Peds

A 2-day-old girl is being discharged from the hospital. Her mother asks the nurse when she will
receive her first hepatitis B immunization. Which is the nurse's best response?
1. "Babies receive the hepatitis B vaccine only if their mother is hepatitis
B-positive."
2. "She will receive her first dose of the hepatitis B vaccine prior to discharge today."
3. "She will receive her first hepatitis B vaccine when she is 1 year of age."
4. "She will receive her first hepatitis B vaccine at 6 months of age."

A 2-day-old girl is being discharged home. The nurse is working on discharge teach- ing with her
parents. They are asking the nurse about how to use the infant car seat and where it should be
placed in their vehicle. Which of the following should the nurse do?
1. Give the parents a pamphlet explaining how to install the car seat.
2. Accompany the parents to the car, and show them how to install the car seat.
3. Contact the hospital's car-seat safety officer, and ask the officer to accompany the
parents to the car for car-seat installation.
4. Show the parents a video on car-seat installation and safety, and ask if they are
comfortable with the information.

A 2-year-old boy has been admitted to the hospital for anemia. His
mother asks the nurse what foods to include in his diet to improve his
nutritional status. Which of the following should the nurse recommend?
1. Increase the child's intake of whole cow's milk to 32 ounces a day.
2. Increase the child's intake of meats, eggs, and green vegetables.
3. Increase the child's intake of fruits, whole grains, and rice.

ANS: 2
The first dose of hepatitis B vaccine is
recommended between birth and 2
months. Most hospitals give the
vaccine prior to discharge home.

ANS: 3
The car-seat safety officer is the best
choice, as that individual would have
the needed information and
certification to help the family.

ANS: 2
Meat, eggs, and green vegetables are
excellent sources of iron.

4. Increase the number of snacks the child eats during the day.

A 2-year-old girl has just become a big sister. Her mother has been a
stay-at-home mother. Based on the developmental level of a 2-year-old,
which comment should the child's mother expect from her toddler about
her new baby brother?
1. "Mommy, when my baby brother takes a nap,
will you play with me?"
2. "Mommy, can I play with my baby brother?"
3. "Mommy, he is so cute. I love him."
4. "Mommy, it is time to put him away so we can
play."

A 3-month-old infant dies shortly after arrival to the
emergency department. The infant has subdural and
retinal hemorrhages but no external signs of trauma. The
nurse should suspect:
a. Unintentional injury.
b. Shaken-baby syndrome.
c. Sudden infant death syndrome (SIDS).
d. Congenital neurologic problem.

ANS: 4
This is a typical statement that would
be made by a toddler. Toddlers are
very egocentric and do not consider
the needs of the other child.

ANS: B
Shaken-baby syndrome causes internal bleeding but may have no
external signs. Violent shaking of the brain results in shearing
forces that tears blood vessels and neurons. The baby will then
present with subdural hematoma and retinal hemorrhage. This is
not the characteristic injury pattern of a baby who has received an
unintentional injury. With SIDS the baby usually presents to the
emergency department with no signs of life. These findings are
inconsistent with a congenital neurologic problem.

A 3-month-old infant, born at 38 weeks of gestation, will
hold a rattle if it is put in her hands, but she will not
voluntarily grasp it. The nurse should interpret this as:
a. Normal development.
b. Significant developmental lag.
c. Slightly delayed development caused by prematurity.
d. Suggestive of a neurologic disorder such as cerebral
palsy.
A 3-year-old boy has been hospitalized because he fell down the stairs.
His mother is crying and states, "This is all my fault." Which is the
nurse's best response to the child's mother?
1. "Accidents happen. You shouldn't blame yourself."
2. "Falls are one of the most common injuries for toddlers."
3. "It may be a good idea to put a baby gate on the stairs."
4. "Your son should be proficient at walking down the stairs by now."

A 3-year-old female is hospitalized for a femur fracture. As her nurse,
what nursing action would help foster the child's sense of autonomy?
1. Allow the child to choose what time to take
her oral antibiotics.
2. Allow the child to have a doll for medical play.
3. Allow the child to administer her own dose of
Keflex (cephalexin) via oral syringe.
4. Allow the child to watch age-appropriate
videos.

ANS: A
This indicates normal development.
Reflexive grasping occurs during the first
2 to 3 months and then gradually
becomes voluntary. No evidence of
neurologic dysfunction is present.

ANS: 2
Falls are one of the most common injuries, and it may make the parent
feel better to know that this is
common among all toddlers.

ANS: 3
Allowing toddlers to participate in
actions of which they are capable is
an excellent way to enhance their
autonomy.

A 3-year-old female is hospitalized for an ASD repair. Her parents have
decided to go home for a few hours to spend time with her siblings. The child
asks when her mommy and daddy will be back. The nurse's best response is:
1. "Your mommy and daddy will be back after your nap."
2. "Your mommy and daddy will be back at 6 p.m."
3. "Your mommy and daddy will be back later this evening."

ANS: 1
Preschoolers understand time in relation to events.

4. "Your mommy and daddy will
be back in 3 hours."

A 3-year-old girl is attending her grandfather's funeral. Her parents have told
her that her grandfather is in heaven with God. The child is taken up to the
open casket with her parents. Which statement by the child describes a 3-yearold child's understanding of spirituality?
1. "Grandpa's body is here with us on Earth, and his spirit is in heaven."
2. "Grandpa is in heaven. Is this heaven?"
3. "Grandpa's spirit is no longer in his body."
4. "Grandpa won't need his body in heaven."

ANS: 2
Children 3 years old are literal thinkers.
The child's parents told her that Grandpa
was in heaven. She sees his body, so she
thinks they are all in heaven.

A 3-year-old was admitted to the hospital with croup. His nurse just obtained vital signs. The child's heart rate is 90, his
respiratory rate is 44, his blood pressure is 100/52, and his temperature is 98.8°F (37.1° C). The parents ask the nurse if his
vital signs are appropriate for a child his age. The nurse's best response to the parents is:
1. "Your son's blood pressure is elevated, but the other vital signs are within normal
limits."
2. "Your son's temperature is elevated, but the other vital signs are within normal
limits."
3. "Your son's respiratory rate is elevated, but the other vital signs are within normal
limits."
4. "Your son's heart rate is elevated, but the ogther vital signs are within normal
limits."

ANS: 3
A normal respiratory rate for a child
from 3 to 6 years is 20 to 30 breaths
per minute.

3. A 6-month-old male is at his well-child checkup. The nurse weighs him, and
his mother asks if his weight is normal for his age. The nurse's best response
is:
1. "At 6 months his weight should be
approximately three times his birth weight."
2. "Each child gains weight at his or her own
pace."
3. "At 6 months his weight should be
approximately twice his birth weight."
4. "At 6 months a child should weigh about 10
lb more than his or her birth weight."

A 4-year-old boy is hospitalized with a serious bacterial
infection. He tells the nurse that he is sick because he was
"bad." The nurse's best interpretation of this comment is
that it is:
a. A sign of stress.
b. Common at this age.
c. Suggestive of maladaptation.
d. Suggestive of excessive discipline at home.

A 4-year-old has been hospitalized with FTT. The child has orders for daily
weights, strict input and output, and calorie counts as a means of measuring
her nutritional status. Which action by the nurse would be a concern?
1. The nurse weighs the child every morning before the child eats breakfast.
2. The nurse weighs the child with no clothing except for undergarments.
3. The nurse sits with the child when the child eats her meals.
4. The nurse weighs the child using the same scale every morning.

A 4-year-old is visiting the pediatrician's office for his well-child checkup. The
nurse needs to take his blood pressure. Which action by the nurse is a
developmentally appropriate method for eliciting the child's cooperation?
1. Have the child's parents help put on the blood pressure cuff.
2. Tell the child that if he sits still, the blood pressure machine will go quickly.
3. Ask the child if he feels a squeezing of his arm.
4. Tell the child that blood pressures do not hurt.

ANS: 3
Children should double their birth
weight by 4 to 6 months of age.

ANS: B
Preschoolers cannot understand the cause and effect of
illness. Their egocentrism makes them think that they are
directly responsible for events, making them feel guilt for
things outside of their control. Children of this age show
stress by regressing developmentally or acting out.
Maladaptation is unlikely. This comment does not imply
excessive discipline at home.

ANS: 1
The child should be weighed every
day before she eats. Her weight will
not be an accurate reflection if she is
fed prior to being weighed.

ANS: 3
Preschool children enjoy games, and
it is a good way to elicit their
assistance and cooperation during a
procedure.

A 5-year-old boy has always been one of the shortest children in class since pre- school. His
mother tells the school nurse that her husband is 6' and she is 5'7". She is concerned about her
son's height. Based on her knowledge of a child's physical growth during the school-age years,
what should the nurse tell the child's mother?
1. She should expect him to grow about 3 inches every year from ages 6 to 9 years.
2. She should expect him to grow about 2 inches every year from ages 6 to 9 years.
3. She should have him seen by an endocrinologist for growth hormone injections.

ANS: 2
During the school-age years, a child
grows approximately 2 inches per
year.

4. Be sure to have her son's growth reevaluated when he is 7 years old.

A 5-year-old boy is being screened for developmental delays using
the Denver Developmental Screening Test. The child's mother is
explaining to the nurse her understanding of the screening test.
The nurse realizes that the child's mother needs further education
about the test when she states which of the following?
1. "It screens my son's gross motor skills."
2. "It screens my son's fine motor skills."
3. "It screens my son's intelligence level."
4. "It screens my son's language development."

A 5-year-old girl has been brought to the ER for suspected child abuse. What approach should
the nurse use to gather information from the child?
1. The nurse should promise the child that her parents will not know what she tells
the nurse.
2. The nurse should promise the child that she will not have to see the suspected
abuser again.
3. The nurse should use correct anatomical terms to discuss body parts.
4. The nurse should tell the child that the abuse is not her fault and that she is a
good person.

A 5-year-old is at the pediatrician's office for his well-child checkup. The
nurse will be administering three immunizations to the child. The nurse
should expect which reaction from the child when she gives his
immunizations?
1. The child will likely remain silent and still.
2. The child will likely cry and tell the nurse
that it hurts.
3. The child will likely try to stall the nurse.
4. The child will likely remain still while telling
the nurse that she is hurting him.

A 7-year-old female is being admitted to the hospital for a diagnosis of acute lympho- cytic
leukemia. The nurse wants to gather information from the child regarding her feelings about her
diagnosis. Which nursing action is most appropriate to gain infor- mation about how the child
is feeling?
1. The nurse should actively attempt to make friends with the child before asking her about her
feelings.
2. The nurse should ask the child's parents what feelings she has expressed in regard to her
diagnosis.
3. The nurse should provide the child with some paper to draw a picture of how she is feeling.
4. The nurse should ask the child direct questions about how she is feeling.

ANS: 3
The Denver Developmental Test does
not test a child's level of intelligence.

ANS: 4
Many young children believe abuse or illness
is their fault, and they should be reminded
they are not to blame. Many children of this
age believe they have acquired a disease or
have been abused because they are bad
people.

ANS: 2
The common response of a 5-year-old
is to cry and protest during an
immunization.

ANS: 3
Often children will include much more
detail of their feelings in drawings. They
will often express things in pictures they
are unable to verbalize.

An 8-day old female was admitted to the hospital with vomiting and dehydration. The nurse has
just obtained vital signs. The child's heart rate is 185, her respiratory rate is 44, her blood
pressure is 85/52, and her temperature is 99°F (37.2° C). The child's parents ask the nurse if her
vital signs are within normal limits. What is the nurse's best response to the parents?
1. "Your daughter's blood pressure is elevated, but the other vital signs are within normal
limits."
2. "Your daughter's temperature is elevated, but the other vital signs are within normal limits."
3. "Your daughter's respiratory rate is elevated, but the other vital signs are within normal
limits."

ANS: 4
A normal heart rate for a child from
birth to 1 month is 90 to 160.

4. "Your daughter's heart rate is elevated, but the other vital signs are within normal limits."

An 8-week-old male has just had surgery for pyloric stenosis. His nurse is assessing his level of
pain. The child's mother asks the nurse what vital sign changes she should expect to see in a child
who is experiencing pain. The nurse's best response is:
1. "We expect to see a child's heart rate decrease and respiratory rate increase."
2. "We expect to see a child's heart rate and blood pressure decrease."
3. "We expect to see a child's heart rate and blood pressure increase."
4. "We expect to see a child's heart rate increase and blood pressure decrease."

An 8-year-old girl is at the pediatrician's office for a well-child checkup.
Her mother tells the nurse that she has been having some difficulty
getting her daughter to com- plete her chores. The child's mother asks
the nurse for techniques for gaining the child's cooperation with chores.
Which of the following should the nurse suggest the mother do?
1. Use "grounding" as a technique.
2. Use "time-out" as a technique.
3. Use a reward system as a technique.
4. Use spanking as a technique.

An 8-year-old girl tells the nurse that she has cancer because God is
punishing her for "being bad." She shares her concern that, if she dies,
she will go to hell. The nurse should interpret this as being:
a. A belief common at this age.
b. A belief that forms the basis for most
religions.
c. Suggestive of excessive family pressure.
d. Suggestive of a failure to develop a
conscience.

An 8-year-old is NPO while he awaits surgery for central line placement later
in
the afternoon. The nurse is trying to engage the child in some form of activity
to distract him from thinking about his upcoming surgery. Which is the best
method of distraction for a child of this age in this situation?
1. Encourage the child to use the telephone to
call friends.
2. Encourage the child to watch television.
3. Encourage the child to play a board game.
4. Encourage the child to read the central line
pamphlet he was given.

ANS: 3
When a child is experiencing pain,
the normal physiological response is
for the heart rate, respiratory rate,
and blood pressure to increase.
ANS: 3
School-age children usually respond very
well to a reward system and often enjoy
the rewards so much that they will
continue chores without continual
reminders.

ANS: A
Children at this age may view illness or
injury as a punishment for a real or
imagined mystique. The belief in divine
punishment is common at this age.

ANS: 3
A board game is the optimal choice because school-age children enjoy being
engaged in an activity with others that
will require some skill and challenge.

A 9-year-old boy has been hospitalized following a bicycle injury. What
should the nurse recommend to the child's parents to prevent future
injury?
1. Their son should wear safety equipment while riding bicycles.
2. Their son should read educational material on bicycle safety.
3. Their son should watch a video on bicycle safety.
4. Their son should ride his bike in the presence of adults.

A 9-year-old child has just been diagnosed with recurrent abdominal
pain (RAP). What should the nurse include in preparing the family for
discharge? Choose all that apply.
a. "Your child should be on a high-fiber diet."
b. "You may give your child a stimulant
laxative once a week."
c. "You should help your child with bowel
training to establish regular bowel habits."
d. "Your child may place ice packs on the
abdomen when pain occurs."

A 9-year-old girl builds a clubhouse in her backyard. She hangs a sign outside
her clubhouse that says "No boys allowed." The child's parents are concerned
that she is excluding their neighbor's son, and they are upset. What should the
school nurse tell the child's parents?
1. Her behavior is cause for concern and should be addressed.
2. Her behavior is common among school-age children.
3. Her feelings about boys will subside within the next year.

ANS: 1
Safety equipment is essential for bicycling,
skateboarding, and participating in contact
sports. Most injuries occur during the
school-age years, when children are more
active and participate in contact sports.

ANS: A, C
A high-fiber diet with possible addition of bulk
laxatives is beneficial in children with RAP. Bowel
training is recommended to assist the child in
establishing regular bowel habits. Giving a child a
stimulant laxative once a week and placing ice packs
on the abdomen for pain would not be included in
discharge teaching for this patient and family.

ANS: 2
This is common behavior. Girls of 9
and 10 generally prefer to have
friends who are of the same gender.

4. They should have their daughter speak with the school counselor.

A 9-year-old girl often comes to the school nurse complaining of stomach
pains. Her teacher says that she is completing her schoolwork
satisfactorily, but lately she has been somewhat aggressive and stubborn
in the classroom. The school nurse should recognize this as:
a. Signs of stress.
b. Developmental delay.
c. A physical problem causing emotional
stress.
d. Lack of adjustment to the school
environment.

A 10-year-old girl needs to have another intravenous (IV) line started.
She keeps telling the nurse, "Wait a minute," and, "I'm not ready." The
nurse should recognize that:
a. This is normal behavior for a school-age
child.
b. This behavior is usually not seen past the
preschool years.
c. The child thinks the nurse is punishing her.
d. The child has successfully manipulated the
nurse in the past.

ANS: A
Signs of stress include stomach pains or
headache, sleep problems, bed-wetting,
changes in eating habits, aggressive or
stubborn behavior, reluctance to participate,
or regression to early behaviors. This child is
exhibiting signs of stress.
ANS: A
This school-age child is attempting to maintain
control. The nurse should provide the girl with
structured choices about when the IV will be
inserted. This can be characteristic behavior when an
individual needs to maintain some control over a
situation. The child is trying to have some control in
the hospital experience.

An 11-month-old girl has a diagnosis of iron-deficiency anemia. The child's mother tells the
nurse that her daughter is currently taking iron and a multivitamin. Which statement made by
the mother should be of concern to the nurse?
1. "I give my daughter her iron and multivitamin at the same time each morning."
2. "I give my daughter her iron and her multivitamin in her morning 6-oz
bottle."
3. "I give my daughter her iron and multivitamin in a nipple before I feed her the
morning bottle."
4. "I give my daughter her iron and multivitamin in oral syringes toward the back
of her cheek."

An 11-year-old male is being evaluated in the ER for an inguinal hernia. Which statement
accurately describes how the nurse should approach him for his physical assessment?
1. The nurse should ask the child's parents to remain in the room during the
physical exam.
2. The nurse should auscultate the child's heart, lungs, and abdomen first.
3. The nurse should explain to the child that the physical exam will not hurt.
4. The nurse should explain to the child what the nurse will be doing in basic
understandable terms.

A 12-month-old boy weighed 8 lb 2 oz at birth.
Understanding developmental mile- stones, what should
the nurse caring for the child calculate his current weight
as?
1. Approximately 16 lb 4 oz.
2. Approximately 20 lb 5 oz.
3. Approximately 24 lb 6 oz.
4. Approximately 32 lb 8 oz.
A 13-year-old boy is hospitalized for a femur fracture. He was hit by a car
while he and his friends were racing bikes near a major intersection. The
child's parents are concerned about his judgment. What should the nurse
understand?
1. The child's behavior is typical of young teens.
2. The child's behavior is related to hormonal surges during adolescence.
3. This was an isolated incident and will not likely happen again.
4. The child's behavior is related to teen rebellion.

A 13-year-old boy is visiting the pediatrician's office for his well-child checkup. The child tells the
nurse that he is worried because his breasts are growing and they hurt. He tells the nurse he is
afraid to take his shirt off in front of the other boys during gym class. What should the nurse tell
him?
1. "The pediatrician will draw some blood to find out why your breasts are growing."
2. "It is just a slight hormonal imbalance that can be easily corrected with medication."
3." This is a normal condition of puberty that will resolve within a year or two."
4. "This is a rare finding that occurs in about 5% of boys during puberty."

ANS: 2
Medications should never be mixed in a large
amount of food or formula because the
parent cannot be sure that the child will take
the entire feeding. Formula decreases the
absorption
of iron.

ANS: 4
School-age children are capable of
understanding basic functions of the
body and should be taught about their
diagnosis in simple, basic terms.

ANS: 3
Children should triple their birth
weight by 12 months of age.

ANS: 1
The brains of young teens are not
completely developed, which often
leads to poor judgment and low
impulse control.

ANS: 3
Gynecomastia and breast tenderness are
common for about a third of boys during
middle puberty. Gynecomastia usually
resolves in 2 years.

A 14-year-old boy and his parents are concerned about bilateral breast
enlargement. The nurse's discussion of this should be based on knowing
that:
a. This is usually benign and temporary.
b. This is usually caused by Klinefelter
syndrome.
c. Administration of estrogen effectively
reduces gynecomastia.
d. Administration of testosterone effectively
reduces gynecomastia.

A 16-year-old boy has a diagnosis of new onset diabetes. The child
is meeting with the nurse educator regarding changes that will
need to be made in his diet. What would most influence a
teenager's food choices?
1. Parents and their dietary choices.
2. Cultural background.
3. Peers and their dietary choices.
4. Television and other forms of media
influence.

A 16-year-old girl is having a discussion with her nurse about her recent diagnosis of lupus. The
nurse understands how to best answer the young woman's questions about her prognosis
because she understands that cognitively:
1. Adolescents are preoccupied with thoughts of the here and now.
2. Adolescents are able to understand and imagine possibilities for the future.
3. Adolescents are capable of thinking only in concrete terms.
4. Adolescents are overly concerned with past events and relationships.

A 16-year-old male is hospitalized for cystic fibrosis. He will be an inpatient for
2 weeks while he receives IV antibiotics. As the nurse caring for this patient, what action can you
take that will most enhance his psychosocial development?
1. Fax the teen's teacher, and have her send in
his homework.
2. Encourage the teen's friends to visit him in
the hospital.
3. Encourage the teen's
grandparents to visit frequently.
4. Tell the teen he is free to use his phone to call
friends.

A 17-month-old child would be expected to
be in what stage according to Piaget?
a. Trust
b. Preoperations
c. Secondary circular reaction
d. Tertiary circular reaction

ANS: A
The male breast responds to hormone changes. Some
degree of bilateral or unilateral breast enlargement
occurs frequently in boys during puberty. This is not
a manifestation of Klinefelter syndrome.
Administration of estrogen and testosterone will
have no effect on the reduction of breast tissue and
may aggravate the condition.

ANS: 3
As a teen, the child is most
influenced by his peers. Teens long to
be like others around them.

ANS: 2
Adolescents are becoming abstract
thinkers and are able to imagine
possibilities for the future.

ANS: 2
Teens are most concerned about being
like their peers. Having the teen's friends
visit will help him feel he is still part of
the school and social environment.

ANS: D
The 17-month-old is in the fifth stage of the sensorimotor
phase: tertiary circular reactions. The child uses active
experimentation to achieve previously unattainable goals.
Trust is Erikson's first stage. Preoperations is the stage of
cognitive development usually present in older toddlers
and preschoolers. Secondary circular reactions last from
about ages 4 to 8 months.

A 17-year-old male has had some recent behavioral changes. His mother calls the nurse at the
pediatrician's office and tells her that her son has been coming home from school every day,
closing his door, and refraining from interaction with his parents. The child's mother does not
know what she should do about her son's unsociable behavior. The nurse's best response to the
child's mother is:
1. "You should go speak with your son and ask him directly what is wrong with him."
2. "You should set limits with your son and tell him that this is unacceptable behavior."
3. "Your son's behavior is abnormal, and he is going to need a psychiatric referral."

ANS: 4
The child's behavior is typical of a
teen's response to developmental and
psychosocial changes of adolescence.

4. "Your son's behavior is normal. You should listen to him without being
judgmental."

A 17-year-old male is being seen in the ER. In order to obtain the
adolescent's health information, his nurse should:
1. Interview the adolescent using direct
questions.
2. Gather information during a casual
conversation.
3. Interview the adolescent only in the presence
of his parents.
4. Gather information only from the parents.

An 18-year-old boy comes to the ER complaining of a rash and itching in the
groin area. He is concerned that he has contracted a sexually transmitted
disease and worries that his parents will find out. The nurse's best response is:
1. "We will need to contact your parents to let t
2. "We will not contact your parents regarding this visit."
3. "Who would you like us to contact about your visit here today?"

ANS: 2
Frequently adolescents will share
more information when it is gathered
during a casual conversation.

ANS: 2
An adolescent has every right to privacy as long as the situation is not
life-threatening.

4. "We cannot promise that the hospital will not contact your parents."

According to developmental theories, which
important event does the nurse understand is
essential to the development of the toddler?
1. The child learns to feed self.
2. The child develops friendships.
3. The child learns to walk.
4. The child participates in being potty-trained.

According to Erikson, the psychosocial
task of adolescence is developing:
a. Intimacy. c. Initiative.
b. Identity. d. Independence.

ANS: 4
Developmental theorists like
Erickson and Freud believe that toilet
training is the essential event that
must be mas- tered by the toddler.
ANS: B
Traditional psychosocial theory holds that the
developmental crises of adolescence lead to the
formation of a sense of identity. Intimacy is the
developmental stage for early adulthood. Initiative is
the developmental stage for early childhood.
Independence is not one of Erikson's developmental
stages.

According to Piaget the adolescent is in the fourth
stage of cognitive development, or period of:
a. Formal operations.
b. Concrete operations.
c. Conventional thought.
d. Postconventional thought.

According to Piaget, the 6-month-old infant would be
in what stage of the sensorimotor phase?
a. Use of reflexes
b. Primary circular reactions
c. Secondary circular reactions
d. Coordination of secondary schemata

Acyclovir (Zovirax) is given to children with
chickenpox to:
a. Minimize scarring
b. Decrease the number of lesions.
c. Prevent aplastic anemia.
d. Prevent spread of the disease.
An adolescent boy tells the nurse that he has recently had homosexual
feelings. The nurse's response should be based on knowledge that:
a. This indicates that the adolescent is
homosexual.
b. This indicates that the adolescent will
become homosexual as an adult.
c. The adolescent should be referred for
psychotherapy.
d. The adolescent should be encouraged to
share his feelings and experiences.

An adolescent girl asks the school nurse for advice because she has dysmenorrhea. She says that
a friend recommended that she try an over-the-counter nonsteroidal antiinflammatory drug
(NSAID). The nurse's response should be based on knowing that:
a. Aspirin is the drug of choice for the
treatment of dysmenorrhea.
b. Over-the-counter NSAIDs are rarely strong
enough to provide adequate pain relief.
c. NSAIDs are effective because of their
analgesic effect.
d. NSAIDs are effective because they inhibit
prostaglandins, leading to reduction in
uterine activity.

ANS: A
Cognitive thinking culminates with capacity for
abstract thinking. This stage, the period of formal
operations, is Piaget's fourth and last stage. The
concrete operations stage usually develops between
ages 7 and 11 years. Conventional and
postconventional thought refer to Kohlberg's stages
of moral development.

ANS: C
Infants are usually in the secondary circular reaction stage from age 4
months to 8 months. This stage is characterized by a continuation of the
primary circular reaction for the response that results. Shaking is
performed to hear the noise of the rattle, not just for shaking. The use of
reflexes is primarily during the first month of life. Primary circular
reaction stage marks the replacement of reflexes with voluntary acts. The
infant is in this stage from age 1 month to 4 months. The fourth
sensorimotor stage is coordination of secondary schemata. This is a
transitional stage in which increasing motor skills enable greater
exploration of the environment.

ANS: B
Acyclovir decreases the number of lesions; shortens
duration of fever; and decreases itching, lethargy, and
anorexia; however, it does not prevent scarring.
Preventing aplastic anemia is not a function of
acyclovir. Only quarantine of the infected child can
prevent the spread of disease.

ANS: D
These adolescents are at increased risk for health-damaging
behaviors, not because of the sexual behavior itself, but because of
society's reaction to the behavior. The nurse's first priority is to give
the young man permission to discuss his feelings about this topic,
knowing that the nurse will maintain confidentially, appreciate his
feelings, and remain sensitive to his need to talk it. In recent
studies among self-identified gay, lesbian, and bisexual
adolescents, many of the adolescents report changing their selflabels one or more times during their adolescence.

ANS: D
First-line therapy for adolescents with dysmenorrhea is
NSAIDs. This group of drugs blocks the formation of
prostaglandins. NSAIDs are the drug of choice for this
condition. Aspirin may increase bleeding. In most cases
NSAIDs are sufficient to treat the symptoms of
dysmenorrhea. They should be started at the first sign of
bleeding and taken for 2 to 3 days. NSAIDs are effective
because of their antiinflammatory effects.

An adolescent girl tells the nurse that she is very suicidal. The
nurse asks her if she has a specific plan. Asking this should be
considered:
a. An appropriate part of the assessment.
b. Not a critical part of the assessment.
c. Suggesting that the adolescent needs a
plan.
d. Encouraging the adolescent to devise a
plan.

Although a 14-month-old girl received a shock from an electrical outlet
recently, her parents find her about to place a paper clip in another outlet. The
best interpretation of this behavior is:
a. Her cognitive development is delayed.
b. This is typical behavior because toddlers
are not very developed.
c. This is typical behavior because of inability
to transfer knowledge to new situations.
d. This is not typical behavior because
toddlers should know better than to repeat
an act that caused pain.

Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse
overhears her school-age siblings tell her, "We are sick of Mom always sitting with you in the
hospital and playing with you. It isn't fair that you get everything and we have to stay with the
neighbors." The nurse's best assessment of this situation is that:
a. The siblings are immature and probably spoiled.
b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling.
c. The family has ineffective coping mechanisms to deal with chronic illness.
d. The siblings need to better understand their sister's illness and needs.

Anorexia nervosa may best be described as:
a. Occurring most frequently in adolescent
males.
b. Occurring most frequently in adolescents
from lower socioeconomic groups.
c. Resulting from a posterior pituitary
disorder.
d. Resulting in severe weight loss in the
absence of obvious physical causes.

An appropriate nursing intervention to minimize
separation anxiety in a hospitalized toddler is to:
a. Provide for privacy.
b. Encourage parents to room in.
c. Explain procedures and routines.
d. Encourage contact with children the same
age.

ANS: A
Routine health assessments of adolescents should include
questions that assess the presence of suicidal ideation or
intent. Questions such as, "Have you ever developed a
plan to hurt yourself or kill yourself" should be part of
that assessment. Threats of suicide should always be
taken seriously and evaluated. Suggesting that the
adolescent needs a plan and encouraging them to devise
this plan are inappropriate statements by the nurse.

ANS: C
During the tertiary circular reactions stage, children have
only a rudimentary sense of the classification of objects.
The appearance of an object denotes its function for these
children. The slot of an outlet is for putting things into.
Her cognitive development is appropriate for her age and
represents typical behavior for a toddler. Only some
awareness exists of a causal relation between events.

ANS: B
Siblings experience loneliness, fear, worry, anger,
resentment, jealousy, and guilt. The siblings
experience stress equal to that of the hospitalized
child. These are not uncommon responses by normal
siblings. There is no evidence that the family has
maladaptive coping.

ANS: D
The etiology of anorexia remains unclear, but a distinct
psychologic component is present. The diagnosis is based
primarily on psychologic and behavioral criteria. Anorexia nervosa
is observed more commonly in adolescent girls and young women.
It does not occur most frequently in adolescents from a lower
socioeconomic group. In reality, these are often families of means
who have high parental expectations for achievement. Anorexia is
a psychiatric disorder.

ANS: B
A toddler experiences separation anxiety secondary to
being separated from the parents. To avoid this, the
parents should be encouraged to room in as much as
possible. Maintaining routines and ensuring privacy are
helpful interventions, but they would not substitute for
the parents. Contact with same-aged children would not
substitute for having the parents present.

An appropriate play activity for a 7-monthold infant to encourage visual stimulation is:
a. Playing peek-a-boo.
b. Playing pat-a-cake.
c. Imitating animal sounds.
d. Showing how to clap hands.

ANS: A
Because object permanence is a new achievement,
peek-a-boo is an excellent activity to practice this
new skill for visual stimulation. Playing pat-a-cake
and showing how to clap hands will help with kinetic
stimulations. Imitating animal sounds will help with
auditory stimulation.

a. Substitute raisins for candy.
b. Serve sweets after a meal.
c. Use honey or molasses instead of refined
sugar.
d. Serve sweets between meals.

ANS: B
Sweets should be consumed with meals so
the teeth can be cleaned afterward. This
decreases the amount of time that the sugar
is in contact with the teeth. Raisins, honey,
and molasses are highly cariogenic and
should be avoided.

At what age should the nurse expect
an infant to begin smiling in
response to pleasurable stimuli?
a. 1 month c. 3 months
b. 2 months d. 4 months

ANS: B
At age 2 months the infant has a social,
responsive smile. A reflex smile is usually
present at age 1 month. The 3-month-old can
recognize familiar faces. At age 4 months the
infant can enjoy social interactions.

An appropriate recommendation in preventing tooth
decay in young children is to:

At which age can most infants sit
steadily unsupported?
a. 4 months c. 8 months
b. 6 months d. 10 months

Austin, age 6 months, has six teeth. The
nurse should recognize that this is:
a. Normal tooth eruption.
b. Delayed tooth eruption.
c. Unusual and dangerous.
d. Earlier-than-normal tooth eruption.

ANS: C
Sitting erect without support is a developmental
milestone usually achieved by 8 months. At age 4
months an infant can sit with support. At age 6
months, the infant will maintain a sitting position if
propped. By 10 months the infant can maneuver from
a prone to a sitting position.

ANS: D
This is earlier than expected. Most infants at
age 6 months have two teeth. The average
number of teeth in 6-month-old infants is
two. Six teeth at 6 months is not delayed; it
is early tooth eruption. Although unusual, it
is not dangerous.

Because of their striving for independence and
productivity, which age group of children is particularly
vulnerable to events that may lessen their feeling of
control and power?
a. Infants
b. Toddlers
c. Preschoolers
d. School-age children

The best play activity for a 6-month-old
infant to provide tactile stimulation is to:
a. Allow to splash in bath.
b. Give various colored blocks.
c. Play music box, tapes, or CDs.
d. Use infant swing or stroller.

By what age does the posterior
fontanel usually close?
a. 6 to 8 weeks c. 4 to 6 months
b. 10 to 12 weeks d. 8 to 10 months

By what age should concerns about
pubertal delay be considered in boys?
a. 12 to 12.5 years c. 13 to 13.5 years
b. 12.5 to 13 years d. 13.5 to 14 years

By what age should the nurse expect
that an infant will be able to pull to a
standing position?

ANS: D
When a child is hospitalized, the altered family role, physical
disability, loss of peer acceptance, lack of productivity, and
inability to cope with stress usurps individual power and identity.
This is especially detrimental to school-age children, who are
striving for independence and productivity and are now
experiencing events that lessen their control and power. Infants,
toddlers, and preschoolers, although affected by loss of power, are
not as significantly affected as are school-age children.

ANS: A
The feel of the water while the infant is splashing
provides tactile stimulation. Various colored blocks
provide visual stimulation for a 4- to 6-month-old.
Music box, tapes, and CDs provide auditory
stimulation. Swings and strollers provide kinesthetic
stimulation.

ANS: A
The bones surrounding the posterior
fontanel fuse and close by age 6 to 8
weeks. Ten weeks or longer is too
late.

ANS: D
Concerns about pubertal delay in boys should
be considered for boys who exhibit no
enlargement of the testes or scrotal changes
from 13.5 to 14 years. Ages younger than 13.5
years are too young for initial concern.

ANS: C
Most infants can pull themselves to a standing position at age 9
months. Infants who are not able to pull themselves to standing by
age 11 to 12 months should be further evaluated for developmental
dysplasia of the hip. At 6 months the infant has just obtained
coordination of arms and legs. By age 8 months infants can bear
full weight on their legs. Any infant who cannot pull to a standing
position by age 1 year should be referred for further evaluation.

By what age would the nurse expect that
most children could obey prepositional
phrases such as "under," "on top of,"
"beside," and "in back of"?
a. 18 months c. 3 years
b. 24 months d. 4 years
A characteristic of children with depression is:
a. Increased range of affective response.
b. Preoccupation with need to perform well in
school.
c. Change in appetite, resulting in weight loss
or gain.
d. Tendency to prefer play instead of
schoolwork.
The clinic is lending a federally approved car seat to an infant's
family. The nurse should explain that the safest place to put the car
seat is:
a. Front facing in back seat.
b. Rear facing in back seat.
c. Front facing in front seat with airbag on
passenger side.
d. Rear facing in front seat if an air bag is on
the passenger side.

A common characteristic of those who sexually abuse
children is that they:
a. Pressure the victim into secrecy.
b. Are usually unemployed and unmarried.
c. Are unknown to victims and victims'
families.
d. Have many victims that are each abused
only once.

Developmentally most children at age 12 months:
a. Use a spoon adeptly.
b. Relinquish the bottle voluntarily.
c. Eat the same food as the rest of the family.
d. Reject all solid food in preference to the bottle.

ANS: D
At 4 years, children can understand
directional phrases. 18 to 24 months
and 3 years is too young.

ANS: C
Physiologic characteristics of children with depression include
change in appetite resulting in weight loss or gain, nonspecific
complaints of not feeling well, alterations in sleeping pattern,
insomnia or hypersomnia, and constipation. This child displays a
predominantly sad facial expression with absence or diminished
range of affective response. The child has lower grades in school,
with lack of interest in doing homework or achieving in school.
Solitary play, disinterest in play, or a tendency to be alone are more
characteristic.

ANS: B
The rear-facing car seat provides the best protection for
an infant's disproportionately heavy head and weak neck.
Infants should face the rear from birth to 20 pounds and
as close to 1 year of age as possible. The middle of the
back seat provides the safest position. Severe injuries and
deaths in children have occurred from air bags deploying
on impact in the front passenger seat

ANS: A
Sex offenders may pressure the victim into secrecy, regarding the
activity as a "secret between us" that other people may take away if
they find out. Abusers are often employed upstanding members of
the community. Most sexual abuse is committed by men and
persons who are well known to the child. Abuse is often repeated
with the same child over time. The relationship may start
insidiously without the child realizing that sexual activity is part of
the offer.

ANS: C
By age 12 months most children are eating the same food that is
prepared for the rest of the family. Using a spoon usually is not
mastered until age 18 months. The parents should be engaged in
weaning a child from a bottle if that is the source of liquid.
Toddlers should be encouraged to drink from a cup at the first
birthday and weaned totally by 14 months. The child should be
weaned from a milk/formula-based diet to a balanced diet that
includes iron-rich sources of food.

During the preschool period the emphasis of
injury prevention should be placed on:
a. Constant vigilance and protection.
b. Punishment for unsafe behaviors.
c. Education for safety and potential hazards.
d. Limitation of physical activities.
An ER nurse is assessing a 12-month-old female. Which statement
accurately describes the best method for assessing this child?
1. The nurse should assess the child on the examining table.
2. The nurse should assess the child in a head-to-toe sequence.
3. The nurse should have the child's mother assist in holding her down.
4. The nurse should assess the child while she is in her mother's lap.

The father of 12-year-old Ryan tells the nurse that he is concerned
about his son getting "fat." Ryan's body mass index for age is at the
60th percentile. The most appropriate nursing action is to:
a. Reassure the father that Ryan is not "fat."
b. Reassure the father that Ryan is just a
growing child.
c. Suggest a low-calorie, low-fat diet.
d. Explain that this is typical of the growth
pattern of boys at this age.

A father tells the nurse that his daughter wants the same
plate and cup used at every meal, even if they go to a
restaurant. The nurse should explain that this is:
a. A sign that the child is spoiled.
b. A way to exert unhealthy control.
c. Regression, common at this age.
d. Ritualism, common at this age.

A female nurse caring for a 5-year-old boy is trying to encourage
developmental growth. What can the nurse do to reinforce the child's
intellectual initiative when he asks the nurse about his upcoming surgery?
1. Answer the child's questions about his upcoming surgery in simple terms.
2. Provide the child with a book that has vivid illustrations about his surgery.
3. Tell the child he should wait and ask the doctor his questions.
4. Tell the child that she will answer his questions at a later time.

ANS: C
Education for safety and potential hazards is appropriate
for preschoolers because they can begin to understand
dangers. Constant vigilance and protection is not
practical at this age since preschoolers are becoming
more independent. Punishment may make children
scared of trying new things. Limitation of physical
activities is not appropriate.

ANS: 4
Infants are most secure when in
prox- imity to the parent. The
parent's lap is an excellent place to
assess the child.

ANS: D
This is a characteristic pattern of growth in preadolescent boys, in which
the growth in height has slowed in preparation for the pubertal growth
spurt but weight is still gained. This should be reviewed with both the
father and Ryan, and a plan should be developed to maintain physical
exercise and a balanced diet. Saying that Ryan is not "fat" is false
reassurance. His weight is high for his height. Ryan needs to maintain
his physical activity. The father is concerned; an explanation is required.
A nutritional diet with physical activity should be sufficient to maintain
his balance.

ANS: D
The child is exhibiting the ritualism that is characteristic at this
age. Ritualism is the need to maintain sameness and reliability. It
provides a sense of comfort to the toddler. It will dictate certain
principles in feeding practices, including rejecting a favorite food
because it is served in a different container. This does not indicate
a child who has unreasonable expectations, but rather normal
development. Toddlers use ritualistic behaviors to maintain
necessary structure in their lives. This is not regression, which is a
retreat from a present pattern of functioning.

ANS: 1
The child is taking the initiative to ask
questions, as all toddlers do, and the
nurse should always answer those
questions as appropriately and accurately as possible.

A first-time mother brings in her 5-day-old baby for a well-child visit. The nurse weighs the
infant and reports a weight of 7 lb 5 oz to the mother. The mother looks concerned and tells the
nurse that her baby weighed 7 lb 10 oz when she was dis- charged 4 days ago. The nurse's best
response to the mother is:
1. "I will let the doctor know, and he will talk with you about possible causes of your infant's
weight loss."
2. "An initial weight loss of a few ounces is common among newborns, especially for
breastfeeding mothers."
3. "I can tell you are a first-time mother. Don't worry; we will find out why she is losing weight."
4. "Maybe she isn't getting enough milk. How often are you breastfeeding her?"

ANS: 2
Newborns can lose up to 10% of their
birth weight without concern but
should regain their birth weight by
2 weeks of age.

Four-year-old Brian appears to be upset by
hospitalization. An appropriate intervention is to:
a. Let him know that it is all right to cry.
b. Give him time to gain control of himself.
c. Show him how other children are
cooperating.
d. Tell him what a big boy he is to be so quiet.

ANS: A
Crying is an appropriate behavior for the upset
preschooler. The nurse provides support through
physical presence. Giving the child time to gain
control is appropriate, but the child must know that
crying is acceptable. The preschooler does not engage
in competitive behaviors.

Generally the earliest age at which
puberty begins is:
a. 13 years in girls, 13 years in boys
b. 11 years in girls, 11 years in boys
c. 10 years in girls; 12 years in boys
d. 12 years in girls, 10 years in boys

ANS: C
Puberty signals the beginning of the development of
secondary sex characteristics. This begins in girls
earlier than in boys. Usually a 2-year difference
occurs in the age at onset. Girls and boys do not
usually begin puberty at the same age; girls usually
begin earlier than boys do.

A group of boys ages 9 and 10 years have formed a "boys-only" club that is
open to neighborhood and school friends who have skateboards. This should
be interpreted:
a. Behavior that encourages bullying and
sexism.
b. Behavior that reinforces poor peer
relationships.
c. Characteristic of social development of this
age.
d. Characteristic of children who later are at
risk for membership in gangs.

he nurse is caring for an adolescent who had an external fixator placed after
suffering a fracture of the wrist during a bicycle accident. Which statement by
the adolescent would be expected about separation anxiety?
a. "I wish my parents could spend the night with me while I am in the
hospital."
b. "I think I would like for my siblings to visit me but not my friends."
c. "I hope my friends don't forget about visiting me."
d. "I will be embarrassed if my friends come to the hospital to visit."

ANS: C
One of the outstanding characteristics of middle
childhood is the creation of formalized groups or
clubs. Peer-group identification and association are
essential to a child's socialization. Poor relationships
with peers and a lack of group identification can
contribute to bullying. A boys-only club does not
have a direct correlation with later gang activity.
ANS: C
Loss of peer-group contact may pose a severe emotional
threat to an adolescent because of loss of group status;
friends visiting are an important aspect of hospitalization
for an adolescent and would be very reassuring.
Adolescents may welcome the opportunity to be away
from their parents. The separation from siblings may
produce reactions from difficulty coping to a welcome
relief.

How can the nurse best facilitate the trust relationship between infant and parent while the
infant is hospitalized?
1. The nurse should encourage the parents to remain at their child's bedside as much
as possible.
2. The nurse should keep parents informed about all aspects of their child's
condition.
3. The nurse should encourage the parents to hold their child as much as possible.
4. The nurse should encourage the parents to participate actively in their child's care.

Imaginary playmates are beneficial to the preschool
child because they:
a. Take the place of social interactions.
b. Take the place of pets and other toys.
c. Become friends in times of loneliness.
d. Accomplish what the child has already
successfully accomplished.

An important consideration for the school nurse who is planning a class
on bicycle safety is:
a. Most bicycle injuries involve collision with
an automobile.
b. Head injuries are the major causes of
bicycle-related fatalities.
c. Children should wear bicycle helmets if
they ride on paved streets.
d. Children should not ride double unless the
bicycle has an extra-large seat.

An important consideration when the nurse is discussing enuresis with
the parents of a young child is that:
a. Enuresis is more common in girls than in
boys.
b. Enuresis is neither inherited nor does it
have a familial tendency.
c. Organic causes that may be related to
enuresis should be considered first.
d. Psychogenic factors that cause enuresis
persist into adulthood.

In girls the initial indication of puberty is:
a. Menarche.
b. Growth spurt.
c. Growth of pubic hair.
d. Breast development.

ANS: 3
Having parents hold their child while in
the hospital is an excellent means of
building the trust relationship. Infants
are most secure when they are being
held, patted, and spoken to.
ANS: C
One purpose of an imaginary friend is to be a friend
in time of loneliness. Imaginary friends do not take
the place of social interaction but may encourage
conversation.
Imaginary friends do not take the place of pets or
toys. They accomplish what the child is still
attempting, not what has already been accomplished.
ANS: B
The most important aspect of bicycle safety is to
encourage the rider to use a protective helmet. Head
injuries are the major cause of bicycle-related fatalities.
Although motor vehicle collisions do cause injuries to
bicyclists, most injuries result from falls. The child should
always wear a properly fitted helmet approved by the U.S.
Consumer Product Safety Commission. Children should
not ride double.

ANS: C
Organic causes that may be related to
enuresis should be ruled out before
psychogenic factors are considered. Enuresis
is more common in boys and has a strong
familial tendency. Nocturnal bed-wetting
usually ceases long before adulthood.
ANS: D
In most girls the initial indication of puberty is the
appearance of breast buds, an event known as the
larche. The usual sequence of secondary sexual
characteristic development in girls is breast changes,
rapid increase in height and weight, growth of pubic
hair, appearance of axillary hair, menstruation, and
abrupt deceleration of linear growth.

In order to prevent separation anxiety in a hospitalized toddler, which of the
following should the nurse do?
1. Assume the parental role when parents are not able to be at the bedside.
2. Encourage the parents to remain at the bedside always.
3. Establish a routine that is similar to that of the child's home.
4. Rotate nursing staff so the child becomes comfortable with a variety of
nurses.

In terms of cognitive development the 5-year-old
child would be expected to:
a. Use magical thinking.
b. Think abstractly.
c. Understand conservation of matter.
d. Be unable to comprehend another person's
perspective.

In terms of fine motor development, the infant of 7
months should be able to:
a. Transfer objects from one hand to the other.
b. Use thumb and index finger in crude pincer grasp.
c. Hold crayon and make a mark on paper.
d. Release cubes into a cup.

ANS: 3
It is very important to try to maintain a
child's home routine both when par- ents
are present and when they have to leave
the hospital. This will increase the child's
sense of security and de- crease anxiety.

ANS: A
Magical thinking is believing that thoughts can cause
events. Abstract thought does not develop until
school-age years. The concept of conservation is the
cognitive task of school-age children ages 5 to 7 years.
Five-year-olds cannot understand another's
perspective.

ANS: A
By age 7 months infants can transfer objects from one
hand to the other, crossing the midline. The crude
pincer grasp is apparent at about age 9 months. The
child can scribble spontaneously at age 15 months. At
age 12 months the child can release cubes into a cup.

a. Tie shoelaces.
b. Use scissors or a pencil very well.
c. Draw a person with seven to nine parts.
d. Copy (draw) a circle.

ANS: D
3-year-olds are able to accomplish the fine
motor skill of drawing a circle. Tying
shoelaces, using scissors or a pencil very well,
and drawing a person with multiple parts are
fine motor skills of 5-year-old children.

In terms of gross motor development, what
would the nurse expect a 5-month-old infant
to do?
a. Roll from abdomen to back.
b. Roll from back to abdomen.
c. Sit erect without support.
d. Move from prone to sitting position.

ANS: A
Rolling from abdomen to back is developmentally
appropriate for a 5-month-old infant. The ability to
roll from back to abdomen usually occurs at 6
months old. Sitting erect without support is a
developmental milestone usually achieved by 8
months. The 10-month-old infant can usually move
from a prone to a sitting position.

In terms of fine motor development, what could the
3-year-old child be expected to do?

In terms of gross motor development, what would the nurse expect
a 5-month-old infant to do? Choose all that apply.
a. Roll from abdomen to back
b. Put feet in mouth when supine
c. Roll from back to abdomen
d. Sit erect without support
e. Move from prone to sitting position
f. Adjust posture to reach an object

In terms of language and cognitive development, a 4year-old child would be expected to:
a. Think in abstract terms.
b. Follow simple commands.
c. Understand conservation of matter.
d. Comprehend another person's perspective.

In the clinic waiting room a nurse observes a parent showing an 18-month-old
child how to make a tower out of blocks. In this situation the nurse should
recognize that:
a. Blocks at this age are used primarily for
throwing.
b. Toddlers are too young to imitate the
behavior of others.
c. Toddlers are capable of building a tower of
blocks.
d. Toddlers are too young to build a tower of
blocks.

In which communicable disease are
Koplik spots present?
a. Rubella
b. Measles (rubeola)
c. Chickenpox (varicella)
d. Exanthema subitum (roseola)
Kimberly, age 3 years, is being admitted for about 1 week of hospitalization.
Her parents tell the nurse that they are going to buy her "a lot of new toys
because she will be in the hospital." The nurse's reply should be based on an
understanding that:
a. New toys make hospitalization easier.
b. New toys are usually better than older ones
for children of this age.
c. At this age children often need the comfort
and reassurance of familiar toys from home.
d. Buying new toys for a hospitalized child is a
maladaptive way to cope with parental guilt.

ANS: A, B
Rolling from abdomen to back and
placing the feet in the mouth when
supine are developmentally
appropriate for a 5-month-old infant.
ANS: B
Children ages 3 to 4 years can give and follow
simple commands. Children cannot think
abstractly at age 4 years. Conservation of
matter is a developmental task of the schoolage child. A 4-year-old child cannot
comprehend another's perspective.

ANS: C
This is a good parent-child interaction. The 18month-old is capable of building a tower of 3 or 4
blocks. The ability to build towers of blocks usually
begins at age 15 months. With ongoing development
the child is able to build taller towers. At this age
children imitate others around them.

ANS: B
Koplik spots are small, irregular red
spots with a minute, bluish white center
found on the buccal mucosa 2 days
before systemic rash. Koplik spots are not
present with rubella, varicella, or roseola.
ANS: C
Parents should bring favorite items from home to be with
the child. Young children associate inanimate objects with
significant people; they gain comfort and reassurance
from these items. New toys will not serve the purpose of
familiar toys and objects from home. The parents may
experience some guilt as a response to the hospitalization,
but there is no evidence that it is maladaptive.

Kimberly's parents have been using a
rearward-facing convertible car seat since
she was born. Most car seats can be safely
switched to the forward-facing position
when the child weighs:
a. 10 pounds c. 30 pounds
b. 20 pounds d. 40 pounds
Latasha is a breastfed infant being seen in the clinic for her 6month checkup. Her mother tells the nurse that she recently began
to suck her thumb. The best nursing intervention is to:

ANS: B
Although the transition point for switching to the
forward-facing position is defined by the manufacturer, it
is generally at 9 kg or 20 pounds. Ten pounds is too small
to be safe. The relatively large head of this size child
should be in the rear-facing position.
It is usually safe to put children who weigh more than 20
pounds in forward-facing convertible safety seats.

a. Recommend that the mother substitute a pacifier for her thumb.
b. Assess Latasha for other signs of sensory deprivation.
c. Reassure the mother that this is very normal at this age.
d. Suggest that the mother breastfeed Latasha more often to satisfy
sucking needs.

ANS: C
Sucking is an infant's chief pleasure, and she may not be satisfied
by bottle-feeding or breastfeeding alone. During infancy and early
childhood there is no need to restrict nonnutritive sucking. Dental
damage does not appear to occur unless the use of the pacifier or
finger persists after age 4 to 6 years. The nurse should explore with
the mother her feelings about pacifier vs. thumb. This is a normal
behavior to meet nonnutritive sucking needs. No data support that
Latasha has sensory deprivation.

The leading cause of death during the
toddler period is:
a. Injuries.
b. Infectious diseases.
c. Congenital disorders.
d. Childhood diseases.

ANS: A
Injuries are the single most cause of death in children
ages 1 through 4 years. It is the period of highest
death rate from injuries of any childhood age group
except adolescence. Infectious and childhood diseases
are less common cause of deaths in this age group.
Congenital disorders are the second leading cause of
death in this age group.

A male infant is visiting the pediatrician for his 6-month well-child checkup. His mother tells the
nurse she wants to advance the infant's diet. Which statement by the infant's mother leads the
nurse to believe that she needs further education about the nutritional needs of a 6-month-old?
1. "I will continue to breastfeed my son and will give him rice cereal three times a day."
2. "I will start my son on fruits and gradually introduce vegetables."
3. "I will start my son on carrots and will introduce one new vegetable every few
days."
4. "I will not give my son any more than 8 ounces of baby juice per day."

Matt, age 14 years, seems to be always eating, although his weight
is appropriate for his height. The best explanation for this is:
a. This is normal because of increase in body
mass.
b. This is abnormal and suggestive of future
obesity.
c. His caloric intake would have to be
excessive.
d. He is substituting food for unfilled needs.

ANS: 2
Infants should be started on
vegetables prior to fruits. The
sweetness of the fruits may inhibit
them from taking vegetables.
ANS: A
In adolescence nutritional needs are closely related
to the increase in body mass. The peak requirements
occur in the years of maximal growth. The caloric and
protein requirements are higher than at almost any
other time of life. This describes the expected eating
pattern for young adolescents as long as weight and
height are appropriate; obesity is not a concern.

Matthew, age 18 months, has just been admitted with croup. His parent is
tearful and tells the nurse, "This is all my fault. I should have taken him to the
doctor sooner so he wouldn't have to be here." What is appropriate in the care
plan for this parent who is experiencing guilt?
a. Clarify the misconception about the illness.
b. Explain to the parent that the illness is not
serious.
c. Encourage the parent to maintain a sense of
control.
d. Assess further why the parent has excessive
guilt feelings.

The mean age of menarche in the
United States is:
a. 11.5 years c. 13.5 years
b. 12.75 years d. 14 years
The most common cause of death in the
adolescent age-group involves:
a. Drownings.
b. Firearms.
c. Drug overdoses.
d. Motor vehicles.
The most effective way to clean a toddler's teeth is for the:
a. Child to brush regularly with toothpaste of
his or her choice.
b. Parent to stabilize the chin with one hand
and brush with the other.
c. Parent to brush the mandibular occlusive
surfaces, leaving the rest for the child.
d. Parent to brush the front labial surfaces,
leaving the rest for the child.

The most fatal type of burn in the toddler age group
is:
a. Flame burn from playing with matches.
b. Scald burn from high-temperature tap
water.
c. Hot object burn from cigarettes or irons.
d. Electric burn from electrical outlets.

ANS: A
Guilt is a common response of parents when a child is
hospitalized. They may blame themselves for the child's illness or
for not recognizing it soon enough. The nurse should clarify the
nature of the problem and reassure parents that the child is being
cared for. Croup is a potentially very serious illness. The nurse
should not minimize the parents' feelings. Encouraging the parent
to maintain a sense of control would be difficult for the parents
while their child is seriously ill. No further assessment is indicated
at this time—guilt is a common response for parents.

ANS: B
The average age of menarche is 12
years and 9.5 months in North
American girls, with a normal range
of 10.5 to 15 years.

ANS: D
36% of all adolescent deaths in the United
States are the result of motor vehicle
accidents. Drownings, firearms, and drug
overdoses are major concerns in adolescence
but do not cause the majority of deaths.

ANS: B
For young children the most effective cleaning of
teeth is by the parents. Different positions can be
used if the child's back is to the adult. The adult
should use one hand to stabilize the chin and the
other to brush the child's teeth. The child can
participate in brushing, but for a thorough cleaning
adult intervention is necessary.

ANS: A
Flame burns from matches and lighters represent one of the most
fatal types of burns in the toddler age group. Scald burns from
water, hot object burns from cigarettes or irons, and electric burns
from outlets are all significant causes of burn injury. The child
should be protected from these causes by reducing the temperature
on the hot water in the home, keeping objects such as cigarettes
and irons away from children, and placing protective guards over
electric outlets when not in use.

Most infants begin to fear strangers
at age:
a. 2 months c. 6 months
b. 4 months d. 12 months

A mother calls the school nurse saying that her daughter has developed a
school phobia. She has been out of school 3 days. The nurse's
recommendations should include:
a. Immediately returning the child to school.
b. Explaining to the child that this is the last
day she can stay home.
c. Determining the cause of the phobia before
returning child to school.
d. Seeking professional counseling before
forcing child to return to school.

The mother has brought her 16-year-old daughter to the ER because she
is concerned her daughter is anorexic. During the child's initial physical
assessment, the nurse notes the daughter has signs and symptoms of
nutritional deficit. Which assessment item led the nurse to this initial
conclusion?
1. The child has a protein level within normal
limits.
2. The child's blood pressure is 110/66.
3. The child's hair and nails are brittle and dry.
4. The child's teeth appear to be eroded.

The mother of 11-year-old fraternal twins tells the nurse at their well-child checkup that she is
concerned because her daughter has gained more weight and height than her twin brother. The
mother is concerned that there is something wrong with her son. The nurse's best response is:
1. "I understand your concern. I will talk with the physician, and we can draw some lab work."
2. "I understand your concern. Has your son been ill lately?"
3. "It is normal for girls to grow a little taller and gain more weight than boys
at this age."
4. "It is normal for you to be concerned, but I am sure your son will catch up with
your daughter eventually."

The mother of a 13-year-old girl tells the nurse that she is concerned because her daughter has
gained 10 lb since she began puberty. The child's mother asks the nurse for advice about what to
do about her daughter's weight gain. Which of the following should the nurse do?
1. Provide the child's mother with some pamphlets on nutrition and healthy eating.
2. Provide the child's mother with information about a new exercise program
for teens.
3. Inform the child's mother that it is common for teen girls to gain weight during
puberty.
4. Inform the child's mother that her daughter will likely gain another 5 to 10 lb in
the next year.

ANS: C
Between ages 6 and 8 months fear of strangers and stranger
anxiety become prominent and are related to the infant's ability to
discriminate between familiar and nonfamiliar people. At age 2
months infants are just beginning to respond differentially to the
mother. At age 4 months the infant is beginning the process of
separation individuation when the infant begins to recognize self
and mother as separate beings. Twelve months is too late and
requires referral for evaluation if the child does not fear strangers at
this age.

ANS: A
The primary goal is to return the child to school. Parents must be
convinced gently but firmly that immediate return is essential and that
it is their responsibility to insist on school attendance. Telling the child
that this is the last day she can stay home will increase the fear of the
child. She must play a role in preparing for her return to school.
Beginning with half days might be beneficial. The child may not be able
to identify the cause for the phobia. Treatment will depend on the cause
if known. Relaxation techniques are commonly used. Professional
counseling is usually not necessary to resolve this condition.

ANS: 3
Dry and brittle hair and nails are
common among people who have a
nutritional deficit.

ANS:3
This is the appropriate response. The
nurse understands that it is normal for
girls to grow taller and gain more weight
than boys near the end of mid- dle
childhood.

ANS: 3
The nurse should tell the child's
mother that this is a normal finding
in teenage girls as they enter puberty.

The mother of a 15-year-old boy is frustrated because he spends much of his weekend time
sleeping. She informs the nurse, "My son sleeps longer now than he did when he was in
kindergarten." What is the nurse's best response to the child's mother's frustration?
1. "Your son may be trying to catch up on the sleep he misses during the week while
he is studying."
2. "Developmental theorists believe that teens require more sleep as they begin to
integrate new roles into their lives."
3. "Teens require more sleep due to the rapid physical growth that is occurring
during adolescence."

ANS: 3
Teens require more sleep due to the
rapid physical growth that occurs
during adolescence.

4. "Teens require more sleep due to the increase in their social obligations."

The mother of a child 2 years 6 months has arranged a play date with the neighbor and her 3year-old daughter. During the play date the two mothers should expect that the children will do
which of the following?
1. The children will share and trade their toys while playing.
2. The children will play with one another with little or no conflict.
3. The children will play alongside one another but not actively with one another.
4. The children will play with one or two items, ignoring most of the other toys.

A mother requests that her child receive the varicella vaccine at her 9-month
well-child checkup. The nurse tells the mother that:
1. Children who are vaccinated will likely develop a mild case of the disease
from the
vaccine.
2. The nurse cannot give the vaccine.
3. The nurse will administer the vaccine after the physician examines the child.
4. The child will need a booster vaccination at 18 months of age.

A mother tells the nurse that she doesn't want her infant
immunized because of the discomfort associated with injections.
The nurse should explain that:
a. This cannot be prevented.
b. Infants do not feel pain as adults do.
c. This is not a good reason for refusing
immunizations.
d. A topical anesthetic, eutectic mixture of
local anesthetic (EMLA), can be applied
before injections are given.

A mother tells the nurse that she is discontinuing
breastfeeding her 5-month-old infant. The nurse
should recommend that the infant be given:
a. Skim milk.
b. Whole cow's milk.
c. Commercial iron-fortified formula.
d. Commercial formula without iron.

ANS: 3
Toddlers engage in parallel play.
They often play alongside another
child but they rarely engage in
activities with the other child.

ANS: 2
The nurse should not give the
vaccine. The varicella vaccine is not
usually administered prior to 1 year
of age.
ANS: D
Several topical anesthetic agents can be used to minimize the discomfort
associated with immunization injections. These include EMLA and
vapor coolant sprays. Pain associated with many procedures can be
prevented and minimized by using the principles of atraumatic care.
With preparation the injection site can be properly anesthetized to
decrease the amount of pain felt by the infant. Infants have the neural
pathways to sense pain. Numerous research studies have indicated that
infants perceive and react to pain in the same manner as do children
and adults. The mother should be allowed to discuss her concerns and
the alternatives available. This is part of the informed consent process.

ANS: C
For children younger than 1 year the American Academy
of Pediatrics recommends the use of breast milk. If
breastfeeding has been discontinued, iron-fortified
commercial formula should be used. Cow's milk should
not be used in children younger than 12 months.
Maternal iron stores are almost depleted by this age; the
iron-fortified formula will help prevent the development
of iron-deficiency anemia.

Natasha, age 8 years, is being admitted to the hospital from the emergency
department with an injury from falling off her bicycle. What will help her most
in her adjustment to the hospital?
a. Explain hospital schedules such as mealtimes.
b. Use terms such as "honey" and "dear" to show a caring attitude.
c. Explain when parents can visit and why siblings cannot come to see her.
d. Orient her parents, because she is young, to her room and hospital facility.

A normal characteristic of the language
development of a preschool-age child is:
a. Lisp
b. Stammering
c. Echolalia
d. Repetition without meaning

The nurse caring for a 4-year-old female in the ER is about to start a peripheral IV. The nurse's
best method for explaining the procedure to the child is to:
1. Show the child a pamphlet with pictures
showing the IV placement procedure.
2. Have the 5-year-old patient next door tell the
4-year-old about her experience with her IV
placement.
3. Show the child the IV placement equipment,
and demonstrate the procedure on a doll.
4. Tell the child that if she remains still, the
procedure will be over quickly.

The nurse caring for a 9-month-old is using the FLACC scale to rate her pain
level. The child's parents ask the nurse what the FLACC scale is. Which is the
nurse's best response?
1. "It estimates a child's level of pain utilizing vital sign information."
2. "It estimates a child's level of pain based on parents' perception."
3. "It estimates a child's level of pain utilizing behavioral and physical
responses."
4. "It estimates a child's level of pain utilizing a numeric scale from 0 to 5."

The nurse caring for an 8-year-old boy is trying to encourage developmental
growth. What activity can the nurse provide for the child to encourage his
sense of industry?
1. Allow the child to choose what time to take
his medication.
2. Provide the child with the homework his
teacher has sent in.
3. Allow the child to assist with his bath.
4. Allow the child to help with his dressing
change.

ANS: A
School-age children need to have control of their
environment. The nurse should offer explanations or
prepare the child for experiences that are unavoidable.
The nurse should refer to the child by the preferred name.
Telling the child about all of the limitations of visiting
does not help her adjust to the hospital. At the age of 8
years the child and parent should be oriented to the
environment.

ANS: B
Stammering and stuttering are normal
dysfluency in preschool-age children.
Lisps are not a normal characteristic of
language development. Echolalia and
repetition are traits of toddlers' language.
ANS: 3
A 4-year-old child understands things in
very concrete and simple terms.
Therefore, medical play is an excellent
method for helping her understand the
procedure.
ANS:3
The FLACC scale utilizes behavioral and
physical responses of the child to measure
the child's level of pain. The scale utilizes
facial expression, leg position, activity,
intensity of cry,
and level of consolability.

ANS: 2
The school-age child is focused on academic performance; therefore the child
can achieve a sense of industry by completing his homework and staying on
track with his classmates.

The nurse is assessing a 6-month-old
healthy infant who weighed 7 pounds at
birth. The nurse should expect the infant
to now weigh approximately:
a. 10 pounds c. 20 pounds
b. 15 pounds d. 25 pounds
The nurse is assisting the family of a child with a history of encopresis. What
should be included in the nurse's discussion with this family?
a. Instruct the parents to sit the child on the
toilet at twice-daily routine intervals.
b. Instruct the parents that the child will
probably need to have daily enemas.
c. Suggest the use of stimulant cathartics
weekly.
d. Reassure the family that most problems are
resolved successfully, with some relapses
during periods of stress.

The nurse is caring for a 6-month-old in the ER. The physician orders the
nurse to give the child a dose of Rocephin IM. The 1.5-mL dose arrives from
the pharmacy. The nurse must do which of the following?
1. Administer the injection in the deltoid muscle.
2. Split the dose into two injections.
3. Administer the injection in the dorsogluteal muscle.

ANS: B
Birth weight doubles at about age 5 to 6 months. At 6
months a child who weighed 7 pounds at birth would
weigh approximately 15 pounds. Ten pounds is too
little. The infant would have gone from the 50th
percentile at birth to below the 5th percentile.
Twenty pounds or more is too much. The infant
would have tripled the birth weight at 6 months.

ANS: D
Children may be unaware of a prior sensation and unable to control the
urge once it begins. They may be so accustomed to bowel accidents that
they are unable to smell or feel it. Family counseling is directed toward
reassurance that most problems resolve successfully, although relapses
during periods of stress are possible. Constipation is the most common
cause of encopresis. This should be corrected, and, if the condition
persists, behavioral therapy may be necessary. Relief of fecal impaction
does not require daily enemas. Dietary changes are necessary and would
be more beneficial that cathartics.

ANS: 2
A nurse should not deliver more than
1 mL per IM injection to a child of
6 months.

4. Administer the dose as a single injection to the vastus lateralis muscle.

The nurse is caring for a 7-year-old female on the school-age unit. Her mother
is con- cerned that she may have some developmental delays. Which of the
following statements would indicate to the nurse that the child is not
developmentally on track for her age:
1. The child is able to follow a four-to-five-step command.
2. The child started wetting the bed on this admission to the hospital.
3. The child has an imaginary friend named Kelly.
4. The child enjoys playing board games with her sister.

The nurse is caring for a 12-month-old girl. The child's mother
asks if the unit has any toys that her daughter can play with. The
nurse goes to the toy area in search of a toy for the child. Which toy
is the best choice for this child?
1. A doll.
2. A musical rattle.
3. A board book.
4. Colorful beads.

ANS: 3
Most school-age children do not have
imaginary friends. This is much more
common for children of 3 and 4 years
of age.

ANS: 2
A musical rattle is the perfect toy for
this child. Infants have short
attention spans and enjoy auditory
and visual stimulation.

The nurse is caring for a hospitalized 4-year-old boy, Ryan. His parents
tell the nurse that they will be back to visit at 6 PM. When Ryan asks the
nurse when his parents are coming, the nurse's best response is:
a. "They will be here soon."
b. "They will come after dinner."
c. "Let me show you on the clock when 6 PM
is."
d. "I will tell you every time I see you how
much longer it will be."

The nurse is caring for an adolescent brought to the hospital with
acute drug toxicity. Cocaine is believed to be the drug involved.
Data collection should include the:
a. Mode of administration.
b. Actual content of the drug.
c. Function the drug plays in the adolescent's
life.
d. Adolescent's level of interest in
rehabilitation.

The nurse is discussing with a parent group the importance of fluoride for
healthy teeth. The nurse should recommend that the parents:
a. Use fluoridated mouth rinses in children
older than 1 year.
b. Have children brush teeth with fluoridated
toothpaste unless fluoride content of water
supply is adequate.
c. Give fluoride supplements to breastfed
infants beginning at age 1 month.
d. Determine whether water supply is
fluoridated.

The nurse is doing a prehospitalization orientation for Diana, age 7, who
is scheduled for cardiac surgery. As part of the preparation, the nurse
explains that she will not be able to talk because of an endotracheal tube
but that she will be able to talk when it is removed. This explanation is:
a. Unnecessary.
b. The surgeon's responsibility.
c. Too stressful for a young child.
d. An appropriate part of the child's
preparation.

The nurse is doing a routine assessment on a 14-month-old infant
and notes that the anterior fontanel is closed. This should be
interpreted as:
a. A normal finding.
b. A questionable finding—infant should be rechecked in 1 month.
c. An abnormal finding—indicates need for immediate referral to
practitioner.
d. An abnormal finding—indicates need for developmental
assessment.

ANS: B
A 4-year-old understands time in relation to events such
as meals. Children perceive "soon" as a very short time.
The nurse may lose the child's trust if his parents do not
return in the time he perceives as "soon." Children cannot
read or use a clock for practical purposes until age 7
years. This answer assumes that the child understands
the concept of hours and minutes, which is not developed
until age 5 or 6 years.

ANS: A
When the drug is questionable or unknown, every effort must be
made to determine the type, amount of drug taken, the mode and
time of administration, and factors relating to the onset of
presenting symptoms. Because the actual content of most street
drugs is highly questionable, this information would be difficult to
obtain. It is helpful to know the pattern of use but not essential
during this emergency. This is an inappropriate time for an
evaluation about the level of interest in rehabilitation.

ANS: D
The decision about fluoride supplementation cannot be
made until it is known whether the water supply contains
fluoride and the amount. It is difficult to teach this age
group to spit out the mouthwash. Swallowing fluoridated
mouthwashes can contribute to fluorosis. Fluoridated
toothpaste is still indicated, but very small amounts are
used. Fluoride supplementation is not recommended
until after age 6 months.

ANS: D
This is a necessary part of preoperative preparation that
will help reduce the anxiety associated with surgery. If the
child wakes and is not prepared for the inability to speak,
she will be even more anxious. It is a joint responsibility of
nursing, medical staff, and child life personnel. This is a
necessary component of preparation that will help reduce
the anxiety associated with surgery.

ANS: A
Because the anterior fontanel normally
closes between ages 12 and 18 months,
this is a normal finding, and no further
intervention is required.

The nurse is guiding parents in selecting a day care
facility for their child. When making the selection, it is
especially important to consider:
a. Structured learning environment.
b. Socioeconomic status of children.
c. Cultural similarities of children.
d. Teachers knowledgeable about
development.

The nurse is instructing a new breastfeeding mother in the need to provide her pre- mature infant
with an adequate source of iron in her diet. Which one of the following statements reflects a need
for further education of the new mother?
1. "I will use only breast milk or an iron-fortified formula as a source of milk for my baby until
she is at least 12 months old."
2. "My baby will need to have iron supplements introduced when she is 4 months old."
3. "I will need to add iron supplements to my baby's diet when she is 9 months old."
4. "When my baby begins to eat solid foods, I should introduce iron-fortified cereals
to her diet."

The nurse is interviewing the father of 10-month-old Megan. She
is playing on the floor when she notices an electrical outlet and
reaches up to touch it. Her father says "No" firmly and removes her
from near the outlet. The nurse should use this opportunity to teach
the father that Megan:
a. Is old enough to understand the word "No."
b. Is too young to understand the word "No."
c. Should already know that electrical outlets are dangerous.
d. Will learn safety issues better if she is spanked.

The nurse is performing a physical assessment on a 6month-old baby. Which finding should the nurse
understand as abnormal for this child?
1. The child's posterior fontanel is open.
2. The child's anterior fontanel is open.
3. The child has the beginning signs of tooth
eruption.
4. The child is able to track and follow objects.

The nurse notices that a 10-month-old infant being seen in the clinic is
wearing expensive, inflexible, high-top shoes. The nurse should explain
that:
a. Soft and flexible shoes are generally better.
b. High-top shoes are necessary for support.
c. Inflexible shoes are necessary to prevent in-toeing and out-toeing.
d. This type of shoe will encourage the infant to walk sooner.

ANS: D
A teacher knowledgeable about development will
structure activities for learning. A structured learning
environment is not necessary at this age.
Socioeconomic status is not the most important
factor in selecting a preschool. Preschool is about
expanding experiences with others; cultural
similarities are not necessary.

ANS: 3
Premature infants have iron stores from the mother
that last approxi- mately 2 months, so it is important
to introduce an iron supplement by
2 months. Full-term infants have iron stores that last
approximately
4 to 6 months.

ANS: A
By age 10 months children are able to associate meaning
with words. The father is using both verbal and physical
cues to alert the child to dangerous situations. The child
should be old enough to understand the word "No." The
10-month-old is too young to understand the purpose of
an electric outlet. The father is using both verbal and
physical cues to teach safety measures. Physical discipline
should be avoided.

ANS: 1
The posterior fontanel should close
between 6 and 8 weeks of age.

ANS: A
The main purpose of the shoe is protection. Soft,
well-constructed, athletic-type shoes are best for
infants and children. High-top shoes are not
necessary for support but may be helpful keeping the
child's foot in the shoe. Inflexible shoes can delay
walking, aggravate in-toeing and out-toeing, and
impede development of the supportive foot muscles.

The nurse recommends to parents that peanuts are
not a good snack food for toddlers. The nurse's
rationale for this action is:
a. They are low in nutritive value.
b. They are very high in sodium.
c. They cannot be entirely digested.
d. They can be easily aspirated.

Pacifiers can be extremely dangerous because of the frequency of use
and the intensity of the infant's suck. In teaching parents about
appropriate pacifier selection, the nurse should explain that a pacifier
should have which characteristics? Choose all that apply.
a. Easily grasped handle
b. One-piece construction
c. Ribbon or string to secure to clothing
d. Soft, pliable material
e. Sturdy, flexible material

A parent asks the nurse about negativism in toddlers.
The most appropriate recommendation is to:
a. Punish the child.
b. Provide more attention.
c. Ask child not always to say "no."
d. Reduce the opportunities for a "no" answer.

The parent of 2-week-old Sarah asks the nurse if Sarah needs fluoride
supplements because she is exclusively breastfed. The nurse's best
response is:
a. "She needs to begin taking them now."
b. "They are not needed if you drink
fluoridated water."
c. "She may need to begin taking them at age
6 months."
d. "She can have infant cereal mixed with
fluoridated water instead of supplements."

The parent of 16-month-old Chris asks, "What is the best way to keep Chris
from getting into our medicines at home?" The nurse should advise that:
a. "All medicines should be locked securely
away."
b. "The medicines should be placed in high
cabinets."
c. "Chris just needs to be taught not to touch
medicines."
d. "Medicines should not be kept in the
homes of small children."

ANS: D
Foreign-body aspiration is common during the second year of life.
Although they chew well, this age child may have difficulty with
large pieces of food such as meat and whole hot dogs and with
hard foods such as nuts or dried beans. Peanuts have many
beneficial nutrients but should be avoided because of the risk of
aspiration in this age group. The sodium level may be a concern,
but the risk of aspiration is more important. Many foods pass
through the gastrointestinal tract incompletely digested. This is not
necessarily detrimental to the child.

ANS: A, B, E
A good pacifier should be easily grasped by the infant.
One-piece construction is necessary to avoid having
the nipple and guard separate. The material should
be sturdy and flexible. An attached ribbon or string
and soft, pliable material are not characteristics of a
good pacifier.

ANS: D
The nurse should suggest to the parent that questions should be
phrased with realistic choices rather than yes or no answers. This
provides a sense of control for the toddler and reduces the
opportunity for negativism. Negativism is not an indication of
stubbornness or insolence and should not be punished. The
negativism is not a function of attention; the child is testing limits
to gain an understanding of the world. The toddler is too young to
be asked to not always say "no."

Fluoride supplementation is recommended by the
American Academy of Pediatrics beginning at age 6
months if the child is not drinking adequate amounts
of fluoridated water. The recommendation is to begin
supplementation at 6 months. The amount of water
that is ingested and the amount of fluoride in the
water are considered when supplementation is being
considered.

ANS: A
The major reason for poisoning in the home is improper storage.
Toddlers can climb, unlatch cabinets, and obtain access to highsecurity places. For medications only a locked cabinet is safe.
Toddlers can climb by using furniture. High places are not a
deterrent to an exploring toddler. Toddlers are not able to
generalize as dangerous all of the different forms of medications
that may be available in the home. This is not feasible. Many
parents require medications for chronic illnesses. They must be
taught safe storage for their home and when they visit other homes.

The parent of a 4-year-old son tells the nurse that the child believes "monsters
and boogeyman" are in his bedroom at night. The nurse's best suggestion for
coping with this problem is to:
a. Insist that the child sleep with his parents
until the fearful phase passes.
b. Suggest involving the child to find a
practical solution such as a night light.
c. Help the child understand that these fears
are illogical.
d. Tell the child frequently that monsters and
boogeyman do not exist.

A parent of an 18-month-old boy tells the nurse that he says "no" to
everything and has rapid mood swings. If he is scolded, he shows anger
and then immediately wants to be held. The nurse's best interpretation
of this behavior is that:
a. This is normal behavior for his age.
b. This is unusual behavior for his age.
c. He is not effectively coping with stress.
d. He is showing he needs more attention.

The parents of a 2-year-old boy are concerned about his behavior. Since the child's admission to
the hospital 2 days ago he has been crying much more than usual and is inconsolable much of the
time. The nurse's best response to the child's parents is:
1. The child is in the detachment phase of separation anxiety, which is normal for
children during hospitalization.
2. The child is in the despair stage of separation anxiety, which is normal for
children during hospitalization.
3. The child is in the bargaining stage of separation anxiety, which is normal for
children during hospitalization.
4. The child is in the protest stage of separation anxiety, which is normal for
children during hospitalization.

The parents of a 2-year-old tell the nurse that they are concerned
because the toddler has started to use "baby talk" since the arrival of
their new baby. The nurse should recommend that the parents:
a. Ignore the "baby talk."
b. Explain to the toddler that "baby talk" is for
babies.
c. Tell the toddler frequently, "You are a big
kid now."
d. Encourage the toddler to practice more
advanced patterns of speech.

The parents of a 4-month-old infant tell the nurse that they are
getting a microwave oven and will be able to heat the baby's
formula faster. The nurse should recommend to:
a. Never heat a bottle in a microwave oven.
b. Heat only 10 ounces or more.
c. Always leave bottle top uncovered to allow heat to escape.
d. Shake bottle vigorously for at least 30 seconds after heating.

ANS: B
A night light shows a child that imaginary
creatures do not lurk in the darkness. Letting
the child sleep with parents will not get rid of
the fears. A 4-year-old is in the
preconceptual age and cannot understand
logical thought.

ANS: A
Toddlers use distinct behaviors in the quest for
autonomy. They express their will with continued
negativity and the use of the word "no." Children at
this age also have rapid mood swings. The nurse
should reassure the parents that their child is
engaged in expected behavior for an 18-month-old.

ANS: 4
During the protest stage of separation
anxiety, children are often inconsolable,
and they often cry more than they do
when they are at home. These children
also frequently ask to go home.
ANS: A
The baby talk is a sign of regression in the toddler. It
should be ignored, while praising the child for
developmentally appropriate behaviors. Regression is
children's way of saying that they are expressing stress.
The parents should not introduce new expectations and
should allow the child to master the developmental tasks
without criticism.

ANS: C
If a microwave is being used, the bottle should be left
uncovered. This will allow heat to escape. Bottles can
be heated safely in microwave ovens if safe guidelines
are followed. No more than 4 ounces should be
heated at any one time. The bottle should be inverted
10 times; vigorous shaking is not necessary.

The parents of a 7-month-old girl are attending a class
on child safety. Following the class, what should the
child's parents understand as one of the most common
causes of injury and death for a 7-month-old child?
1. Poisoning.
2. Child abuse.
3. Aspiration.
4. Dog bites.
The parents of a 9-month-old infant tell the nurse that they have noticed
foods such as peas and corn are not completely digested and can be seen
in their infant's stool. The nurse bases her explanation on knowing that:
a. Child should not be given fibrous foods until digestive tract matures
at age 4 years.
b. Child should not be given any solid foods until this digestive problem
is resolved.
c. This is abnormal and requires further investigation.
d. This is normal because of the immaturity of digestive processes at
this age.

The parents of a 12-month-old child ask the nurse if the child can
eat hot dogs. The nurse's reply should be based on knowing that:
a. The child is too young to digest hot dogs.
b. The child is too young to eat hot dogs safely.
c. Hot dogs must be sliced into sections to
prevent aspiration.
d. Hot dogs must be cut into small, irregular
pieces to prevent aspiration.

The parents of a newborn say that their toddler "hates the baby . . . he suggested that we put him
in the trash can so the trash truck could take him away." The nurse's best reply is:
a. "Let's see if we can figure out why he hates
the new baby."
b. "That's a strong statement to come from
such a small boy."
c. "Let's refer him to counseling to work this
hatred out. It's not a normal response."
d. "That is a normal response to the birth of a
sibling. Let's look at ways to deal with
this."

Parents tell the nurse that their 1-year-old son often sleeps with them.
They seem unconcerned about this. The nurse's response should be
based on knowing that:
a. Children should not sleep with their parents.
b. Separation from parents should be completed
by this age.
c. Daytime attention should be increased.
d. This is a common and accepted practice,
especially in some cultural groups.

ANS: 3
Aspiration is a common cause of injury and
death among children of this age. These
children often find small objects lying on the
floor and place them in their mouths. Older
siblings are often responsible for leaving
small objects around.

ANS: D
The immaturity of the digestive tract is evident in the
appearance of the stools. Solid foods are passed
incompletely broken down in the feces. An excess
quantity of fiber predisposes the child to large, bulky
stools. This is a normal part of the maturational
process, and no further investigation is necessary.

ANS: D
Hot dogs are of a consistency, diameter, and round shape
that may cause complete obstruction of the child's airway.
If given to young children, the hot dog should be cut into
small irregular pieces rather than served whole or in
slices. The child's digestive system is mature enough to
digest hot dogs. To eat the hot dog safely, the child
should be sitting down, and the hot dog should be
appropriately cut into irregularly shaped pieces.

ANS: D
The arrival of a new infant represents a crisis for even the best-prepared
toddler. Toddlers have their entire schedule and routines disrupted
because of the new family member. The nurse should work with parents
on ways to involve the toddler in the newborn's care and help focus
attention on the toddler. The toddler does not hate the infant. This is an
expected response to the changes in routines and attention that affect
the toddler. This is a normal response. The toddler can be provided with
a doll to care for to tend to its needs when the parent is performing
similar care for the newborn

ANS: D
Co-sleeping or sharing the family bed, in which the parents allow the
children to sleep with them, is a common and accepted practice in many
cultures. Parents should evaluate the options available and avoid
conditions that place the infant at risk. Population-based studies are
currently under way; no evidence at this time supports or abandons the
practice for safety reasons. This is a cultural practice. This is the age at
which children are just beginning to individuate. Increased daytime
activity may help decrease sleep problems in general, but co-sleeping is
a culturally determined phenomenon.

Parents tell the nurse that their toddler daughter eats little at mealtime,
only sits at the table with the family briefly, and wants snacks "all the
time." The nurse should recommend that the parents:
a. Give her planned, frequent, and nutritious
snacks.
b. Offer rewards for eating at mealtimes.
c. Avoid snacks so she is hungry at
mealtimes.
d. Explain to her in a firm manner what is
expected of her.

Peer relationships become more important during adolescence
because:
a. Adolescents dislike their parents.
b. Adolescents no longer need parental
control.
c. They provide adolescents with a feeling of
belonging.
d. They promote a sense of individuality in
adolescents.

Preschoolers' fears can best be dealt with by:
a. Actively involving them in finding practical
methods to deal with the frightening
experience.
b. Forcing them to confront the frightening
object or experience in the presence of
their parents.
c. Using logical persuasion to explain away
their fears and help them recognize how
unrealistic the fears are.
d. Ridiculing their fears so they understand
that there is no need to be afraid.

The psychologic effects of being obese during
adolescence include:
a. Sexual promiscuity.
b. Poor body image.
c. Memory has no effect on eating behavior.
d. Accurate body image but self-deprecating
attitude.

The psychosocial developmental tasks of toddlerhood
include:
a. Development of a conscience.
b. Recognition of sex differences.
c. Ability to get along with age mates.
d. Ability to withstand delayed gratification.

ANS: A
Most toddlers exhibit a physiologic anorexia in response to the
decreased nutritional requirement associated with the slower
growth rate. Parents should assist the child to develop healthy
eating habits. The toddler is often unable to sit through a meal.
Frequent nutritious snacks are a good way to ensure proper
nutrition. To help with developing healthy eating habits, food
should not be used as positive or negative reinforcement for
behavior. The child may develop habits of overeating or eat
nonnutritious foods in response.

ANS: C
The peer group serves as a strong support to teenagers,
providing them with a sense of belonging and strength
and power. During adolescence the parent/child
relationship changes from one of protection-dependency
to one of mutual affection and quality. Parents continue
to play an important role in the personal and healthrelated decisions. The peer group forms the transitional
world between dependence and autonomy.

ANS: A
Actively involving the child in finding practical
methods to deal with the frightening experience is
the best way to deal with fears. Forcing a child to
confront fears may make the child more afraid.
Preconceptual thought prevents logical
understanding. Ridiculing

ANS: B
Common emotional consequences of obesity include poor
body image, low self-esteem, social isolation, and feelings
of depression and isolation. Sexual promiscuity is an
unlikely effect of obesity. The obese adolescent often
substitutes food for affection. Eating behaviors are closely
related to memory. Memory and appetite are closely
linked and can be modified over time with treatment.
Obese adolescents most often have a very poor self-image.

ANS: D
If the need for basic trust has been satisfied, toddlers can give up
dependence for control, independence, and autonomy. One of the
tasks that the toddler is concerned with is the ability to withstand
delayed gratification. Development of a conscience occurs during
the preschool years. The recognition of sex differences occurs
during the preschool years. The ability to get along with age mates
develops during the preschool and school-age years.

Research has shown that the most successful smoking cessation
programs among teens include (choose all that apply):
a. Peer-led education and support.
b. Information on the long-term effects of
smoking.
c. Programs including the media.
d. School-based programs.
e. Information on the immediate effects of
smoking.

The role of the peer group in the life of school-age children is that
it:
a. Gives them an opportunity to learn
dominance and hostility.
b. Allows them to remain dependent on their
parents for a longer time.
c. Decreases their need to learn appropriate
sex roles.
d. Provides them with security as they gain
independence from their parents.

Ryan has just been unexpectedly admitted to the intensive care unit after
abdominal surgery. The nursing staff has completed the admission process,
and Ryan's condition is beginning to stabilize. When speaking with the parents,
the nurses should expect which stressors to be evident? Choose all that apply.
a. Unfamiliar environment
b. Usual day-night routine
c. Strange smells
d. Provision of privacy
e. Inadequate knowledge of condition and
routine

Samantha, age 5 years, tells the nurse that she "needs a
Band-Aid" where she had an injection. The best nursing
action is to:
a. Apply a Band-Aid.
b. Ask her why she wants a Band-Aid.
c. Explain why a Band-Aid is not needed.
d. Show her that the bleeding has already
stopped.

Sara, age 4 months, was born at 35 weeks' gestation. She seems to be
developing normally, but her parents are concerned because she is a "more
difficult" baby than their other child, who was term. The nurse should explain
that:
a. Infants' temperaments are part of their unique characteristics.
b. Infants become less difficult if they are not kept on scheduled feedings and
structured routines.
c. Sara's behavior is suggestive of failure to bond completely with her parents.
d. Sara's difficult temperament is the result of painful experiences in the
neonatal period.

ANS: A, C, D, E
Two areas of antismoking campaigns that have shown success are
those that are peer-led and use media in education related to
smoking prevention. School-based programs have also shown
success and can be strengthened by expansion into the community
and youth groups. Teens respond much better to education that
focuses on the immediate effects of smoking. For the most part,
smoking prevention programs that focus on the negative long-term
effects of smoking have been ineffective.

ANS: D
Peer-group identification is an important factor in gaining
independence from parents. Through peer relationships children
learn ways to deal with dominance and hostility. They also learn
how to relate to people in positions of leadership and authority and
explore ideas and the physical environment. Peer-group
identification helps in gaining independence rather than
remaining dependent. A child's concept of appropriate sex roles is
influenced by relationships with peers.

ANS: A, C, E
Intensive care units, especially when the family is unprepared for
the admission, are a strange and unfamiliar place. There are many
pieces of unfamiliar equipment, and the sights and sounds are
much different from a general hospital unit. Also, with the child's
condition being more precarious, it may be difficult to keep the
parents updated and knowledgeable about what is happening.
Lights are usually on around the clock, seriously disrupting the
diurnal rhythm. There is usually little privacy available for families
in intensive care units.

ANS: A
Children at this age group still fear
that their insides may leak out at the
injection site. Provide the Band-Aid.
No explanation should be required.
ANS: A
Infant temperament has a strong biologic component. Together
with interactions with the environment, primarily the family, the
biologic component contributes to the infant's unique
temperament. Children perceived as difficult may respond better to
scheduled feedings and structured caregiving routines than to
demand feedings and frequent changes in routines. Sara's
temperament has been created by both biologic and environmental
factors. The nurse should provide guidance in parenting techniques
that are best suited to Sara's temperament.

The school nurse has been asked to begin teaching sex education in the 5th
grade. The nurse should recognize that:
a. Children in 5th grade are too young for sex
education.
b. Children should be discouraged from
asking too many questions.
c. Correct terminology should be reserved for
children who are older.
d. Sex can be presented as a normal part of
growth and development.

The school nurse is planning an educational program centered on abstinence for adolescents.
Which of the following methods does the nurse recognize as the most effective way to present this
program?
1. Use peer-led programs that emphasize the consequences of unprotected sexual
contact.
2. Teach students methods to resist peer pressure.
3. Offer students the opportunity to care for a simulator infant for 1 week.
4. Offer statistics, pamphlets, and films discussing the consequences of unprotected
sexual contact.

The school nurse is preparing a discussion on nutrition with the fourth-grade class. Based on the
childrens' developmental level, what information should she include in her presentation?
1. A review of the number of calories that a fourth-grade child should consume
in a day.
2. A review of a list of high-calorie foods that all fourth-graders should avoid.
3. A review of how to read food labels so children know which foods are good for
them.
4. A review of nutritious foods with basic scientific information about how they
affect the body organs and systems.

The school nurse tells adolescents in the clinic that confidentiality and
privacy will be maintained unless a life-threatening situation arises.
This practice is:
a. Not appropriate in a school setting.
b. Never appropriate because adolescents are
minors.
c. Important in establishing trusting
relationships.
d. Suggestive that the nurse is meeting his or
her own needs.

Steve, 14 years old, mentions that he now has to use deodorant but never had
to before. The nurse's response should be based on knowledge that:
a. Eccrine sweat glands in the axillae become
fully functional during puberty.
b. Sebaceous glands become extremely active
during puberty.
c. New deposits of fatty tissue insulate the
body and cause increased sweat
production.
d. Apocrine sweat glands reach secretory
capacity during puberty.

ANS: D
When sex information is presented to school-age
children, sex should be treated as a normal part of
growth and development. Fifth graders are usually 10 to
11 years old. This age is not too young to speak about
physiologic changes in their bodies. They should be
encouraged to ask questions. Preadolescents need precise
and concrete information.

ANS: 1
Adolescents are most concerned
with what their peers think and feel. They
are most receptive to information that
comes from another adolescent.

ANS: 4
Reviewing nutritious choices keeps the lesson
on a positive note, and school- age children
are very interested in how food affects their
bodies. They are ca- pable of understanding
basic medical terminology.

ANS: C
Health professionals who work with adolescents should consider
the adolescents' increasing independence and responsibility while
maintaining privacy and ensuring confidentiality. However,
circumstances may occur in which they are not able to maintain
confidentiality such as self-destructive behavior or maltreatment by
others. Confidentiality and privacy are necessary to facilitate trust
with this age group. The nurse must be aware of the limits placed
on confidentiality by local jurisdiction.

ANS: D
The apocrine sweat glands, nonfunctional in children, reach secretory capacity during puberty.
They secrete a thick substance as a result of emotional stimulation that, when acted on by surface
bacteria, becomes highly odoriferous. They are limited in distribution and grow in conjunction
with hair follicles in the axilla, genital, anal areas, and others. Eccrine sweat glands are present
almost everywhere on the skin and become fully functional and respond to emotional and
thermal stimulation. Sebaceous glands become extremely active at this time, especially those on
the genitals and the "flush" areas of the body such as face, neck, shoulders, upper back, and chest.
This increased activity is important in the development of acne.
New deposits of fatty tissue insulate the body and cause increased sweat production is not the
etiology of apocrine sweat gland activity.

Strict isolation is required for a child who is
hospitalized with (choose all that apply):
a. Mumps.
b. Chickenpox.
c. Exanthema subitum (roseola).
d. Erythema infectiosum (fifth disease).
e. Parvovirus B19.

A toddler's parent asks the nurse for suggestions on dealing with
temper tantrums. The most appropriate recommendation is to:
a. Punish the child.
b. Leave the child alone until the tantrum is
over.
c. Ignore the behavior, provided that it is not
injurious.
d. Explain to child that this is wrong.

Turner's syndrome is suspected in an adolescent girl with
short stature. This is caused by:
a. Absence of one of the X chromosomes.
b. Presence of an incomplete Y chromosome.
c. Precocious puberty in an otherwise healthy
child.
d. Excess production of both androgens and
estrogens.
Two toddlers are playing in a sandbox when one child suddenly grabs a
toy from the other child. The best interpretation of this behavior is that:
a. This is typical behavior because toddlers are
aggressive.
b. This is typical behavior because toddlers are
egocentric.
c. Toddlers should know that sharing toys is
expected of them.
d. Toddlers should have the cognitive ability to
know right from wrong.

A useful skill that the nurse should expect a
5-year-old child to be able to master is to:
a. Tie shoelaces.
b. Use a knife to cut meat.
c. Hammer a nail.
d. Make change from a quarter.

ANS: A, B, C, D
Childhood communicable diseases requiring strict
transmission-based precautions (contact, airborne,
droplet) include: diphtheria, chickenpox, measles,
mumps, tuberculosis, adenovirus, hemophilus B,
mumps, pertussis, plague, streptococcal pharyngitis
or scarlet fever. Strict isolation is not required for
parvovirus B19.

ANS: C
The parent should be told that the best way to deal with temper
tantrums is to ignore the behaviors, provided that the actions are not
dangerous to the child. Tantrums are common during this age group as
the child becomes more independent and increasingly complex tasks
overwhelm him or her. The parents and caregivers need to have
consistent and developmentally appropriate expectations. Punishment
and explanations will not be beneficial. The presence of the parent is
necessary both for safety and to provide a feeling of control and security
to the child when the tantrum is over.

ANS: A
Turner's syndrome is caused by an absence of one of the
X chromosomes. Most girls who have this disorder have
one X chromosome missing from all cells. A Y
chromosome is not part of the genetic makeup of girls.
Puberty is delayed and amenorrhea is a clinical
manifestation in girls with Turner's syndrome. These girls
often need hormone therapy to increase their levels of
these hormones.

ANS: B
Play develops from the solitary play of infancy to the parallel play of
toddlers. The toddler plays alongside other children, not with
them. This typical behavior of the toddler is not intentionally
aggressive. Shared play is not within their cognitive development.
Toddlers do not conceptualize shared play. Because the toddler
cannot view the situation from the perspective of the other child, it
is okay to take the toy. Therefore no right or wrong is associated
with taking a toy.

ANS: A
Tying shoelaces is a fine motor task typical of
5-year-olds. Using a knife to cut meat is a
fine motor task of a 7-year-old. Hammering a
nail and making change from a quarter are
fine motor tasks of an 8- to 9-year-old.

Vitamin A supplementation may be
recommended for the young child who
has:
a. Mumps. c. Measles (rubeola).
b. Rubella. d. Erythema infectiosum.
The weight loss of anorexia nervosa is often
triggered by:
a. Sexual abuse.
b. School failure.
c. Independence from family.
d. Traumatic interpersonal conflict.
What behavior indicates that an infant has
developed object permanence?
a. Recognizes familiar face such as mother
b. Recognizes familiar object such as bottle
c. Actively searches for a hidden object
d. Secures objects by pulling on a string
What describes a child who is abused by the parent(s)?
a. Unintentionally contributes to the abusing
situation
b. Belongs to a low socioeconomic population
c. Is healthier than the nonabused siblings
d. Abuses siblings in the same way as child is
abused by the parent(s)

What describes a toddler's cognitive development at age 20
months?
a. Searches for an object only if he or she sees it
being hidden
b. Realizes that "out of sight" is not out of reach
c. Puts objects into a container but cannot take
them out
d. Understands the passage of time such as "just
a minute" and "in an hour"

ANS: C
Evidence shows that vitamin A decreases
morbidity and mortality associated with
measles. Vitamin A will not lessen the
effects of mumps, rubella or fifth disease.

ANS: D
Weight loss may be triggered by a typical adolescent crisis such as the
onset of menstruation or a traumatic interpersonal incident; situations
of severe family stress such as parental separation or divorce; or
circumstances in which the young person lacks personal control such as
being teased, changing schools, or entering college. There may in fact be
a history of sexual abuse; however, this is not the trigger.
These girls are often overachievers who are successful in school, not
failures in school. The adolescent is most often enmeshed with his or her
family.

ANS: C
During the first 6 months of life infants believe that objects exist only as long
as they can see them. When infants search for an object that is out of sight,
this signals the attainment of object permanence, whereby an infant knows
that an object exists even when it is not visible. Between ages 8 and 12 weeks
infants begin to respond differentially to the mother. They cry, smile, vocalize,
and show distinct preference for the mother. This preference is one of the
stages that influence the attachment process, but it is too early for object
permanence. Recognizing familiar objects is an important transition for the
infant, but it does not signal object permanence. The ability to understand
cause and effect is part of secondary schema development.

ANS: A
A child's temperament, position in the family, additional
physical needs, activity level, or degree of sensitivity to
parental needs unintentionally contributes to the abusing
situation. Socioeconomic status is an environmental
characteristic. This child is less likely to be abused than
one who is premature, disabled, or very young. The
abused child does not in turn abuse his or her siblings.

ANS: B
At this age the child is in the final sensorimotor stage. Children
will now search for an object in several potential places, even
though they saw only the original hiding place. Children have a
more developed sense of objective permanence. They will search for
objects even if they have not seen them hidden. Putting an object in
a container but being able to take it out indicates tertiary circular
reactions. An embryonic sense of time exists, although the children
may behave appropriately to time-oriented phrases; their sense of
timing is exaggerated.

What describes moral development in younger school-age children?
a. The standards of behavior now come from
within themselves.
b. They do not yet experience a sense of guilt
when they misbehave.
c. They know the rules and behaviors
expected of them but do not understand
the reasons behind them.
d. They no longer interpret accidents and
misfortunes as punishment for misdeeds.

What describes the cognitive abilities of school-age children?
a. Have developed the ability to reason
abstractly
b. Become capable of scientific reasoning and
formal logic
c. Progress from making judgments based on
what they reason to making judgments
based on what they see
d. Have the ability to classify, group and sort,
and hold a concept in their minds while
making decisions based on that concept

What information could be given to the parents of a 12-month-old
child regarding appropriate play activities for this age?
a. Give large push-pull toys for kinetic stimulation.
b. Place cradle gym across crib to facilitate fine motor skills.
c. Provide child with finger paints to enhance fine motor skills.
d. Provide stick horse to develop gross motor coordination.

What is characteristic of dishonest behavior in children ages 8 to 10
years?
a. Cheating during games is now more
common.
b. Lying results from the inability to
distinguish between fact and fantasy.
c. They may steal because their sense of
property rights is limited.
d. They may lie to meet expectations set by
others that they have been unable to attain.

What is descriptive of bulimia during adolescence?
a. Strong sense of control over eating
behavior
b. Feelings of elation after the binge-purge
cycle
c. Profound lack of awareness that the eating
pattern is abnormal
d. Weight that can be normal, slightly above
normal, or below normal

ANS: C
Children who are ages 6 and 7 years know the rules and behaviors
expected of them but do not understand the reasons for them.
Young children do not believe that standards of behavior come
from within themselves but that rules are established and set down
by others. Younger school-age children learn standards for
acceptable behavior, act according to these standards, and feel
guilty when they violate them. Misfortunes and accidents are
viewed as punishment for bad acts.

ANS: D
In Piaget's stage of concrete operations children have
the ability to group and sort and make conceptual
decisions. Children cannot reason abstractly until late
adolescence. Scientific reasoning and formal logic is a
skill of adolescents. Making judgments on what the
child sees versus what they reason is not a
developmental skill.

ANS: A
The 12-month-old child is able to pull to a stand and
walk holding on or independently. Appropriate toys
for this age child include large pull toys for
kinesthetic stimulation. A cradle gym should not be
placed across the crib. Finger paints are appropriate
for older children. A 12-month-old child does not
have the stability to use a stick horse.
ANS: D
Older school-age children may lie to meet expectations set
by others to which they have been unable to measure up.
Cheating usually becomes less frequent as the child
matures. In this age group children are able to
distinguish between fact and fantasy. Young children may
lack a sense of property rights; older children may steal to
supplement an inadequate allowance, or it may be an
indication of serious problems.
ANS: D
Individuals with bulimia are of normal or more
commonly slightly above normal weight. Those who also
restrict their intake can become severely underweight.
Behavior related to this eating disorder is secretive,
frenzied, and out of control. These cycles are followed by
self-deprecating thoughts and a depressed mood. These
young women are keenly aware that this eating pattern is
abnormal.

What is descriptive of the play of school-age children?
a. Individuality in play is better tolerated than
at earlier ages.
b. Knowing the rules of a game gives an
important sense of belonging.
c. They like to invent games, making up the
rules as they go.
d. Team play helps children learn the
universal importance of competition and
winning.

What is descriptive of the preschooler's
understanding of time?
a. Has no understanding of time
b. Associates time with events
c. Can tell time on a clock
d. Uses terms like "yesterday" appropriately

What may be given to high risk children after
exposure to chickenpox to prevent varicella?
a. Acyclovir
b. Vitamin A
c. Diphenhydramine hydrochloride
d. Varicella zoster immune globulin (VZIG)

What represents the major stressor of
hospitalization for children from middle infancy
throughout the preschool years?
a. Separation anxiety
b. Loss of control
c. Fear of bodily injury
d. Fear of pain

What would the nurse expect of a healthy 3year-old child?
a. Jump rope
b. Ride a two-wheel bicycle
c. Skip on alternate feet
d. Balance on one foot for a few seconds

ANS: B
Play involves increased physical skill, intellectual ability, and
fantasy. Children form groups and cliques and develop a sense of
belonging to a team or club. At this age children begin to see the
need for rules. Conformity and ritual permeate their play. Their
games have fixed and unvarying rules, which may be bizarre and
extraordinarily rigid. With team play children learn about
competition and the importance of winning, an attribute highly
valued in the United States.

ANS: B
In a preschooler's understanding time has a relation
with events such as, "We'll go outside after lunch."
Preschoolers develop an abstract sense of time at age
3 years. Children can tell time on a clock at age 7
years. Children do not fully understand use of timeoriented words until age 6 years.

ANS: D
VZIG is given to high risk children to help prevent the
development of chickenpox. Immune globulin
intravenous may also be recommended. Acyclovir is given
to immunocompromised children to reduce the severity of
symptoms. Vitamin A reduces morbidity and mortality
associated with the measles. The antihistamine
diphenhydramine is administered to reduce the itching
associated with chickenpox.

ANS: A
The major stress for children from infancy through
the preschool years is separation anxiety, also called
anaclitic depression. This is a major stressor of
hospitalization. Loss of control, fear of bodily injury,
and fear of pain are all stressors associated with
hospitalization. However, separation from family is a
primary stressor in this age group.

ANS: D
3-year-olds are able to accomplish the
gross motor skill of balancing on one
foot. Jumping rope, riding a two-wheel
bike, and skipping on alternative feet are
gross motor skills of 5-year-old children

When a preschool child is hospitalized without
adequate preparation, the nurse should recognize
that the child may likely see hospitalization as:
a. Punishment.
b. Threat to child's self-image.
c. An opportunity for regression.
d. Loss of companionship with friends.

When is a child with chickenpox considered
to be no longer contagious?
a. When fever is absent
b. When lesions are crusted
c. 24 hours after lesions erupt
d. 8 days after onset of illness

When is the best age for solid food to be
introduced into the infant's diet?
a. 2 to 3 months
b. 4 to 6 months
c. When birth weight has tripled
d. When tooth eruption has started
When teaching injury prevention during the school-age
years, the nurse should include:
a. Teach the need to fear strangers.
b. Teach basic rules of water safety.
c. Avoid letting children cook in microwave
ovens.
d. Caution children against engaging in
competitive sports.
Which aspect of cognition develops during adolescence?
a. Capability to use a future time perspective
b. Ability to place things in a sensible and
logical order
c. Ability to see things from the point of view
of another
d. Progress from making judgments based on
what they see to making judgments based
on what they reason

ANS: A
If a toddler is not prepared for hospitalization, a typical
preschooler fantasy is to attribute the hospitalization to
punishment for real or imagined misdeeds. Threat to
child's self-image and loss of companionship with friends
are reactions typical of school-age children. Regression is
a response characteristic of toddlers when threatened
with loss of control.

ANS: B
When the lesions are crusted, the chickenpox is no
longer contagious. This may be a week after onset of
disease. The child is still contagious once the fever
has subsided, after the lesions erupt, and may or may
not be contagious any time after 6 days as long as all
lesions are crusted over.

ANS: B
Physiologically and developmentally the 4- to 6-month-old is in a transition
period. The extrusion reflex has disappeared, and swallowing is a more
coordinated process. In addition, the gastrointestinal tract has matured
sufficiently to handle more complex nutrients and is less sensitive to
potentially allergenic food. Infants of this age will try to help during feeding.
Two to three months is too young. The extrusion reflex is strong, and the child
will push food out with the tongue. No research base indicates that the
addition of solid food to a bottle has any benefit. Infant birth weight doubles at
1 year. Solid foods can be started earlier. Tooth eruption can facilitate biting
and chewing; most infant foods do not require this ability.

ANS: B
Water safety instruction is an important source of injury prevention at
this age. The child should be taught to swim, select safe and supervised
places to swim, swim with a companion, check sufficient water depth for
diving, and use an approved flotation device. Teach stranger safety, not
fearing strangers. This includes not going with strangers, not having
personalized clothing in public places, having children tell parents if
anyone makes them uncomfortable, and teaching children to say "no" in
uncomfortable situations. Teach children safe cooking methods. Caution
against engaging in hazardous sports such as those involving
trampolines.

ANS: A
Adolescents are no longer restricted to the real and
actual. They also are concerned with the possible; they
think beyond the present. During concrete operations
(between ages 7 and 11 years) children exhibit the ability
to place things in a sensible and logical order, the ability
to see things from another's point of view, and the ability
to make judgments based on what they reason rather
than just what they see.

Which characteristic best describes the gross
motor skills of a 24-month-old child?
a. Skips
b. Rides tricycle
c. Broad jumps
d. Walks up and down stairs
Which characteristic best describes the language of a 3year-old child?
a. Asks meanings of words
b. Follows directional commands
c. Can describe an object according to its
composition
d. Talks incessantly, regardless of whether
anyone is listening

Which factor is most important in predisposing toddlers to frequent infections
such as otitis media, tonsillitis, and upper respiratory tract infections?
a. Respirations are abdominal.
b. Pulse and respiratory rates are slower than
those in infancy.
c. Defense mechanisms are less efficient than
those during infancy.
d. Short, straight internal ear/throat
structures and large tonsil/adenoid lymph
tissue are present.

Which is characteristic of physical development of a 30month-old child? Choose all that apply.
a. Birth weight has doubled.
b. Primary dentition is complete.
c. Sphincter control is achieved.
d. Anterior fontanel is open.
e. Length from birth is doubled.
f. Left- or right-handedness is established.

Which of the following are stressors common to
hospitalized toddlers? Select all that apply.
1. Social isolation.
2. Interrupted routine.
3. Sleep disturbances.
4. Self-concept disturbances. 5. Fear of being hurt.

ANS: D
The 24-month-old child can go up and
down stairs alone with two feet on each
step. Skipping and the ability to broad
jump are skills acquired at age 3. Tricycle
riding is achieved at age 4.

ANS: D
Because of the dramatic vocabulary increase at this
age, 3-year-olds are known to talk incessantly,
regardless of whether anyone is listening. A 4- to 5year-old asks lots of questions and can follow simple
directional commands. A 6-year-old can describe an
object according to its composition.

ANS: D
Toddlers continue to have the short, straight internal ear canal of
infants. The lymphoid tissue of the tonsils and adenoids continues
to be relatively large. These two anatomic conditions combine to
predispose the toddler to frequent infections. The abdominal
respirations and lowered pulse and respiratory rate of toddlers do
not affect their susceptibility to infection. The defense mechanisms
are more efficient compared with those of infancy.

ANS: B, C
Usually by age 30 months, the primary dentition of
20 teeth is completed, and the child has sphincter
control in preparation for bowel and bladder control.
A doubling of birth weight, opening of the anterior
fontanel, doubling of length, and handedness
orientation are not characteristic of the physical
development of a 30-month-old child.

ANS: 2,3,5
2. Common stressors of the hospitalized toddler include interrupted routine,
sleep pattern disturbances, and fear of being hurt.
3. Common stressors of the hospitalized toddler include interrupted routine,
sleep pattern disturbances, and fear of being hurt.
5. Common stressors of the hospitalized toddler include interrupted routine,
sleep pattern disturbances, and fear of being hurt. The stressors of social isolation and self-concept disturbances are stressors of the hospitalized teen.

Which predisposes the adolescent to feel an increased
need for sleep?
a. An inadequate diet
b. Rapid physical growth
c. Decreased activity that contributes to a
feeling of fatigue
d. The lack of ambition typical of this age
group
Which statement accurately describes physical development during the
school-age years?
a. The child's weight almost triples.
b. A child grows an average of 2 inches per
year.
c. Few physical differences are apparent
among children at the end of middle
childhood.
d. Fat gradually increases, which contributes
to the child's heavier appearance.

Which statement best describes fear in school-age children?
a. They are increasingly fearful for body
safety.
b. Most of the new fears that trouble them are
related to school and family.
c. They should be encouraged to hide their
fears to prevent ridicule by peers.
d. Those who have numerous fears need
continuous protective behavior by parents
to eliminate these fears.

Which statement best describes the infant's physical
development?
a. Anterior fontanel closes by age 6 to 10 months.
b. Binocularity is well established by age 8 months.
c. Birth weight doubles by age 5 months and triples by
age 1 year.
d. Maternal iron stores persist during the first 12 months
of life.

Which statement by the mother of an 18-month-old would lead the nurse to believe that the child
should be referred for further evaluation for developmental delay?
1. "My child is able to stand but is not yet taking
steps independently."
2. "My child has a vocabulary of approximately
15 words."
3. "My child is still thumb sucking."
4. "My child seems to be quite wary of
strangers."

ANS: B
During growth spurts the need for sleep
is increased. Rapid physical growth, the
tendency toward overexertion, and the
overall increased activity of this age
contribute to fatigue.
ANS: B
In middle childhood growth in height and weight occur
at a slower pace. Between the ages of 6 to 12 years,
children grow 2 inches per year. In middle childhood
children's weight will almost double; they gain 3 kg/year.
At the end of middle childhood girls grow taller and gain
more weight than boys. Children take on a slimmer look
with longer legs in middle childhood.

ANS: B
During the school-age years children experience a wide variety of
fears, but new fears related predominantly to school and family
bother children during this time. During the middle-school years
children become less fearful of body safety than they were as
preschoolers. Parents and other persons involved with children
should discuss their fear with them individually or as a group
activity. Sometimes school-age children hide their fears to avoid
being teased. Hiding the fears does not end them and may lead to
phobias.

ANS: C
Growth is very rapid during the first year of life. The
birth weight has approximately doubled by age 5 to 6
months and triples by age 1 year. The anterior
fontanel closes at age 12 to 18 months. Binocularity is
not established until age 15 months. Maternal iron
stores are usually depleted by age 6 months.

ANS: 1
The child should be walking independently by 15 to 18 months. Because this
toddler is 18 months and not walk- ing, a
referral should be made for a
developmental consult.

Which statement characterizes moral development in older school-age
children?
a. They are able to judge an act by the
intentions that prompted it rather than just
by the consequences.
b. Rules and judgments become more
absolute and authoritarian.
c. They view rule violations in an isolated
context.
d. They know the rules but cannot understand
the reasons behind them.

Which statement is correct about childhood obesity?
a. Heredity is an important factor in the
development of obesity.
b. Childhood obesity in the United States is
decreasing.
c. Childhood obesity is the result of inactivity.
d. Childhood obesity can be attributed to an
underlying disease in most cases.
Which statement is correct about toilet training?
a. Bladder training is usually accomplished
before bowel training.
b. Wanting to please the parent helps
motivate the child to use the toilet.
c. Watching older siblings use the toilet
confuses the child.
d. Children must be forced to sit on the toilet
when first learning.

Which statement is true about smoking in adolescence?
a. Smoking is related to other high-risk
behaviors.
b. Smoking is more common among athletes.
c. Smoking is less common when the
adolescent's parent(s) smokes.
d. Smoking among adolescents is becoming
more prevalent.

Which type of play is most typical of
the preschool period?
a. Solitary c. Associative
b. Parallel d. Team

ANS: A
Older school-age children are able to judge and act by
the intentions that prompted the behavior rather
than just by the consequences. Rules and judgments
become less absolute and authoritarian. Rule
violation is likely to be viewed in relation to the total
context in which it appears. Both the situation and
the morality of the rule itself influence reactions.

ANS: A
Heredity is an important fact that contributes to obesity. Identical
twins reared apart tend to resemble their biologic parents to a
greater extent than their adoptive parents. It is difficult to
distinguish between hereditary and environmental factors. The rate
of childhood obesity has increased so dramatically that it has now
reached epidemic proportions. Inactivity is an important
contributing factor; however, obesity is the result of a combination
of a number of other factors. Fewer than 5% of all cases of obesity
can be linked to underlying disease.

ANS: B
Voluntary control of the anal and urethral sphincters is achieved
sometime after the child is walking. The child must be able to
recognize the urge to let go and to hold on. The child must want to
please the parent by holding on rather than pleasing self by letting
go. Bowel training precedes bladder training. Watching older
siblings provides role modeling and facilitates imitation for the
toddler. The child should be introduced to the potty chair or toilet in
a nonthreatening manner.

ANS: A
Cigarettes are considered a gateway drug. Teenagers
who smoke are 11.4 times more likely to use an illicit
drug. Teens who refrain from smoking often have a
desire to succeed in athletics. If a parent smokes, it is
more likely that the teen will smoke. Cigarette
smoking has declined among all groups since the
1990s.

ANS: C
Associative play is group play in similar or
identical activities but without rigid
organization or rules. Solitary play is that of
infants. Parallel play is that of toddlers.
School-age children play in teams.