Question 1

The nurse is caring for a preschool-age child whose grandparent died 3 days ago.  Which intervention is inappropriate?

Accepted Answer

11ecbb05_caca_78e1_b433_a73315e6dfb3_MD0009_00 The preschool-age (3-5 years) child's view of death is related to their developmental stage. They believe death is temporary and reversible, similar to a prolonged nap. The child may ask repeatedly when the deceased individual will return, or they may feel guilty and responsible for the death because of their wishes or thoughts (magical thinking). Talking about the death in simple, accurate terms as often as needed helps the preschool-age child to process their loss. Avoiding discussion of the loved one's death is not therapeutic and may increase anxiety or cause confusion (Option B). (Option A) Familiar faces are comforting to the child, and consistently assigning the same nurses and caregivers promotes therapeutic relationships and trust. (Option C) When considering the idea of death, preschool-age children have significant fear of separation from their parents. Therefore, it is appropriate to explain the importance of remaining with the child as much as possible to the parents. (Option D) Play allows the child to cope with grief and provides an outlet to express or work through feelings/experiences that the child may not be able to vocalize. Educational objective: Therapeutic interventions for preschool-age children who are experiencing the death of a loved one include providing familiarity (eg, same nurses, parental presence), ensuring that time each day is devoted to play, and speaking openly to the child about the death as often as needed.

Question 2

The school nurse is conducting an educational session for middle school teachers that is designed to heighten awareness of school bullying. The nurse recognizes that further instruction is needed when one of the teachers makes which comment?

Accepted Answer

Despite increased media coverage, articles, and discussion about school bullying, myths and "old" attitudes toward school bullying persist. A number of parents and teachers continue to perceive bullying as a normal part of childhood, with the attitude of "kid will be kids." Some may even believe that bullying is "fun" and will help make those who are bullied stronger over time. These beliefs are one of the most common reasons why teachers and parents may ignore bullying behavior. The consequences of bullying are lasting harm and distress, including anxiety, depression, school adjustment problems, sleep difficulties, and even death. (Option B) This is a true statement. Children who bully often target those who seem different or are physically weak. Children with disabilities are easy targets. (Option C) This is a true statement. Most victims of bullying are afraid to tell an adult for fear that the bullying will get worse. They may also feel embarrassed that they appear to be a "weakling." (Option D) Bullying includes physical, verbal, and psychological aggression. Studies indicate that verbal abuse (eg, yelling obscenities, derogatory remarks, intimidation) is the most common type of bullying. Physical bullying tends to decrease from middle school to high school, but verbal bullying intensifies. Verbal attacks are more difficult to identify as they occur when adults are out of earshot. Educational objective: Bullying is not a part of normal childhood growth and development. It is abusive behavior that can have lasting and harmful physical and psychological effects on its victims.

Question 3

The nurse is assessing a 3-month-old during a well-child visit.  Which developmental finding should the nurse expect to observe in the client?

Accepted Answer

11ecbb05_cacb_8a52_b433_07cf7a4d6020_MD0009_00 Developmental milestones (eg, motor, sensory, verbal, cognitive) are known patterns of growth and development noted in most children by a specific age. These milestones are used as a general assessment guide, although each child has a unique pattern of development. By age 3 months, the infant recognizes familiar items and faces (Option B). Any 3-month-old who does not respond to familiar faces may have visual impairment or an underlying neurological disorder (eg, autism). (Option A) Stranger anxiety is part of the infant's normal social and cognitive development and usually begins around age 6 months. (Option C) Transferring objects from one hand to the other hand is a fine motor skill that usually develops between age 6 and 9 months. Failure to develop this skill may indicate neuromuscular or developmental delays. (Option D) A 3-month-old is usually not strong enough to roll from the back to the front. Infants should be able to turn from the abdomen to the back at around age 4 months and then from the back to the abdomen by age 6 months. Failure to roll over by age 6 months may indicate slower-than-normal neck, leg, back, and arm muscle development and should be investigated. Educational objective: Developmental milestones (known patterns of growth and development) are used as a general assessment guide. By age 3 months, the infant should recognize familiar items and faces. Any 3-month-old who does not respond to familiar faces (eg, by cooing) may have visual impairment or an underlying neurological disorder (eg, autism).

Question 4

The clinic nurse is caring for a 3-year-old client.  Which task, if not observed or reported by the parents as accomplished, will cause the nurse concern?

Accepted Answer

Things that most children can do by a certain age are considered developmental milestones. These include the following areas of development: social/emotional, language/communication, cognitive, and physical. Each child develops in a unique pattern, and ages are considered as general guidelines for assessing development. Normally, a toddler develops the ability to use a spoon by 18 months. Therefore, a 3-year-old should be able to eat with a spoon. (Option A) Catching a ball 50% of the time is a developmental expectation for a 4-year-old. (Option B) A 4-year-old can copy or draw a square with a pencil or crayon. Copying shapes other than a circle is a developmental expectation for a 5-year-old. (Option D) Hopping on one foot is a developmental expectation for a 4-year-old. Educational objective: A 3-year-old should be able to eat with a spoon.

Question 5

The nurse is admitting an infant who has severe growth deficiency and facial characteristics of indistinct philtrum, a thin upper lip, and short palpebral fissures.  Which question should the nurse ask to assess the cause of these clinical findings?

Accepted Answer

11ecbb05_cac7_e0cf_b433_7181dca74508_MD0009_00 Fetal alcohol syndrome (FAS) is a leading cause of intellectual disability and developmental delay in the United States. Diagnosis includes history of prenatal exposure to any amount of alcohol, growth deficiency, neurological symptoms (eg, microcephaly), or specific facial characteristics (indistinct philtrum, thin upper lip, epicanthal folds, flat midface, and short palpebral fissures). Asking about alcohol use during pregnancy can identify newborns and infants who are at risk for FAS. Family support, early intervention, and prevention for subsequent pregnancies are important for families with an infant with this diagnosis. (Option A) Advanced maternal age has been associated with a higher incidence of trisomy 21 (Down syndrome). Characteristic features include a single palmar crease and a short neck with excess skin (nuchal fold). (Option B) Cigarette smoking is linked to perinatal loss, sudden infant death syndrome, low birth weight, and prematurity. Specific facial characteristics or syndromes are not typically caused by tobacco exposure in utero. (Option D) Valproate (Depakote), a medication used to control seizures, is an FDA pregnancy category D drug that can cause neural tube defects such as spina bifida, but not the distinct facial features of FAS. Educational objective: Consumption of any amount of alcohol during pregnancy places a fetus at risk for fetal alcohol syndrome. Clinical manifestations include intellectual disability, developmental delay, and distinct facial characteristics (indistinct philtrum, thin upper lip, epicanthal folds, flat midface, and short palpebral fissures).

Question 6

A teenage client with sickle cell disease is admitted with a diagnosis of crisis.  The client's current prescription is morphine 2 mg intravenous push every 4 hours prn.  The client appears comfortable while watching television and tells the nurse "I have severe intolerable pain," and rates it a "10."  What action should the nurse take?

Accepted Answer

Clients with sickle cell crisis often have excruciating pain related to the occlusion from the sickling and resulting ischemia. These individuals usually need large doses of narcotics as prior treatment has led to drug tolerance; they may also metabolize the drugs differently. Using only external cues to judge a client's pain is invalid as these clients have often learned how to distract themselves from focusing on the pain. Use of continuous PCA is recommended for relief rather than prn administration. (Option A) Nonsteroidal anti-inflammatory drugs (eg, ibuprofen) are not very effective in treating the pain of sickle cell crisis. (Option C) Meperidine (Demerol) is contraindicated for a sickle cell crisis as large frequent doses can result in normeperidine (toxic metabolite) accumulation. Symptoms start with tremors and can result in a seizure. (Option D) Clients with sickle cell crisis are often undertreated due to the suspicion of drug abuse. However, studies have shown that the risk of abuse is small (0%-9%) and this range is similar to substance abuse risk in the general population. Therefore, the client's self-report is valid and appropriate treatment in the acute setting is warranted. Educational objective: Clients with sickle cell crisis often have excruciating pain and need large doses of narcotics. The most effective method is PCA of morphine or hydromorphone (Dilaudid).

Question 7

The nurse is reviewing the plan of care for a 4-year-old client who will receive daily dressing changes for an infected leg wound. Which of the following interventions should the nurse include in the plan of care for a preschool-age child? Select all that apply.

Accepted Answer

Planning care during pediatric hospitalization requires the nurse to consider the child's stage of psychosocial and cognitive development. For the preschool-age child (3-5 years), developing a sense of initiative (ie, start and accomplish tasks, learn new things) is a primary psychosocial need, and cognitive development is marked by preoperational thinking (ie, egocentrism, poor causality, continuing language development). During preprocedural education, the nurse should: Promote a sense of security and reduce fear by allowing the parents to stay with the child during the procedure (Option A) Address misconceptions related to preoperational thinking (ie, state that the procedure is not punishment for misbehavior) (Option B) Foster initiative by encouraging the child to ask questions, voice concerns, and participate during dressing changes (Option C) Enhance the child's learning ability and confirm the child's understanding of the procedure by allowing the child to imitate the procedure using a doll or toy equipment (Option D) (Option E) Peer support from other clients undergoing similar procedures is a coping technique that is more appropriate for adolescents. Educational objective: Interventions that meet the psychosocial (ie, sense of initiative) and cognitive (ie, preoperational thinking) needs of preschool-age children during preprocedural education include allowing parents to remain with the client during the procedure, emphasizing that the procedure is not punishment, encouraging the child to ask questions, and utilizing toys to communicate about the procedure.

Question 8

The parents of a 4-year-old tell the nurse that the child won't go to sleep at night due to fear of tigers living under the bed. Which response by the nurse is most helpful?

Accepted Answer

Preschool children (age 3-5) are magical thinkers. Night fears are common during this period, and distinguishing between reality and fantasy is difficult. It is appropriate for parents to acknowledge the child's fears. A preschooler would be comforted and fears would be allayed if the parents looked under the bed and reassured the child that no tigers were there (Option C). (Option A) This reply does not educate the parents about normal growth and development. It is not a therapeutic response. (Option B) Fantasy fears are normal during the preschool years. They are not common during other developmental periods. (Option D) The parents should be told that magical thinking is common during the preschool period. This is not an accurate or therapeutic response. Educational objective: Magical thinking is common during the preschool period. It is not unusual for a child to have an imaginary friend, and parents should be taught that this is a normal part of development. Magical thinking satisfies children's questions about the world they live in.

Question 9

Several children seen at a local pediatric clinic are found to have a hemoglobin level of 10-11 g/dL (100-110 g/L). Which dietary modification would most likely help increase hemoglobin levels in these clients?

Accepted Answer

Iron deficiency is the leading cause of anemia worldwide. Most cases of iron deficiency anemia (IDA) result from inadequate intake of foods high in iron. In IDA, red blood cells are small (microcytic) with reduced hemoglobin content, appearing paler (hypochromic) under a microscope. The richest dietary sources of iron include meat, fish, and poultry, which provide a form of iron that is easily absorbed by the body (Option A). Plant-based foods (eg, dried fruits, nuts, legumes, green leafy vegetables, whole grains) are not as iron rich and contain a less bioavailable form of iron than animal-based foods. However, foods high in vitamin C (eg, tomatoes, potatoes, strawberries) may boost iron absorption when consumed with iron-rich foods. (Option B) Fruits and vegetables are not the best sources of dietary iron. (Option C) Milk and milk products are poor sources of dietary iron, and excessive calcium intake interferes with iron absorption. Overconsumption of milk, along with little or no consumption of other foods, is a leading cause of iron deficiency in young children. (Option D) Although sources of vitamin C (eg, orange juice) may enhance iron absorption, increased intake of iron-rich foods is priority in treatment of IDA. Vitamin D has no direct effect on anemia. Educational objective: Most cases of iron deficiency anemia result from inadequate intake of iron-rich foods. The richest dietary sources of iron include meat, fish, and poultry. Consuming fruits or juices high in vitamin C may enhance the absorption of iron.

Question 10

The nurse is providing teaching to the parents of a child with Marfan syndrome. Which topic is the priority for the nurse to address?

Accepted Answer

11ecbb05_cac8_5600_b433_679840c02aa8_MD0009_00 Marfan syndrome is an autosomal dominant disorder affecting the connective tissues of the body. Abnormalities are mainly seen in the cardiovascular, musculoskeletal, and ocular systems. Clients with Marfan syndrome are very tall and thin, with disproportionately long arms, legs, and fingers. Cardiovascular manifestations of Marfan syndrome include abnormalities of the aorta and cardiac valves, including aneurysms, tears (dissection), and leaky heart valves that may require replacement or repair. Therefore, competitive or contact sports are discouraged due to the risk of cardiac injury and sudden death (Option A). (Option B) The client may also experience crowding of the teeth from a very high-arched palate. Preventive antibiotics prior to dental work may be needed to provide prophylaxis against infective endocarditis, especially in clients with an artificial valve replacement. However, this is not a priority. (Option C) These clients have an increased risk for scoliosis, especially during the adolescent years of increased growth; therefore, the child should be monitored regularly for curvature of the spine. This is not a priority. (Option D) Ocular problems (eg, lens dislocation [ectopia lentis], retinal detachment, cataracts, glaucoma) can be common for the child with Marfan syndrome. Annual eye examinations with an ophthalmologist are important to monitor for developing issues. Educational objective: Aortic root disease (ie, aneurysm, dissection) is the major cause of morbidity and mortality in Marfan syndrome. Therefore, competitive or contact sports are discouraged due to the risk of cardiac injury and sudden death.

Question 11

The nurse is caring for a 4-year-old who was hospitalized with influenza. Which nursing action would be most effective to maintain psychosocial integrity?

Accepted Answer

Clients with influenza are maintained on droplet precautions, and anyone entering the room must wear a facemask. Medical play during the preschool period (age 3-5 years) facilitates psychosocial integrity. Crayons are age-appropriate toys. Drawing noses on facemasks will help the child feel more comfortable with procedures and provides a developmentally appropriate diversion. (Option A) Puzzles would be more appropriate for the school-age child (6-12 years). (Option B) Stacking blocks would be more appropriate for the toddler (age 1-3 years). (Option D) Maintaining contact with peers would be more appropriate for the adolescent (age 12-19 years). Educational objective: Maintaining psychosocial integrity is a priority when a child is hospitalized. This is achieved by integrating age-appropriate diversions (eg, medical play for a preschooler) in the nursing care.

Question 12

The nurse is providing care to a 9-year-old client who is awaiting surgery.  Which intervention is developmentally appropriate for this client's plan of care?

Accepted Answer

Planning care during a pediatric hospitalization requires the nurse to consider the child's stage of psychosocial and cognitive development. For the school-age child (age 6-12 years), developing a sense of industry (ie, confidence in skills and abilities) is a primary psychosocial need, and cognitive development is marked by concrete thinking (ie, based on actual objects or activities). During preprocedural education, the nurse should foster a sense of industry by involving the child in discussions about the procedure, interacting with the child directly, and using correct anatomical terminology. In addition, the use of simple diagrams helps to meet the child's need for concrete learning (Option A). (Option B) A school-age child has a concrete way of thinking and may not think abstractly about the future until adolescence. (Option C) Adolescents are more aware of body image than school-age children. Exploring feelings and concerns regarding the appearance of a surgical scar is not a primary focus. (Option D) Toddlers (age 1-3 years) should receive initial teaching about a procedure immediately before it occurs due to a limited concept of time. School-age children can be prepared in advance of a procedure (eg, a day before), which gives them time to process. Educational objective: During preprocedural education, the nurse should use developmentally appropriate methods of teaching. Using simple diagrams with correct anatomical terminology appropriately meets the psychosocial (ie, sense of industry) and cognitive needs (ie, concrete thinking) of school-aged children.

Question 13

A 10-year-old weighs 99 lb (44.9 kg) and has a BMI of 24.8 kg/m² (>95th percentile). Which is the most important assessment for the nurse to make before initiating a weight loss plan?

Accepted Answer

Before initiating a treatment plan for weight loss, it is most important to make certain that the child and family are ready for change. Attempting to engage the family and child in weight loss strategies and dietary changes before they are ready could easily result in frustration, treatment failure, and reluctance to try new approaches in the future. The nurse needs to explore the reasons and desire for weight loss by assessing: Motivation and confidence Willingness to change behaviors and food choices Perceived importance of a weight loss treatment plan Confidence in ability to take on healthier eating habits (Option A) Physical activity is an important component of a weight loss treatment plan, but it is not the priority nursing assessment. (Option B) The family's eating habits will have a strong influence on the child's ability to make changes and need to be assessed. However, it is more important to assess the family's readiness for change. (Option C) Assessing the family's financial resources is important in planning education about healthy food choices, but it is not the priority nursing action. Educational objective: Before initiating a treatment program that requires a client and family to make major lifestyle and behavior changes, the nurse needs to assess readiness for change. Motivation and a desire for change are the keys to successful weight loss.

Question 14

The parents of a 5-year-old ask the school nurse for advice on how to tell their child about being adopted.  Which developmentally appropriate thought about adoption by the child does the nurse counsel the parents to anticipate?

Accepted Answer

11ecbb05_cac7_448e_b433_f5084b79d2bd_MD0009_00 Children age 3-6 (preschool) are in Piaget's preoperational stage of cognitive development. At age 5, children are not able to fully understand cause and effect and will therefore ascribe inappropriate causes to phenomena (eg, scraped knee was caused by earlier misbehavior). Five-year-olds are developmentally capable of understanding adoption on a basic level; however, it may be difficult for them to understand the concept of having another family. The child might notice that friends are not adopted. Preschool-age children may also believe they are responsible for being adopted and may develop separation issues and fear abandonment. (Option B) School-age children may imagine how life would be different if they were with their biological parents. Self-esteem issues begin to develop around this time with the possible sense of loss of the biological family. School-age children may be sensitive to physical differences between themselves and their adoptive family. (Option C) Children age 3 and under are unable to understand differences between adoptive and biological parents. The age at which to begin discussions about being adopted is debatable, but use of positive language is always encouraged. The terms "given up" or "put up" for adoption or someone's "real" parents are inappropriate and should be avoided. (Option D) Adolescents have abstract thinking abilities that enable introspection about their adoption. They typically do not like differing from their peers. Open and honest communication is important at this age. Educational objective: Preschool-age children (3-6 years) are in Piaget's preoperational stage of cognitive development. They become increasingly verbal but are unable to understand cause and effect, often ascribing inappropriate causes to phenomena; therefore, the adopted child may feel responsible for being adopted.

Question 15

The clinic nurse is asked by the mother of a 15-month-old, "I am worried about my child's thumb sucking and its effects on tooth alignment. What should I do?" What is the nurse's best response?

Accepted Answer

Rooting and sucking are a part of an infant's natural reflexes. Nonnutritive sucking assists in helping the infant to feel secure. Some parents become very concerned about their infants sucking fingers, thumbs, or a pacifier and try to stop the behavior. As a rule, if thumb sucking stops before the permanent teeth begin to erupt, misalignment of the teeth and malocclusion can be avoided. Parents should be taught that teasing and punishing a child for using a pacifier or sucking the thumb is not an effective method for getting the child to stop. This can increase the child's anxiety and cause the child to increase the behavior. (Options A, B, and C) These options are incorrect. Use of a pacifier or thumb sucking prior to eruption of the permanent teeth does not tend to cause dental issues such as teeth misalignment or malocclusion. Educational objective: The risk of teeth misalignment and malocclusion occurs when a child uses a pacifier or sucks the thumb after the eruption of the permanent teeth.

Question 16

What play behavior would the nurse be most likely to observe in a group of 4-year-old children?

Accepted Answer

Play is an important developmental task of childhood and is an indication of physical, social, and emotional health. Preschoolers (age 3-6) enjoy associative play, in which they engage in similar activities or play with the same or similar items, but the play is unorganized without specific goals or rules. They often borrow items from each other without directing each other's play. Preschoolers also enjoy play involving motor activities and imaginative, pretend play. (Option B) Cooperative play is common in school-age children (age 6-12). These children play with one another with a specific goal (eg, building a castle from blocks), often within a rigid set of rules. Cooperative play is likely too advanced for preschool-age children, as it involves more organizational skills. (Option C) Parallel play is more common in toddlers (age 1-3). During parallel play, these children play next to each other and are happy to be in the presence of peers, but they do not play directly with one another. (Option D) Solitary play is common in infants (birth to 1 year). Children at this stage are focused on their own activity and will play alone in the presence of others. Educational objective: Preschoolers (age 3-6) enjoy associative play, in which children engage in the same type of activity, but the play is unorganized without specific goals or rules. Infants play alone (solitary), toddlers play next to each other (parallel), and school-age children play with others with a common goal (cooperative).

Question 17

A 5-year-old child is receiving morphine sulfate for pain. Which statement by the caregiver indicates that further teaching is necessary?

Accepted Answer

The child who is playing or sleeping might still be experiencing pain but is using distraction as a coping mechanism. This statement by the caregiver indicates that further teaching is needed. (Option A) Preschool-age children may become physically or verbally aggressive when in pain. (Option B) The preschool-age child experiences magical thinking and might feel that pain is a punishment for wrongdoing. (Option D) Age-appropriate pain scales can be used to assess pain in children. The FACES pain rating scale consists of 6 cartoon faces with expressions from no pain to worst pain. Educational objective: A child's expression of pain varies based on developmental stage and past experiences with pain. The nurse should use age-appropriate pain scales. A child who is asleep or playing may be experiencing pain.

Question 18

The nurse is teaching the parents of a 4-month-old who has developed positional plagiocephaly (flat head syndrome). Which statement by the parents indicates a need for further teaching?

Accepted Answer

Positional plagiocephaly (flat head syndrome) occurs when an infant's soft, pliable skull is placed in the same position for an extended time. Positional plagiocephaly has become common due to the Safe to Sleep (formerly Back to Sleep) campaign, which advocates for infants to sleep in the supine position to prevent sudden infant death syndrome (SIDS). The risk of SIDS outweighs the benefit of a shapely head; the infant should not be placed in the prone position to sleep, even for a daytime nap (Option B). Plagiocephaly can usually be prevented or corrected by: Frequently alternating the supine infant's head position from side to side (Option A) Minimizing the amount of time an infant's head rests against a firm surface (eg, car seat) (Option C) Placing pictures and toys opposite the favored (affected) side to encourage turning the head (Option D) Placing the infant in the prone position for 30-60 min/day ("tummy time") Educational objective: Positional plagiocephaly, or flattening of the skull, can develop when infants spend a lot of time in the same position. Positioning techniques (eg, "tummy time," alternating the head position) can prevent or correct plagiocephaly. Infants should always be placed in the supine position to sleep.

Question 19

The clinic nurse reviews teaching provided to the parent of a child being considered for growth hormone replacement therapy at home.  Which statement by the parent indicates that teaching has been effective?

Accepted Answer

A child who demonstrates a slow growth pattern will undergo diagnostic evaluation to determine the cause. If the cause is found to be growth hormone deficiency, the child may undergo growth hormone replacement therapy. The biosynthetic hormone is administered via subcutaneous injection on a daily basis. Despite replacement therapy, the child may still have a final height less than "normal." Treatment is most successful when diagnosis and replacement therapy begin early in the child's life. When to stop therapy is decided by the client, family, and provider. However, growth less than 1 inch (2.5 cm) per year and bone age of 14 years in girls and 16 years in boys are the criteria often used to stop therapy. (Option A) Growth hormone replacement does not guarantee that a child will grow at a rate equal to peers. Treated children often remain shorter than their peers. (Option B) Replacement therapy is not continued throughout a child's life. It is stopped when bone growth begins to cease or when the child, parents, and provider make the decision. (Option C) Replacement therapy is most successful when treatment begins early, as soon as growth delays are noted. Educational objective: Growth hormone replacement is an option for children who are not growing according to accepted standards. The treatment should begin as soon as delays are noted and continue until bone growth begins to cease despite replacement therapy. Replacement is administered via subcutaneous injections.

Question 20

The parents of a 2-year-old client ask how they can help their child cope with hospitalization. Which of the following suggestions should the nurse give the parents? Select all that apply.

Accepted Answer

Hospitalization for toddlers (ie, 12-36 months) is particularly difficult due to separation anxiety and a limited ability to cope with stress. Toddlers thrive on home rituals and routines, which bring stability and reassurance. Hospitalization can severely disrupt these routines, triggering frustration and temper tantrums. Caregivers should maintain as many home routines as possible (eg, sleeping, eating) to help the child cope with unfamiliar hospital surroundings and procedures (Option A). Parents should also stay with the child as much as possible, including overnight (ie, rooming-in), to provide consistency and alleviate separation anxiety (Option C). Play, an important part of a child's emotional and social well-being, is an effective coping mechanism for children of all ages to deal with the stress of being away from home. The playroom is a safe place for children to act out their fears and anxieties related to illness and hospitalization (Option D). (Option B) A visit from friends is not likely to provide much comfort to a toddler and may actually cause additional stress. Adolescents, who are driven by peer interaction, would be more likely to benefit from this strategy. (Option E) Preschool-aged children (3-5 years) have egocentric and magical thinking, which may cause them to think that their illness is due to something they have done or thought. Toddlers do not think this way. Educational objective: Coping mechanisms used by hospitalized toddlers include following homes rituals and routines, having parents stay with the child (including overnight), and using the playroom for relief of anxiety and fear.

Exam 2: Child Health

The nurse is caring for a preschool-age child whose grandparent died 3 days ago. Which intervention is inappropriate?

The school nurse is conducting an educational session for middle school teachers that is designed to heighten awareness of school bullying. The nurse recognizes that further instruction is needed when one of the teachers makes which comment?

The nurse is assessing a 3-month-old during a well-child visit. Which developmental finding should the nurse expect to observe in the client?

The clinic nurse is caring for a 3-year-old client. Which task, if not observed or reported by the parents as accomplished, will cause the nurse concern?

The nurse is admitting an infant who has severe growth deficiency and facial characteristics of indistinct philtrum, a thin upper lip, and short palpebral fissures. Which question should the nurse ask to assess the cause of these clinical findings?

The nurse is reviewing the plan of care for a 4-year-old client who will receive daily dressing changes for an infected leg wound. Which of the following interventions should the nurse include in the plan of care for a preschool-age child? Select all that apply.

The parents of a 4-year-old tell the nurse that the child won't go to sleep at night due to fear of tigers living under the bed. Which response by the nurse is most helpful?

Several children seen at a local pediatric clinic are found to have a hemoglobin level of 10-11 g/dL (100-110 g/L) . Which dietary modification would most likely help increase hemoglobin levels in these clients?

The nurse is providing teaching to the parents of a child with Marfan syndrome. Which topic is the priority for the nurse to address?

The nurse is caring for a 4-year-old who was hospitalized with influenza. Which nursing action would be most effective to maintain psychosocial integrity?

The nurse is providing care to a 9-year-old client who is awaiting surgery. Which intervention is developmentally appropriate for this client's plan of care?

A 10-year-old weighs 99 lb (44.9 kg) and has a BMI of 24.8 kg/m² (>95th percentile) . Which is the most important assessment for the nurse to make before initiating a weight loss plan?

The parents of a 5-year-old ask the school nurse for advice on how to tell their child about being adopted. Which developmentally appropriate thought about adoption by the child does the nurse counsel the parents to anticipate?

The clinic nurse is asked by the mother of a 15-month-old, "I am worried about my child's thumb sucking and its effects on tooth alignment. What should I do?" What is the nurse's best response?

What play behavior would the nurse be most likely to observe in a group of 4-year-old children?

A 5-year-old child is receiving morphine sulfate for pain. Which statement by the caregiver indicates that further teaching is necessary?

The nurse is teaching the parents of a 4-month-old who has developed positional plagiocephaly (flat head syndrome) . Which statement by the parents indicates a need for further teaching?

The clinic nurse reviews teaching provided to the parent of a child being considered for growth hormone replacement therapy at home. Which statement by the parent indicates that teaching has been effective?

The parents of a 2-year-old client ask how they can help their child cope with hospitalization. Which of the following suggestions should the nurse give the parents? Select all that apply.