E Two areas of antismoking campaigns that have shown success are those that are peer-led and use media in education related to smoking prevention. School-based programs have also shown success and can be strengthened by expansion into the community and youth groups. Teens respond much better to education that focuses on the immediate effects of smoking. For the most part, smoking prevention programs that focus on the negative long-term effects of smoking have been ineffective. What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Separation anxiety b. Loss of control c. Fear of bodily injury d. Fear of pain 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. When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as: a. Punishment. b. Threat to child's self-image. c. An opportunity for regression. d. Loss of companionship with friends. If a toddler is not prepared for hospitalization, a typical preschooler fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds. Threat to child's self-image and loss of companionship with friends are reactions typical of school-age children. Regression is a response characteristic of toddlers when threatened with loss of control. 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 b. Toddlers c. Preschoolers d. School-age children When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurps 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. 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. 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. Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, "We are sick of Mom always sitting with you in the hospital and playing with you. It isn't fair that you get everything and we have to stay with the neighbors." The nurse's best assessment of this situation is that: a. The siblings are immature and probably spoiled. b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling. c. The family has ineffective coping mechanisms to deal with chronic illness. d. The siblings need to better understand their sister's illness and needs. Siblings experience loneliness, fear, worry, anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. These are not uncommon responses by normal siblings. There is no evidence that the family has maladaptive coping. An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler is to: a. Provide for privacy. b. Encourage parents to room in. c. Explain procedures and routines. d. Encourage contact with children the same age. 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. Four-year-old Brian appears to be upset by hospitalization. An appropriate intervention is to: a. Let him know that it is all right to cry. b. Give him time to gain control of himself. c. Show him how other children are cooperating. d. Tell him what a big boy he is to be so quiet. Crying is an appropriate behavior for the upset preschooler. The nurse provides support through physical presence. Giving the child time to gain control is appropriate, but the child must know that crying is acceptable. The preschooler does not engage in competitive behaviors. Natasha, 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. 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 parent should be oriented to the environment. Samantha, age 5 years, tells the nurse that she "needs a Band-Aid" where she had an injection. The best nursing action is to: a. Apply a Band-Aid. b. Ask her why she wants a Band-Aid. c. Explain why a Band-Aid is not needed. d. Show her that the bleeding has already stopped. Children at this age group still fear that their insides may leak out at the injection site. Provide the Band-Aid. No explanation should be required. Kimberly, age 3 years, is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." The nurse's reply should be based on an understanding that: a. New toys make hospitalization easier. b. New toys are usually better than older ones for children of this age. c. At this age children often need the comfort and reassurance of familiar toys from home. d. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt. Parents should bring favorite items from home to be with the child. Young children associate inanimate objects with significant people; they gain comfort and reassurance from these items. New toys will not serve the purpose of familiar toys and objects from home. The parents may experience some guilt as a response to the hospitalization, but there is no evidence that it is maladaptive. Matthew, age 18 months, has just been admitted with croup. His parent is tearful and tells the nurse, "This is all my fault. I should have taken him to the doctor sooner so he wouldn't have to be here." What is appropriate in the care plan for this parent who is experiencing guilt? a. Clarify the misconception about the illness. b. Explain to the parent that the illness is not serious. c. Encourage the parent to maintain a sense of control. d. Assess further why the parent has excessive guilt feelings. Guilt is a common response of parents when a child is hospitalized. They may blame themselves for the child's illness or for not recognizing it soon enough. The nurse should clarify the nature of the problem and reassure parents that the child is being cared for. Croup is a potentially very serious illness. The nurse should not minimize the parents' feelings. Encouraging the parent to maintain a sense of control would be difficult for the parents while their child is seriously ill. No further assessment is indicated at this time—guilt is a common response for parents. The nurse is doing a prehospitalization orientation for Diana, age 7, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that she 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. 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. he 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." Loss of peer-group contact may pose a severe emotional threat to an adolescent because of loss of group status; friends visiting are 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. Ryan has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and Ryan's condition is beginning to stabilize. When speaking with the parents, the nurses should expect which stressors to be evident? Choose all that apply. a. Unfamiliar environment b. Usual day-night routine c. Strange smells d. Provision of privacy e. Inadequate knowledge of condition and routine , C, E Intensive care units, especially when the family is unprepared for the admission, are a strange and unfamiliar place. There are many pieces of unfamiliar equipment, and the sights and sounds are much different from a general hospital unit. Also, with the child's condition being more precarious, it may be difficult to keep the parents updated and knowledgeable about what is happening. Lights are usually on around the clock, seriously disrupting the diurnal rhythm. There is usually little privacy available for families in intensive care units. A 3-year-old female is hospitalized for a femur fracture. As her nurse, what nursing action would help foster the child's sense of autonomy? 1. Allow the child to choose what time to take her oral antibiotics. 2. Allow the child to have a doll for medical play. 3. Allow the child to administer her own dose of Keflex (cephalexin) via oral syringe. 4. Allow the child to watch age-appropriate videos. ANS: 3 Allowing toddlers to participate in actions of which they are capable is an excellent way to enhance their autonomy. A 16-year-old male is hospitalized for cystic fibrosis. He will be an inpatient for 2 weeks while he receives IV antibiotics. As the nurse caring for this patient, what action can you take that will most enhance his psychosocial development? 1. Fax the teen's teacher, and have her send in his homework. 2. Encourage the teen's friends to visit him in the hospital. 3. Encourage the teen's grandparents to visit frequently. 4. Tell the teen he is free to use his phone to call friends. ANS: 2 Teens are most concerned about being like their peers. Having the teen's friends visit will help him feel he is still part of the school and social environment. 3. A 6-month-old male is at his well-child checkup. The nurse weighs him, and his mother asks if his weight is normal for his age. The nurse's best response is: 1. "At 6 months his weight should be approximately three times his birth weight." 2. "Each child gains weight at his or her own pace." 3. "At 6 months his weight should be approximately twice his birth weight." 4. "At 6 months a child should weigh about 10 lb more than his or her birth weight." ANS: 3 Children should double their birth weight by 4 to 6 months of age. The nurse caring for a 4-year-old female in the ER is about to start a peripheral IV. The nurse's best method for explaining the procedure to the child is to: 1. Show the child a pamphlet with pictures showing the IV placement procedure. 2. Have the 5-year-old patient next door tell the 4-year-old about her experience with her IV placement. 3. Show the child the IV placement equipment, and demonstrate the procedure on a doll. 4. Tell the child that if she remains still, the procedure will be over quickly. ANS: 3 A 4-year-old child understands things in very concrete and simple terms. Therefore, medical play is an excellent method for helping her understand the procedure. A 17-year-old male is being seen in the ER. In order to obtain the adolescent's health information, his nurse should: 1. Interview the adolescent using direct questions. 2. Gather information during a casual conversation. 3. Interview the adolescent only in the presence of his parents. 4. Gather information only from the parents. ANS: 2 Frequently adolescents will share more information when it is gathered during a casual conversation. A 7-year-old female is being admitted to the hospital for a diagnosis of acute lympho- cytic leukemia. The nurse wants to gather information from the child regarding her feelings about her diagnosis. Which nursing action is most appropriate to gain infor- mation about how the child is feeling? 1. The nurse should actively attempt to make friends with the child before asking her about her feelings. 2. The nurse should ask the child's parents what feelings she has expressed in regard to her diagnosis. 3. The nurse should provide the child with some paper to draw a picture of how she is feeling. 4. The nurse should ask the child direct questions about how she is feeling. ANS: 3 Often children will include much more detail of their feelings in drawings. They will often express things in pictures they are unable to verbalize.