Exam, Elsevier and Book questions Flashcards
1. A nurse is selecting a family theory to assess a patient’s family dynamics. Which family theory best describes a series of tasks for the family throughout its life span? Select one: a. Duvall's Developmental Theory b. Family Systems Theory c. Structural-functional theory d. Interactional theory
a. Duvall’s Developmental Theory
Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? Select one: a. Family Stress Theory b. Developmental Systems Theory c. Duvall’s Developmental Theory d. Interactional theory
a. Family Stress Theory
Which is the term for a family in which the paternal grandmother, the parents, and two minor children live together? Select one: a. Blend b. Traditional Nuclear c. Binuclear d. Extended
d. Extended
A nurse is assessing a family’s structure. Which describes a family in which a mother, her children, and a stepfather live together? Select one: a. Extended b. Nuclear c. Blended d. Binuclear
c. Blended
The nurse is teaching a group of new parents about the experience of role transition. Which statement by a parent would indicate a correct understanding of the teaching?
Select one:
a. “Young parents can adjust to the new role easier than older parents.”
b. “My marital relationship can have a positive or negative effect on the role transition.”
c. “A parent’s previous experience with children makes the role transition more difficult.”
d. “If an infant has special care needs, the parents’ sense of confidence in their new role is strengthened.”
b. “My marital relationship can have a positive or negative effect on the role transition.”
A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, “I want to go back to work, but I don’t want Eric to suffer because I’ll have less time with him.” The nurse’s most appropriate answer would be which statement?
Select one:
a. “You will need to stay home until Eric starts school.”
b. “You should go back to work so Eric will get used to being with others.”
c. “Let’s talk about the child care options that will be best for Eric.”.
d. “I’m sure he’ll be fine if you get a good babysitter.”
c. “Let’s talk about the child care options that will be best for Eric.”.
Which term best describes a group of people who share a set of values, beliefs, practices, social relationships, law, politics, economics, and norms of behavior? Select one: a. Race b. Social group c. Culture d. Ethnicity
c. Culture
A nurse is interviewing the parents of a toddler about use of complementary or alternative medical practices. The parents share several practices they use in their household. Which should the nurse document as complementary or alternative medical practices? Select one or more: a. Tylenol for fever b. Cool air humidifier c. Black tea at bedtime d. Acupressure for headaches
d. Acupressure for headaches
Which is the major cause of death for children older than 1 year? Select one: a. Heart disease b. Congenital anomalies c. Unintentional injuries d. Cancer
c. Unintentional injuries
The nurse is teaching parents of toddlers about animal safety. Which should be included in the teaching session?
Select one:
a. Teach your toddler not to disturb an animal that is eating.
b. It is permissible for your toddler to feed treats to a dog.
c. The toddler is safe to approach an animal if the animal is chained.
d. Petting dogs in the neighborhood should be encouraged to prevent fear of dogs.
a. Teach your toddler not to disturb an animal that is eating.
The school nurse is conducting a class on bicycle safety. Which statement made by a participant indicates a need for further teaching?
Select one:
a. Most bicycle injuries occur from a fall
b. I should replace my helmet every 5 years
c. Head injuries are the major cause of bicycle related fatalities
d. I can ride double with a friend on a bicycle if it has a large seat
d. I can ride double with a friend on a bicycle if it has a large seat
Parents need further teaching about the use of car safety seats if they make which statement?
Select one:
a. “Even if our toddler helps buckle the straps, we will double-check the fastenings.”
b. “We will anchor the car seat to the car’s anchoring system.”
c. “We won’t start the car until everyone is properly restrained.”
d. “We won’t need to use the car seat on short trips to the store.”
d. “We won’t need to use the car seat on short trips to the store.”
In providing a health promotion plan for new parents aimed at maintaining safety of children, which option should be stressed?
Select one:
a. Children’s anatomical proportions make them less likely to suffer traumatic brain injury.
b. Children should not be left alone in highchairs even if the chair is properly locked with the tray table secured.
c. As long as you provide firm directions and instructions, children typically will not get into trouble in their home environment.
d. Toddlers should be allowed to experiment with all types of foods as long as they are cut into two inch “bite size pieces.”
b. Children should not be left alone in highchairs even if the chair is properly locked with the tray table secured.
After obtaining a health history, the nurse is charting information on the admission checklist for a child who was admitted to the pediatric unit for a respiratory infection. The nurse should include all of the following information under general appearance except: Select one: a. Facial symmetry b. Vital signs c. Fine and Gross motor skills d. Nutrition
b. Vital signs
The nurse is doing a routine assessment on an 18-month-old child and notes that the anterior fontanel is closed. This should be interpreted as which of the following?
Select one:
a. Normal finding - indicates child is developing as expected
b. Abnormal finding – indicates need for immediate referral to practitioner
c. Abnormal finding – indicates need for neurological assessment
d. Questionable finding – indicates child should be checked in 1 month
a. Normal finding - indicates child is developing as expected
The posterior fontanelle is usually smaller and closes up by about 4 months of age.
The anterior fontanelle is usually bigger, starts getting smaller around 6 months, and doesn’t close up until 9-18 months of age (by 3 years at the latest).
The student nurse is assessing the vital signs on a 7 month-old child who is crying while being held by the mother. The student nurse recognizes that the blood pressure is high for the child’s age. The next step the student nurse should take is:
Select one:
a. Report the blood pressure to the instructor
b. Repeat the blood pressure with the child in the crib
c. Repeat the blood pressure on the other leg
d. Repeat the blood pressure when the child is quiet
d. Repeat the blood pressure when the child is quiet
The nurse is preparing to do a physical assessment on a 2 year-old child at a local clinic. The approach most likely to establish rapport and enable an accurate assessment is:
Select one:
a. Give the child a gown to wear
b. Insist the child sit on the examining table
c. Offer to let the child inspect the stethoscope
d. Use soft soothing sounds to communicate with the child
c. Offer to let the child inspect the stethoscope
The nurse is discussing growth and development with a group of new parents. The nurse explains that the child’s physical development during the first year occurs primarily: Select one: a. Cephalocaudal b. In length of legs c. In muscle size d. Distal to proximal
a. Cephalocaudal\
Infant -Head circ = chest circ Toddler -Squat, pot-bellied, bow-legged -Growth in legs -Taller/leaner after 2 years
When recording a history which of the following fine motor skills would the nurse expect to be most recently achieved by a seven month-old infant?
Select one:
a. Voluntarily grasps an object.
b. Transfers object from one hand to the other.
c. Strong grasp reflex
d. Uses thumb and index finger in pincer grasp
b. Transfers object from one hand to the other.
While discussing the progression of play with a group of parents, the nurse describes the play that is typical of a toddler as: Select one: a. Associative b. Solitary c. Parallel d. Competative
c. Parallel
The nurse is admitting a 4 month-old infant to the pediatric unit. The nurse recommends that hospital staff, nurses and parents hold the child during feedings in the plan of care to prevent all of the following common issues with hospitalization except for: Select one: a. Interrupted routine b. Parental separation c. Lack of stimulation d. Skin breakdown from prolonged bedrest
d. Skin breakdown from prolonged bedrest
The nurse is observing parents playing with their 10-month-old daughter. Which of the following should the nurse recognize as an example that the child is developing object permanency?
Select one:
a. Looks for a toy that parent hides under a blanket.
b. Bangs two cubes held in her hands
c. Recognizes that a ball of clay is the same when flattened out.
d. Returns the blocks to the same spot on the table
a. Looks for a toy that parent hides under a blanket.
The RN is preparing a four-year old child for surgery. Which intervention best demonstrates the RN understands the needs of the preschooler during hospitalization:
Select one:
a. Explaining to the child that surgery will involve just “first we will put you to sleep and then make a cut in your belly while you are asleep”
b. Pulling the curtain while the child changes to provide the child privacy.
c. Insist the child lay in the hospital bed instead of sitting on mom’s lap during preparation procedures
d. Asking the child, “Do you want to wear green or blue hospital socks?”
d. Asking the child, “Do you want to wear green or blue hospital socks?”
The mother of a 3 year-old is upset because her child “has been acting like a baby since he was admitted to the hospital”. The nurse explains that:
Select one:
a. The child is experiencing stranger anxiety
b. Children this age really are babies
c. Children often demonstrate signs of regression in their behavior when they are hospitalized
d. The child is acting this way to get the mother’s attention
c. Children often demonstrate signs of regression in their behavior when they are hospitalized
While reviewing for the NCLEX, the student nurse remembers that a preschool child:
Select one or more:
a. Are learning self control
b. Have a fear of mutilation
c. Believes their thoughts are powerful.
d. Engage in ritualistic behaviors
b. Have a fear of mutilation
c. Believes their thoughts are powerful.
While preparing medication to give to a 4 year-old child, remembers the 6 rights and 3 checks procedure for medication administration. The nurse recognizes a priority safety concern is:
Select one:
a. Teaching the child about the side effects of the medication
b. Monitoring parental involvement in medication administration
c. Calculating and administering safe doses .
d. Determining which oral fluid to give with the medication
c. Calculating and administering safe doses .
Which is probably the single most important influence on growth at all stages of development? Select one: a. Culture b. Environment c. Heredity d. Nutrition
d. Nutrition
The nurse observes a mother with her 18-month-old child. In a period of just a few minutes the child has said “No” to her several times when she asks him to do something. The nurse recognizes that the child is:
Select one:
a. Trying to differentiate himself from his father
b. Exhibiting attempts at autonomy
c. Practicing domestic mimicry
d. Trying to differentiate himself from his mother
b. Exhibiting attempts at autonomy
The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their 4 year old child. Which is most likely lacking in their particular diet? Select one: a. Complete Protein. b. Fiber c. Carbohydrates d. Fat
a. Complete Protein.
When a preschool child is hospitalized without adequate preparation, how does the child often react to the hospitalization?
Select one:
a. The child’s self-image may be threatened
b. Child may react to a potential loss of friends
c. Child may exhibit regression
d. Child may see hospitalization as a punishment
d. Child may see hospitalization as a punishment
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 this as which description?
Select one:
a. The child thinks the nurse is punishing her.
b. The child has successfully manipulated the nurse in the past.
c. This is normal behavior for a school-age child.
d. The behavior is not seen past the preschool years.
c. This is normal behavior for a school-age child.
Samantha, age 4 years, tells the nurse that she “needs a Band-Aid” where she had an injection. Which is the best nursing action?
Select one:
a. Ask her why she wants a Band-Aid
b. Explain why a Band-Aid is not needed
c. Apply a Band-Aid
d. Show her that the bleeding has already stopped.
c. Apply a Band-Aid
A nurse is caring for four patients; three are toddlers and one is a preschooler. Which represents the major stressor of hospitalization for these four patients? Select one: a. Separation anxiety b. Loss of control c. Fear of pain d. Fear of bodily injury
a. Separation anxiety
During the first 4 days of hospitalization, Eric, age 18 months, cried inconsolably when his parents left him, and he refused the staff’s attention. Now the nurse observes that Eric appears to be “settled in” and unconcerned about seeing his parents. The nurse should interpret this as which statement?
Select one:
a. Because he is “at home now in the hospital” seeing his mother again would only start the cycle of crying all over again
b. He may be experiencing detachment, which is the third stage of separation anxiety
c. He has transferred his trust to the nursing staff
d. He has successfully adapted to the hospital environment
b. He may be experiencing detachment, which is the third stage of separation anxiety
Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by which of the following responses? Select one: a. Guilt and anger b. Acceptance of child's limitations c. Denial d. Social reintegration
a. Guilt and anger
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.” Which is the nurse’s best assessment of this situation?
Select one:
a. Siblings need to better understand their sister’s illness and special needs
b. Siblings are immature and probably spoiled
c. Family has ineffective coping mechanisms to deal with chronic illness
d. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling with chronic illness
d. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling with chronic illness
The nurse is providing support to parents at the time their child is diagnosed with chronic disabilities. The nurse notices that the parents keep asking the same questions. What is the nurse’s best intervention?
Select one:
a. Recognize that some parents cannot understand explanations
b. Kindly refer them to someone else for answering their questions
c. Patiently continue to answer questions
d. Suggest that they ask their questions when they are not upset
c. Patiently continue to answer questions
A nurse plans therapeutic play time for a hospitalized child. What are the benefits of play? (Select all that apply.)
Select one or more:
a. Allows child a way to express feelings
b. The child can deal with concerns and feelings
c. The nurse can gain insight into the child’s feelings and fears
d. Gives the child a structured play environment
e. Serves as a method to assist disturbed children
a. Allows child a way to express feelings
b. The child can deal with concerns and feelings
c. The nurse can gain insight into the child’s feelings and fears
A 12-year-old child enjoys collecting stamps, playing soccer, and participating in Boy Scout activities. The nurse recognizes that the child is displaying which developmental task? Select one: a. Identity b. Intimacy c. Integrity d. Industry
d. Industry
Erickson’s psychosocial stages of development are listed below, match the stage associated with the age range.
Trust vs Mistrust-> ________________
Autonomy vs Shame and Doubt-> ________________
Industry vs Inferiority-> ________________
Initiative vs Guilt -> ________________
Trust vs Mistrust-> infant to 18mo
Autonomy vs Shame and Doubt-> 18mo to 3 yr
Industry vs Inferiority-> 5-13 years
Initiative vs Guilt -> 3-5 years
According to Erikson, infancy is concerned with acquiring a sense of Select one: a. Industry b. Trust c. Initiative d. Separation
b. Trust
Erickson’s psychosocial stages of development are listed below, match the stage associated with the age range.
Trust vs Mistrust-> ________________
Autonomy vs Shame and Doubt-> ________________
Industry vs Inferiority-> ________________
Initiative vs Guilt -> ________________
Trust vs Mistrust-> infant to 12mo
Autonomy vs Shame and Doubt-> 12mo to 3 yr
Industry vs Inferiority-> 6-12 years
Initiative vs Guilt -> 3-5 years
A nurse is examining a toddler and is discussing with the mother psychosocial development according to Erikson’s theories. Based on the nurse’s knowledge of Erikson, the most age-appropriate activity to suggest to the mother at this stage is to
Select one:
a. Allow the toddler to play with a talking duck toy
b. Allow the toddler to start making choices about what to wear.
c. Feed lunch
d. Turn on the TV with loud songs and bright colors
b. Allow the toddler to start making choices about what to wear.
Based on Piaget’s theory of cognitive development, what is one basic concept a child is expected to attain during the first year of life?
Select one:
a. If an object is hidden, that does not mean that it is gone.
b. Parents are not perfect.
c. He or she cannot be fooled by changing shapes.
d. Most procedures can be reversed.
a. If an object is hidden, that does not mean that it is gone.
According to Kohlberg, children develop moral reasoning as they mature. Which statement is most characteristic of a preschooler’s stage of moral development?
Select one:
a. Actions are determined as good or bad in terms of their consequences.
b. Obeying the rules of correct behavior is important.
c. Behavior that pleases others is considered good.
d. Showing respect for authority is important behavior.
a. Actions are determined as good or bad in terms of their consequences.
A nurse is assessing a preschool-age child and notes the child exhibits magical thinking. According to Piaget, which describes magical thinking?
Select one:
a. Events have cause and effect
b. God is like an imaginary friend
c. If the skin is broken, the child’s insides will come out.
d. Thoughts are all-powerful
d. Thoughts are all-powerful
Zosyn IV is ordered to infuse over a ½ hour. The total volume that you want to infuse is 30 mls. What hourly rate (mL/hr) should you set the pump to run for this antibiotic to be delivered at the ordered rate?
Answer:
_______mL/hr
60 mL/hr
An infant is having an anaphylactic reaction, and the nurse is preparing to administer epinephrine 0.001 mg/kg. The child weighs 22 pounds. What is the epinephrine dose the nurse should administer? (Record your answer using two decimal places.)
Answer:
_______ mg
0.01 mg
Amoxicillin 600 mg, po, tid is ordered for a child with otitis media. Amoxicillin is supplied in a concentration of 200 mg/5 ml. How many mL(s) should be given per dose?
Answer:
_______ mL
15
Which of the following terms best describes a group of people who share a set of values, beliefs, practices, social relationships, laws, politics, economics, and norms of behavior? A. Race B. Culture C. Ethnicity D. Social group
B. Culture
Currently, the fastest-growing segment of the homeless population in the United States consists of which of the following? A. Families B. “Runaway” adolescents C. Migrant farm workers D. Individuals with mental disorders
A. Families
Maria is a Spanish-speaking 5-year-old girl who has started kindergarten in an English-speaking school. Crying most of the time, she appears helpless and unable to function in this new situation. What is the best explanation for this behavior?
A. She lacks adequate maturity for attending school.
B. She lacks the knowledge needed in school.
C. She is experiencing cultural shock.
D. She is experiencing minority group discrimination.
C. She is experiencing cultural shock.
The father of a hospitalized child tells the nurse, “He can’t have meat. We are Buddhist and vegetarians.” What is the nurse’s best intervention?
A. Order the child a meatless tray as requested.
B. Ask a Buddhist priest to visit the family.
C. Explain that hospital patients are exempt from dietary rules.
D. Help the parent understand that meat provides protein needed for healing.
A. Order the child a meatless tray as requested.
Which of the following statements is true concerning folk remedies?
A. They may be used to reinforce the treatment plan.
B. They are incompatible with modern medical regimens.
C. They are a leading cause of death in some cultural groups.
D. They are not a part of the culture in large, developed countries.
A. They may be used to reinforce the treatment plan.
When discussing oxygenation with colleagues on the pediatric unit, one nurse explains that the concept of oxygenation is:
Select one:
a. Increased as the child gets older
b. Is the process of providing cells with oxygen through the respiratory system
c. A reflection the child’s developmental status
d. Presents problems primarily in children under the age of 5 years
b. Is the process of providing cells with oxygen through the respiratory system
The nurse is reviewing information on medications to be used for children with respiratory distress. The nurse notes that medication that stimulates beta2 receptors include Select one: a. Mast cell stablizers b. Leukotriene modifiers c. Bronchodilators d. e. Corticosteroids
c. Bronchodilators
When assessing the respiratory status of a child, the nurse should look for intercostal retractions during: Select one: a. Coughing b. Sneezing c. Expiration d. Inspiration
d. Inspiration
While assessing a six-month-old child diagnosed with an upper respiratory infection, the nurse notes a heart rate of 116, abdominal breathing, a respiratory rate of 62, and capillary refill of < 2 seconds. Which finding is indicative of increasing respiratory distress? Select one: a. Heart rate of 116 b. Capillary refill less than 2 seconds c. Abdominal breathing d. Respiratory rate of 62
d. Respiratory rate of 62
The nurse caring for a toddler with acute laryngotracheobronchitis encourages the mother to stay at the bedside as much as possible. Which of the following is the primary rationale for this action?
Select one:
a. Mothers of hospitalized toddlers often experience guilt
b. The mother can provide constant respiratory care for the child
c. The mother’s presence will promote comfort and ease the child’s respiratory efforts
d. Separation from the mother is a major developmental threat at this age
c. The mother’s presence will promote comfort and ease the child’s respiratory efforts
The mother of a three week-old infant being admitted to the pediatric unit with RSV asks the nurse why the child is being hospitalized. The nurse explains that the child requires close monitoring and observation to prevent complications of RSV in infants this age such as: Select one: a. Fever b. tachycardia c. Apnea d. wheezing
c. Apnea
The nurse recognizes that signs of respiratory distress in a 4-month old infant includes all of the following except: Select one: a. Nasal flaring b. Tripod positioning c. Restlessness d. Grunting
b. Tripod positioning
An 18 month-old child was brought to the emergency department (ED) at 1:00 am with a barking cough and a low-grade fever. After several hours of treatment and observation, coughing has subsided, and the patient is ready for discharge to home. Which of the following should the nurse include in the discharge instructions?
Select one:
a. “Give the child extra fluids and suction his nose every 4 hours”
b. “Administer antipyretics every 6 hours for the next 48 hours”
c. “The child can return to daycare this morningat 9:00”
d. “Bring the child back to the ED if he has difficulty breathing or starts to cough again”
d. “Bring the child back to the ED if he has difficulty breathing or starts to cough again”
The nurse is discussing cystic fibrosis with the parents of a child newly diagnosed with CF. Which of the following statements by the parents indicates that they need more education?
Select one:
a. “CF causes thick mucus secretions of the respiratory and GI system”
b. “CF is a self-limiting illness which will subside after puberty”
c. “My child will be prone to more frequent respiratory infections”
d. “My child will require frequent chest physiotherapy”
b. “CF is a self-limiting illness which will subside after puberty”
The nurse is receiving report at 0700 on the four children she will be caring for today. The nurse determines that the child she should assess first is:
Select one:
a. A 4-year-old with cystic fibrosis and an fever
b. A 10-year-old admitted this morning following an acute asthma exacerbation
c. An 18-month-old with LTB admitted 48 hours ago
d. A 3-week-old admitted at 0400 with RSV Bronchiolitis
d. A 3-week-old admitted at 0400 with RSV Bronchiolitis
Respiratory illness in children may result in hypoxia. When providing care for children in respiratory distress, the nurse should know that which of the following would provide the best assessment of the child’s oxygenation status? Select one: a. Dietary intake b. Vital signs with O2 Sat c. Urine output d. Respiratory rate
b. Vital signs with O2 Sat
The nurse is reviewing the plan of care for a newly admitted 2 year-old child with an acute respiratory infection. Which of the following nursing interventions would be appropriate respiratory care for this child?
Select one:
a. Keep child in the crib with mattress flat
b. Start intravenous fluids
c. CPT and suction every 4 hours
d. Provide humidified oxygen prn as ordered by MD
d. Provide humidified oxygen prn as ordered by MD
A nurse receives report on a 3 year-old boy with suspected epiglottitis. His temperature is 38.7 C, he has mild hypoxia, he is drooling and having intercostal retractions. On further examination, you note inspiratory stridor. The nurse’s highest priority while taking care of this child is to:
Select one:
a. Monitor the child’s vital signs every 4 hours
b. Use cool compresses to reduce the fever
c. Provide a calm environment and allow the child to assume a position of comfort.
d. Insist the child wear an O2 mask even if it agitates him
c. Provide a calm environment and allow the child to assume a position of comfort.
A child brought to the emergency room with a severe asthma attack is being admitted to the pediatric unit. Which of the following is an appropriate nursing action to include in the plan of care?
Select one:
a. Maintain strict bedrest
b. Restrict oral fluids to 50% of maintenance
c. Calm nursing presence
d. Sedate the child for adequate rest
c. Calm nursing presence
The mother of a child with asthma asks the nurse why Singulair has been prescribed for her child. The nurse explains that Singulair is used to treat children with asthma because it
Select one:
a. Is a preventative medication for asthma
b. Controls allergic rhinitis
c. Decreases mucous production
d. Is an anti-inflammatory
d. Is an anti-inflammatory
The nurse mentioned in the previous question explains to the mother that Singulair is in a classification of drugs called Select one: a. Xanthine derivatives b. Nonselective beta-adrenergics c. Bronchodilators d. Leukotriene modifiers
d. Leukotriene modifiers
The nurse is taking care of an infant with RSV bronchiolitis. The nurse explains to the parent that the benefits and actions of the Ribavirin medication are listed below with one exception which is:
Select one:
a. It is associated with decreased length of hospital stay
b. Blocks viral replication
c. Stabilization of cell membranes
d. Enhances antiviral response genes
c. Stabilization of cell membranes
A 1-day old neonate is suspected of having cystic fibrosis. The mother asks the nurse what symptoms led the physician to suspect cystic fibrosis. The nurse explains that the earliest clinical manifestation of cystic fibrosis is often: Select one: a. Rectal prolapse b. Steatorrheac stools c. Constipation d. Meconium ileus
d. Meconium ileus
A child is undergoing diagnostic evaluation to confirm a diagnosis of cystic fibrosis. Which of the following would the nurse most likely identify as being used to confirm the diagnosis?
Select one:
a. Quantitative sweat chloride test
b. Complete blood count with differential
c. Anaerobic blood culture
d. Arterial blood gas
a. Quantitative sweat chloride test
A nurse is assessing a previously healthy 3-year-old child who was brought to the ED after a sudden episode of coughing, acute onset of stridor, followed by respiratory distress. The nurse understands the most probable cause of this child's respiratory distress is: Select one: a. Acute nasopharyngitis b. Asthma exacerbation c. Foreign body aspiration d. RSV bronchiolitis
c. Foreign body aspiration
The nurse is receiving report at 0700 on the four children she will be caring for today. The nurse determines that the child she should assess first is:
Select one:
a. A four year-old with cystic fibrosis admitted last night with a fever
b. A three week old admitted at 0400 with RSV
c. A ten year-old admitted 16 hours ago following an acute asthma exacerbation
d. An eighteen month-old admitted 2 days ago with LTB
b. A three week old admitted at 0400 with RSV
The nurse is preparing to admit a 2 month-infant child with an acute respiratory infection. The nurse understands that this child is at increased risk for respiratory failure due to all of the following except:
Select one:
a. Younger children are at higher risk than older children
b. The pharynx is larger in the infant than in the adult
c. The epiglottis is floppier in an infant than an adult
d. The infant airway is smaller than the adult airway
b. The pharynx is larger in the infant than in the adult
The nurse enters the room of a 5 year old child, Molly, who has pneumonia. Molly has is working hard to breathe and her O2 Sat monitor reads 92%. The nurse raises the head of the bed and has Molly tilt her head back. Which of the following would the nurse do next?
Select one:
a. Provide oxygen therapy as ordered by MD
b. Give Molly a drink of milk
c. Take Molly’s temperature orally
d. Tell her mother that Molly is fine and go get some lunch
a. Provide oxygen therapy as ordered by MD
When assessing perfusion on a 6-month-old infant admitted to the pediatric unit, the nurse understands that perfusion:
Select one:
a. Is accomplished by pulmonary ventilation
b. Is dependent on a functioning respiratory and cardiac system
c. Presents problems primarily in children with chronic disorders
d. Reflects the child’s heart rate during activities
b. Is dependent on a functioning respiratory and cardiac system
Which heart defect and hemodynamic change pairing is correct?
Select one:
a. Tetrology of Fallot and increased pulmonary blood flow
b. Aortic stenosis and obstruction to blood flow out of the heart
c. Ventricular septal defect and decreased pulmonary blood flow
d. Pulmonic stenosis and increased pulmonary blood flow
b. Aortic stenosis and obstruction to blood flow out of the heart
The nurse is caring for a 2 year-old who is scheduled for repair of an uncomplicated ventricular-septal defect. When discussing the defect with the parents the nurse explains that:
Select one:
a. Blood is shunted from the aorta to the pulmonary system
b. Blood is shunted from the right ventricle to the left ventricle
c. The oxygen content in the right ventricle is higher than the left ventricle
d. Blood is shunted from the left ventricle to the right ventricle
d. Blood is shunted from the left ventricle to the right ventricle
The left to right shunting of blood through the VSD causes increased blood pressure in the right ventricle and heavy pulmonary blood flow. If untreated, this can cause irreversible changes in the pulmonary circulation
An infant is admitted to the pediatric unit with a congenital heart defect caused by an outflow obstruction. The nurse understands that the child may have which of the following heart defects? Select one: a. Ventricular Septal Defect b. Pulmonary Stenosis c. Hypoplastic Left Heart d. Complete AV Canal
b. Pulmonary Stenosis
When assessing 10-year-old child on the cardiac unit, the nurse notes cool mottled skin on the lower extremities, hypertension in the upper extremities, and decreased femoral pulses. The nurse understands that these assessment findings are indicative of: Select one: a. Aortic stenosis b. Tetralogy of Fallot c. Ventricular septal defect d. Coarctation of the aorta
d. Coarctation of the aorta
- also called aortic narrowing, is a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts. … Coarctations are most common in the aortic arch
The cardiologist is planning on meeting with the parents of a 3 month-old child to discuss the plan to medically close the child’s Patent Ductus Arteriosis. Which medication should the nurse have information on for the parents? Select one: a. Indomethacin b. Digoxin c. Amiodarone d. Prostaglandin
a. Indomethacin
- When surgical ligation is not indicated, prostaglandin inhibitors (eg, nonsteroid antiinflammatory drugs [NSAIDs]) are used to close the ductus arteriosus. Intravenous (IV) indomethacin or IV ibuprofen is used to treat patent ductus arteriosus (PDA) in the neonate and in premature infants
Two nurses are discussing the difference between hypoxemia and hypoxia. They determine that hypoxemia
Select one:
a. Is a result of reduction of oxygen supply to the tissues
b. Results from left to right shunts
c. Is seen as increased tissue perfusion
d. Is associated with decreased partial pressure of oxygen in blood.
d. Is associated with decreased partial pressure of oxygen in blood.
When reviewing heart failure in the pediatric population, the nurse understands that left sided heart failure in children is often seen as: Select one: a. Pulmonary edema b. Hepatomegaly c. Increased systemic venous congestion d. Decreased pulmonary venous pressure
a. Pulmonary edema
A nurse caring for a child with heart failure due to a complex congenital heart defect understands that symptoms commonly seen include 1. Warm, pale extremities 2. Activity intolerance 3. Capillary refill > 2 secs 4. Developmental delay Choose from the following: Select one: a. 2,3,4 b. 2,4 c. 1,2,4 d. 2,3
a. 2,3,4
While assessing a child admitted with Tetralogy of Fallot, the nurse notes clubbing of the child’s fingers. The nurse understands that the cause of clubbing is usually due to: Select one: a. Chronic tissue hypoxemia b. Chronic activity intolerance c. Chronic low doses of Lasix d. Chronic low doses of Digoxin
a. Chronic tissue hypoxemia
tetralogy of fallot
A heart defect that features four problems.
They are:
a hole between the lower chambers of the heart
an obstruction from the heart to the lungs
The aorta (blood vessel) lies over the hole in the lower chambers
The muscle surrounding the lower right chamber becomes overly thickened
A child with congestive heart failure has been admitted to the pediatric unit. The nurse would expect the child to exhibit which of the following?
Select one:
a. Weight loss and cold extremities
b. Increased blood pressure and cyanosis
c. Bradycardia and dyspnea
d. Tachycardia and activity intolerance
d. Tachycardia and activity intolerance
You are discharging a 10-week-old infant with CHD who will be going home on digoxin. Which of the following answers by the father indicate the need for more teaching?
Select one:
a. “Digoxin reduces the workload on the heart”
b. “I know that this medication will improve the function of the heart muscle”
c. “If I miss a dose because , then I should give 2 doses next time”
d. “I know I should give the drug slowly directing it to the side and back of the mouth”
c. “If I miss a dose because , then I should give 2 doses next time”
A 4-month-old child with a congenital heart defect has a hypercyanotic spell, the nurse’s priority action should be (which should be done first)? Select one: a. Administer oxygen b. Notify the child’s primary physician c. Put child in a knee-chest position d. Administer Lanoxin
c. Put child in a knee-chest position
The nurse is discussing Rheumatic Heart Disease with the parents of a child in the clinic the nurse explains that rheumatic heart disease usually occurs
Select one:
a. Among un-immunized children
b. In children attending day care
c. As sequelae to a viral upper respiratory illness
d. Following a Group A beta-hemolytic strep infection
d. Following a Group A beta-hemolytic strep infection
The nurse is admitting a child diagnosed with Rheumatic Fever. The nurse explains to the parents that the most serious symptom of rheumatic fever is: Select one: a. Erythema marginatum b. Polyarthritis c. Carditis d. Carditis
c. Carditis
While explaining Kawasaki disease to the parents of a 5 year-old child. The nurse explains that children are treated primarily to prevent:
Select one:
a. Fever from lasting longer than 5 days
b. Development of erythematous rash
c. Coronary artery aneurysms and thrombosis
d. Edema of hands and feet
c. Coronary artery aneurysms and thrombosis
During the assessment of a 3 year-old child admitted with Kawasaki Disease, the nurse notes bilateral conjunctivitis, thick nasal discharge, oral mucosal changes, and edema of the hands and feet. The nurse recognizes all findings are related to Kawasaki Disease except: Select one: a. Edema of the hands and feet b. Oral mucosal changes c. Thick nasal discharge d. Bilateral conjunctivitis
c. Thick nasal discharge
Kawasaki Disease
Kawasaki disease is a rare childhood disease. It makes the walls of the blood vessels in the body become inflamed. It can affect any type of blood vessel, including the arteries, veins, and capillaries.
No one knows what causes Kawasaki disease. Symptoms include
High fever that lasts longer than 5 days
Swollen lymph nodes in the neck
A rash on the mid-section and genital area
Red, dry, cracked lips and a red, swollen tongue
Red, swollen palms of the hands and soles of the feet
Redness of the eyes
While assessing a 4-year-old child scheduled to receive Digoxin for heart failure, the nurse notes that the child has an apical heart rate of 68. The mother reports that the child was vomiting earlier. The nurse should:
Select one:
a. Give the medication with only a sip of water
b. Ask if the child is still nauseous before giving the medication
c. Recognize that these are possible signs of toxicity and withhold the medication
d. Give half the dose and make a note that the pulse is lower than normal
c. Recognize that these are possible signs of toxicity and withhold the medication
- features of digoxin toxicity are nausea, vomiting, abdominal pain, headache, dizziness, confusion, delirium, vision disturbance (blurred or yellow vision)
The mother of a child with a heart defect is questioning the nurse about the child’s medication. The nurse explains that Aldactone:
Select one:
a. Promotes vascular relaxation
b. Produces rapid diuresis
c. Blocks reabsorption of sodium and water in the renal tubules
d. Is a potassium sparing diuretic
d. Is a potassium sparing diuretic
- Aldactone (spironolactone) is a potassium-sparing diuretic that prevents your body from absorbing too much salt and keeps your potassium levels from getting too low.
The nurse is assessing a 3 year-old with congestive heart failure, weighing 10 kg, prior to administering the 10 mg Lasix IV. The nurse notes bilateral lung crackles, a blood pressure of 120/80, urine output of 350 ml over the last 24 hours, and a potassium level of 2.9. Which of these findings is a contraindication to giving the Lasix?
Select one:
a. Potassium level of 2.9
b. Blood pressure of 120/80
c. Bilateral lung crackles
d. Urine output of 350 mL over the last 24 hours
a. Potassium level of 2.9
The nurse is receiving morning shift report on the four children she will be caring for today. The nurse determines that the child she should assess first is:
Select one:
a. A two year-old admitted yesterday morning with bronchiolitis
b. A three year-old child with Tetrology of Fallot who had 2 hypercyanotic spells since admission late last evening
c. A five year-old with Kawasaki disease admitted three hours ago for IVIG infusion
d. A fifteen month-old with a VSD scheduled for surgery tomorrow
b. A three year-old child with Tetrology of Fallot who had 2 hypercyanotic spells since admission late last evening
When reviewing pediatric cardiac medications the student nurse notes that ACE inhibitors
1. Cause vasoconstriction and decreased sodium excretion
2. Block the conversion of angiotension I to angiotensin II
3. Enhance cardiac output
4. Reduce peripheral resistance
Choose from the following:
Select one:
a. 2,3
b. 2,4
c. 1,2,4
d. 2,3,4
d. 2,3,4
Which of the following should the nurse consider when having informed consent forms signed for surgery and procedures on children?
A. Only a parent or legal guardian can give consent.
B. The person giving consent must be at least 18 years old.
C. The risks and benefits of a procedure are part of the consent process.
D. A mental age of 7 years or older is required for a consent to be considered “informed.”
C. The risks and benefits of a procedure are part of the consent process.
The informed consent must include the nature of the procedure, benefits and risks, and alternatives to the procedure. In special circumstances, such as emancipated minors, the consent can be given by someone younger than age 18 years without the parent or legal guardian. A mental age of 7 years is too young for consent to be informed.
The nurse is planning how to prepare a 4-year-old child for some diagnostic procedures. Guidelines for preparing this preschooler should include which of the following?
A. Keep equipment out of the child’s view.
B. Plan for a short teaching session of about 30 minutes.
C. Tell the child procedures are never a form of punishment.
D. Use correct scientific and medical terminology in explanations
C. Tell the child procedures are never a form of punishment.
Preschoolers may view illness and hospitalization as punishment. Always state directly that procedures are never a form of punishment. Demonstrate the use of equipment and allow the child to play with miniature or actual equipment. Teaching sessions for this age group should be 10 to 15 minutes in length. Explain the procedure and how it affects the child in simple terms.
The nurse is preparing a 12-year-old girl for a bone marrow aspiration. She tells the nurse she wants her mother with her “like before.” The most appropriate nursing action is to
A. grant her request.
B. explain why this is not possible.
C. identify an appropriate substitute for her mother.
D. offer to provide support to her during the procedure.
A. grant her request.
The parents’ preferences for assisting, observing, or waiting outside the room should be assessed, as well as the child’s preference for parental presence. The child’s choice should be respected. If the mother and child agree, then the mother is welcome to stay. An appropriate substitute for the mother is necessary only if the mother does not wish to stay. Support is offered to the child regardless of parental presence.
Which of the following would be helpful word(s) to substitute for the word “shot” when working with a 4-year-old? A. Stick B. Bee sting C. Injection D. Medication under the skin
D. Medication under the skin
“Medication under the skin” clearly and simply describes what will be occurring. A 4-year-old child is in the stage of preoperational thought. The child may literally think the nurse is going to use a stick. This could be frightening to a child at this age. Most likely, there would be no prior experience with a bee sting. “Injection” is a technical term that the child may not understand. It could add additional anxiety.
When should clear liquids be stopped before scheduled surgery?
A. Two hours before surgery \
B. Six hours before surgery
C. The night before surgery at 8 PM
D. The night before surgery at midnight
A. Two hours before surgery \
Clear liquids can be given up to 2 hours before surgery to children of any age without risk of aspiration. Six hours is the recommended waiting time for infant formula, nonhuman milk, and light meals. Clear liquids can be given up to 2 hours before surgery to children of any age without risk of aspiration.
Which of the following is a potential cause of a postoperative decrease in blood pressure? A. Shock (early sign) B. Carbon dioxide retention C. Vasodilating anesthetic agents D. Increased intracranial pressure
C. Vasodilating anesthetic agents
Anesthetic agents and opioids can contribute to a decrease in blood pressure in the postoperative period. Decreased blood pressure is a late sign of shock. Carbon dioxide retention results in increased blood pressure. Increased intracranial pressure results in increased blood pressure
The nurse is caring for an unconscious 10-year-old child. Skin care should include which of the following?
A. Avoid use of a pressure-reduction device on the bed.
B. Massage reddened bony prominences to prevent deep tissue damage.
C. Use a draw sheet to move the child in bed to reduce friction and shearing injuries.
D. Avoid rinsing the skin after cleansing with mild antibacterial soap to provide a protective barrier.
C. Use a draw sheet to move the child in bed to reduce friction and shearing injuries.
A draw sheet should be used to move the child in the bed or onto a gurney to reduce friction and shearing injuries. Do not drag the child from under the arms. Pressure-reduction devices should be used to redistribute weight. Bony prominences should not be massaged if reddened. Deep tissue damage can occur. Pressure-reduction devices should be used instead. The skin should be cleansed with mild nonalkaline soap or soap-free cleaning agents for routine bathing.
An appropriate intervention to encourage food and fluid intake in a hospitalized child is which of the following?
A. Force the child to eat to combat caloric losses.
B. Administer large quantities of flavored fluids at frequent intervals.
C. Give high-quality foods and snacks whenever the child expresses hunger.
D. Discourage participation in noneating activities until caloric intake is sufficient.
C. Give high-quality foods and snacks whenever the child expresses hunger.
A 3-year-old child has a fever. Her mother calls the nurse reporting a fever of 38.8º C (102º F) even though the child had acetaminophen 2 hours ago. The nurse’s action should be based on which of the following?
A. Fevers such as this are common with viral illnesses.
B. Temperatures this high indicate greater severity of illness.
C. Fevers over 102º F indicate a probable bacterial infection.
D. Seizures are common in children when antipyretics are ineffective.
A. Fevers such as this are common with viral illnesses.
Most fevers are of brief duration, with limited consequences, and are viral. Neither the increase in temperature nor its response to antipyretics indicates the severity or etiology of infection. Little evidence supports the use of antipyretic drugs to prevent febrile seizures.
The nurse wears gloves during a dressing change. When the gloves are removed, the nurse should do which of the following?
A. Wash hands thoroughly.
B. Check the gloves for leaks.
C. Rinse gloves in disinfectant solution.
D. Apply new gloves before touching the next patient.
A. Wash hands thoroughly.
A 2-year-old child is being admitted to the hospital for possible bacterial meningitis. When preparing for a lumbar puncture, the nurse should do which of the following?
A. Place the child in a side-lying position.
B. Set up a tray with equipment the same size as for adults.
C. Apply EMLA to the puncture site 15 minutes before the procedure.
D. Reassure the parents that the test is simple, painless, and risk free.
A. Place the child in a side-lying position.
Which of the following is an important nursing intervention when performing a bladder catheterization on a young boy?
A. Insert 2% lidocaine lubricant into the urethra.
B. Clean technique, not Standard Precautions, is needed.
C. Lubricate the catheter with water-soluble lubricant such as K-Y Jelly.
D. Delay catheterization for 20 minutes while anesthetic lubricant is absorbed.
A. Insert 2% lidocaine lubricant into the urethra.
The nurse needs to do a heel stick on an ill neonate to obtain a blood sample. Which of the following is recommended to facilitate this? A. Elevate the foot for 5 minutes. B. Apply a tourniquet to the ankle. C. Apply cool, moist compresses. D. Wrap the foot in a warm washcloth.
D. Wrap the foot in a warm washcloth.
Before the blood sample is taken, the heel is heated with warm moist compresses for 5 to 10 minutes to dilate the blood vessels in the area. Elevating the foot will decrease the blood in the foot available for collection. A tourniquet is used to constrict superficial veins. It will have an insignificant effect on capillaries. Cooling causes vasoconstriction, making blood collection more difficult.
When giving liquid medication to a crying 10-month-old infant, which approach minimizes the possibility of aspiration?
A. Keep the child upright with the nasal passages blocked for 1 minute after administration.
B. Mix the medication with the infant’s regular formula or juice and administer by bottle.
C. Administer the medication with a cup as rapidly as possible with the infant securely restrained.
D. Administer the medication with a syringe (without needle) placed along the side of the infant’s tongue
D. Administer the medication with a syringe (without needle) placed along the side of the infant’s tongue
Administering the medication with a syringe (without a needle) placed along the side of the infant’s tongue allows the contents to be administered slowly in small amounts. The child is able to swallow between deposits. Holding the child’s nasal passages will increase the risk of aspiration. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking or eating, it is difficult to determine how much medication was consumed. Essential foods also should not be used. Medications should be given slowly to avoid aspiration.
When administering a gavage feeding to a school-age child, the nurse should do which of the following?
A. Administer feedings over 5 to 10 minutes.
B. Position the child on the right side after administering the feeding.
C. Check the placement of the tube by inserting 20 ml of sterile water.
D. Lubricate the tip of the feeding tube with Vaseline to facilitate passage.
B. Position the child on the right side after administering the feeding.
Position the child with the head elevated about 30 degrees and on the right side or abdomen for at least 1 hour. This is in the same manner as after any infant feeding to minimize the possibility of regurgitation and aspiration. Feedings should be administered via gravity flow and take from 15 to 30 minutes to complete. With a syringe attached to the feeding tube, apply negative pressure. Aspiration of stomach contents indicates proper placement. Then inject a small amount of air into the tube while simultaneously listening with a stethoscope over the stomach area. Insert the tube that has been lubricated with sterile water or water-soluble lubricant.
The nurse is assessing a 6-month-old healthy infant who weighed 3.2 kg at birth. The nurse should expect the infant to now weigh approximately how many kilograms? A. 5.2 B. 6.3 C. 8.7 D. 9.6
B. 6.3
Birth weight doubles at about ages 5 to 6 months. At 6 months, a child who weighed 3.2 kg at birth would weigh approximately 6.3 kg. The infant would have gone from the 50th percentile at birth to below the 5th percentile; 5.2 kg is too little. The infant would have tripled the birth weight by 6 months; 8.7 kg to 9.6 kg is too much.
Which of the following reflexes appear at about 7 to 9 months of age? A. Moro B. Parachute C. Neck righting D. Labyrinth righting
B. Parachute
The parachute reflex appears at 7 to 9 months of age and persists indefinitely. The Moro reflex is one of the primitive reflexes present at birth. Neck righting appears at 3 months of age and persists until 24 to 36 months. Labyrinth righting appears at 2 months and is strongest at 10 months
In terms of fine motor development, what should an infant of 7 months be able to do?
A. Transfer objects from one hand to the other.
B. Use the thumb and index finger in crude pincer grasp.
C. Hold a crayon and make a mark on paper.
D. Release cubes into a cup.
A. Transfer objects from one hand to the other.
The ability to transfer objects from one hand to another occurs at about age 7 months. The infant can use one hand for grasping and hold a cube in the other at the same time. A crude pincer grasp develops by ages 8 to 9 months. The ability to hold a crayon and mark on a piece of paper develops between ages 12 and 15 months. Infants can release a cube into a cup at ages 9 to 12 months.
The nurse is assessing a 6-month-old infant who has head lag. The nurse should recognize which of the following?
A. This is normal.
B. The child is probably cognitively impaired.
C. Developmental-neurologic evaluation is needed.
D. The parent needs to work with the infant to stop head lag
C. Developmental-neurologic evaluation is needed.
Most infants have only slight head lag when pulled from a lying to a sitting position at 4 months of age. By 6 months, head control should be well established. Developmental-neurologic evaluation is indicated to determine why the child is not achieving an expected milestone. The head lag is suggestive of a developmental delay. It does not provide information about cognitive status. As part of normal development, interventions cannot be done until a cause is identified.
According to Erikson, infancy is concerned with acquiring a sense of which of the following? A. Trust B. Industry C. Initiative D. Autonomy
A. Trust
During the first year of life, the infant focuses on the task of developing a sense of trust of self, of others, and of the world. This presents challenges for infants who are separated from parents or consistent caregivers. Industry is the focus of school-age children. Preschoolers are engaged in acquiring initiative. Autonomy is a developmental task during the toddler years.
Which of the following behaviors indicates that an infant has developed object permanence?
A. Secures objects by pulling on a string
B. Actively searches for a hidden object
C. Recognizes familiar face, such as mother
D. Recognizes familiar object, such as bottle
B. Actively searches for a hidden object
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 an object exists even when it is not visible. The ability to understand cause and effect is part of secondary schema development, which is a later developmental task. Between ages 8 and 12 weeks, infants begin to respond differentially to their mothers. They cry, smile, vocalize, and show distinct preference for the mother. This preference is one of the stages that influences the attachment process but is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object
The parent of a 10-week-old infant tells the nurse, “She cries sometimes when nothing is wrong—for example, when she is dry and has recently been fed.” The most appropriate nursing intervention is which of the following?
A. Reassure the parent that nothing is wrong.
B. Explain how to better interpret infant cues.
C. Evaluate for failure of the parent to bond with the infant.
D. Reassure the parent that periods of “unexplained fussiness” are normal
D. Reassure the parent that periods of “unexplained fussiness” are normal
A crying infant can be a source of great distress for parents. There is great variability in the amount of crying that can be expected from an infant. Parents should be reassured that some crying without apparent cause is normal. Persistent and inconsolable crying may need further attention. Reassuring the parent that nothing is wrong negates the parent’s concern about the child. The parent is responding to cues from the infant by feeding and changing diapers. There is no evidence that an attachment issue exists. The parent is seeking information about how to care for the infant.
Sara, age 4 months, was born at 35 weeks of 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 full term. The nurse should explain that
A. infants tend to become more difficult over time.
B. infants become less difficult if they are kept on scheduled feedings and structured routines.
C. Sara’s behavior is suggestive of failure to completely bond with her parents.
D. Sara’s difficult temperament is the result of painful experiences in the neonatal period.
B. infants become less difficult if they are kept on scheduled feedings and structured routines.
Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. 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. 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.
The nurse is guiding parents in selecting a daycare facility for their child. Which of the following is especially important to consider when making the selection?
A. Health practices of the facility
B. Structured learning environment
C. Socioeconomic status of the children
D. Cultural similarities of the children
A. Health practices of the facility
Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when hand washing and other hygienic measures are not consistently used. A structured learning environment is not the highest priority for a child this age. The socioeconomic status of the children should have little effect on the choice of facility. Cultural similarities may be important to some families, but the facility’s health care practices are more important.
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 formula without iron. D. commercial iron-fortified formula
D. commercial iron-fortified formula
For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, then 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.
What information should the nurse give a mother regarding the introduction of solid foods during infancy?
A. Fruits and vegetables should be introduced into the diet first.
B. Foods should be introduced one at a time at intervals of 5 to 7 days.
C. Solid foods can be mixed in a bottle to make the transition easier for the infant.
D. Solid foods should not be introduced until 8 to 10 months when the extrusion reflex begins to disappear.
B. Foods should be introduced one at a time at intervals of 5 to 7 days.One food item is introduced at intervals of 5 to 7 days to allow the identification of food allergies. Iron-fortified cereal should be the first solid food introduced into the infant’s diet. Mixing solid foods in a bottle has no effect on the transition to solid food. Solid foods can be introduced earlier than 8 to 10 months. The extrusion reflex usually disappears by age 6 months.
The parents of a 3-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. Which of the following should the nurse suggest to help them deal with this problem?
A. Let her cry herself back to sleep.
B. Put her in parents’ bed to cuddle.
C. Start putting her to bed while still awake and while the parent is present.
D. Give her a bottle of formula instead of breastfeeding her so often at night.
C. Start putting her to bed while still awake and while the parent is present.
Current research suggests that parents be present at bedtime until the child is drowsy. The child should then be allowed to fall asleep alone. This encourages self-soothing behaviors. Children who learn to fall asleep on their own have longer sustained sleep periods than those who fall asleep with parents present. Letting the child cry herself back to sleep is difficult to implement for many parents. Co-bedding could be unsafe at this age. The type of feeding will not affect the child’s sleep pattern.
Which of the following vaccines is recommended for administration at birth? A. MMR (measles, mumps, and rubella) B. Hepatitis B C. Hepatitis A D. Haemophilus influenzae type b (Hib)
B. Hepatitis B
Hepatitis B immunization is recommended early. Hepatitis B virus infections that occur during childhood can lead to fatal consequences from cirrhosis or liver cancer during adulthood. MMR is recommended for children ages 12 to 15 months. The hepatitis A series should begin between 12 and 23 months. Hib is administered beginning at age 2 months.
The clinic is loaning a federally approved car seat to a 10-lb (4.5-kg) infant’s family. The nurse should explain that the safest place to put the car seat is in the
A. back seat facing forward.
B. middle of the back seat facing rearward.
C. front seat with airbags on passenger side.
D. front seat if there is no air bag on the passenger side.
B. middle of the back seat facing rearward.
The rear-facing car seat provides the best protection for an infant’s disproportionately heavy head and weak neck in the event of an accident. The middle of the back seat is the safest position for the child. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat
Myelination of the spinal cord is almost complete by 2 years of age. As a result of this, which of the following can gradually be achieved?
A. Visual acuity of 20/20
B. Throwing a ball without falling
C. Respirations becoming diaphragmatic
D. Control of anal and urethral sphincters
D. Control of anal and urethral sphincters
With complete myelination of the spinal column, voluntary control of elimination occurs. Control of anal and urethral sphincters is gradually achieved. Visual acuity is acceptable at 20/40. Throwing a ball without falling is achieved by 18 months of age. Respirations remain abdominal in this age-group.
Which of the following is descriptive of toddlers’ cognitive development at age 20 months?
A. Realize that “out of sight” is not out of reach.
B. Search for an object only if they see it hidden.
C. Put objects into a container but cannot take them out.
D. Understand the passage of time, such as “just a minute” and “in an hour.”
A. Realize that “out of sight” is not out of reach.
At this age, children are in the final sensorimotor stage. They 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. When a child is able to put objects into a container but cannot take them out, this is indicative of tertiary circular reactions, which appear between the ages of 13 and 18 months. An embryonic sense of time exists; although children may behave appropriately to time-oriented phrases, their sense of timing is exaggerated.
Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. Which of the following is the best interpretation of this behavior?
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.
B. This is typical behavior because toddlers are egocentric.
Play develops from the solitary play of infancy to the parallel play of toddlers. A toddler plays alongside other children, not with them. When a child grabs a toy from another child, it is typical behavior of the toddler and is not intentionally aggressive. Shared play is not within their cognitive development. Toddlers do not conceptualize shared play. Because a 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.
A toddler’s parent asks the nurse for suggestions on dealing with temper tantrums. Which one of the following is the most appropriate recommendation?
A. Punish the child.
B. Explain to the child why the tantrum is wrong.
C. Leave the child alone until the tantrum is over.
D. Remain close by the child but ignore the behaviors.
D. Remain close by the child but ignore the behaviors.
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 overwhelmed by increasingly complex tasks. 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.
Which statement characterizes toddlers’ eating behavior?
A. Food fads are common.
B. They have increased appetite.
C. They have few food preferences.
D. Their table manners are predictable.
A. Food fads are common.
Appetite and food preferences are sporadic during the toddler years. The child may enjoy the same food several days in a row and then refuse to eat it. It is difficult to change the food fad. At approximately 18 months of age, toddlers have decreased nutritional needs. This is labeled physiologic anorexia. Toddlers have distinct food preferences that may not be consistent or predictable. At the toddler age, sitting at a table for a meal may be more disruptive than functional.
Recommendations for parents of toddlers to meet fluoride requirements include all of the following except
A. supervise the use of toothpaste.
B. supervise the use of fluoride rinses.
C. store fluoride products out of reach.
D. administer fluoride supplements if water fluoride content is low.
B. supervise the use of fluoride rinses.
Fluoride rinses are only suggested for children at high risk for cavities or over the age of 6 years. Toothpaste supervision, storage of fluoride products out of reach, and administration of fluoride supplements if water fluoride content is low are all recommended for toddlers.
A parent has a 2-year-old child in the clinic for a well-child checkup. Which of the following statements by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention?
A. “We locked all the medicines in the bathroom cabinet.”
B. “We turned the thermostat down on our hot water heater.”
C. “We placed gates at the top and bottom of the basement steps.”
D. “We stopped using the car seat now that our child is older.”
D. “We stopped using the car seat now that our child is older.”
Convertible car seats are necessary until the child is at least 18 kg (40 lb). Booster seats are required until the child is 36.2 kg (80 lb). Locking medicines in the bathroom cabinet will help prevent the child from accidentally ingesting medicines. Decreasing the temperature on the water heater can help prevent burns. Gates are appropriate to keep the toddler from falling down the stairs.
In terms of fine motor development, what could a 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. Draw single-line shapes such as circles.
D. Draw single-line shapes such as circles.
Three-year-old children are able to draw single-line shapes such as circles. A 5-year-old child’s fine motor skills include the ability to tie shoelaces, use scissors or a pencil, and draw a person with seven to nine parts.
Which of the following is descriptive of a preschooler’s concept of time?
A. Has no understanding of time
B. Associates time with events
C. Can tell time on a clock
D. Uses terms such as “yesterday” appropriately
B. Associates time with events
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.
Imaginary playmates are beneficial to the preschool child because they do which of the following?
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.
C. Become friends in times of loneliness.
One purpose of an imaginary friend is to be a friend in times 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. Imaginary friends accomplish what the child is still attempting.
When preparing parents to teach their children about human sexuality, the nurse should emphasize which of the following?
A. Parents should determine exactly what the child knows and wants to know before answering a question about sex.
B. A parent’s words may have a greater influence on the child’s understanding than the parent’s actions.
C. Parents should avoid using correct anatomic terms because they are confusing to preschoolers.
D. Parents should allow children to satisfy their sexual curiosity by “playing doctor.”
A. Parents should determine exactly what the child knows and wants to know before answering a question about sex.
Parents should be told that there are two rules that should be followed: find out what the child knows and be honest. Parents should model sexual behavior that is consistent with what they are teaching their children. Anatomic terms, although sometimes difficult to pronounce, will lay the groundwork for honest discussions later. Parents should not condone or condemn “playing doctor,” which is an extension of curiosity.
Preschoolers’ fears can best be dealt with by which of the following interventions?
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 that they understand that there is no need to be afraid
A. Actively involving them in finding practical methods to deal with the frightening experience
Actively involving preschoolers in finding methods to deal with frightening experiences 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 fears does not make them go away.
Which of the following statements accurately describes physical development during the school-age years?
A. The child’s weight almost triples.
B. The child grows an average of 5 cm (2 inches) per year.
C. Few physical differences are apparent among children of different genders at the end of middle childhood.
D. Fat gradually increases, which contributes to the child’s heavier appearance
B. The child grows an average of 5 cm (2 inches) per year.
In middle childhood, growth in height and weight occurs at a slower pace. Between the ages of 6 and 12 years, children grow 5 cm (2 inches) per year. In middle childhood, children’s weight will almost double; they gain 3 kg (6.6 lb) per year. At the end of middle childhood, girls grow taller and gain more weight than boys. Children take on a slimmer look with longer legs in middle childhood.
Which of the following is characteristic of the psychosocial development of school-age children?
A. Peer approval is not yet a motivating power.
B. A developing sense of initiative is very important.
C. Motivation comes from extrinsic rather than intrinsic sources.
D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.
D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.
A sense of industry, or accomplishment, is achieved between the ages of 6 years and adolescence. Erikson labels this stage as industry versus inferiority. Interaction with peers is a source of satisfaction for school-age children. Initiative is the developmental task of the preschooler. Intrinsic motivation is associated with increased competence in mastering skills.
Which of the following 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 place things in a logical order, to group and sort, and to hold a concept in their minds while making decisions based on that concept.
D. Have the ability to place things in a logical order, to group and sort, and to 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 are skills of adolescents. Progressing from making judgments based on what school-age children reason to making judgments based on what they see is not a developmental skill.
Which of the following describes moral development in younger school-age children?
A. The standards of behavior now come from within themselves.
B. They do not yet experience a sense of guilt when they misbehave.
C. They know the rules and behaviors expected of them but do not understand the reasons behind them.
D. They no longer interpret accidents and misfortunes as punishment for misdeeds
C. They know the rules and behaviors expected of them but do not understand the reasons behind them.
Children who are ages 6 and 7 years know the rules and behaviors expected of them but do not understand the reasons for these rules and behaviors. 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.
A group of boys ages 9 and 10 have formed a “boys only” club that is open to neighborhood and school friends who have skateboards. This should be interpreted as which of the following?
A. Behavior that encourages bullying and sexism
B. Behavior that reinforces poor peer relationships
C. Characteristic of social development of this age
D. Characteristic of children who are later at risk for membership in gangs
C. Characteristic of social development of this age
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. Forming a boys-only club at this age does not have a direct correlation with later gang activity.
Bullying can be common during the school-age years. The nurse should recognize that bullying
A. can have a lasting effect on children.
B. is not a significant threat to self-concept.
C. is rarely based on anything that is concrete.
D. is usually ignored by the child who is being teased.
A. can have a lasting effect on children.
Bullying in this age-group is common and can have a long-lasting effect. Increasing awareness of differences, especially when accompanied by unkind comments and taunts from others, may make a child feel inferior and undesirable. Physical impairments such as hearing or visual defects, ears that “stick out,” or birth marks assume great importance.
Which of the following should the nurse include when giving parents guidelines about helping their children in school?
A. Punish children who fail to perform adequately.
B. Help children as much as possible with their homework.
C. Communicate with teachers if there appears to be a problem.
D. Accept responsibility for children’s successes and failures.
C. Communicate with teachers if there appears to be a problem.
Communication between the parent and teachers is essential. It demonstrates that parents consider school important and that education is a shared responsibility. Excessive pressure or lack of encouragement from parents can inhibit the development of the child’s maximum potential. Children need to be responsible for their schoolwork. By being responsible, children learn to meet deadlines and be successful.
Sleep problems in school-age children are often demonstrated by
A. night terrors that awaken them.
B. delaying tactics because they do not wish to go to bed.
C. somatic illness that awakens them.
D. increasing need for sleep time as they get older.
B. delaying tactics because they do not wish to go to bed.
Children in middle childhood must be reminded to go to sleep. Older children up to age 11 years are particularly resistant, and they may demonstrate delaying tactics because they do not wish to go to bed. Night terrors are common in the preschool-age child. If somatic illness is present, a thorough assessment is indicated. The amount of sleep needed decreases as children get older.
