unit one study guide peds

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  1. The most important nursing action to prevent infection in any patient is to :
    1. Use disposable equipment
    2. consistently perform hand hygiene
    3. limit visitors to family members
    4. wear hsopital-laundered clothes.
    • Answer: 2
    • Rationale: Because the nurse must handle equipment, dressings, and patient care activities, both with and without gloves, consistent hand hygiene reduces the number of resident bacteria that can be transmitted to others who may not be resistant to infection.
  2. To best imporve the care of a pregnant woman from a different cultrual group, the nurse should
    1. identify the woman's expectations about pregnancy and birth
    2. observe the woman and ehr family as they interact
    3. learn about members of different local cultrural groups
    4. encourage the woman to adopt local childbearing practices
    • Answer: 3
    • Rationale: Most nurses can identify major cultural groups that reside in the area where they work. Patients and their families appreciate the extra attention to incorporate cultural needs into other nursing care.
  3. One way in which nurses may use statistics is to:
    1. determine daily staaffing to maintain the best patient care
    2. predict the hospital census for the following year
    3. evaluate the outcomes of prenatal care provided
    4. compute the number of women who concieve each year
    • Answer: 3
    • Rationale: Because statistics examine trends in large groups of people, they can help evaluate the quality of care, including prenatal care.
  4. Choose the best description of certified nurse-midwife (CNM) qualifications
    1. gives limited care to women after normal childbirth
    2. assists in the prenatal care of high-risk women
    3. primarily provides care to low-income women
    4. attends uncomplicated births of low-risk women
    • Answer: 4
    • Rationale: The CNM is an advanced-practice nurse with special training in providing care to the childbearing woman. The CNM works under protocols that specify under what conditions that medical care must be sought for the woman
  5. The nursing process is best described as a method to
    1. identify patients who have an increased risk for medical complications
    2. reduce the incidence of complications for expectant mothers and infants
    3. identify and solve patient problems with individualized nursing care
    4. promote breast feeding in groups that do not usually nurse infants
    • Answer: 3
    • Rationale: The nursing process helps nurses individualize care for all patients, both well and ill.
  6. Choose the best description for a variance in a clinical pathway.
    1. the patient did not cooperate with the recommended therapy.
    2. an achieved patient outcome differs from the expected outcome.
    3. patient care is individualized, appropriate to a specific person.
    4. reimbursement will be curtailed because of a complication
    • Answer: 2
    • Rationale: Clinical pathways provide "targets" for expected progress along a time line and are often collaborative, using skills of multiple professionals. When the patient "falls off" the expected course, a variance occurs.
  7. A child must be able to sit before he can walk.  This is an example of which directional pattern of development?
    1. cephalocaudal
    2. proportional
    3. proximodistal
    4. linear
    • Answer: 1
    • Rationale: The head end matures before the lower end of a child’s body. This describes the expected cephalocaudal direction of maturation.
  8. One of themost accurate indicators of biological age is
    1. height
    2. weight
    3. bone growth
    4. teeth eruption
    • Answer: 3
    • Rationale: Bone growth, determined by imaging studies, is the best determinant of biologic age.
  9. The nurse instructs the parent of an infant that dentalcaries are precented through the administration of oral
    1. iodine
    2. fluoride
    3. sodium
    4. iron 
    • Answer: 2
    • Rationale: Fluoride taken topically or systemically reduces the incidence of tooth decay.
  10. Most children are able to feed themselves using a spoon by age:
    1. 1 year
    2. 2 years
    3. 3 years
    4. 4 years
    • Answer: 2
    • Rationale: Most children can feed themselves by the end of the second year.
  11. The theorist know for his work on moral development is:
    1. Freud
    2. Kohlberg
    3. Sullivan
    4. Piaget
    • Answer: 2
    • Rationale: Lawrence Kohlberg is considered an expert on moral development.
  12. A current comic strip depicts a family in which parents, children, and the children's grandparents live together.  This is an example of a(n):
    1. nuclear family
    2. alternat family
    3. extended family
    4. reconstituted family
    • Answer: 3
    • Rationale: The extended family refers to three generations living in a household.
  13. Blood cholesterol below which level is considered acceptable in children and adolescents?
    1. <170mg/dL
    2. <180mg/dL
    3. <200mg/dL
    4. <220mg/dL
    • Answer: 1
    • Rationale: Acceptable levels of blood cholesterol are lower than 170 mg/dL.
  14. The nurse understands that primary dentition is usally completed by age:
    1. 18months
    2. 2 1/2 years
    3. 4 years
    4. 6 years
    • Answer: 2
    • Rationale: Primary teeth are usually in by 2 1⁄2 years.
  15. An infant weighed 7 pounds 11 ounces (3487 g) at birth. what would the nurse expect this infant to weigh at 12 months of age?
    1. 15 pounds (6.8kg)
    2. 20 pounds (9kg)
    3. 23 pounds (10.4kg)
    4. 35 pounds (11.2kg)
    • Answer: 3
    • Rationale: Infants usually triple their birth weight by 1 year of age. This baby’s birth weight was 7 lb, 11 oz, or 3487 g. Triple the birth weight would be 23 pounds or 10.4 kg. Instructor may specify if demonstration of math skills is required in answer.
  16. Which statement would have the most positive outcome when the nurse is counseling adolescents on nutrition?
    1. If you don't eat properly now, you may have heart trouble when you get older
    2. You will get run down and sick if you don't eat properly
    3. Shiny hair and good muscles are linked to good nutrition
    4. If you eat nutritiously, you won't have acne
    • Answer: 3
    • Rationale: Physical appearance is paramount to a teenager. He or she is most likely to change behavior if it will improve looks. The nurse cannot accurately tell an adolescent that certain foods prevent acne.
  17. Young children are playing with action figures in the hospital playroom.  Closer observation reveals they are playing alongside on another, rather than interacting with each other.  The nurse is observing:
    1. solitary play
    2. parallel play
    3. cooperative play
    4. creative play
    • Answer: 2
    • Rationale: Parallel play is characterized by children playing next to each other, but not with each other and is characteristic of 1- to 2-year-old children.
  18. The nurse determines a parent needs additional teaching about nutrition when the partent states:
    1. My 2-year-old child uses a spoon to feed himself.
    2. I feed my 8-month-old infant iron-fortified cereal
    3. My 1-year-old infat falls asleep with a bottle of formula
    4. I give my 3-year-old 3 tablespoons of vegetables
    • Answer: 3
    • Rationale: Milk (or sweet juice) can pool in the mouth and encourage development of cavities (bottle mouth caries).
  19. The nurse would teach a parent to introduce solid foods to an infant at what age:
    1. 3 months
    2. 6 months
    3. 8 months
    4. 10 months
    • Answer: 2
    • Rationale: A 6-month-old infant is physiologically and developmentally ready to ingest solid foods. The gastrointestinal tract is mature enough to handle more complex nutrients, tooth eruption is beginning, the extrusion reflex has disappeared, head control is present, and voluntary grasping and eye-hand coordination are improved.
  20. What is the best nursing response to a parent who asks when her 3-month-old infant can switch from iron-fortified formula to milk?
    1. Switch to milk when you introduce solid foods.
    2. The baby can have milk when she can drink from a cup
    3. Milk can be given at 6 months of age
    4. Infants can drink milk after their first birthday
    • Answer: 4
    • Rationale: Whole milk is not given until the infant reaches 1 year of age. Infants do not have the ability to digest whole milk well before the age of 1 year.
  21. A 4-year-old child had a low score on the Denver II. The nurse understand that this findin indicates:
    1. the need for further evaluation
    2. the child has a cognitive impairment
    3. there is a problem with the child's speech
    4. the child has a developmental delay
    • Answer: 1
    • Rationale: A low score merely indicates the need for further evaluation.
  22. Which statement made by a parent indicates an understanding about a child's dental health?
    1. I give my son a new toothbrush every year on his birthday.
    2. I rinse my toothbrush bristles in hot water after my son brushes.
    3. My 1-year-old brushes his teeth all by himself every day
    4. I replaced the toothbrush after my son had a sore throat
    • Answer: 4
    • Rationale: Toothbrushes should be replaced after a viral illness.
  23. The nurse is assessing the nutritional status of a 6-year-old child.  Which finding suggests the child is well-nourished?
    1. protuerant abdomen
    2. pale oral mucous membranes
    3. alert and energetic
    4. course, thin hair
    • Answer: 3
    • Rationale: Alert and energetic are characteristics of a well-nourished child.
  24. The nurse should teach the mother of a 19-month-old which action(s) to recommend best oral care? select all that apply
    1. if fussy at bedtime, give the baby about 1/2 cup of clear juice in a bottle
    2. brush your baby's teeth before bedtime each night
    3. fluoride is beneficial to the teeth of a child at this age
    4. children will have permanent teeth to replace any "baby teeth" they lose
    5. water in a bottle is safe for teeth at any time
    6. add thoothbrushes for your family to a dishwasher load once a week for thorough cleaning
    • Answer: 2, 3, 5
    • Rationale: Brushing teeth before bedtime each night, providing fluoride, and giving water in a bottle are all appropriate actions to promote oral care.
  25. The priority need in personality development during the first year is to acquire
    1. fear when meeting strangers
    2. mastering self-feeding
    3. trust in the primary caregivers
    4. regular sleeping, waking, and feeding
    • Answer: 3
    • Rationale: Acquisition of trust is essential for the child to develop the security needed to become independent later. Fear of strangers is expected at about 9 months but is not a factor in personality development. Routines are desirable but not a requirement for personality development.
  26. The primary use of growth and development guidelines is to :
    1. help parents anticipate their child's changing needs
    2. compare children of similar ages with each other
    3. predict general inteligence and school performance
    4. identify the child who may be mentally retarded
    • Answer: 1
    • Rationale: Knowing expected developments as their child matures helps parents anticipate the need for changes in the household, such as added or different safety precautions. The guidelines also help identify the child with a developmental delay, but cannot be used to diagnose mental retardation. Expected milestones should only be considered a guide, not predictive of intelligence or identifiers of mental retardation.
  27. Which developmental milestone is expected for the child's age?
    1. passes a toy from one hand to the other at 3months
    2. uses the root reflex to seek the nipple at 5months
    3. sits steadily and without support at 6months
    4. pulls self to standing position at 10months
    • Answer: 4
    • Rationale: A 10-month-old infant often pulls to a standing position as a preliminary development for walking in a few months.
  28. The mother of a 2-month-old is bringing her to the office for a routine checkup and immunizations.  She says the baby cries quite a bit but she just lets her cry so she won't become "spoiled." As a nurse, the best response is to:
    1. tell the mother she should also lower the lights and play soft music or other "white noise"
    2. explain that babies this young cannot be spoiled, then give her some ideas to help soothe the baby
    3. encourage the mother to continue helping her baby become more independent
    4. reassure the mother that she has an irritable baby, but that this phase will not continue for long
    • Answer: 2
    • Rationale: Although the infant may have colic or be an irritable baby, it is important to explain that infants of this age cannot be spoiled and that it is vital for the baby to develop a sense of trust.
  29. The best position for a newborn to sleep is
    1. on the abdomen
    2. in an infant seat
    3. with the caregiver
    4. on the back or side
    • Answer: 4
    • Rationale: Prone position for sleep has been associated with SIDS. Therefore, unless the prone position is medically indicated, the American Academy of Pediatrics recommends a supine or side-lying position. Rolled blankets or other support should be used to maintain the side-lying position for the young infant.
  30. If a parent wants to microwave formula before feeding, the nurse should:
    1. explain that microwaving overheats formula because of hight fat content and can cause severe burns
    2. tell the parent that cold formula preserves the nutrients better than heating it
    3. advise the parent to wait until the infant takes at least 8 ounces of formula at each feeding
    4. teach guidlines for microwaving and caution the parent to test the temperature of the formula before feeding
    • Answer: 4
    • Rationale: Although microwaving can cause hot spots in formula, it is popular to heat it this way. The most practical solution is to provide safe guidelines for microwaving, such as stirring and testing the temperature rather than assuming the parent will not heat formula in this way. Cold formula does not hurt the infant but is not needed to preserve nutrients; partly consumed formula should not be re-refrigerated. Drinking heated or cold is unrelated to quantity taken.
  31. The primary focus of regular infant health care is to:
    1. prevent disease
    2. accelerate development
    3. delay onset of allergies
    4. assess growth rate
    • Answer: 1
    • Rationale: Regular health care provides immunization and safety teaching that helps prevent disease and accidents as the child matures. It will not accelerate development, but helps assess it. Advice may help parents avoid allergic reactions (primarily to foods) but is not the primary purpose. Growth rate is assessed, but this is part of identifying either slowed development or possibly disease.
  32. A mother wants to know if she can keep leftover baby food in a jar.  Choose the best nursing response:
    1. If you heard a definite 'pop' wehn opening the jar, refrigerating leftovers is safe.
    2. Refrigerate the leftover food within 2 hours of opening
    3. When the baby has eaten all she wants fromt he jar, prompley refrigerate the remainder
    4. Remove the amount of food you think the baby will eat from the jar and refrigerate the rest
    • Answer: 4
    • Rationale: Economizes on food and avoids contamination or food breakdown with the infant’s saliva. Jar should always have a pop, whether or not any uncontaminated leftovers are refrigerated. Two hours is too long to leave opened food unrefrigerated. The infant should not be fed from the jar (especially if planning to refrigerate leftovers) because of contamination with saliva.
  33. A formula often prescribed for the infant who cannot tolerate cow's milk formulase is based on:
    1. goat's milk
    2. soy
    3. rice
    4. artificial protein
    • Answer: 2
    • Rationale: Soy-based formulas are the usual choice if cow’s milk formulas are not tolerated, such as a bout of diarrhea. They are often prescribed for infants with many allergies or from allergic families as well.
  34. A nurse counsels a mother who is starting her baby on solid food she should wait ____ days before introducing the next food.
    1. 1-2
    2. 3
    3. 4-7
    4. 14
    • Answer: 3
    • Rationale: This time allows parents to identify intolerance or allergy to the new food. While within the 4– to 7–day time recommendation, waiting 14 days would cause introduction of new solid foods to be extended unnecessarily for most infants.
  35. Social development that is common for the 2-month-old infant is:
    1. responsive smiling
    2. laughing aloud
    3. recognizig his/her name
    4. anxiety around strangers
    • Answer: 1
    • Rationale: Two-month-old infants smile back when parents or others smile at them.
  36. When bringing her 9-month-old baby in for a checkup, a new mother asks if she can feed the baby pureed fish since this is a low-fat food that is a staple in the family's diet.  The bet response of the nurse is:
    1. It is never too early to begin a heart-healthy diet
    2. Fish protein is one of the best quality proteins available
    3. You can try, but many infants dislike the taste of fish
    4. Fish is more likely than other meats to cause allergies
    • Answer: 4
    • Rationale: Although fish is a good adult food for many reasons, it is more likely than other meats to cause infant allergies. Mercury content of fish is a consideration for any age served.
  37. The parents should make safety preparations prior to the time their infants crawls, usually about age:
    1. 4months
    2. 7months
    3. 9months
    4. 12months
    • Answer: 2
    • Rationale: Seven months is an average age for the infant to begin crawling.
  38. Which is the most important teaching about use of the microwave for heating infant food?
    1. use less time than would be needed for larger pieces of food
    2. rotate the food two or more times while warming it
    3. avoid heating foods that are higher in fat, such as meat
    4. test the temperature of any warmed food on the inner wrist
    • Answer: 4
    • Rationale: Even with guidelines for time, microwaving can overheat all foods. Testing the temperature of the food or formula on the wrist identifies if food is too hot.
  39. A fruit that should be delayed until after the infants first birthday is:
    1. strawberries
    2. applesauce
    3. apricots
    4. pears
    • Answer: 1
    • Rationale: Strawberries are one of the more highly allergenic fruits, as is orange juice. Problems with food allergies are less after 1 year of age. The other fruits are not contraindicated although they should be introduced one at a time, with 4 to 7 days between each introduction.
  40. Considering safety when choosing toys for a 5-month-old, one hsould assume that all of them will go into the baby's:
    1. tub
    2. food
    3. mouth
    4. bed
    • Answer: 3
    • Rationale: Infancy is the oral stage. Avoid toys with small parts that could cause choking.
  41. Miner head lag when pulling a 1-month-old infant to the sitting position:
    1. is an expected finding
    2. demonstrates prematurity
    3. identifies poor nutrition]
    4. suggests developmental delay
    • Answer: 1
    • Rationale: One-month-old infants usually have a slight head lag because their neck muscles are not strong enough to support their relatively large heads. The preterm infant may achieve milestones later because of his or her early birth, but head lag alone is not a demonstrator of prematurity.
  42. A mother is concerned because her 1-year-old, who was 7 pounds (3178 g) at birth is "getting fat." the baby now weighs 21 pounds and all developmental milestones have been reached at approriate ages.  What should the nurse tell the mother about her baby's weight?
    1. the weight at 12 months is about twice the birth weight
    2. the baby's weight gain is what is expected at this age
    3. a low-fat diet helps avoid being overweight later in life
    4. infants normally weigh about 25 pounds by 1 year
    • Answer: 2
    • Rationale: General guidelines are that the birth weight should double at 6 months and triple at 1 year. Low-fat diets can compromise an infant’s growth before 2 years of age. An absolute weight guideline such as this one does not take into consideration varying infant birth weights.
  43. The nurse can reassure parents that their infant's colic will probably  not last beyond the age of:
    1. 1month
    2. 3months
    3. 6months
    4. 9months
    • Answer: 2
    • Rationale: Although distressing, colic usually disappears by about 3 months of age.
  44. The baby can usually be offerd finger foods such as toast or Zwieback crackers beginning at about age:
    1. 3months
    2. 5months
    3. 7months
    4. 9months
    • Answer: 3
    • Rationale: At 7 months, the teeth are beginning to erupt and the infant has the hand dexterity to hold the cracker while chewing it.
  45. A good initial method to deal with a 9-month-old infant who is attracted to a dangerous situation is to:
    1. shout a quick, loud "no"
    2. take his favorite toys away
    3. spank him with one light blow
    4. distract him from the situation
    • Answer: 4
    • Rationale: Easy distractibility at 9 months works in favor of helping an infant avoid danger. Shouting is not necessary as the initial method to help infant avoid danger. Infant is too young to understand taking toys away, and physical discipline is not recommended.
  46. A first-time mother is concerned because she believes her 18-momth-old son is not growing properly.  Assessment indicates that the little boy's height and weight are average for his age.  How can the nurse best advise her?
    1. He will soon resume the rapid growth of the first year
    2. It is normal for a child's growth to slow down after the first year
    3. Toddlers grow at inconsistent rates, much like adolescents
    4. The physician will do testing if your son's growth remains slow
    • Answer: 2
    • Rationale: Physical growth slows during the toddler years. Head and brain growth slow, and the chest grows at a faster rate than the head. Toddlers grow at a slower rate than infants, but growth is steady, unlike adolescents. Testing related to slower growth is unnecessary at this time.
  47. When helping a toddler choose clothing for the day, the best approach is to:
    1. ask him what he wants to wear
    2. ask which of two appropriate outfits he prefers
    3. select the best outfit for the weather
    4. remove all inappropriate clothing from his closet
    • Answer: 2
    • Rationale: Toddlers need the opportunity to make choices, but they must be presented with appropriate choices and not too many of them. Asking the child what he wants to wear gives him an array of confusing choices and might result in a temper tantrum if the choice is inappropriate. Selecting the outfit does not give the child a chance to make choices and be autonomous, although the choices offered should be suitable for the weather. Removing inappropriate clothing is unnecessary and takes away opportunities for learning appropriate choices.
  48. The position that best facilitates adult-child conversation is:
    1. at the child's eye level
    2. above the child's eye level
    3. standing while the child sits
    4. both seated at a small table
    • Answer: 1
    • Rationale: Communication is best if people, including children, make eye contact. Standing above the child’s eye level or while the child sits can make the adult seem overpowering to the child. Seating is not necessary but being at the same eye level is best, whether seated or standing.
  49. When teaaching parents of the toddler about eating, the nurse should stress that the toddler:
    1. prefers a variety of foods mixed on the plate
    2. must usually be coaxed to eat adequately
    3. eats one food for awhile, then rejects it
    4. usually enjoys regular addition of new foods
    • Answer: 3
    • Rationale: Toddlers love ritual and have strong preferences and equally strong aversions to certain foods. Their appetite fluctuates. The number of choices if many foods are mixed may overwhelm a toddler. A toddler may not eat because he is not hungry; coaxing encourages the child to use meals to manipulate others. Strong preferences and aversions make the toddler less open to new foods.
  50. The mother of a 2-year-old asks the nurse whether she should begin toilet training now.  Themost appropriate nursing response is:
    1. Waiting about 6 months will improve the child's success with training
    2. Does your child ever wake up dry in the morning?
    3. Is it important to you and your family that the child be trained now?
    4. It is probably easy to toilet train your child if he will sit on the potty chair
    • Answer: 2
    • Rationale: The 2-year-old child may or may not be ready for toilet training. Assessing for the length of daytime dryness, awakening dry, ability to communicate, willingness to sit, and voluntary control helps the nurse and parents determine if this is an appropriate time to begin. Regardless of the importance of toilet training to family members, the child must be physically mature enough for toilet training. In addition, this response is a closed-end (yes/no) question that is unlikely to yield much relevant information.
  51. Automobile child restraint devices should be used when the child:
    1. begins sitting in the rear seat
    2. crawls about in the car
    3. resists activity restraints
    4. travels anywhere in the car
    • Answer: 4
    • Rationale: Child restraint devices should be used on all car trips, no matter how short the distance. It is the law in most states. Air bags often may be turned off if the child must ride in the passenger seat in the restraint device, such as in a pickup truck. Rear seat, center position is the safest but not an option in all vehicles. However, car seats or other age-appropriate restraints should be used regardless of where in the vehicle they are attached. Car seat use should begin with the child’s first ride, usually upon discharge from the hospital.
  52. Select the toy that is most likely to injure a toddler
    1. ballon
    2. block
    3. sand box
    4. pull toy
    • Answer: 1
    • Rationale: A balloon can become lodged in the toddler’s trachea, causing asphyxiation. The other options are all safe and appropriate toys for toddlers.
  53. Which is the best description of a 2-year-old's speech and language ability?
    1. naming objects precedesthe ability to describe what they do
    2. some words such as swearing are used because they shock adults
    3. talking to the child delays clear speach by limiting time to practice
    4. the child understands more than he or she is able to verbalize
    • Answer: 4
    • Rationale: Understanding precedes the toddler’s ability to verbalize needs, thoughts, and feelings. Describing function (such as that of an object’s or animal’s sounds) precedes saying the name of the object. Using shocking words is more characteristic of older children. Talking to the child sets an example of how to use language rather than delaying language.
  54. Choose the best description of physical changes during the toddler years.
    1. head growth slows and chest growth continues
    2. muscle size and strength remain steady
    3. body temperature regulation is erratic
    4. risk for infections is greater than during infancy
    • Answer: 1
    • Rationale: Growth of the relatively large head slows, and the chest continues growing steadily.
  55. The nurse  can help reduce accidental injuries to toddlers by:
    1. providing toys that help accelerate motor development
    2. teaching parents about expected behavioral changes
    3. providing written information about common child hazards
    4. using restraints whenever the child is uncooperative
    • Answer: 2
    • Rationale: If parents know what to expect next in their child’s development and interests, they can better anticipate dangerous situations. Growth and development proceed at an individual’s pace. Toys can promote normal development but not accelerate it. Providing written information is good but does not take into account how anticipatory guidance can reduce accidents simply because the parent did not know that the child would acquire a skill at that time. Restraints are unnecessary. Removal from an unsafe situation is most effective.
  56. Select the assessment that should make a parent or health care provider suspect a communication disorder
    1. an 18-month-old child does not respond when his name is called
    2. a 15-month-old child can point to one picture when the parent calls it's name
    3. a 3-year-old child can use plurals and pronouns currectly
    4. a 16-month-old child cannot use two word phrases when appropriate
    • Answer: 1
    • Rationale: Recognition of one’s name should occur at about 10 months. Hearing impairment or autism should be considered. Most newborns have hearing screens prior to discharge from birth center but later hearing loss may occur.
  57. When assessing a 2-year-old child hospitalized for minor day surgery, the nurse should expect that the pulse rate will be about ___bpm
    1. 60-80
    2. 70-110
    3. 125-135
    4. 120-140
    • Answer: 2
    • Rationale: This is the expected range for a 2-year-old child (about 30 bpm slower than infant values).
  58. When buying shoes for their toddler, parentsshould choose those that provide:
    1. a firm, straight sole to facilitate walking
    2. a strong arch to prevent "fallen" arches
    3. protection from objects that might injure the feet
    4. adequate movement of the heel within the shoe
    • Answer: 3
    • Rationale: Protection is the chief purpose of shoes for children, including toddlers. Special support shoes are needed only for children with specific problems. Shoes are not needed to facilitate walking. Too much heel movement is most likely a sign that the shoes are too large.
  59. Choose the recommendation that best helps to promote safety for the toddler
    1. keep medicines on a shelf rather than on the countertop
    2. provide stickers for each phone with the poison control center number
    3. advise parents to have a cell phone with them when driving
    4. do not use a hair dryer to dry the child's hair after shampooing
    • Answer: 2
    • Rationale: Action helps parent keep this essential number handy at all times. A locked cabinet is best. Nothing mentioned in this option about the height of the shelf. Having a cell phone while driving is not necessary and is a common cause of motor vehicle accidents. Cell phone use is often illegal in a school zone. Drying the child’s hair with a hair dryer is unnecessary. Cords and appliances must be kept out of water.
  60. A mother asks you what she should do about her 2-year-old child's temper tantrums.  The best response is:
    1. He is trying to tell you that he needs more attention from you and other important adults
    2. If you let him get away with temper tantrums now, he will have more problems later
    3. Have you tried rewarding his good behavior
    4. Try putting him in his room for about 30 minutes
    • Answer: 3
    • Rationale: By reinforcing good behavior with a reward, the child learns that good behaviors have positive results and that temper tantrums are either ignored or lead to "time out." Tantrums are not necessarily a sign that the child needs more attention but that they need some limits. Timeouts are valuable means to set limits, but 30 minutes is too long; time out for a 2-year-old child is about 2 minutes.
  61. A preschool child falls off the swing and cries, "Bad swing! You made me fall!" This child's response is an example of
    1. egocentism
    2. intuition
    3. animism
    4. symbolism
    • Answer: 3
    • Rationale: The child is attributing lifelike qualities ("You made me fall!") to an inanimate object (the swing).
  62. Choose the best example of egocentric thinking
    1. The airplane takes me to Grandma's
    2. Water is blue because someone colored it
    3. This big box is a truck
    4. The moon sleeps during the daytime
    • Answer: 1
    • Rationale: The child focuses on the airplane’s mission as taking him/her (not the other passengers) to grandma’s (not the destination city).
  63. The nurse would explain to parents that fears of preschool children are usually:
    1. similar to those of older children
    2. a result of the child's easy distration
    3. less intense than when they were younger
    4. greater than those they had as toddlers
    • Answer: 4
    • Rationale: The preschool child now has enough experience and memory to realize that some things actually can hurt them. However, they may have other fears that are not realistic because they do not understand the true nature of the situation, such as fear of bodily injury. These children often want a Band-Aid® when one is not really needed because they are fearful about their blood "leaking out."
  64. When planning to read with a 5-year-old child, the nurse understands that favorite stories of preschool children are those related to their:
    1. aggressive tendencies
    2. self-centeredness
    3. daily experiences
    4. relationships with others
    • Answer: 3
    • Rationale: Preschool children can best relate to stories that are about people, animals, and occurrences in their daily lives.
  65. A healthy preschool girl asks her parents if she will die.  The best response is to tell her that:
    1. people do not usually die until they are old
    2. she does not need to worry about dying
    3. parents usually die before their children
    4. she will not die for a long time
    • Answer: 1
    • Rationale: One cannot assure a person of any age that they will not die. However, it is appropriate to reassure the child that death usually comes only when people are old. Remember that the child’s definition of "old" is likely to be quite different from a parent’s.
  66. What is the most appropriate advice for the nurse to offer parents who are concerned about their preschooler's masturbation?
    1. remove the child's hands from the genitals
    2. try to interest the child in another activity
    3. tell the child not to touch hiself there
    4. ask the child why he is rubbing that area
    • Answer: 2
    • Rationale: Masturbation is a reflection of the child’s curiosity about sex and sometimes reflects anxiety. Interesting the child in another activity usually suffices to end the masturbation.
  67. One effective method of discipline for a preschool child is to:
    1. reward the child for good behavior
    2. give the child a light spanking
    3. review the reasons for discipline
    4. stop interacting with the child
    • Answer: 1
    • Rationale: As with most adults, positive reinforcement by rewarding good behavior increases the likelihood that this behavior will continue
  68. Choose the most effective way for parents to deal with a preschool child's jealousy of her new brother:
    1. help her choose toys to share with the new baby
    2. remind her of things she can do that the baby cannot
    3. explain that she will soon lover her new brother
    4. ask her to share her room with the new baby at first
    • Answer: 2
    • Rationale: The arrival of a new sibling may be the preschooler’s first experience with sharing parents’ attention. Setting aside time to be with the older child and reinforcing individual talents promotes his/her emotional security in relation to the sibling.
  69. A child who sucks his thumb is unlikely to have damage to the mouth if the thumb sucking stops before:
    1. all deciduous teeth are erupted
    2. speech is established first
    3. the first teeth erupt
    4. the permanent teeth erupt
    • Answer: 4
    • Rationale: Thumb-sucking rarely causes problems unless it persists after the permanent (second) teeth erupt.
  70. Choose the most appropriate teaching for parents of a child with enuresis:
    1. enuresis is suggestive of emotional instability in a child
    2. the child's fluid intake should be restricted during the day
    3. the child should empty his bladder before going to bed
    4. a relapse during treatment for enuresis is uncommon
    • Answer: 3
    • Rationale: The child should routinely void before going to bed.
  71. According to Erikson, the developmental task of the preschool period is to achieve a sense of:
    1. trust
    2. autonomy
    3. initiative
    4. industry
    • Answer: 3
    • Rationale: Initiative versus guilt is the psychosocial task of the preschool period.
  72. Which is the best choice for a play activity for a 4-year-old?
    1. watch a videotape
    2. play a computer game
    3. ride a bicycle
    4. build with blocks
    • Answer: 4
    • Rationale: The preschool child enjoys simple toys and common objects. A tricycle rather than a bicycle would be more suitable. Videotapes and computer games do not actively involve a child physically.
  73. Choose the approximate age when children begin playing games that have simple rules?
    1. 3years
    2. 4years
    3. 5years
    4. 6years
    • Answer: 3
    • Rationale: Children younger than 5 years are usually too immature to maintain sustained play in games that have rules.
  74. Bedtime for the preschool child should include:
    1. flexibility in the time the child goes to bed
    2. a period of exercise after dinner
    3. warm milk
    4. a quiet activity such as a story
    • Answer: 4
    • Rationale: Children often have difficulty moving from a very active day to bedtime. By providing quiet activities prior to bedtime, the child is assisted in the transition.
  75. A major cause of health problems in preschool children is:
    1. immunization reactions
    2. communicable diseases
    3. environmental allergies
    4. accidental injuries
    • Answer: 4
    • Rationale: Greater independence combined with curiosity, inexperience, and lack of judgment enhances the preschool child’s likelihood of suffering accidental injury.
  76. The school-age child who has few experiences of success is likely to develop a sense of:
    1. dependence
    2. inferiority
    3. trust
    4. industry
    • Answer: 2
    • Rationale: Having successful experiences helps the child see him- or herself as a competent person and encourages him/her to try out new things. Adequate successful experiences counteract the occasional unsuccessful ones.
  77. Which best describes physical growth of the school-age child?
    1. rapid growth occurs from 6-9 years of age and then slows
    2. slow growth continues until just before puberty
    3. height increases faster than weight
    4. height and weight remain stable until the onset of puberty
    • Answer: 2
    • Rationale: Growth is slow and steady until shortly before puberty, when growth in height accelerates markedly.
  78. Choose the normal characteristics of vital signs that the nurse should expect when assessing a 9-year-old girl.
    1. blood pressure and pulse are higher than those of boys the same age
    2. blood pressure, pulse, and respirations are close to adult levels
    3. blood pressure is higher, but pulse and respirations are lower than the adult
    4. blood pressure, pulse, and respirations are higher than those of a 6-year-old girl
    • Answer: 2
    • Rationale: During this period of childhood, vital sign normal values approach those of adults.
  79. How would the nurse advise parents regarding a school-age child's questions about sex?
    1. initiate discussions before the child asks any questions
    2. answer questions at the child's level of understanding
    3. assure parents the topic will be part of the school curriculum
    4. select terms that are used by school-age children
    • Answer: 2
    • Rationale: Children need to be taught factually about sex, but at their level of understanding
  80. The most significant physical development at age 6 years is:
    1. loss of the primary teeth
    2. elongation of the face
    3. better infection resistance
    4. rabig growth in height
    • Answer: 1
    • Rationale: Loss of deciduous teeth begins about age 6, with loss of lower central incisors (front teeth).
  81. Worries and minor compulsions are more common at the age of:
    1. 6years
    2. 7years
    3. 9years
    4. 11years
    • Answer: 3
    • Rationale: Various nervous habits, worries, and compulsions often reflect the child’s tension while growing up.
  82. A preadolsecent is more likely to accept her parents' decision if:
    1. she understands why her parents made the decision
    2. the parents do not change decisions once they are made
    3. the parents carefully control the child's friends
    4. her friends have values similar to her own family's
    • Answer: 1
    • Rationale: Preadolescents need to understand the rationale behind rules and decisions of adults so they are more likely to accept them. This helps them make better-reasoned decisions as they mature further.
  83. Which statement made by a 10-year-old child indicates the need for teaching about living a healthy lifestyle?
    1. I go to the dentist twice a year
    2. I wear a helmet when I ride my bike
    3. I watch 4 hours of television after school
    4. I go to bed at 9:00 pm and get up at 7:00 am
    Answer: 3 Rationale: Four hours of television each evening indicates the need for teaching about a healthy lifestyle. Four hours of inactivity contributes to childhood obesity and replaces active play with other children.
  84. The preadolescent girl should have supplies for menstruation:
    1. before her first menstrual period
    2. as soon as she knows how heavy her flow is
    3. when her friends are prepared for theirs
    4. about six months after breast development begins
    • Answer: 1
    • Rationale: It is very embarrassing for a preadolescent girl to go to an unrelated adult (such as a teacher) because she lacks supplies for her first menstrual period. Likewise, girls this age are usually horrified at the thought of purchasing supplies themselves. The growth spurt and breast development precede menstruation, which allows the parent to prepare her for the first period, although its exact onset cannot be predicted.
  85. A group of 8- and 9-year-old boys has formed a "club." The boys have a secret password and handshake before they meet. Parents should interpret this behavior as:
    1. typical for children in this age group
    2. a way to avoid being around adults
    3. preceding criminal-type gang membership
    4. rebellion against bossy older children
    • Answer: 1
    • Rationale: Nine-year-olds typically form strong friendships with others of the same sex. There is some teasing of the opposite sex, although not as strong as it becomes during the preadolescent years. Rituals and secret codes allow the children to keep outsiders (adults and those of the opposite sex) away, while cementing bonds with the "in" group.
  86. A father is concerned because his 9-year-old son has developed the habit of wrinkling his nose unconsciously.  The nurse should tell the father that his son:
    1. may have a nerve problem and should be seen by a physician
    2. cannot get adequate adult attention without taking this action
    3. is probably doing this because of unresolved tension
    4. should be corrected any time he is  caught doing this action
    • Answer: 3
    • Rationale: Various nervous tics and other habits are common at age 9. They usually disappear spontaneously as the tension is resolved.
  87. A school-age child has an adult "hero" of the same sex.  What is the most appropriate interpretation of this behavior? 
    1. the child feels insecure and inadequate around other children
    2. identifying with adults of the same sex is common at this time
    3. molestation of sexual abuse by the adult should be considered
    4. the child is exploring various career and lifestyle options
    • Answer: 2
    • Rationale: As the child grows, attachment to the parents decreases. They still need an adult role model, such as a non-parent adult of the same sex, with whom they can identify.
  88. Which statement characterizes the 8-year-old child?
    1. eight-year-olds are totally disorganized
    2. they are beginning to take an increased interest in their appearance
    3. at this age, children are quieter an dmore modest than the year before
    4. they like competitive sports, but are poor losers
    • Answer: 4
    • Rationale: The 8-year-old enjoys competitive sports but is generally a poor loser
  89. Younger adolescents often have an awkward appearance because:
    1. maturation occurs earlier than in previous generations
    2. body parts grow and mature at different rates
    3. growth and development slows during adolescence
    4. self-consciousness causes the adolescent to slump
    • Answer: 2
    • Rationale: Growth during adolescence does not proceed at the same rate in all systems. Therefore, teens often have "gangly" appearances and movements.
  90. A person who does not establish an didentity during adolescence is more likely to:
    1. conform to a peer group for a prolonged time
    2. seek close relationships with others
    3. become insensitive to the needs of others
    4. have an overly superior self-image
    • Answer: 1
    • Rationale: People who never develop a strong self-identity take their identity from others. This "identity" is likely to fluctuate according to the group they are with.
  91. A parent can best help an adolescent make a wise decision by:
    1. explaining what he or she would have done when he or she was a teenager
    2. reviewing problems with the decision after the teenager makes it
    3. serving as a role model by making the decision for the teenager
    4. respecting the teenager's decision, even if he or she makes a mistake
    • Answer: 4
    • Rationale: An adolescent must learn from mistakes to gain experience needed as an adult. Learning from one’s mistakes is closely related to development of an identity.
  92. Younger adolsecents tend to be egocentric because they are:
    1. certain that their parents are ignorant
    2. believe no-one is paying attention to them
    3. preoccupied with their physical development
    4. proud of their greater responsibilities
    • Answer: 3
    • Rationale: Young adolescents are so overwhelmed by the dramatic physical changes that they believe everyone is watching them.
  93. The adolescent's peer group helps him or her move away from:
    1. same sex friendships
    2. values of his or her family
    3. individual responsibility
    4. dependence on his or her family
    Answer: 4 Rationale: Peers provide a haven for the adolescent as he/she bridges the time between dependence on the family and the independence of adulthood.
  94. What is the best ursing response to a parent who is concerned about her 15-year-old's frequent day-dreaming?
    1. Daydreaming is a normal adolescent occurence
    2. This behavior is an indicator of adolescent insecurity
    3. Your concern is valid because this is a sign of depression
    4. It is a way for teenagers to ignor their parents
    • Answer: 1
    • Rationale: Daydreaming is the adolescent’s way of "rehearsing" for situations or events he/she encounters. It is not a problem unless it interferes significantly with grades or activities
  95. An adolescent who adopts a strict vegetarian diet is at risk for a deficiency of which nutrient?
    1. carbohydrates
    2. vitamin C
    3. protein
    4. fiber
    • Answer: 3
    • Rationale: Strict vegetarians who eat no animal protein are most at risk for protein deficiency. Adequate protein can be obtained from plant foods, but these must be combined carefully to achieve enough of the high-quality (complete) proteins that are necessary for body functions.
  96. Most accidents in adolescents occur when they:
    1. participate in contact sports
    2. handle guns or knives
    3. drive a car or other vehicle
    4. work at part-time jobs
    • Answer: 3
    • Rationale: Car accidents are the principal type of accident during adolescence. The teenager’s inexperience with driving, distractions from passengers, and a sense of invulnerability combine to increase the risk for having a motor vehicle accident.
  97. The nurse assessing an adolescent's physical development knows that then Tanner stages describe the:
    1. sequence of physical maturation in the adolescent
    2. change from concrete thinking to abstract thinking
    3. hormonal changes that cause ovulation and menstruation
    4. development of a mature gender identity
    • Answer: 1
    • Rationale: Tanner stages are an orderly, standardized method to classify the maturation of secondary sexual characteristics during puberty. They include five stages for both boys and girls.
  98. The major psychosocial task of adolescence is to devlop a sense of:
    1. sexual orientation
    2. concern for other people
    3. family unity
    4. identity as an individual
    • Answer: 4
    • Rationale: Adolescence is a time for boys and girls to separate from the family and develop their own identities.
  99. A parent is worried because her 14-year-old son seems to be constantly in the bathroom, shampooing and styling his hair.  She worries that her son may be homosexual because he is so concerned about his appearance.  What is the most appropriate nursing response to the mother's concern?
    1. Homosexual thoughts and experimentation are normal during the early teens
    2. Boys are usually more concerned bout their athletic abilities than their appearance
    3. You should be more concerned about why he does not want to be with his friends
    4. Teens are preoccupied with their appearance because of dramatic body changes
    • Answer: 4
    • Rationale: Preoccupation with their rapidly changing appearance is normal for teenagers.
  100. What is the best information for the nurse to include in a class for adolescents about healthy eating habits?
    1. how to choose foods from the basic food pyramid
    2. the need to eat three balanced meals per day
    3. the importance of an adequate diet to better health during adulthood
    4. nutrients that are often lakcing in a adolescent's diet
    • Answer: 1
    • Rationale: Foods should be selected from the basic food pyramid.
  101. What is the best food choice for an adolescnet who just finished playing a game of field hockey?
    1. cheeseburger
    2. chocolate bar
    3. garden salad
    4. toasted bagel
    • Answer: 4
    • Rationale: A bagel is the best choice because it will provide a rapid supply of carbohydrates to muscles.

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