Unit 1 - Growth and Development

Question 1

Which statement best describes development in infants and children?

• a. Development, a predictable and orderly process, occurs at varying rates within normal limits.
• b. Development is primarily related to the growth in the number and size of cells.
• c. Development occurs in a proximodistal direction with fine muscle development occurring first.
• d. Development is more easily and accurately measured than growth.

Answer 1

ANS: A

A Development, a continuous and orderly process, provides the basis for increases in the child’s function and complexity of behavior. The increases in rate of function and complexity can vary normally within limits for each child.

B An increase in the number and size of cells is a definition for growth.

C Development proceeds in a proximodistal direction with fine muscle organization occurring as a result of large muscle organization.

D Development is a more complex process that is affected by many factors; therefore it is less easily and accurately measured. Growth is a predictable process with standard measurement methods.

Question 2

Frequent developmental assessments are important for which reason?

• a. Stable developmental periods during infancy provide an opportunity to identify any delays or deficits.
• b. Infants need stimulation specific to the stage of development.
• c. Critical periods of development occur during childhood.
• d. Child development is unpredictable and needs monitoring.

Answer 2

ANS: C

A Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress.

B Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage.

C Critical periods are blocks of time during which children are ready to master specific developmental tasks. Children can master these tasks more easily during particular periods of time in their growth and developmental process.

D Normal growth and development is orderly and proceeds in a predictable pattern on the basis of each individual’s abilities and potentials.

Question 3

Which factor has the greatest influence on child growth and development?

• a. Culture
• b. Environment
• c . Genetics
• d. Nutrition

Answer 3

ANS: C

A Culture is a significant factor that influences how children grow toward adulthood. Culture influences both growth and development but does not eliminate inborn genetic influences.

B Environment has a significant role in determining growth and development both before and after birth. The environment can influence how and to which extent genetic traits are manifested, but environmental factors cannot eliminate the effect of genetics.

C Genetic factors (heredity) determine each individual’s growth and developmental rate. Although factors such as environment, culture, nutrition, and family can influence genetic traits, they do not eliminate the effect of the genetic endowment, which is permanent.

D Nutrition is critical for growth and plays a significant role throughout childhood.

Question 4

According to Piaget’s theory, the period of cognitive development in which the child is able to distinguish between concepts related to fact and fantasy, such as human beings are incapable of flying like birds, is which period?

• a. The sensorimotor period of cognitive development
• b. The formal operations period of cognitive development
• c. The concrete operations period of cognitive development
• d. The preoperational period of cognitive development

Answer 4

ANS: C

A The sensorimotor stage occurs in infancy and is a period of reflexive behavior. During this period the infant’s world becomes more permanent and organized. The stage ends with the infant demonstrating some evidence of reasoning.

B Formal operations is a period in development in which new ideas are created through previous thoughts. Analytic reason and abstract thought emerge in this period.

C Concrete operations is the period of cognitive development in which children’s thinking is shifted from egocentric to being able to see another’s point of view. They develop the ability to distinguish fact from fantasy.

D The preoperational stage is a period of egocentrism in which the child’s judgments are illogical and dominated by magical thinking and animism.

Question 5

The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is:

• a. Erikson.
• b. Freud.
• c. Kohlberg.
• d. Piaget.

Answer 5

ANS: A

A Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled.

B Sigmund Freud proposed a psychosexual theory of development. He proposed that certain parts of the body assume psychological significance as foci of sexual energy. The foci shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of development.

C Lawrence Kohlberg described moral development as having three levels (preconventional, conventional, and postconventional). His theory closely parallels Piaget’s.

D Jean Piaget’s cognitive theory interprets how children learn and think and how this thinking progresses and differs from adult thinking. Stages of his theory include sensorimotor, preoperations, concrete operations, and formal operations.

Question 6

What does the nurse need to know when observing chronically ill children at play?

• a. Play is not important to hospitalized children.
• b. Children need to have structured play periods.
• c. Children’s play is a form of communication.
• d. Play is to be discouraged because it tires hospitalized children.

Answer 6

ANS: C

A Play is important to all children in all environments. Play for children is a mechanism for mastering their environment.

B Although children’s play activities appear to be unorganized and at times chaotic, play has purpose and meaning. Imposing structure on play interferes with the tasks being worked on.

C Play for all children is an activity woven with meaning and purpose. For chronically ill children, play can indicate their state of wellness and response to treatment. It is a way to express joy, fear, anxiety, and disappointments.

D Children who have fewer energy reserves still require play. For these children, less-active play activities will be important.

Question 7

Which child is most likely to be frightened by hospitalization?

• a. A 4-month-old infant admitted with a diagnosis of bronchiolitis
• b. A 2-year-old toddler admitted for cystic fibrosis
• c. A 9-year-old child hospitalized with a fractured femur
• d. A 15-year-old adolescent admitted for abdominal pain

Answer 7

ANS: B

A Young infants are not as likely to be frightened as toddlers by hospitalization because they are not as aware of the environment.

B Toddlers are most likely to be frightened by hospitalization because their thought processes are egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange environments.

C The 9-year-old child’s cognitive ability is sufficient enough for the child to understand the reason for hospitalization.

D The 15-year-old adolescent has the cognitive ability to interpret the reason for hospitalization.

Question 8

During a routine health care visit, a parent asks the nurse why her 9-month-old infant is not walking as her older child did at the same age. Which response by the nurse best demonstrates an understanding of child development?

• a. “She’s a little slow.”
• b. “If she is pulling up, you can help her by holding her hand.”
• c. “Babies progress at different rates. Your infant’s development is within normal limits.”
• d. “Maybe she needs to see a behavioral specialist.”

Answer 8

ANS: C

A The infant is within normal developmental limits. The statement is inappropriate for the nurse to make.

B Infants will walk when they are developmentally ready. “Hurrying” an infant does not result in the developmental task being achieved at an earlier time period.

C Ninety percent of infants walk by 14 months of age. (See DDST II in Appendix, which assesses for age-appropriate development in children from birth to age 6 years.)

D Consulting a behavioral specialist for diagnostic evaluation is indicated when a child demonstrates developmental delays. The child has no evidence of a delay.

Question 9

Which “expected outcome” would be developmentally appropriate for a hospitalized 4-year-old child?

• a. The child will be dressed and fed by the parents.
• b. The child will independently ask for play materials or other personal needs.
• c. The child will be able to verbalize an understanding of the reason for the hospitalization.
• d. The child will have a parent stay in the room at all times.

Answer 9

ANS: B

A Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior.

B Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrates developmental appropriateness.

C A 4-year-old child cannot be expected to cognitively understand the reason for hospitalization. Expecting the child to verbalize an understanding for hospitalization is an inappropriate outcome.

D Parents staying with the child throughout a hospitalization is an inappropriate outcome. Although children benefit from parental involvement, parents may not have the support structure to stay in the room with the child at all times.

Question 10

Which statement identifies an appropriate level of language development for a 4-year-old child?

• a. The child has a vocabulary of 300 words and uses simple sentences.
• b. The child uses correct grammar in sentences.
• c. The child is able to pronounce consonants clearly.
• d. The child uses language to express abstract thought.

Answer 10

ANS: B

A Simple sentences and a 300-word vocabulary are appropriate for a 2-year-old child.

B The 4-year-old child is able to use correct grammar in sentence structure.

C The 4-year-old child typically has difficulty in pronouncing consonants.

D The use of language to express abstract thought is developmentally appropriate for the adolescent.

Question 11

Which children are at greater risk for not receiving immunizations?

• a. Children who attend licensed daycare programs
• b. Children entering school
• c. Children who are homeschooled
• d. Young adults entering college

Answer 11

ANS: C

A All states require immunizations for children in daycare programs.

B All states require immunizations for children entering school.

C Home-schooled children are at risk for being underimmunized and need to be monitored.

D Most colleges require a record of immunizations as part of a health history.

Question 12

Which developmental assessment instrument is appropriate to assess a 5-year-old child?

• a. Brazelton Behavioral Scale
• b. Denver Developmental Screening Test II (DDST-II)
• c. Dubowitz Scale
• d. New Ballard Scale

Answer 12

ANS: B

A Brazelton’s Behavioral Scale is used for newborn assessment.

B The DDST-II is used for infants and children between birth and 6 years of age.

C The Dubowitz Scale is used for estimation of gestational age.

D The New Ballard Scale is used for newborn screening.

Question 13

A 2-month-old child has not received any immunizations. Which immunizations should the nurse give?

• a. DTaP, Hib, HepB, IPV, varicella
• b. DTaP, Hib, HepB, MMR, IPV, Rota
• c. DTaP, Hib, HepB, PCV, IPV, Rota
• d. DTaP, Hib, HepB, PCV, IPV, HepA

Answer 13

ANS: C

A The child should not receive varicella until at or after 12 months of age.

B MMR is not given to children until at or after 12 months of age.

C DTaP, Hib, HepB, PCV, IPV, and Rota are appropriate immunizations for an unimmunized 2-month-old child.

D HepA is recommended for all children at 1 year of age.

Question 14

Which immunizations can cause fever and rash to occur 1 to 2 weeks after administration?

a. HepB
b. DTaP

c . Hib

d. MMR

Answer 14

ANS: D

A HepB does not cause fever or rash.

B DTaP does not cause fever or rash

C Hib does not cause fever or rash.

D MMR is a live virus vaccine and can cause fever and rash 1 to 2 weeks after administration.

Question 15

Which is the preferred site for administration of the Hib vaccine to an infant?

a. Deltoid
b. Anterolateral thigh
c. Upper, outer aspect of the arm
d. Dorsal gluteal

Answer 15

ANS: B

A The deltoid muscle is not used for infants.

B The anterolateral thigh is the preferred site for intramuscular administration of vaccines for infants.

C Subcutaneous injections can be given in the upper arm. The HIB vaccine is given by the intramuscular route.

D The dorsal gluteal site is never used for vaccines.

Question 16

Which milestone is developmentally appropriate for a 2-month-old infant?

• a. Pulled to a sitting position, head lag is absent.
• b. Pulled to a sitting position, the infant is able to support the head when the trunk is lifted.
• c. Can lift head from the prone position and briefly hold the head erect.
• d. In the prone position, the infant is fully able to support and hold the head in a straight line.

Answer 16

ANS: C

A A 2-month-old infant’s neck muscles are stronger; however, head lag is present when pulled to a sitting position.

B A 2-month-old infant continues to have some head lag when pulled to a sitting position.

C A 2-month-old infant is able to briefly hold the head erect when in a prone position.

D It is not until 4 months of age that the infant can easily lift his or her head and hold it steadily erect when in the prone position.

Question 17

Approximately what would a newborn who weighed 7 pounds 6 ounces at birth weigh at 1 year of age?

• a. 14 3/4 lb
• b. 22 1/8 lb
• c. 29 1/2 lb
• d. Unable to estimate weight at 1 year

Answer 17

ANS: B

A An infant doubles the birth weight by 6 months of age.

B An infant triples the birth weight by 1 year of age.

C An infant quadruples the birth weight by 2 years of age.

D Weight at 6 months, 1 year, and 2 years of age can be estimated from the birth weight.

Question 18

Which statement made by a mother would be consistent with a developmental delay?

• a. “I have noticed that my 9-month-old infant responds consistently to the sound of his name.”
• b. “I have noticed that my 12-month-old child does not get herself to a sitting position or pull to stand.”
• c. “I am so happy when my 11/2-month-old infant smiles at me.”
• d. “My 5-month-old infant is not rolling over in both directions yet.”

Answer 18

ANS: B

A An infant who responds to his name at 9 months of age is demonstrating abilities to both hear and interpret sound.

B Critical developmental milestones for gross motor development in a 12-month-old include standing briefly without support, getting to a sitting position, and pulling to stand. If a 12-month-old child does not perform these activities, it may be indicative of a developmental delay.

C A social smile is present by 2 months of age.

D Rolling over in both directions is not a critical milestone for gross motor development until the child reaches 6 months of age.

Question 19

At a healthy 2-month-old infant’s well-child clinic visit, the nurse will give which immunization sequence? The child received hepatitis B #1 at birth and hepatitis B #2 at 1 month of age.

• a. DTaP, IPV, Hib, PCV, and Rota
• b. MMR, DTaP, and IPV
• c . Hib, DTaP, IPV, Hep B, and Rota
• d. Hib and MMR

Answer 19

ANS: A

A DTaP, IPV, Hib, PCV, and Rota are the appropriate immunizations for a healthy 2-month-old infant.

B MMR is given at or after 12 months of age.

C This is an incomplete sequence; PCV is also given at 2 months of age. The second dose of Hep B was given at 1 month of age. The third dose of hep B is due at 24 weeks of age.

D MMR is given to the infant at or after 12 months of age. DTaP, PCV, IPV, and Rota are also given to a healthy infant at 2 months of age.

Question 20

The nurse advises the mother of a 3-month-old exclusively breastfed infant to do what?

• a. Start giving the infant a vitamin D supplement.
• b. Start using an infant feeder and add rice cereal to the formula.
• c. Start feeding the infant rice cereal with a spoon at the evening feeding.
• d. Continue breastfeeding without any supplements.

Answer 20

ANS: A

A Breast milk does not provide an adequate amount of dietary vitamin D. Infants who are exclusively breastfed need vitamin D supplements to prevent rickets.

B An infant feeder is an inappropriate method of providing the infant with caloric intake. Solid foods are not recommended for a 3-month-old infant.

C Rice cereal and other solid foods are contraindicated in a 3-month-old infant. Solid feedings do not typically begin before 4 to 6 months of age.

D Because breast milk is not an adequate source of fluoride, infants need to be given a fluoride supplement.

Question 21

At what age would an infant first be expected to locate an object hidden from view?

a. 4 months of age
b. 6 months of age
c. 9 months of age
d. 20 months of age

Answer 21

ANS: C

A Four-month-old infants are not cognitively capable of searching out objects hidden from their view. Infants at this developmental level do not pursue hidden objects.

B Six-month-old infants have not developed the ability to perceive objects as permanent and do not search out objects hidden from their view.

C By 9 months of age an infant will actively search for an object that is out of sight.

D Twenty-month-old infants actively pursue objects not in their view and are capable of recalling the location of an object not in their view. They first look for hidden objects around age 9 months.

Question 22

The parents of a newborn infant state, “We will probably not have our baby immunized because we are concerned about the risk of our child being injured.” What is the best response for the nurse to make?

• a. “It is your decision.”
• b. “Have you talked with your parents about this? They can probably help you think about this decision.”
• c. “The risks of not immunizing your baby are greater than the risks from the immunizations.”
• d. “You are making a mistake.”

Answer 22

ANS: C

A It is the parents’ decision not to immunize the child; however, the nurse has a responsibility to inform parents about the risks to infants who are not immunized.

B Grandparents can be supportive but are not the primary decision makers for the infant.

C Although immunizations have been documented to have a negative effect in a small number of cases, an unimmunized infant is at greater risk for development of complications from childhood diseases than from the vaccines.

D Telling parents that they are making a mistake is an inappropriate response.

Question 23

The mother of a 9-month-old infant is concerned because the infant cries when approached by an unknown shopper at the grocery store. What is the best response for the nurse to make to the mother?

a. “You could consider leaving the infant more often with other people so he can adjust.”
b. “You might consider taking him to the doctor because he may be ill.”
c. “Have you noticed whether the baby is teething?”
d. “This is a sign of stranger anxiety and demonstrates healthy attachment.”

Answer 23

ANS: D

A An infant who manifests stranger anxiety is showing a normal sign of healthy attachment. This behavior peaks at 7 to 9 months and is developmentally appropriate. The mother leaving the child more often will not change this developmental response to new strangers.

B Assessing developmental needs is appropriate before taking an infant to a physician.

C Pain from teething expressed by the infant’s cries would not occur only when the mother left the room.

D The nurse can reassure parents that healthy attachment is manifested by stranger anxiety in late infancy.

Question 24

Which statement concerning physiologic factors is true?

• a. The infant has a slower metabolic rate than an adult.
• b. An infant has an inability to digest protein and lactase.
• c. Infants have a slower circulatory response than adults do
• d. The kidneys of an infant are less efficient in concentrating urine than an adult’s kidneys.

Answer 24

ANS: D

A The infant’s metabolic rate is faster, not slower, than an adult’s.

B Although the newborn infant’s gastrointestinal system is immature, it is capable of digesting protein and lactase, but the ability to digest and absorb fat does not reach adult levels until approximately 6 to 9 months of age.

C Circulation is faster in infants than in adults.

D The infant’s kidneys are not as effective at concentrating urine compared with an adult’s because of immaturity of the renal system and slower glomerular filtration rates. This puts the infant at greater risk for fluid and electrolyte imbalance.

Question 25

Which is a priority in counseling parents of a 6-month-old infant?

• a. Increased appetite from secondary growth spurt
• b. Encouraging the infant to smile
• c. Securing a developmentally safe environment for the infant
• d. Strategies to teach infants to sit up

Answer 25

ANS: C

A The infant’s appetite and growth velocity decrease in the second half of infancy.

B Although a social smile should be present by 6 months of age, encouraging this is not of higher priority than ensuring environmental safety.

C Safety is a primary concern as an infant becomes increasingly mobile.

D Unless the infant has a neuromuscular deficit, strategies for teaching a normally developing infant to sit up are not necessary.

Question 26

A mother of a 2-month-old infant tells the nurse, “My child doesn’t sleep as much as his older brother did at the same age.” What is the best response for the nurse?

• a. “Have you tried to feed the baby more often?”
• b. “Infant sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time.”
• c. “It is helpful to keep a record of your baby’s eating, waking, sleeping, and elimination patterns and to come back in a week to discuss them.”
• d. “This infant is difficult. It is important for you to identify what is bothering the baby.”

Answer 26

ANS: B

A Infants typically do not need more caloric intake to improve sleep behaviors.

B Newborn infants may sleep as much as 17 to 20 hours per day. Sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time.

C Keeping intake, output, waking, and sleeping data is not typically helpful to discuss differences among infants’ behaviors.

D Just because an infant may not sleep as much as a sibling did does not justify labeling the child as being difficult. Identifying an infant as difficult without identifying helpful actions is not a therapeutic response for a parent concerned about sleep.

Question 27

The mother of a 10-month-old infant tells the nurse that her infant “really likes cow’s milk.” What is the best response to this mother?

a. “Milk is good for him.”
b. “It is best to wait until he is a year old before giving him cow’s milk.”
c. “Limit cow’s milk to his bedtime bottle.”
d. “Mix his cereal with cow’s milk and give him formula in a bottle.”

Answer 27

ANS: B

A Although milk is a good source of calcium and protein for children after the first year of life, it is not the best source of nutrients for children younger than 1 year old.

B It is best to wait until the infant is at least a year old before giving him cow’s milk because of the risk of allergies and intestinal problems. Cow’s milk protein intolerance is the most common food allergy during infancy.

C Bedtime bottles of formula or milk are contraindicated because of their high sugar content, which leads to dental decay in primary teeth.

D Cereal can be mixed with formula.

Question 28

The mother of a 10-month-old infant asks the nurse about beginning to wean her child from his bottle. Which statement by the mother suggests that the child is not ready to be weaned?

• a. “My son is frequently throwing his bottle down.”
• b. “The baby takes a few ounces of formula from the bottle.”
• c. “He is constantly chewing on the nipple. It concerns me.”
• d. “He consistently is sucking.”

Answer 28

ANS: D

A A decreased interest in the bottle starts between 6 and 12 months. Throwing the bottle down is a sign of a decreased interest in the bottle.

B When the child is taking more fluids from a cup and decreasing amounts from the bottle, the child is demonstrating a readiness for weaning.

C Chewing on the nipple is another sign that the infant is ready to be weaned.

D Consistent sucking is a sign that the child is not ready to be weaned.

Question 29

Which is appropriate play for a 6-month-old infant?

• a. Pat-a-cake, peek-a-boo
• b. Ball rolling, hide-and-seek game
• c. Bright rattles and tactile toys
• d. Push and pull toys

Answer 29

ANS: A

A Six-month-old children enjoy playing pat-a-cake and peek-a-boo.

B Nine-month-old infants enjoy rolling a ball and playing hide-and-seek games.

C Four-month-old infants enjoy bright rattles and tactile toys.

D Twelve-month-old infants enjoy playing with push and pull toys.

Question 30

Which statement by a mother indicates that her 5-month-old infant is ready for solid food?

• a. “When I give my baby solid foods, she has difficulty getting it to the back of her throat to swallow.”
• b. “She has just started to sit up without any support.”
• c. “I am surprised that she only weighs 11 lb. I expected her to have gained some weight.”
• d. “I find that she really has to be encouraged to eat.”

Answer 30

ANS: B

A Children who are ready to manage solid foods are able to move food to the back of their throats to swallow. This child’s extrusion reflex may still be present.

B Sitting is a sign that the child is ready to begin with solid foods.

C Infants who weigh less than 13 pounds and demonstrate a lack of interest in eating are not ready to be started on solid foods.

D Infants who are difficult feeders and do not demonstrate an interest in solid foods are not ready to be started on them.

Question 31

A mother asks the nurse, “When should I begin to clean my baby’s teeth?” What is the best response for the nurse?

• a. “You can begin when all her baby teeth are in.”
• b. “You can easily begin now. Just put some toothpaste on a gauze pad to clean the teeth.”
• c. “I don’t think you have to worry about that until she can handle a toothbrush.”
• d. “You can begin as soon as your child has a tooth. The easiest way is to take cotton swabs or a face cloth and just wipe the teeth. Toothpaste is not necessary.”

Answer 31

ANS: D

A An infant’s teeth need to be cleaned as soon as they erupt. Waiting until all the baby teeth are in is inappropriate and prolongs cleaning until 2 years of age.

B Because toothpaste contains fluoride and infants will swallow the toothpaste, parents should avoid its use.

C The infant’s teeth need to be cleaned by the parent as soon as they erupt. Even when a child has the ability to hold a toothbrush, the parent should continue cleaning the child’s teeth.

D An infant’s teeth need to be cleaned as soon as they erupt. Cleaning the teeth with cotton swabs or a face cloth is appropriate.

Question 32

The mother of a 14-month-old child is concerned because the child’s appetite has decreased. The best response for the nurse to make to the mother is:

• a. “It is important for your toddler to eat three meals a day and nothing in between.”
• b. “It is not unusual for toddlers to eat less.”
• c. “Be sure to increase your child’s milk consumption, which will improve nutrition.”
• d. “Giving your child a multivitamin supplement daily will increase your toddler’s appetite.”

Answer 32

ANS: B

A Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age-group.

B Physiologically, growth slows and appetite decreases during the toddler period.

C Milk consumption should not exceed 16 to 24 oz daily. Juice should be limited to 4 to 6 oz per day. Increasing the amount of milk will only further decrease solid food intake.

D Supplemental vitamins are important for all children, but they do not increase appetite.

Question 33

Which toy is the most developmentally appropriate for an 18- to 24-month-old child?

• a. A push-and-pull toy
• b. Nesting blocks
• c. A bicycle with training wheels
• d. A computer

Answer 33

ANS: A

A Push-and-pull toys encourage large muscle activity and are appropriate for toddlers.

B Nesting blocks are more appropriate for a 12- to 15-month-old child.

C A bicycle with training wheels is appropriate for a preschool or young school-age child.

D A computer can be appropriate as early as the preschool years.

Question 34

Which is the priority concern in developing a teaching plan for the parents of a 15-month-old child?

• a. Toilet training guidelines
• b. Guidelines for weaning children from bottles
• c. Instructions on preschool readiness
• d. Instructions on a home safety assessment

Answer 34

ANS: D

A Although it is appropriate to give parents of a 15-month-old child toilet training guidelines, the child is not usually ready for toilet training, so it is not the priority teaching intervention.

B Parents of a 15-month-old child should have been advised to beginning weaning from the breast or bottle at 6 to 12 months of age.

C Educating a parent about preschool readiness is important and can occur later in the parents’ educational process. The priority teaching intervention for the parents of a 15-month-old child is the importance of a safe environment.

D Accidents are the major cause of death in children, including deaths caused by ingestion of poisonous materials. Home and environmental safety assessments are priorities in this age-group because of toddlers’ increased motor skills and independence, which puts them at greater risk in an unsafe environment.

Question 35

What is the primary purpose of a transitional object?

• a. It helps the parents deal with the guilt they feel when they leave the child.
• b. It keeps the child quiet at bedtime.
• c. It is effective in decreasing anxiety in the toddler.
• d. It decreases negativism and tantrums in the toddler.

Answer 35

ANS: C

A A decrease in parental guilt (distress) is an indirect benefit of a transitional object.

B A transitional object may be part of a bedtime ritual, but it may not keep the child quiet at bedtime.

C Decreasing anxiety, particularly separation anxiety, is the function of a transitional object; it provides comfort to the toddler in stressful situations and helps make the transition from dependence to autonomy.

D A transitional object does not significantly affect negativity and tantrums, but it can comfort a child after tantrums.

Question 36

Which statement best identifies the characteristics of language development in a toddler?

• a. Language development skills slow during the toddler period.
• b. The toddler understands more than he can express.
• c. Most of the toddler’s speech is not easily understood.
• d. The toddler’s vocabulary contains approximately 600 words.

Answer 36

ANS: B

A Although language development varies in relationship to physical activity, language skills are rapidly accelerating by 15 to 24 months of age.

B The toddler’s ability to understand language (receptive language) exceeds the child’s ability to speak it (expressive language).

C By 2 years of age, 60% to 70% of the toddler’s speech is understandable.

D The toddler’s vocabulary contains approximately 300 or more words.

Question 37

A mother asks when toilet training is most appropriately initiated. What would be the nurse’s best response?

• a. “When your child is 12 to 18 months of age.”
• b. “When your child exhibits signs of physical and psychological readiness.”
• c. “When your child has been walking for 9 months.”
• d. “When your child is able to sit on the ‘potty’ for 10 to 15 minutes.”

Answer 37

ANS: B

A Toilet training is not arbitrarily started at 12 to 18 months of age. The child needs to demonstrate signs of bowel or bladder control before attempting toilet training. The average toddler is not ready until 18 to 24 months of age. Waiting until 24 to 30 months of age makes the task easier; toddlers are less negative, more willing to control their sphincters, and want to please their parents.

B Neurologic development is completed at approximately 18 months of age. Parents need to know that both physical and psychological readiness are necessary for toilet training to be successful.

C One of the physical signs of readiness for toilet training is that the child has been walking for 1 year.

D The ability to sit on the “potty” for 10 to 15 minutes may demonstrate parental control rather than being a sign of developmental readiness for toilet training.

Question 38

Which statement by a mother of a toddler indicates a correct understanding of the use of discipline?

• a. “I always include explanations and morals when I am disciplining my toddler.”
• b. “I always try to be consistent when disciplining the children, and I correct my children at the time they are misbehaving.”
• c. “I believe that discipline should only be done by one family member.”
• d. “My rule of thumb is no more than one spanking a day.”

Answer 38

ANS: B

A The toddler’s cognitive level of development precludes the use of explanations and morals as a part of discipline.

B Consistent and immediate discipline for toddlers is the most effective approach. Unless disciplined immediately, the toddler will have difficulty connecting the discipline with the behavior.

C Discipline for the toddler should be immediate; therefore the family member caring for the child should provide discipline to the toddler when it is necessary.

D Discipline is required for unacceptable behavior, and the one-spanking-a-day rule contradicts the concept of a consistent response to inappropriate behavior. Additionally, spanking is an inappropriate method of disciplining a child.

Question 39

Which comments indicate that the mother of a toddler needs further teaching about dental care?

• a. “We use well water so I give my toddler fluoride supplements.”
• b. “My toddler brushes his teeth with my help.”
• c. “My child will not need a dental checkup until his permanent teeth come in.”
• d. “I use a small nylon bristle brush for my toddler’s teeth.”

Answer 39

ANS: C

A Toddlers need fluoride supplements when they use a water supply that is not fluorinated.

B Toddlers need supervision with dental care. The parent should finish brushing areas not reached by the child.

C Children should first see the dentist 6 months after the first primary tooth erupts and no later than age 30 months.

D A small nylon bristle brush works best for cleaning toddlers’ teeth.

Question 40

Which assessment finding in a preschooler would suggest the need for further investigation?

• a. The child is able to dress independently.
• b. The child rides a tricycle.
• c. The child has an imaginary friend.
• d. The child has a 2-lb weight gain in 12 months.

Answer 40

ANS: D

A A preschool child should be able to dress independently.

B A preschool child should be able to ride a tricycle.

C Imaginary friends are common for preschoolers.

D Preschool children gain an average of 5 pounds a year. A gain of only 2 pounds is less than half of the expected weight gain and should be investigated.

Question 41

Which is the most appropriate action for the nurse to take when telling a preschool child about an upcoming procedure?

• a. Explain all the information in detail to the child.
• b. Speak loudly and clearly to the child.
• c. Inform the parents of the procedure and ask them to tell the child.
• d. Allow the child to play with medical supplies that may be used during the procedure.

Answer 41

ANS: D

A It is inappropriate to give a preschooler all the information in detail. The child needs to understand what is going to happen to him or her without explicit details of the procedure.

B Speaking in clear sentences with simple words is important, but the conversation should be conducted at a nonthreatening, normal sound level.

C The nurse has the most knowledge and best ability for explaining the procedure to the child; however, the parents can be an important resource when explaining the procedure.

D Symbolic play is important for emotional development because it allows the child to work through distressing feelings and can be therapeutic.

Question 42

In caring for a 4-year-old child with a diagnosis of suspected child abuse, which is the best nursing intervention?

• a. Avoid touching the child.
• b. Provide the child with play situations that allow for disclosure.
• c. Discourage the child from remembering the incident.
• d. Deny the suspected perpetrator visiting rights to the child.

Answer 42

ANS: B

A All children need to be touched. What is important is to tell the child in simple, clear terms what you are doing and why you are doing it. Nurses have the opportunity to teach children the normal, healthy boundaries of their bodies and what constitutes inappropriate behavior.

B Play allows the child to disclose what happened to him or her without having to talk about the incident. Symbolic play is important for emotional development and it allows the child to work through distressing feelings.

C If the child chooses to remember what happened, it is inappropriate to discourage it. It is important to listen to the child in a nonjudgmental way, allowing the child to discuss what happened, to make statements, or to ask questions.

D It is not the nurse’s role or responsibility to restrict visitors unless child safety is an issue. The child may be negatively affected if a caregiver, who may be the abuser, does not visit.

Question 43

What is helpful to tell a mother who is concerned about preventing sleep problems in her 2-year-old child?

• a. Have the child always sleep in a quiet, darkened room.
• b. Provide high-carbohydrate snacks before bedtime.
• c. Communicate with the child’s daytime caretaker about eliminating the afternoon nap.
• d. Use a nightlight in the child’s room.

Answer 43

ANS: D

A A dark, quiet room may be scary to a preschooler.

B High-carbohydrate snacks increase energy and do not promote relaxation.

C Most 2-year-olds take one nap each day. Many give up the habit by age 3. Insufficient rest during the day can lead to irritability and difficulty sleeping at night.

D The preschooler has a great imagination. Sounds and shadows can have a negative effect on sleeping behavior. Nightlights provide the child with the ability to visualize the environment and decrease the fear felt in a dark room.

Question 44

Which statement, made by a 4-year-old child’s father, is true about the care of the preschooler’s teeth?

• a. “Because the ‘baby teeth’ are not permanent, they are not important to the child.”
• b. “My son can be encouraged to brush his teeth after I have thoroughly cleaned his teeth.”
• c. “My son’s ‘permanent teeth’ will begin to come in at 4 to 5 years of age.”
• d. “Fluoride supplements can be discontinued when my son’s ‘permanent teeth’ erupt.”

Answer 44

ANS: B

A Deciduous teeth are important because they maintain spacing and play an important role in the growth and development of the jaws and face and in speech development.

B Toddlers and preschoolers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility.

C Secondary teeth erupt at about 6 years of age.

D If the family does not live in an area where fluoride is included in the water supply, fluoride supplements should be continued.

Question 45

What do parents of preschool children need to understand about discipline?

• a. Both parents and the child should agree on the method of discipline.
• b. Discipline should involve some physical restriction.
• c. The method of discipline should be consistent with the discipline methods of the child’s peers.
• d. Discipline should include positive reinforcement of desired behaviors.

Answer 45

ANS: D

A Discipline does not need to be agreed on by the child. Preschoolers feel secure with limits and appropriate, consistent discipline. Both parents should be in agreement so that the discipline is consistently applied.

B Discipline does not necessarily need to include physical restriction.

C Discipline does not need to be consistent with that of the child’s peers.

D Effective discipline strategies should involve a comprehensive approach that includes consideration of the parent-child relationship, reinforcement of desired behaviors, and consequences for negative behaviors.

Question 46

In providing anticipatory guidance to parents whose child will soon be entering kindergarten, which is a critical factor in preparing a child for kindergarten entry?

• a. The child’s ability to sit still
• b. The child’s sense of learned helplessness
• c. The parent’s interactions and responsiveness to the child
• d. Attending a preschool program

Answer 46

ANS: C

A The child’s ability to sit still is important to learning; however, parental responsiveness and involvement are more important factors.

B Learned helplessness is the result of a child feeling that he or she has no effect on the environment and that his or her actions do not matter. Parents who are actively involved in a supportive learning environment will demonstrate a more positive approach to learning.

C Interactions between the parent and child are an important factor in the development of academic competence. Parental encouragement and support maximize a child’s potential.

D Preschool and daycare programs can supplement the developmental opportunities provided by parents at home, but they are not critical in preparing a child for entering kindergarten.

Question 47

Which statement made by a mother of a school-age boy indicates a need for further teaching?

• a. “My child is playing soccer this year.”
• b. “He is always busy with his friends playing games. He is very active.”
• c. “I limit his television watching to about 2 hours a day.”
• d. “I am glad his coach is a good role model. He emphasizes the importance of winning in today’s society. The kids really are disciplined.”

Answer 47

ANS: D

A Team sports such as soccer are appropriate for exercise and refinement of motor skills.

B School-age children need to participate in physical activities, which contribute to their physical fitness skills and well-being.

C Limiting television to 2 hours a day is an appropriate restriction. School-age children should be encouraged to participate in physical activities.

D Team sports are important for the development of sportsmanship and teamwork and for exercise and refinement of motor skills. A coach who emphasizes winning and strict discipline is not appropriate for children in this age-group.

Question 48

Which behavior is not demonstrated in the 8 year-old child?

• a. Understands that his or her point of view is not the only one
• b. Enjoys telling riddles and silly jokes
• c. Understands that pouring liquid from a small to large container does not change the amount
• d. Engages in fantasy and magical thinking

Answer 48

ANS: D

A School-age children enter the stage of concrete operations. They learn that their point of view is not the only one.

B The school-age child has a sense of humor. The child’s increased language mastery and increased logic allow for appreciation of plays on words, jokes, and incongruities.

C The school-age child understands that properties of objects do not change when their order, form, or appearance does.

D The preschool child engages in fantasy and magical thinking. The school-age child moves away from this type of thinking and becomes more skeptical and logical. Belief in Santa Claus or the Easter Bunny ends in this period of development.

Question 49

The ability to mentally understand that 1 + 3 = 4 and 4 – 1 = 3 occurs in which stage of cognitive development?

• a. Concrete operations stage
• b. Formal operations stage
• c. Intuitive thought stage
• d. Preoperations stage

Answer 49

ANS: A

A By 7 to 8 years of age, the child is able to retrace a process (reversibility) and has the skills necessary for solving mathematical problems. This stage is called concrete operations.

B The formal operations stage deals with abstract reasoning and does not occur until adolescence.

C Thinking in the intuitive stage is based on immediate perceptions. A child in this stage often solves problems by random guessing.

D In preoperational thinking, the child is usually able to add 1 + 3 = 4 but is unable to retrace the process.

Question 50

Which activity is most appropriate for developing fine motor skills in the school-age child?

• a. Drawing
• b. Singing
• c. Soccer
• d. Swimming

Answer 50

ANS: A

A Activities such as drawing, building models, and playing a musical instrument increase the school-age child’s fine motor skills.

B Singing is an appropriate activity for the school-age child, but it does not increase fine motor skills.

C The school-age child needs to participate in group activities to increase both gross motor skills and social skills, but group activities do not increase fine motor skills.

D Swimming is an activity that also increases gross motor skills.

Question 51

Which statement best describes growth in the early school-age period?

• a. Boys grow faster than girls do.
• b. Puberty occurs earlier in boys than in girls.
• c. Puberty occurs at the same age for all races and ethnicities.
• d. It is a period of rapid physical growth.

Answer 51

ANS: A

A During the school-age developmental period, boys are approximately 1 inch taller and 2 lb heavier than girls.

B Puberty occurs 1.5 to 2 years later in boys, which is developmentally later than puberty in girls (not unusual in 9- or 10-year-old girls).

C Puberty occurs approximately 1 year earlier in African-American girls than white girls.

D Physical growth is slow and steady during the school-age years.

Question 52

Which comment is most developmentally typical of a 7-year-old boy?

• a. “I am a Power Ranger, so don’t make me angry.”
• b. “I don’t know whether I like Mary or Joan better.”
• c. “My mom is my favorite person in the world.”
• d. “Jimmy is my best friend.”

Answer 52

ANS: D

A Magical thinking is developmentally appropriate for the preschooler.

B Opposite-sex friendships are not typical for the 7-year-old child.

C Seven-year-old children socialize with their peers, not their parents.

D School-age children form friendships with peers of the same sex.

Question 53

Which nursing action is indicated for a 7-year-old child who uses appropriate vocabulary and frequently speaks about sex?

• a. Ascertain what the child understands about sex.
• b. Involve the child in teaching sex information to his peers.
• c. Ask the child where he got this important information.
• d. Ask the child if he was sexually abused.

Answer 53

ANS: A

A School-age children often use correct vocabulary and yet have no real understanding of what the words mean.

B Having the child teach his peers about sex is an inappropriate action.

C Asking the child about his source of information is not particularly relevant.

D Asking direct questions about sexual abuse is not an appropriate action.

Question 54

Identify the statement that is the most accurate about moral development in the 9-year-old school-age child.

• a. Right and wrong are based on physical consequences of behavior.
• b. The child obeys parents because of fear of punishment.
• c. The school-age child conforms to rules to please others.
• d. Parents are the determiners of right and wrong for the school-age child.

Answer 54

ANS: C

A Children 4 to 7 years of age base right and wrong on consequences.

B Consequences are the most important consideration for the child between 4 and 7 years of age.

C The 7- to 12-year-old child bases right and wrong on a good-boy or good-girl orientation in which the child conforms to rules to please others and avoid disapproval.

D Parents determine right and wrong for the child younger than 4 years of age.

Question 55

In providing anticipatory guidance to parents, which parental behavior is the most important in fostering moral development?

• a. Telling the child what is right and wrong
• b. Vigilantly monitoring the child and her peers
• c. Weekly family meetings to discuss behavior
• d. Living as the parents say they believe

Answer 55

ANS: D

A Telling the child what is right and wrong is not effective unless the child has experienced what she hears. Parents need to live according to the values they are teaching to their children.

B Vigilant monitoring of the child and her peers is an inappropriate action for the parent to initiate. It does not foster moral development and reasoning in the child.

C Weekly family meetings to discuss behaviors may or may not be helpful in the development of moral reasoning.

D Parents living what they believe gives nonambivalent messages and fosters the child’s moral development and reasoning.

Question 56

Which behavior by parents or teachers will best assist the child in negotiating the developmental task of industry?

• a. Identifying failures immediately and asking the child’s peers for feedback
• b. Structuring the environment so the child can master tasks
• c. Completing homework for children who are having difficulty in completing assignments
• d. Decreasing expectations to eliminate potential failures

Answer 56

ANS: B

A Asking peers for feedback reinforces the child’s feelings of failure.

B The task of the caring teacher or parent is to identify areas in which a child is competent and to build on successful experiences to foster feelings of mastery and success. Structuring the environment to enhance self-confidence and to provide the opportunity to solve increasingly more complex problems will promote a sense of mastery.

C When teachers or parents complete children’s homework for them, it sends the message that you do not trust them to do a good job. Providing assistance and suggestions and praising their best efforts are more appropriate.

D Decreasing expectations to eliminate failures will not promote a sense of achievement or mastery.

Question 57

The older school-age child’s cognitive development can be evaluated by assessing what?

• a. The child’s addition and subtraction ability
• b. The child’s ability to classify
• c. The child’s vocabulary
• d. The child’s play activity

Answer 57

ANS: B

A Subtraction and addition are appropriate cognitive activities for the young school-age child.

B The ability to classify things from simple to complex and the ability to identify differences and similarities are cognitive skills of the older school-age child; this demonstrates use of classification and logical thought processes.

C Vocabulary is not as valid an assessment of cognitive ability as is the child’s ability to classify.

D Play activity is not as valid an assessment of cognitive function as is the ability to classify.

Question 58

Which is an appropriate disciplinary intervention for the school-age child?

• a. Using time-out periods
• b. Using a consequence that is consistent with the inappropriate behavior
• c. Using physical punishment
• d. Using lengthy dialog about inappropriate behavior

Answer 58

ANS: B

A Time-out periods are more appropriate for younger children.

B A consequence that is related to the inappropriate behavior is the recommended discipline.

C Physical intervention is an inappropriate form of discipline. It does not connect the discipline with the child’s inappropriate behavior.

D Lengthy discussions typically are not helpful.

Question 59

The nurse is explaining Tanner staging to an adolescent and her mother. Which statement best describes Tanner staging?

• a. Predictable stages of puberty that are based on chronologic age
• b. Staging of puberty based on the initiation of menarche and nocturnal emissions
• c. Predictable stages of puberty that are based on primary and secondary sexual characteristics
• d. Staging of puberty based on the initiation of primary sexual characteristics

Answer 59

ANS: C

A Tanner stages are not based on chronologic age. The age at which an adolescent enters puberty is variable.

B The puberty stage in girls begins with breast development. Puberty stage in boys begins with genital enlargement.

C Tanner sexual-maturing ratings are based on the development of stages of primary and secondary sexual characteristics.

D Primary sexual characteristics are not the basis of Tanner staging.

Question 60

Which behavior suggests appropriate psychosocial development in the adolescent?

• a. The adolescent seeks validation for socially acceptable behavior from older adults.
• b. The adolescent is self-absorbed and self-centered and has sudden mood swings.
• c. Adolescents move from peers and enjoy spending time with family members.
• d. Conformity with the peer group increases in late adolescence.

Answer 60

ANS: B

A The peer group validates acceptable behavior during adolescence.

B During adolescence energy is focused within. Adolescents concentrate on themselves in an effort to determine who they are or who they will be. Adolescents are likely to be impulsive and impatient.

C Adolescents move from family and enjoy spending time with peers. Adolescents also spend time alone; they need this time to think and concentrate on themselves.

D Conformity becomes less important in late adolescence.

Question 61

The parents of a 14-year-old girl are concerned that their adolescent spends too much time looking in the mirror. Which statement is the most appropriate for the nurse to make?

• a. “Your teenager needs clearer and stricter limits about her behavior.”
• b. “Your teenager needs more responsibility at home.”
• c. “During adolescence this behavior is not unusual.”
• d. “The behavior is abnormal and needs further investigation.”

Answer 61

ANS: C

A Stricter limits are not an appropriate response for a behavior that is part of normal development.

B More responsibility at home is not an appropriate response for this situation.

C Narcissistic behavior is normal during this period of development. The teenager is seeking a personal identity.

D The behavior is normal and needs no further investigation.

Question 62

Which statement is the most appropriate advice to give parents of a 16-year-old who is rebellious?

• a. “You need to be stricter so that your teen stops trying to test the limits.”
• b. “You need to collaborate with your daughter and set limits that are perceived as being reasonable.”
• c. “Increasing your teen’s involvement with her peers will improve her self-esteem.”
• d. “Allow your teenager to choose the type of discipline that is used in your home.”

Answer 62

ANS: B

A Setting stricter limits typically does not decrease rebelliousness or decrease testing of parental limits.

B Allowing teenagers to choose between realistic options and offering consistent and structured discipline typically enhances cooperation and decreases rebelliousness. Structure helps adolescents to feel more secure and assists them in the decision-making process.

C Increasing peer involvement does not typically increase self-esteem.

D Allowing teenagers to choose the method of discipline is not realistic and typically does not reduce rebelliousness.

Question 63

Which statement by the nurse is most appropriate to a 15-year-old whose friend has mentioned suicide?

• a. “Tell your friend to come to the clinic immediately.”
• b. “You need to gather details about your friend’s suicide plan.”
• c. “Your friend’s threat needs to be taken seriously and immediate help for your friend is important.”
• d. “If your friend mentions suicide a second time, you will want to get your friend some help.”

Answer 63

ANS: C

A Instructing a 15-year-old to tell a friend to come to the clinic immediately provides the teen with limited information and does not address the concern.

B It is important to determine whether a person threatening suicide has a plan of action; however, the best information for the 15-year-old to have is that all threats of suicide should be taken seriously and immediate help is important.

C Suicide is the third most common cause of death among American adolescents. A suicide threat from an adolescent serves as a dramatic message to others and should be taken seriously. Adolescents at risk should be targeted for supportive guidance and counseling before a crisis occurs.

D It is imperative that help is provided immediately for a teenager who is talking about suicide. Waiting until the teen discusses it a second time may be too late.

Question 64

When planning care for adolescents, the nurse should:

• a. teach parents first, and they, in turn, will teach the teenager.
• b. provide information for their long-term health needs because teenagers respond best to long-range planning.
• c. maintain the parents’ role by providing explanations for treatment and procedures to the parents only.
• d. give information privately to adolescents about how they can manage the specific problems that they identify.

Answer 64

ANS: D

A Teenagers are socially and cognitively at the developmental stage where the health care provider can teach them.

B Teenagers are more interested in immediate health care needs than in long-term needs.

C Teenagers are at the developmental level that allows them to receive explanations about health care directly from the nurse.

D Problems that teenagers identify and are interested in are typically the problems that they are the most willing to address. Confidentiality is important to adolescents. Adolescents prefer to confer privately (without parents) with the nurse and health care provider.

Question 65

A 17-year-old tells the nurse that he is not having sex because it would make his parents very angry. This response indicates that the adolescent has a developmental lag in which area?

• a. Cognitive development
• b. Moral development
• c. Psychosocial development
• d. Psychosexual development

Answer 65

ANS: B

A Cognitive development is related to moral development, but it is not the pivotal point in determining right and wrong behaviors.

B The appropriate moral development for a 17-year-old would include evidence that the teenager has internalized a value system and does not depend on parents to determine right and wrong behaviors. Adolescents who remain concrete tinkers may never advance beyond conformity to please others and avoid punishment.

C Identity formation is the psychosocial development task. Energy is focused within the adolescent, who exhibits behavior that is self-absorbed and egocentric.

D Although a task during adolescence is the development of a sexual identity, the teenager’s dependence on the parents’ sanctioning of right or wrong behavior is more appropriately related to moral development.

Question 66

What is the best response a nurse can make to a 15-year-old girl who has verbalized a desire to have a baby?

• a. “Have you talked with your parents about this?”
• b. “Do you have plans to continue school?”
• c. “Will you be able to support the baby?”
• d. “Can you tell me how your life will be if you have an infant?”

Answer 66

ANS: D

A Asking the teenager if she has talked to her parents is not particularly helpful to the teen or the nurse and may terminate the communication.

B A direct question about continuing school will not facilitate communication. Open-ended questions encourage communication.

C Asking the teenager about how she will support the child will not facilitate communication. Open-ended questions encourage communication.

D Having the teenager describe how the infant will affect her life will allow the teen to think more realistically. Her description will allow the nurse to assess the teen’s perception and reality orientation.

Question 67

In an interview with the nurse, a mother states that she is concerned that her 14-year-old is critical and finding fault with her. The nurse counsels the mother that:

• a. the family needs to change its value system to meet the teenager’s changing needs.
• b. the parent-teen relationship is important for the teenager and conflicts are to be expected.
• c. teenagers create psychological distance from the parent to separate from the parent.
• d. parents need to relinquish their relationship with their teenager to the teen’s peers.

Answer 67

ANS: C

A Changing the family’s value system to meet the teenager’s needs is not realistic and will only result in the teenager’s being critical of the new system.

B The parent-teen relationship is not as important to the teenager as it was in earlier years. Friends and peers become more important.

C The teenager uses critical and fault-finding behavior as a mechanism to separate from the parent and become independent.

D Parents should not relinquish their relationship with their teenager to the teen’s peers. Maintaining a consistent parental relationship with the adolescent is important.

Question 68

Which is assessed with Tanner staging?

• a. Hormone levels
• b. Secondary sex characteristics
• c. Response to growth hormone secretion tests
• d. Hyperthyroidism

Answer 68

ANS: B

A Hormone levels are assessed by their concentration in the blood.

B Tanner stages are used to assess staging of secondary sex characteristics at puberty.

C Growth hormone secretion tests are not associated with Tanner staging.

D Tanner stages are not associated with hyperthyroidism.

Question 69

Which information would the nurse include when preparing a 5-year-old child for a cardiac catheterization?

• a. A detailed explanation of the procedure
• b. A description of what the child will feel and see during procedure
• c. An explanation about the dye that will go directly into his vein
• d. An assurance to the child that he and the nurse can talk about the procedure when it is over

Answer 69

ANS: B

A Explaining the procedure in detail is probably more than the 5-year-old child can comprehend and it will produce anxiety.

B For a preschooler, the provision of sensory information about what to expect during the procedure will enhance the child’s ability to cope with the events of the procedure and will decrease anxiety.

C Using the word “dye” with a preschooler can be frightening for the child.

D The child needs information before the procedure.

Question 70

Who are the “experts” in planning for the care of a 9-year-old child with a profound sensory impairment who is hospitalized for surgery?

• a. The child’s parents
• b. The child’s teacher
• c. The case manager
• d. The primary nurse

Answer 70

ANS: A

A The parents, as primary caregivers, can identify the child’s needs to help develop an effective, individualized plan of care.

B The child’s teacher is not as “expert” as her parents for planning her care.

C The case manager is not as aware as the parents are of the child’s individual needs.

D The primary nurse would use the child’s parents as resources in planning the best approach to the child’s care.

Question 71

Which is an effective technique for communicating with toddlers?

• a. Have the toddler make up a story from a picture.
• b. Involve the toddler in dramatic play with dress-up clothing.
• c. Repeatedly read familiar stories to the child.
• d. Ask the toddler to draw pictures of his fears.

Answer 71

ANS: C

A Most toddlers do not have the vocabulary to make up stories.

B Dramatic play is associated with older children.

C Ritualism is a characteristic of the toddler period. By repeating familiar stories and other rituals, the toddler feels a sense of control, which facilitates communication.

D Toddlers probably are not capable of drawing or verbally articulating their fears.

Question 72

What is the most important consideration for effectively communicating with a child?

• a. The child’s chronologic age
• b. The parent-child interaction
• c. The child’s receptiveness
• d. The child’s developmental level

Answer 72

ANS: D

A The child’s age may not correspond with the child’s developmental level; therefore it is not the most important consideration for communicating with children.

B Parent-child interaction is useful in planning communication with children, but it is not the primary factor in establishing effective communication.

C The child’s receptiveness is a consideration in evaluating the effectiveness of communication.

D The child’s developmental level is the basis for selecting the terminology and structure of the message most likely to be understood by the child.

Question 73

Which behavior is most likely to encourage open communication?

• a. Avoiding eye contact
• b. Folding arms across chest
• c. Standing with head bowed
• d. Soft stance with arms loose at the side

Answer 73

ANS: D

A Avoiding eye contact does not facilitate communication.

B Folding arms across the chest is a closed-body posture, which does not facilitate communication.

C Standing with head bowed is a closed-body posture, which does not facilitate communication.

D A swaying body with arms loose at the sides suggests openness.

Question 74

Which strategy is most likely to encourage a child to express his feelings about the hospital experience?

• a. Avoiding periods of silence
• b. Asking direct questions
• c. Sharing personal experiences
• d. Using open-ended questions

Answer 74

ANS: D

A Periods of silence can serve to facilitate communication.

B Direct questions can threaten and block communication.

C Talking about yourself shifts the focus of the conversation away from the child.

D Open-ended questions encourage conversation.

Question 75

Which is the most appropriate question to ask when interviewing an adolescent to encourage conversation?

• a. “Are you in school?”
• b. “Are you doing well in school?”
• c. “How is school going for you?”
• d. “How do your parents feel about your grades?”

Answer 75

ANS: C

A Direct questions with “yes” or “no” answers do not encourage conversation.

B Direct questions that can be interpreted as judgmental do not enhance communication.

C Open-ended questions encourage communication.

D Asking adolescents about their parents’ feelings may block communication.

Question 76

What is the most appropriate response for the nurse to make to the parent of a 3-year-old child found in a bed with the side rails down?

• a. “You must never leave the child in the room alone with the side rails down.”
• b. “I am very concerned about your child’s safety when you leave the side rails down. The hospital has guidelines stating that side rails need to be up if the child is in the bed.”
• c. “It is hospital policy that side rails need to be up if the child is in bed.”
• d. “When parents leave side rails down, they might be considered as uncaring.”

Answer 76

ANS: B

A Framing the communication in the negative does not facilitate effective communication.

B To express concern and then choose words that convey a policy is appropriate.

C Stating a policy to parents conveys the attitude that the hospital has authority over parents in matters concerning their children and may be perceived negatively.

D This statement conveys blame and judgment to the parent.

Question 77

Which is an appropriate preoperative teaching plan for a school-age child?

• a. Begin preoperative teaching the morning of surgery.
• b. Schedule a tour of the hospital a few weeks before surgery.
• c. Show the child books and pictures 4 days before surgery.
• d. Limit teaching to 5 minutes and use simple terminology.

Answer 77

ANS: C

A Preoperative teaching a few hours before surgery is more appropriate for the preschool child. Preoperative materials should be introduced 1 to 5 days in advance for school-age children.

B Preparation too far in advance of the procedure can be forgotten or cause undue anxiety for an extended period of time.

C Preparatory material can be introduced to the school-age child several days (1 to 5) in advance of the event. Books, pictures, charts, and videos are appropriate.

D A very short, simple explanation of the surgery is appropriate for a younger child such as a toddler.

Question 78

When a child broke her favorite doll during a hospitalization, her primary nurse bought the child a new doll and gave it to her the next day. What is the best interpretation of the nurse’s behavior?

• a. The nurse is displaying signs of over-involvement.
• b. The nurse is a kind and generous person.
• c. The nurse feels a special closeness to the child.
• d. The nurse wants to make the child happy.

Answer 78

ANS: A

A Buying gifts for individual children is a warning sign of over-involvement.

B Nurses are kind and generous people, but buying gifts for individual children is unprofessional.

C Nurses may feel closer to some clients and families. This does not make giving gifts to children or families acceptable from a professional standpoint.

D It is not the nurse’s responsibility to replace lost items. Becoming overly involved with a child can inhibit a healthy relationship.

Question 79

When meeting a toddler for the first time, the nurse initiates contact by:

• a. calling the toddler by name and picking the toddler up.
• b. asking the toddler for her first name.
• c. kneeling in front of the toddler and speaking softly to the child.
• d. telling the toddler that you are her nurse.

Answer 79

ANS: C

A Picking a toddler up at an initial meeting is a threatening action and will more likely result in a negative response from the child.

B Toddlers are unlikely to respond to direct questions at a first meeting.

C More positive interactions occur when the toddler perceives the meeting in a nonthreatening way. Placing yourself at the toddler’s level and speaking softly can be less threatening for the child.

D Telling the toddler you are the nurse is not likely to facilitate or encourage cooperation. The toddler perceives you as a stranger and will find the action threatening

Question 80

Which does the nurse need to evaluate before administering the Denver Developmental Screening Test II (DDST-II)? (Choose all that apply.)

• a. The child’s height and weight
• b. The parent’s ability to comprehend the results
• c. The child’s mood
• d. The parent-child interaction
• e. The child’s chronologic age

Answer 80

ANS: C, E

Correct C, E. The results of the screening test are valid if the child acted in a normal and expected manner. The child’s chronologic age in years, months, and days must be calculated in order to draw the age line. This is necessary in order to perform an accurate DDST-II.

Incorrect A, B, D. The child’s height and weight are not relevant to the DDST-II screening process. The parent’s ability to understand the results of the screening is not relevant to the validity of the test. The parent-child interaction is not significantly relevant to the test results.

Question 81

You are preparing immunizations for a 12-month-old child who is immunocompromised. Which immunizations CANNOT be given? (Choose all that apply.)

• a. DTaP
• b. HepA
• c. IPV
• d. Varicella
• e. MMR

Answer 81

ANS: D, E

Correct D, E. Children who are immunologically compromised should not receive live viral vaccines. Varicella is a live vaccine, and should not be given except in special circumstances. MMR is a live vaccine and should not be given to immunologically compromised children.

Incorrect A, B, C. DTaP can be safely given. HepA can be safely given. IPV can be safely given.

Question 82

The nurse is preparing immunizations for a healthy 11-year-old boy who has received all his primary immunizations. Which immunizations will the nurse consider? Select all that apply.

• a. Meningococcal conjugate vaccine (MCV4)
• b. Tdap
• c. Influenza
• d. Human papillomavirus (HPV)

Answer 82

ANS: A, B

Correct A, B. Meningococcal conjugate vaccine should be given to all children at age 11 to 12 years. The American Academy of Pediatrics recommends one dose of Tdap vaccine for children at age 11 to 12 years, as long as they have received the primary DTaP series.

Incorrect C, D. Influenza vaccine is recommended annually for children age greater than 6 months with certain risk factors, including asthma, cardiac disease, sickle cell disease, HIV, diabetes, and conditions that compromise respiratory function. Influenza vaccine is not routinely given to healthy 11-year-old children with no known risk factors. HPV vaccine series is only given to females; it is started at age 11 to 12 years.

Question 83

The nurse is caring for a 12-month-old child who has come to the clinic for a well-child visit. Before this visit the child was up to date on her immunizations. Which immunizations should the nurse prepare to administer? (Choose all that apply.)

• a. DTaP
• b. MMR
• c. Varicella
• d. Hep A
• e. Influenza

Answer 83

ANS: B, C, D, E

Correct B, C, D, E. MMR, varicella, Hep A, and influenza are the appropriate immunizations for a healthy 12-month-old infant who has received all previous immunizations.

Incorrect A. DTaP is not appropriate for this patient.

Question 84

Which play patterns does a 3-year-old child typically display? (Choose all that apply.)

a. Imaginary play
b. Parallel play
c. Cooperative play
d. Structured play

Answer 84

ANS: A, B, C

Correct A, B, C. Children between ages 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Imaginary friends are common around age 3 years.

Incorrect D. Structured play is typical of school-age children.

Question 85

Motor vehicle injuries are a significant threat to young children. Knowing this, the nurse plans a teaching session with a toddler’s parents on car safety. Which will she teach? (Choose all that apply.)

a. Secure in a forward-facing, upright, car safety seat.
b. Place the car safety seat in the rear seat, behind the driver’s seat.
c. Harness safety straps should be fit snugly.
d. Place the car safety seat in the front passenger seat equipped with an airbag.

Answer 85

ANS: A, C

Correct A, C. Toddlers should be secured in a forward-facing, upright, approved car safety seat. Harness straps should be adjusted to provide a snug fit.

Incorrect B, D. The car safety seat should be placed in the middle of the rear seat. Children younger than 13 years should not ride in a front passenger seat that is equipped with an air bag.

Question 86

The nurse is assessing parental knowledge of temper tantrums. Which are true statements about temper tantrums? (Choose all that apply.)

a. Temper tantrums are a common response to anger and frustration in toddlers.
b. Temper tantrums often include screaming, kicking, throwing things, and head banging.
c. Parents can effectively manage temper tantrums by giving in to the child’s demands.
d. Children having temper tantrums should be safely isolated and ignored.

Answer 86

ANS: A, B, D

Correct A, B, D. Temper tantrums are a common response to anger and frustration in toddlers. They occur more often when toddlers are tired, hungry, bored, or excessively stimulated. Tantrums may include screaming, kicking, throwing things, biting themselves, or banging their head. Effective management of tantrums includes safely isolating and ignoring the child.

Incorrect C. The child should learn that nothing is gained by having a temper tantrum. Giving in to the child’s demands only increases the behavior.

Question 87

Which demonstrates the school-age child’s developing logic in the stage of concrete operations? (Choose all that apply.)

• a. The school-age child is able to recognize that 1 lb of feathers is equal to 1 lb of metal.
• b. The school-age child is able to recognize that he can be a son, brother, or nephew at the same time.
• c. The school-age child understands the principles of adding, subtracting, and reversibility.
• d. The school-age child has thinking that is characterized by egocentrism, animism, and centration.

Answer 87

ANS: A, B, C

Correct The school-age child understands that the properties of objects do not change when their order, form, or appearance does. Conservation occurs in the concrete operations stage. Comprehension of class inclusion occurs as the school-age child’s logic increases. The child begins to understand that a person can be in more than one class at the same time. This is characteristic of concrete thinking and logical reasoning. The school-age child is able to understand principles of adding, subtracting, and the process of reversibility, which occurs in the stage of concrete operations.

Incorrect This type of thinking occurs in the intuitive thought stage, not the concrete operations stage of development.

Question 88

What demonstrates a way to prevent childhood obesity? (Choose all that apply.)

• a. Establish consistent times for meals and snacks
• b. Eliminate all snacks. Eat three nutritious meals a day.
• c. Teach the family and child how to select foods and prepare foods.
• d. Encourage schools to provide snack machines with popcorn, cookies, and diet soda.

Answer 88

ANS: A, C

Correct A, C. Preventing obesity includes encouraging families to establish consistent times for meals and snacks and discouraging between-meal eating. Parents and children also need to be taught how to select and prepare healthy foods. Because snacks are an important aspect in childhood nutrition, nutritious snacks should be identified. School-age children usually require a healthy snack after school and in the evening.

Incorrect B, D. Snacks are an important aspect in childhood nutrition. Nutritious snacks should be identified, not eliminated. Healthy snack options include fruit, popcorn, nuts, and yogurt, not cookies and diet soda. In schools with snack machines, children may use their lunch money to purchase high-calorie snacks versus a nutritious lunch.

Question 89

Injuries claim many lives during adolescence. Which factors contribute to early adolescents engaging in risk-taking behaviors? (Choose all that apply.)

• a. Peer pressure
• b. A desire to master their environment
• c. Engagement in the process of separation from their parents
• d. A belief that they are invulnerable
• e. Impulsivity

Answer 89

ANS: A, D, E

Correct A, D, E. Peer pressure (including impressing peers) is a factor contributing to adolescent injuries. During early to middle adolescence, children feel that they are exempt from the consequences of risk-taking behaviors; they believe that negative consequences only happen to others. Feelings of invulnerability (“It can’t happen to me”) are evident in adolescence. Impulsivity places adolescents in unsafe situations.

Incorrect B, C. Mastering the environment is the task of young school-age children. Emancipation is a major issue for the older adolescent. The process is accomplished as the teenager gains an education or vocational training.

Question 90

You are working as the triage nurse in a pediatric emergency room. You receive a telephone call from the mother of an adolescent whose front tooth was completely knocked out of his mouth while he was playing soccer. The mother is seeking advice. Which would be the appropriate response? (Choose all that apply.)

• a. Rinse the tooth in lukewarm tap water.
• b. Place the tooth in saline, milk, or water.
• c. Scrub the tooth with a disinfectant, such as mouth wash.
• d. Bring the child to the emergency room within the next hour for the best prognosis.

Answer 90

ANS: A, B

Correct A, B. Rinse the tooth in lukewarm tap water—this is a correct response. Place the tooth in saline, milk, or water—this is a correct response.

Incorrect C, D. The tooth should not be scrubbed, and cleaning agents and disinfectants should be avoided. The prognosis is best if the injury is treated within 30 minutes.

Question 91

In planning care for a preschool-age child, the nurse knows that the following are open body postures that encourage positive communication. Select all that apply.

• a. Leaning away from the preschooler
• b. Frequent eye contact
• c. Hands on hips
• d. Conversing at eye level
• e. Asking the parents to stay in the room

Answer 91

ANS: B, D

Correct B, D. Frequent eye contact and conversing at eye level are both open body postures that encourage positive communication.

Incorrect A, C, E. Leaning away from the child and placing your hands on your hips are both closed body postures that do not facilitate effective communication. Asking the parents to stay in the room while the nurse is talking to the child is helpful, but is not an open body posture, and therefore is an incorrect response.

Question 92

In planning care for a school-age child with a visual impairment, the nurse knows that the following are important in working with this special needs child. Select all that apply.

• a. Obtain a thorough assessment of the child’s self-care abilities.
• b. Orient the child to various sounds in the environment.
• c. Mandate that the child’s parents stay continuously with their child during hospitalization.
• d. Allow the child to handle equipment as procedures are explained.
• e. Encourage the child to use a dry erase board to write his needs.

Answer 92

ANS: A, B, D

Correct A, B, D. These are correct responses that can be used for a school-age child with a visual impairment.

Incorrect C, E. Mandating that the child’s parents stay continuously with their child may not be possible and is not usually necessary if the school-age child is at the expected level of growth and development. Encouraging a child to write his needs on a dry erase board would be an appropriate intervention for a child who is aphonic, not a child with a visual deficit.