Review

1. Review Developmental Needs Lifespan Question and Answer

2. 1. A new mother asks the RN how best to encourage development of social skills in her newborn. Which should the RN’s reply include based on Erikson’s Theory of Psychosocial Development? • Allow the baby to learn self-amusement • Enroll the infant in an infant-play group • Meet the physical needs and cuddle and comfort • Show the mother the newborn reflexes

3. 1. A new mother asks the RN how best to encourage development of social skills in her newborn. Which should the RN’s reply include based on Erikson’s Theory of Psychosocial Development? • Allow the baby to learn self-amusement • Enroll the infant in an infant-play group • Meet the physical needs and cuddle and comfort • Show the mother the newborn reflexes C. In the Trust vs Mistrust stage, meeting the child’s needs develops trust and prepares the infant for progression to higher levels of psychosocial development.

4. 2. A 6-month-old infant is brought to the well-baby clinic weighing 9 pounds, 2 ounces. The baby’s birth weight was 5 pounds, 15 ounces. What is the correct analysis of the data? A. Baby is gaining less weight than expected B. Baby is gaining weight at an expected rate C. Baby is a candidate for overfeeding D. Baby is a candidate for failure to thrive

5. 2. A 6-month-old infant is brought to the well-baby clinic weighing 9 pounds, 2 ounces. The baby’s birth weight was 5 pounds, 15 ounces. What is the correct analysis of the data? A. Baby is gaining less weight than expected B. Baby is gaining weight at an expected rate C. Baby is a candidate for overfeeding D. Baby is a candidate for failure to thrive A. Normal weight gain is approximately 1½ pounds per month up to 6 months of age.

6. 3. Which statement from the parent of a 6-month-old child would be of concern to the nurse? • A. “We still have to provide support when the baby is sitting up.” • “I’m giving the baby rice cereal at bedtime.” • “I’m so glad the soft spot on the top of the head is gone.” • “The baby has two lower front teeth.”

7. 3. Which statement from the parent of a 6-month-old child would be of concern to the nurse? • A. “We still have to provide support when the baby is sitting up.” • “I’m giving the baby rice cereal at bedtime.” • “I’m so glad the soft spot on the top of the head is gone.” • “The baby has two lower front teeth.” C. The anterior fontanel normally does not close completely until 12 to 18 months of age. The posterior fontanel closes approx. 6 to 8 weeks after birth. The other choices indicate normal developmental patterns.

8. 4. Which behaviors indicate the infant is ready to wean from breastfeeding to a cup? • Taking pureed foods from a spoon • Sleeping 8 hours during the night • Decreasing nursing time • Breastfeeding on a regular schedule

9. 4. Which behaviors indicate the infant is ready to wean from breastfeeding to a cup? • Taking pureed foods from a spoon • Sleeping 8 hours during the night • Decreasing nursing time • Breastfeeding on a regular schedule C. When the infant decreases time spent nursing, it indicates increasing independence and probably readiness to wean. The other behaviors may also be present, but they are not necessarily evidence of readiness to wean.

10. 5. The nurse educates parents of a healthy 6-month-old infant about ways to stimulate language development. Select the most effective approach. • A. Suggest the parents talk regularly to the baby • Have the parents keep the radio turned on next to the baby’s playpen • Encourage the parents to play CDs of various children’s songs during the day • Urge the parents to schedule an evaluation of the infant by a speech therapist

11. 5. The nurse educates parents of a healthy 6-month-old infant about ways to stimulate language development. Select the most effective approach. • A. Suggest the parents talk regularly to the baby • Have the parents keep the radio turned on next to the baby’s playpen • Encourage the parents to play CDs of various children’s songs during the day • Urge the parents to schedule an evaluation of the infant by a speech therapist A. Listening to how words are expressed by the parents and other caregivers, greatly influences the infant’s language development. Parents have familiar voices and are “up close and personal” with the infant on a regular basis.

12. 6. A two month old infant is admitted to the Pediatric ICU with vomiting and drowsiness. A few minutes after admission, the child has a tonic-clonic seizure. Fontanels are bulging and a right retinal hemorrhage is noted. The CT scan shows subdural hemorrhage. Which intervention has priority? • Report findings to social services • Institute seizure precautions • Confront the parents about recent disciplinary actions • Role model speaking softly to the child and handling the child gently

13. 6. A two month old infant is admitted to the Pediatric ICU with vomiting and drowsiness. A few minutes after admission, the child has a tonic-clonic seizure. Fontanels are bulging and a right retinal hemorrhage is noted. The CT scan shows subdural hemorrhage. Which intervention has priority? • Report findings to social services • Institute seizure precautions • Confront the parents about recent disciplinary actions • Role model speaking softly to the child and handling the child gently A. These symptoms are very suspicious for child abuse (shaken baby syndrome). The other choices will be appropriate at some point but are not the priority at this time.

14. 7. An 8-month-old infant is to be catheterized to obtain a sterile specimen. Which response by the nurse is most appropriate when the infant's mother expresses concern that the procedure could traumatize the infant psychologically? A. “The procedure may be somewhat uncomfortable, but it should not have any lasting traumatic effect.” B. “You are right to be concerned. I will obtain the urine by 'clean-catch' rather than do a catheterization.” C. “Your concerns are unrealistic, but you do have the right to refuse catheterization.“ D. “Your worries are appropriate, but the need for a sterile urine specimen is more important at this time.”

15. 7. An 8-month-old infant is to be catheterized to obtain a sterile specimen. Which response by the nurse is most appropriate when the infant's mother expresses concern that the procedure could traumatize the infant psychologically? A. “The procedure may be somewhat uncomfortable, but it should not have any lasting traumatic effect.” B. “You are right to be concerned. I will obtain the urine by 'clean-catch' rather than do a catheterization.” C. “Your concerns are unrealistic, but you do have the right to refuse catheterization.“ D. “Your worries are appropriate, but the need for a sterile urine specimen is more important at this time.” A. Although the procedure may cause some discomfort in the child, the mother's concerns are unrealistic. Procedures such as catheterizations have not been shown to have any long term negative effects.

16. 8. In strict monitoring of an infant's output, which intervention is best for the nurse to use? • A. Recording the number of diaper changes • Weighing the diapers • Estimating the wet area on the diaper • Using urinary collection bags

17. 8. In strict monitoring of an infant's output, which intervention is best for the nurse to use? • A. Recording the number of diaper changes • Weighing the diapers • Estimating the wet area on the diaper • Using urinary collection bags B. Weighing the diapers will provide the most accurate output measurement.

18. 9. Which developmental parameter would the nurse consider important when making a room assignment for a 10-month-old child? • Regression is a normal response • Will want to be with other infants about the same age • May have underlying fear of body mutilation • Primary caretaker is important

19. 9. Which developmental parameter would the nurse consider important when making a room assignment for a 10-month-old child? • Regression is a normal response • Will want to be with other infants about the same age • May have underlying fear of body mutilation • Primary caretaker is important D. The primary care giver is most important to a 10-month-old. Regression is normal in toddlers. Older school-aged children and adolescents are concerned about being with peers and preschoolers fear mutilation.

20. 10. What statement by the parent would indicate more teaching was needed about bottle feeding? • “Putting my baby to bed with a bottle makes bedtime easier.” • “I am beginning to wean my 11-month-old baby to a cup.” • “I should use a cup instead of a bottle for juice.” • “When I use a pacifier, it should never have anything sweet on it.”

21. 10. What statement by the parent would indicate more teaching was needed about bottle feeding? • “Putting my baby to bed with a bottle makes bedtime easier.” • “I am beginning to wean my 11-month-old baby to a cup.” • “I should use a cup instead of a bottle for juice.” • “When I use a pacifier, it should never have anything sweet on it.” A. Putting a baby to bed with a bottle may contribute to bottle mouth caries.

22. 11. An adolescent mother is observed interacting with her infant the day before discharge. The infant was admitted with poor weight gain and diagnosed with nonorganic failure to thrive. Which indicates the family needs close follow-up after discharge? • The mother uses “baby-talk” and allows the baby to play with the nipple during feedings • The mother prepares the powdered formula 1 scoop in 2 ounces of water • The mother times the feeding and after 20 minutes removes the bottle and places the baby in the infant seat • The mother plays pat-a-cake with the infant and giggles while tickling the baby

23. 11. An adolescent mother is observed interacting with her infant the day before discharge. The infant was admitted with poor weight gain and diagnosed with nonorganic failure to thrive. Which indicates the family needs close follow-up after discharge? • The mother uses “baby-talk” and allows the baby to play with the nipple during feedings • The mother prepares the powdered formula 1 scoop in 2 ounces of water • The mother times the feeding and after 20 minutes removes the bottle and places the baby in the infant seat • The mother plays pat-a-cake with the infant and giggles while tickling the baby C. Feedings should not be structured. The other choices are appropriate for infant care.

24. 12. What would the nurse advise parents of a toddler to do when the toddler repeatedly says, “NO” to everything? • Offer the toddler many choices for every activity • Say “no” to the toddler in response to his “no” • Use time out to extinguish the negativistic behavior • Reduce opportunities for “no” answers

25. 12. What would the nurse advise parents of a toddler to do when the toddler repeatedly says, “NO” to everything? • Offer the toddler many choices for every activity • Say “no” to the toddler in response to his “no” • Use time out to extinguish the negativistic behavior • Reduce opportunities for “no” answers D. Negativism is normal in toddlers. Suggest the parent offer two appropriate choices such “Do you want to wear the blue or pink pajamas?”, not “Do you want to go to bed now?”

26. 13. Which finding during the well-child visit of a 2-year-old would require further evaluation? • Lordosis • Broad-based gait • Unilateral bowleg • Fused anterior fontanel

27. 13. Which finding during the well-child visit of a 2-year-old would require further evaluation? • Lordosis • Broad-based gait • Unilateral bowleg • Fused anterior fontanel C. Asymmetry of body parts is usually a sign of a problem. The other findings are normal.

28. 14. What normal behavioral characteristic of a 2 1/2-year-old child presents the greatest potential for injury? • Engaging in parallel play • Adhering to rituals • Exploring the environment • Throwing a temper tantrum

29. 14. What normal behavioral characteristic of a 2 1/2-year-old child presents the greatest potential for injury? • Engaging in parallel play • Adhering to rituals • Exploring the environment • Throwing a temper tantrum C. Left unsupervised, toddlers will get into things where they can get hurt due to their normal curiosity.

30. 15. A parent states the 2-year-old child doesn’t seem to want to eat much anymore. How can the nurse best respond? • “The brain is developing and so the child must be made to eat high quality protein foods.” • “Try offering small amounts of food frequently instead of only 3 meals a day.” • “If the child doesn’t want to eat, give milk in a bottle to get enough calories.” • “It is normal for the appetite to decrease, but make sure the child eats plenty of carbohydrates.”

31. 15. A parent states the 2-year-old child doesn’t seem to want to eat much anymore. How can the nurse best respond? • “The brain is developing and so the child must be made to eat high quality protein foods.” • “Try offering small amounts of food frequently instead of only 3 meals a day.” • “If the child doesn’t want to eat, give milk in a bottle to get enough calories.” • “It is normal for the appetite to decrease, but make sure the child eats plenty of carbohydrates.” B. Frequent small meals will provide for nutritional needs. The majority of calories should come from solid foods with plenty of protein, but do not force a child to eat.

32. 16. Which statement best describes a toddler’s play preferences? • Likes to play with games that have rules. • Shares toys and plays cooperatively most of the time • Imitates observed adult behaviors • Can paint and draw independently

33. 16. Which statement best describes a toddler’s play preferences? • Likes to play with games that have rules. • Shares toys and plays cooperatively most of the time • Imitates observed adult behaviors • Can paint and draw independently C. Likes to imitate observed adult behavior such as cooking, cleaning, or lawn mowing. Play is mostly solitary and sees all toys as “mine.” Can not yet play games, paint, or draw well.

34. 17. The most common dislocation injury in children from 1 to 4 years of age is dislocation of the head of the radius. To prevent this injury, parents should be advised to avoid which situation? • A. Lifting up the 15-month-old by one hand • Walking hand in hand with the 2-year-old • Allowing the 4-year-old to play on the jungle gym • Hoisting the 3-year-old up with hands in the axillae

35. 17. The most common dislocation injury in children from 1 to 4 years of age is dislocation of the head of the radius. To prevent this injury, parents should be advised to avoid which situation? • A. Lifting up the 15-month-old by one hand • Walking hand in hand with the 2-year-old • Allowing the 4-year-old to play on the jungle gym • Hoisting the 3-year-old up with hands in the axillae A. The cause of the subluxation of the head of the radius in the elbow is jerking the child upward while the arm is in an extended position

36. 18. In discussing dental health with parents of a toddler, which activity would the nurse encourage? A. “You may use a finger wrapped in gauze to clean the teeth more thoroughly.” B. “The first dental visit should be scheduled about a year after all 20 primary teeth have erupted.” C. “Encourage your child to brush teeth twice daily to optimize cleaning.” D. “You will need to do the flossing to remove debris from between the child’s teeth.”

37. 18. In discussing dental health with parents of a toddler, which activity would the nurse encourage? A. “You may use a finger wrapped in gauze to clean the teeth more thoroughly.” B. “The first dental visit should be scheduled about a year after all 20 primary teeth have erupted.” C. “Encourage your child to brush teeth twice daily to optimize cleaning.” D. “You will need to do the flossing to remove debris from between the child’s teeth.” D. Parents should be directly involved in both the brushing and flossing of the child’s teeth. A dental visit is recommended after the first teeth erupt, or about one year of age.

38. 19. The parent of a toddler asks the nurse about the best way to discipline the child at this age when misbehavior occurs. What is the best response? • “Put the child in bed for a nap.” • “Scold the child for the behavior.” • “Offer the child candy to stop the behavior.” • “Say NO and move the child to another activity.”

39. 19. The parent of a toddler asks the nurse about the best way to discipline the child at this age when misbehavior occurs. What is the best response? • “Put the child in bed for a nap.” • “Scold the child for the behavior.” • “Offer the child candy to stop the behavior.” • “Say NO and move the child to another activity.” D. Consistently reinforcing rules helps the child understand the rules. Changing activities neither rewards nor reinforces the negative behavior.

40. 20. A 3-year-old child is off the unit having a chest X-ray when the parents approach the nurse and say, “We’re leaving for the night now.” Identify the best nursing response. • “Good night; we’ll see you tomorrow.” • “Please wait to tell your child good-bye before you leave.” • “Go ahead and leave; I’m sure your child won’t mind.” • “I’ll tell your child you had to leave.”

41. 20. A 3-year-old child is off the unit having a chest X-ray when the parents approach the nurse and say, “We’re leaving for the night now.” Identify the best nursing response. • “Good night; we’ll see you tomorrow.” • “Please wait to tell your child good-bye before you leave.” • “Go ahead and leave; I’m sure your child won’t mind.” • “I’ll tell your child you had to leave.” B. Separation anxiety often occurs in this age group. This may be seen as abandonment by the child. This encourages teaching to the parents. A, C and D ignore the client problem and C is untruthful.

42. 21. What would be an example of behavior seen when a 3-year-old child, hospitalized due to an accident, regresses? • A. Blames a sibling for the accident and hospitalization • Requests all lights to be left on in the room all night • Describes details of the accident using grandiose stories • Refuses to take a bath or perform other hygiene tasks

43. 21. What would be an example of behavior seen when a 3-year-old child, hospitalized due to an accident, regresses? • A. Blames a sibling for the accident and hospitalization • Requests all lights to be left on in the room all night • Describes details of the accident using grandiose stories • Refuses to take a bath or perform other hygiene tasks B. Regression is returning to an earlier form of behavior for feelings of safety and security.

44. 22. How would the RN best intervene when a 2-year-old is having a temper tantrum? • Firmly reason with the child • Ignore the child’s behavior • Threaten the child with punishment • Move the child to a private area

45. 22. How would the RN best intervene when a 2-year-old is having a temper tantrum? • Firmly reason with the child • Ignore the child’s behavior • Threaten the child with punishment • Move the child to a private area B. Reasoning and threatening are not appropriate because the child isn’t able to listen during a tantrum. Moving the child might cause injury.

46. 23. A 2-year-old client is admitted to the pediatric unit with a fractured femur. When interviewing the parent, which statement by the parent would serve as a signal for further suspicion of child abuse? • A. “This child is very different from my other two children.“ • “This child is in a day care center five days a week.“ • “This child is a curious child who is always getting into things.“ • “This child is a middle child.”

47. 23. A 2-year-old client is admitted to the pediatric unit with a fractured femur. When interviewing the parent, which statement by the parent would serve as a signal for further suspicion of child abuse? • A. “This child is very different from my other two children.“ • “This child is in a day care center five days a week.“ • “This child is a curious child who is always getting into things.“ • “This child is a middle child.” A. A "special" child is often selected in a family as an object to be abused, with the "something different" increasing the child's vulnerability.

48. 24. What is the emergency department nurse’s best statement to a child who is suspected of being abused and will not speak? • A. “The nurses and doctors are all here to help you.” • “You need to face what has happened and talk about it.” • “Coming to the emergency department can be scary. Maybe in a little while we can talk.” • “I’m right here with you and promise I won’t leave anytime soon.”

49. 24. What is the emergency department nurse’s best statement to a child who is suspected of being abused and will not speak? • A. “The nurses and doctors are all here to help you.” • “You need to face what has happened and talk about it.” • “Coming to the emergency department can be scary. Maybe in a little while we can talk.” • “I’m right here with you and promise I won’t leave anytime soon.” C. This acknowledges feelings the child may be experiencing, without making promises the nurse may not be able to keep (choice D).

50. 25. While evaluating a school-age child, the school nurse begins to suspect sexual abuse at home. Which behavior would make the nurse suspect abuse? • Plays with peers of the same sex and ignores the opposite sex • Discusses sexual matters and displays seductive mannerisms • Displays curiosity about reproduction with other students • Daydreams in class but gets assignments completed on time