Promoting Health from Conception Through Adolescence (21)

Question 1

The parent of an 8-month-old girl who has been admitted to the hospital with pneumonia is worried about the infant having sudden infant death syndrome (SIDS). The parent stated that “My sister’s baby died at the age of 2 months and all he had was a little cold.” Which is the nurse’s best response?

1. ) “You don’t need to worry. Your daughter is too old for SIDS.”
2. ) “Girls are less likely to have SIDS than boys are.”
3. ) “We don’t know what causes SIDS, so I would try not to worry about it.”
4. ) “You must be very anxious; let’s talk about SIDS and what you are thinking.”

Answer 1

4.) “You must be very anxious; let’s talk about SIDS and what you are thinking.”

Providing opportunities for the parent to express worries and discuss facts about SIDS gives more control over the situation. The nurse can also provide her with information about the Back to Sleep campaign. Option 1: The highest incidence of SIDS occurs between 2 and 4 months of age, but it does occur in older in- fants. It is not the best response because it provides facts but does not address the parent’s immediate concerns. Option 2: SIDS affects boys more than girls. However, this information is likely to increase anxiety and does not address the concerns of the parent. Option 3: There is no known cause of SIDS, although respiratory problems may be present in some infants. This response is insensitive to the needs of the mother.

Question 2

Four-year-old Angie, whose grandmother recently died, tells the nurse, “My grandma has wings just like angels. She flew to heaven yesterday and tomorrow she’ll be back.” Which is the nurse’s best response?

1. ) “She’s not coming back, honey.”
2. ) “It is normal for a little one to make believe.”
3. ) “You must miss your grandma a lot.”
4. ) “When people get old they die.”

Answer 2

3.) “You must miss your grandma a lot.”

Preschool-age children use fantasy and make-believe to learn about, understand, and master their environment, including their concepts of death. The child’s conceptualization of death is consistent with her cognitive development. The response in option 1 negates the child’s understanding and limits her ability to develop fuller understanding and adapt to the loss. Option 2 negates the child’s attempts to understand and deal with the loss. Option 4 is incorrect because at 4 years of age, children can hear explanations such as “when people get old they will die,” but these children do not have a firm grasp of the meaning of time and age, and probably will not understand.

Question 3

Because near-drowning is one of the leading causes of vegetative state in young children, which is the best instruction for the nurse to teach parents?

1. ) Supervise children at all times when near any source of water.
2. ) Enroll children in swimming classes at an early age to ensure water safety.
3. ) Make bathroom doors and toilets easily accessible and appropriate for a toddler’s size.
4. ) Allow unsupervised play only in “kiddy pools” designated for young children.

Answer 3

1.) Supervise children at all times when near any source of water.

It is the responsibility of adults to supervise children constantly and closely when around water. Option 2, learning water safety and how to swim, is important and should be encouraged at an early age, but that still does not ensure a child’s safety. Option 3 is incorrect because young children are at risk near any amount of water that can cover the nose and mouth. Option 4: Infants and toddlers can drown in a very small amount of water, even several inches in a bath-tub or “kiddie pool.”

Question 4

Which statement most accurately describes physical development during the school-age years?

1. ) Child’s weight almost triples.
2. ) Child acquires stereognosis.
3. ) Few physical changes occur during middle childhood.
4. ) Fat gradually increases, which contributes to the child’s heavier appearance.

Answer 4

2.) Child acquires stereognosis.

School-age children acquire stereognosis, the ability to identify an unseen object simply by touch. Option 1: Birth weight triples by about 12 months. Children enter school age weigh- ing about 45 pounds and gain about 5 to 7 pounds per year. Option 3: Significant physical change occurs during the school-age years. Option 4: Fat deposits do not normally appear until puberty.

Question 5

Females experience an increase in weight and fat deposition during puberty. Which nursing action is most appropriate to this age group?

1. ) Give reassurance that these changes are normal.
2. ) Suggest dietary measures to control weight gain.
3. ) Recommend increased exercise to control weight gain.
4. ) Encourage low-fat diet to prevent fat deposition.

Answer 5

1.) Give reassurance that these changes are normal.

Increased fat deposits are normal as girls begin hormonal changes of puberty. During this stage of development, females become very sensitive about their appearance and need reas- surance. Option 2: Puberty is a period when children become more self-conscious of their appearance. They need to be reassured that normal weight gain and body changes with fat deposits are to be expected. The nurse would need to perform further individual assessments before determining if a weight problem existed. Option 3: Regular strenuous exercise should be a part of the healthy adolescent’s lifestyle, but its

goal should be to provide energy and strength, not to control weight. Option 4: Dieting and efforts to lose weight can threaten the health of adolescents. This intervention lacks scientific evidence. Unless an actual or potential disease process exists, a balanced diet is most appropriate.

Question 6

A night shift nurse notices that a postpartum (after delivery of a baby) client is crying and rubbing her baby’s head. The mother states, “Look how lopsided my little Sam’s head is. It is all my fault. My mom told me that I should have laid down more instead of sitting. Now, Sam’s head is all smashed and funny looking.” Which is the best response by the nurse?

1. ) “Do you mean to tell me that your mother told you that? Are you serious?”
2. ) “The head is soft and changed shape as it moved through the birth canal.”
3. ) “I will provide you with materials to read that will clear that up for you.”
4. ) “There is no need to cry. His head will return to normal in a few days.”

Answer 6

2.) “The head is soft and changed shape as it moved through the birth canal.”

Many newborn babies have a misshapen head because of the molding made possible by fontanels in the bone structure of the skull and overriding of the sutures. This asymmetry is usually corrected within the first 7 to 10 days. Option 1: The client is crying and upset; the nurse’s response needs to be more sensitive and caring. Option 3: Educational materials are not appropriate for a client who is crying and emotionally upset. Option 4: The client is concerned about the misshapen head right now. The most appropriate interven- tion should focus on relieving the current emotional state.

Question 7

During a physical examination a 24-month-old child clings to
the parent and cries every time the nurse attempts to touch her. From knowledge of psychosocial development, the nurse makes which conclusion about the child?

1. ) The child is displaying normal toddler development.
2. ) The child needs further psychological evaluation.
3. ) The child is manipulative and should be taken from the parent to be examined.
4. ) The child is showing signs of regression.

Answer 7

1.) The child is displaying normal toddler development.

Although toddlers like to explore the environment, they always need to have a significant person nearby. Parents need to know that young children experience acute separation anxiety and that abandonment is their greatest fear. Option 2: This is normal toddler development. Option 3: Child is probably not old enough to perform manipulative-type strategies. Option 4: This is normal behavior for this age group.

Question 8

After falling off playground equipment, a 5-year-old is brought to the emergency department with a broken arm. The parents ask for ways to keep her occupied while wearing the cast. Which is the best response by the nurse?

1. ) “You will need to talk to the primary care provider about this.”
2. ) “Let her watch television or do puzzles and other quiet games.”
3. ) “Activities that do not involve the use of the arm or risk damage to the cast are okay.”
4. ) “She can ride a bike, jump rope, or play with friends if you watch her closely.”

Answer 8

3.) “Activities that do not involve the use of the arm or risk damage to the cast are okay.”

The child can perform regular activities as long as the injured arm and the cast are not placed in jeopardy. Option 1: A competent nurse could answer this question. Option 2: A 5-year- old needs to be physically active. This would be more appropriate for health problems in which moving about could prevent healing or cause injury. Limiting a preschooler to only sitting activities is unrealistic. Option 4: Riding a bike and jumping rope could place the client at risk for injury.

Question 9

According to Piaget’s theory of cognitive development, the movement from intuitive reasoning to logical reasoning in school-age children is called the concrete operations phase. Which is an example of this phase?

1. ) A science-fair project comparing how fast different objects fall from a set height
2. ) Feeling responsible for wishing that a sibling would go away, and now that sibling is ill and hospitalized
3. ) Understanding how geometric figures might fit into a futuristic and idealistic world
4. ) Learning to ride a bike

Answer 9

1.) A science-fair project comparing how fast different objects fall from a set height

During the phase of concrete operations, children change from egocentric interactions to cooperative interactions. They also develop an increased understanding of concepts that are associated with specific objects. They learn to add and subtract and understand cause-and-effect relationships. Option 2 action is indicative of the pre- conceptual phase—an egocentric approach that uses magical thinking. Option 3 action is indicative of the formal operations phase—reasoning is deductive and futuristic. Option 4 is indicative of physical growth.

Question 10

Parents ask the nurse how they will know that their daughter has reached puberty. Which is the best response by the nurse?

1. ) “The first noticeable sign of puberty in females is appearance of the breast bud.”
2. ) “The growth spurt usually begins between ages 10 and 14.”
3. ) “The apocrine glands, found over most of the body, begin to produce sweat.”
4. ) “The adolescent will display significant mood swings.”

Answer 10

1.) “The first noticeable sign of puberty in females is appearance of the breast bud.”

Often the first noticeable sign of puberty in females is the appearance of the breast bud, although the appearance of hair along the labia may precede this. Option 2: The growth spurt in girls is between ages 10 and 14, but is too vague to be noticeable. Option 3: The eccrine glands are found over most of the body and produce sweat. The apocrine glands develop in the axillae, anal and genital areas, external auditory canals, and around the umbilicus and the areola of the breasts. Option 4: Mood swings are not as definitive as physical changes.