(Test Bank) MATERNITY & PEDI EXAM 2 -combined

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Test Bank for MATERNITY & PEDI EXAM 2 -combined, The downloadable file consists of 175 pages, and the total size of the file is 1.51 MB. Purchase now only for highly discounted price.

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Page 1 NR 360-MATERNITY & PEDI EXAM 2 -combined 1. The nurse is discussing a pending hospitalization of an 8-month-old infant with the parents. What should the nurse encourage the parents to do when preparing the child for this hospitalization? A) Pack her favorite toy. B) Buy a new pair of soft pajamas. C) Read her a story on hospitalization. D) Let her watch her suitcase being packed. Ans: A Feedback: Because an infant cannot understand explanations of surgery or treatments, oral preparation is minimal. Remind parents to pack special items such as a favorite toy because this object provides a special kind of security for which there is no substitute. The infant is not old enough to appreciate a new pair of pajamas. Reading a story will have no meaning to the child. The child will not understand a suitcase being packed. 2. The mother of an infant is unable to visit the child in the hospital for 3 days. At first, the baby cries relentlessly but then becomes quiet and withdrawn. What reaction does the nurse identify as occurring with this child? A) The infant is fatigued. B) The infant is developing a sense of denial. C) The infant is confused about being hospitalized. D) The infant is ill, which is causing the change in behavior. Ans: B Feedback: In separation anxiety, the stage of protest is when the child cries loudly and is unable to be comforted. In denial, the child is silent with an expressionless face. The infant's behavior is not because of fatigue, confusion, or the illness. 3. The nurses on a pediatric unit are planning an open house for parents and children to visit the unit in an attempt to reduce the stress when hospitalized. In order to support the 2020 National Health Goals regarding childhood hospitalization and stress, what type of materials should the nurses prepare for the families? A) Location of the hospital cafeteria Page 2 B) Best places to park when visiting the hospital C) Checklist of preventive services needed by children Page 3 D) Suggested times during the day to visit when the child is hospitalized Ans: C Feedback: Hospitalization is a stressful event to children. There are specific 2020 National Health Goals to address stress in hospitalized children. Nurses can help the nation achieve these goals by helping reduce the stress of hospitalization or health care and hospitalization so families use preventive services to help children stay well rather than totally use emergent or ill child care services. The nurses should provide a checklist of preventive services needed by children to prevent hospitalizations. Location of the cafeteria, where to park, and visiting hours will not reduce the stress of hospitalized children. 4. The nurse is assessing a preschool-age child who is being hospitalized for the first time for a surgical procedure. The child expresses the desire to go home and is scared. Which nursing diagnosis should the nurse identify as appropriate for the child at this time? A) Anxiety related to pending hospital admission B) Risk for social isolation related to hospitalization C) Fear related to being away from home for first time D) Health-seeking behaviors related to lack of knowledge regarding illness Ans: C Feedback: The child is scared about being hospitalized for the first time. The most appropriate nursing diagnosis would be fear related to being away from home for the first time. The child is being admitted, so anxiety related to pending hospitalization would not be appropriate. There is no enough information to support the child being at risk for social isolation. The child is not asking for information about the illness so the diagnosis regarding health-seeking behavior is not applicable at this time. 5. The mother of an infant is upset to learn that the baby's diarrhea caused the infant to become quite ill. What should the nurse explain about an infant that makes diarrhea an important problem to treat? A) Infants have shorter intestines than adults. B) Infants have a high proportion of extracellular fluid. C) Infants have a higher proportion of fluid than an adult. D) Infants have a fluid content that is proportionally less than that of an adult. Ans: B Page 4 Feedback: In the adult, extracellular water represents approximately 23% of total body water; in a newborn, extracellular water is closer to 40%. This means that an infant does not have as much water stored in the cells as an adult and so is more likely to lose a devastating amount of body water with diarrhea. Because of this, there is no such thing as “only diarrhea” in a child younger than 1 year of age. Infants do not have shorter intestines than adults. Infants do not have a higher proportion of fluid than adults. Infants do not have a fluid content that is proportionally less than that of an adult. 6. The nurse is caring for a 4-year-old confined to bed. Which play experience should the nurse use as being the most age appropriate for the patient? A) Helping the patient learn to write B) Teaching the patient to play checkers C) Encouraging watching unlimited television D) Supplying a tray of dry oatmeal for “sand” play Ans: D Feedback: Age-appropriate play for a preschool-age child using materials available to the nurse includes pouring breakfast cereal into a basin so the child can dig, similar to playing in sand. Learning to write may not be fun for the child. Checkers is more appropriate for a school-age child. Preschool-age children might get bored with watching television. They need an activity in which they participate. 7. A school-age child who is in the playroom is prescribed to receive an injection. What should the nurse do when preparing to administer this medication to the child? A) Inject it in the playroom. B) Ask to see the patient outside the playroom for the injection. C) Ask the patient if the injection can be given in the playroom. D) Ask the other children if they would mind if you give the injection in the playroom. Ans: B Feedback: The best children's hospital units are equipped with a playroom or play space that is maintained as a “pain-free” zone. No medical procedures, not even painless ones, should be performed in this area. The nurse should not provide the injection in the playroom. Asking the child and other children if the injection can be given in the playroom violates the “pain-free” zone. Page 5 8. Which items should the nurse select as the best to support therapeutic play for a child who receives daily injections of medication? A) A doll with a cast in place B) A syringe to practice injections C) A stuffed bear with Band-Aids D) An anatomically correct puppet Ans: B Feedback: The nurse should provide the child with equipment that has been used with them. The child may poke at a doll with a syringe without a needle or with a small rubber tube attached to simulate a needle or enjoy giving it a “shot” since this is the child's experience. The child does not have a cast and does not have bandages. An anatomically correct puppet is not necessary for the child who receives daily injections. 9. The nurse is completing the teaching for parents of a toddler recovering from a fracture. Which outcome should the nurse identify to help determine if teaching has been effective? A) The child resumes normal activity level at home. B) The parents encourage the child to be independent. C) The parents place a locked gate at the top of the stairs. D) The child waits for the parent to assist before walking down a set of stairs. Ans: D Feedback: Promoting safety for children is a responsibility for all health care providers. Care of a child who is ill or one with a unique concern at home includes assessing the safety of the house and providing family teaching. The expected outcome after teaching would be that the child waits for the parent to assist before walking down a set of stairs. The child is a toddler with a fracture. The child will not be able to resume normal activity level at home. The child is too young to be independent. Locking a gate could be a safety hazard. The child may decide to climb over the gate and fall down the stairs. 10. The nurse is planning care for a school-age child being admitted to the hospital for a chronic illness. Which hazards of hospitalization for children will the nurse use to plan this patient's care? (Select all that apply.) A) Meeting new people Page 6 B) Unsure of acceptable behavior C) Losing control over the environment D) Experiencing physical discomfort and pain E) Being separated from family, school, and friends Ans: B, C, D, E Feedback: Hazards that may occur with children with an illness includes unclear definition of acceptable and expected behavior; losing control over the ability to make decisions; experiencing physical discomfort and pain; and being separated from routines, parents, and peers. Meeting new people is not a hazard for child hospitalized with an illness. 11. The nurse is helping the parents explain to a toddler the need to go to the hospital for a tonsillectomy. When explaining the procedure to the child, which phrase should the nurse and parents avoid using? A) “You will be able to eat popsicles.” B) “Your mommy and daddy will be with you.” C) “The bad tissue will be cut out of your throat.” D) “You will get medicine so that you feel better.” Ans: C Feedback: One chief fear of toddlers is the fear of mutilation. It is always better to use the word “fix” rather than “cut” when talking about surgery with young children, because “cut” automatically suggests pain and mutilation. Saying that bad tissue will be cut out of the throat can conjure up a horrific scene for a toddler and should not be used. Eating popsicles, having the parents with the child, and getting medicine to feel better are appropriate phrases to use when discussing surgery with a toddler. 12. A preschool-age child is being admitted to the hospital for treatment of cellulitis. The child's parents appear upset and frightened. Which question should the nurse use to elicit information concerning the parents' understanding of why the child is being admitted to the hospital? A) “Are you worried? I'll tell you everything you need to know.” B) “Why are you so concerned? We take good care of children here.” C) “Has the doctor told you why your daughter requires hospitalization?” D) “You seem concerned; do you have questions about your child's admission?” Page 7 Ans: D Feedback: When admitting a child to the hospital, the nurse should determine what the parents' understanding is of why the child is being admitted. This could be best assessed by asking if the parents have any questions about the child's admission. The nurse may or may not be able to tell the parents everything they need to know. Minimizing the parent's concerns is an inappropriate response. The parent's understanding of why the child is in the hospital may be different than what the physician may have said or believes. 13. While hospitalized, a school-age child began sleepwalking. The nurse teaches the parents how to handle sleepwalking once the child is discharged. Which statement indicates that this teaching has been effective? A) “We should not wake up the child.” B) “We should shake the child to wake up immediately.” C) “We should wake the child up gently and return the child to bed.” D) “We should keep the child awake in the living room to play before going to bed.” Ans: C Feedback: It is untrue that sleepwalkers should not be wakened. The child should be woken gently, be reoriented, and then returned to bed after reassurance of being safe. The child can be woken up. The child should not be shaken. The child should not be encouraged to play before going back to bed. 14. The nurse is planning to meet the spiritual needs of a 6-year-old child who is hospitalized. Which child behavior should the nurse encourage to provide security to the child who is in a strange environment? A) Saying bedtime prayers B) Hanging a religious picture over the bed C) Giving the child a Bible to keep at the bedside D) Asking the hospital chaplain to visit with the child Ans: A Page 8 Feedback: Bedtime prayers may be especially important to young children because they lend security in a strange environment. Hanging a religious picture, providing with a Bible, and having the hospital chaplain visit will not necessarily provide security to a child in a strange environment. 15. The nurse is identifying ways to increase the oral fluid intake of a preschool-age child. Which interventions should the nurse use with this patient? (Select all that apply.) A) Provide fluids ice cold. B) Offer small full glasses of fluid. C) Provide the child's favorite fluid. D) Encourage popsicles if permitted. E) Provide a straw if not contraindicated. Ans: B, C, D, E Page 9 Feedback: Practice guidelines to encourage fluid intake at any age include offering small full glasses of fluid, provide the favorite fluid, encourage popsicles if permitted, and provide a straw if not contraindicated. The nurse should try changes in temperature of offered fluids for variety. 1. The nurse is planning to evaluate the development of a preschool-age child. On what should the nurse focus when performing this evaluation? A) Appetite B) Current weight C) Change in height D) Ability to perform a skill Ans: D Feedback: Development is measured by observing a child's ability to perform specific skills. Growth is used to denote an increase in physical size such as height and weight. Appetite is not used to evaluate growth or development. 2. A patient asks if a school-age child is going to be tall like others in the family. What should the nurse explain as having the least impact on the child's ultimate height? A) Participation in sports B) Occupations of parents C) Inherited genetic material D) Ingestion of nutritious food Ans: A Feedback: Although children cannot grow taller than their genetically programmed height potential, their adult height can be considerably less than their genetic potential if their environment hinders their growth. Environmental influences on height include socioeconomic status or occupations of parents, genetic material inherited, and availability and ingestion of nutritious foods. Participation in sports will not influence the child's ultimate height. 3. The mother of several children is amazed that the youngest male child achieved toilet training much earlier than the other children. What should the nurse explain as the reason for this early development? A) “He has exceptional intelligence.” B) “He learned by watching your other children.” C) “He needs testing because he is developing too quickly.” D) “He most likely will wet the bed for many years to come.” Ans: B Feedback: Children learn by watching other children so a youngest child who has many Page 10 examples to watch may excel in skills such as toilet training. The child did not become toilet trained early because of exceptional intelligence. The child is not developing too quickly. There is no way for the nurse to know if the child will wet the bed. 4. A patient is concerned that the new baby is going to have a weight problem growing up because other family members are obese. What should the nurse respond to this patient? A) Restrict all fatty foods up until age 5 years. B) Restrict fatty foods after the age of 10 years. C) Do not restrict fatty foods until the age of 2 years. D) Keep fat intake to less than 50% of total daily intake. Ans: C Feedback: For children, fat intake does not need to be restricted for the first 2 years of life because fat is necessary for myelination of spinal nerves. After the age of 2 years, fat intake can be tailored to meet the guidelines of 30% total intake for both children and adults. The patient should not restrict all fatty foods up until the age of 5 years or after the age of 10 years. Fat intake after the age of 2 years should be limited to 30% of total caloric intake. 5. During a home visit, the nurse observes an 8-year-old child pick up toys and place them in the toy box. The child then looks to the mother who says, “Thank you for helping me.” Which stage of Kohlberg's moral development is this child demonstrating? A) Individualism B) Maintenance of social order C) Punishment/obedience orientation D) Interpersonal relations of mutuality Ans: D Feedback: In the stage of interpersonal relations of mutuality, the child will follow rules because of a need to be a “good” person in their own eyes and in the eyes of others. The mother's praise reinforces this behavior. In the punishment/obedience stage, the child does “right” to avoid punishment. In the individualism stage, the child will carry out actions to satisfy own needs rather than others. In the maintenance of social order stage, the child will follow rules of authority figures as well as parents in an effort to keep the “system” working. 6. Which activity should the nurse encourage a new mother to perform to foster the developmental tasks of a toddler according to Erikson's developmental stages? A) Feed the child lunch. B) Read the child a story every night. C) Allow the child to pull a talking duck toy. D) Have the child watch a puppet show on television. Page 11 Ans: C Feedback: The developmental task of the toddler is to learn autonomy versus shame or doubt. Autonomy comes from the toddler's new motor and mental abilities. Children take pride in the new things they can accomplish, and they want to do everything independently. Pulling a talking duck toy will support the development of autonomy. Doing things such as feeding, reading, and watching television does not foster autonomy in the toddler. 7. The nurse pours liquid medication from one tall container to a shorter container. How would the preschool-age child interpret this exchange of the medication? A) The amount of medicine is less. B) The glass changed shape to accommodate the medicine. C) Pouring medicine hurts it in some way because it changes. D) The amount of medicine did not change, only the appearance. Ans: A Feedback: The preschool-age child has not developed conservation or the ability to discern truth, even though physical properties change. This is why the child will think that there is less medicine in the shorter container. The preschool-age child will not interpret this action as the glass changing shape or it is painful to pour medicine. An older child will understand that the appearance of the medication changed but not the amount. 8. The nurse is preparing to assess a school-age child in the community clinic. Which action supports the 2020 National Health Goals for growth and development of children? A) Helping the child with math homework B) Measuring the child's height and weight C) Talking about favorite television programs D) Asking the child to name a favorite subject in school Ans: B Feedback: Recognizing normal growth and development patterns of children helps to determine if children are following normal development and when referrals are needed. Nurses are the health care providers who interact with children and measure height and weight, which are used to recognize developmental delays. Helping with homework, talking about television, and identifying favorite subjects in school will not support the 2020 National Health Goals for growth and development of children. 9. During a home visit, the nurse observes a mother prepare a bottle for an 18- month-old child consisting of skim milk. Which nursing diagnosis should the nurse use to base instruction for this mother? A) Imbalanced nutrition Page 12 B) Health-seeking behaviors C) Delayed growth and development D) Readiness for enhanced family coping Ans: A Feedback: The nursing diagnosis of imbalanced nutrition is appropriate because the child's fat intake should not be restricted up until the age of 2 years. The developing body needs fat to ensure development of the nervous system. The mother using skim milk for the child's bottle does not indicate health-seeking behaviors, delayed growth and development, or readiness for enhanced family coping. 10. Which observation by the nurse indicates that an adolescent's cognitive thinking is developing at an expected level? A) Adolescent says that all plastic remote controls break easily. B) Adolescent asks the mother to provide the sharp item needed to cut meat. C) Adolescent explains how working a part-time job will help pay for a car. D) Adolescent tells the parent that the dog moved the bicycle into the driveway. Ans: C Feedback: The adolescent is capable of abstract reasoning, which would be observed when the adolescent explains how working a part-time job will help pay for a car. All plastic remote controls breaking would be concrete thinking. Asking for a sharp item to cut meat is an example of preschool-age thinking. Saying that the dog moved the bicycle into the driveway is an example of preschool-age thinking. 11. While in the waiting room, a child begins to cry when a toy has been taken from him. The mother immediately hands the child another toy and the crying stops. How should the nurse interpret the child's behavior? A) Easily distractible B) Short attention span C) Negative mood quality D) Extreme intensity of reaction Ans: A Feedback: Children who are easily distracted or who can easily shift their attention to a new situation are easy to care for. If they are crying over the loss of a toy, they can be appeased by the offer of a different one. Attention span is the ability to remain interested in a project or activity for an average length of time. Negative mood quality is when the child is unhappy or whining. A child who has an intensity of rea situations with their whole being. They cry loudly, thrash their arms, and have temper tantrums. 12. The nurse observes a mother telling a toddler that pasta and potatoes will make the child fat. What should the nurse instruct the mother about these food items? Page 13 A) Toddlers need carbohydrates for brain function. B) It is more important to restrict protein than carbohydrates. C) No more than 30% of all food should be from carbohydrate sources. D) The child should be instructed to restrict carbohydrates after the age of 5 years. Ans: A Feedback: Carbohydrates are the main and preferred fuel of the body to supply energy and are essential to the functioning of body systems, the neurologic system in particular. This makes carbohydrates important to toddlers because their brain cells are actively growing. Protein should not be restricted in the toddler. Carbohydrates should not be restricted to 30% or after the age of 5 years. 13. The nurse observes an 8-month-old infant cry when the mother leaves the room. What does this infant's behavior indicate to the nurse? A) Confusion B) Permanence C) Reversibility D) Assimilation Ans: B Feedback: Gaining a concept of permanence also contributes to “8th-month anxiety,” a stage in which infants continue to cry for their parents because they know their parents still exist even when out of sight. Crying when the mother leaves the room does not indicate confusion, reversibility, or assimilation. 14. During a home visit, the nurse determines that a toddler has a difficult temperament. What did the nurse observe in this toddler? (Select all that apply.) A) Rhythmic B) Withdrawing C) Intense mood D) Negative mood E) Minimal adaptability Ans: B, C, D, E Feedback: The child that has a difficult temperament is withdrawing, low in adaptability, intense, and negative in mood. The child that has an easy temperament is rhythmic. 15. The nurse had instructed a mother on the importance of providing a toddler with a balanced diet. Which observation during a home visit indicates that instruction has been effective? A) The child is eating a piece of cake and ice cream for lunch. B) The mother prepares a scrambled egg for the toddler's breakfast. C) The mother places a serving of fried finger foods on a plate for the child. Page 14 D) The child takes candy from a dish that is placed on the coffee table in the living room. Ans: B Feedback: A balanced diet will take into consideration all of the essential nutrients, vitamins, and minerals needed for healthy growth and development of the toddler. A scrambled egg for breakfast will provide the toddler with protein and help to regulate calcium and phosphorous for good bone growth. Cake and ice cream, fried foods, and candy are not nutritious foods for a toddler and indicate that instruction has not been effective. 1. The mother of a 3-month-old baby is concerned because the child is not able to sit independently. What should the nurse respond to this mother's concern? A) Most babies sit steadily at 3 months. B) Most babies sit steadily at 4 months. C) Most babies do not sit steadily until 8 months. D) Sitting ability and the age of first tooth eruption are correlated. Ans: C Feedback: An 8-month-old child can sit securely without any additional support. Babies are not able to sit steadily at age 3 or 4 months. Sitting ability does not correspond with tooth eruption. 2. During an assessment, the nurse determines that a 3-month-old baby has a Moro reflex. What does this finding indicate to the nurse? A) It usually lasts until 9 months. B) It will persist until the age of 1 year. C) Most 3-month-olds still have a Moro reflex. D) If present at 3 months of age, a neurologic exam is needed. Ans: C Feedback: The Moro reflex will begin to fade at age 5 months and disappear by age 6 months. A Moro reflex at age 9 months or 1 year indicates the need for a neurologic examination. 3. The nurse is planning an educational seminar for community members that focus on the 2020 National Health Goals to promote health during the infant year. What should the nurse include in this seminar? (Select all that apply.) A) Using infant car seats B) Placing infants on back to sleep C) Continuing breastfeeding for 6 months D) Introducing solid food by age 6 months E) Receiving immunizations after the age of 1 Ans: A, B, C Page 15 Feedback: Nurses can help the nation achieve the 2020 National Health Goals to promote health during the infant year by educating parents about the importance of using infant car seats, continuing exclusive breastfeeding for 6 months, and instigating measures to prevent SIDS such as placing infants to sleep on their backs. The introduction of solid food would occur after the age of 6 months. Immunizations are provided throughout the infant year. 4. What should the nurse instruct a parent to help a child complete Erikson's developmental task during the infant period? A) Respond to the child's needs consistently. B) Keep the child stimulated with many toys. C) Talk to the child at a special time each day. D) Expose the child to many caregivers to help learn variability. Ans: A Feedback: Consistently responding to an infant's needs helps to build a sense of trust, which is Erikson's developmental task during the infant period. Stimulation with toys, talking at a special time each day, and exposing to many caregivers will not help the child develop a sense of trust. 5. The nurse is visiting a mother who has a 3-month-old infant. Which anticipatory guidance information should the nurse provide to the mother at this time? A) The child will have a fear of strangers. B) The child will experience many moody periods. C) The child will expect things to be done a certain way. D) The child should be able to turn over onto the back at age 4 months. Ans: D Feedback: Infants typically turn over from the front to back at age 4 months. Fear of strangers will not occur until 7 months. The nurse has no way of knowing the infant's temperament to determine that the child will be moody or when the child will expect things to be done a certain way. 6. The nurse is assessing an infant who is being breastfed. Which observation regarding the infant's stools is expected? A) Fewer stools B) Stool will be soft. C) Stool will be hard. D) Stool will have a strong odor. Ans: B Feedback: Stools of breastfed infants are generally softer than those of formula-fed infants. Page 16 Stools of breastfed infants are not fewer in number, hard, nor have a strong odor. 7. The nurse is identifying outcomes for care provided to a new mother whose infant continues to spit up after feedings. Which outcome would be the most appropriate? A) The baby will have forceful episodes of vomitus only once a day. B) The baby will have less episodes of spitting up after sitting upright after a feeding. C) The baby will spit up a large amount of vomitus only after the last feeding of the day. D) The baby will have fewer episodes of spitting up when the type of formula is changed. Ans: B Feedback: Sitting a baby in an infant chair for a half an hour after a feeding can help reduce spitting up. Forceful episodes of vomitus and vomiting large amounts after feedings should be reported to the health care provider. Changing the formula will not impact the amount of spitting up the baby. 8. The nurse is assessing a 2-month-old formula-fed infant who is experiencing colic. Which type of bowel movements should the nurse expect to occur with this health problem? A) Hard and lumpy B) Yellow and semisoft C) Foul smelling and bulky D) Loose and mucus-streaked Ans: B Feedback: With colic, bowel movements are normal. For an infant who is formula-fed this means the stool will be yellow and semisoft. Colic does not affect the type of bowel movement so changes in the stool such as hard and lumpy, foul smelling and bulky, and loose and mucus-streaked should be reported to the health care provider. 9. The nurse is visiting a mother who has a 3-month-old infant that has been hospitalized for cardiac problems. Which nursing diagnosis should the nurse use to guide care for this family at this time? A) Health-seeking behaviors related to adjusting to parenthood B) Risk for impaired parenting related to hospitalization of infant C) Disturbed maternal sleep pattern related to infant's feeding schedule D) Deficient knowledge related to normal infant growth and development Ans: B Feedback: The diagnosis appropriate for the family whose infant has been hospitalized Page 17 would be risk for impaired parenting related to hospitalization. There is no evidence to suggest that the mother is not adjusting to parenthood. There is no information about the infant's feeding schedule. There is no information to suggest the mother has a knowledge deficit regarding normal infant growth and development. 10. A new mother asks the nurse when toothbrushing should begin for the baby. Which response is the most appropriate for the nurse to make at this time? A) Now B) At the age of 12 months C) When solid food is eaten D) When the first tooth appears Ans: A Feedback: Toothbrushing can begin even before teeth erupt by rubbing a soft washcloth over the gum pads. This eliminates plaque and reduces the presence of bacteria, creating a clean environment for the arrival of first teeth. Dental care should begin before the age of 12 months, before solid food is eaten, and before the first tooth appears. 11. The mother of a 4-month-old infant is concerned that the baby does not always want to take a bottle. What should the nurse instruct the mother about feeding the baby? A) Ensure the environment is quiet during mealtime. B) Happy and healthy babies do not always eat well. C) Force the infant to take a bottle when it is time to do so. D) Refusing a bottle means the child is ill and needs to be seen by the health care provider. Ans: A Feedback: If infants are fatigued or overstimulated, they also may not eat well. Providing a quiet environment away from distractions before mealtime might be the solution to this problem. Healthy happy babies will be hungry at mealtime and will eat. The mother should not force the baby to take a bottle when it is time to do so. Refusing a bottle may mean that the baby is tired, distracted, or ill. The baby does not always need to be seen by a health care provider when a bottle is refused. 12. A new mother asks the nurse what she should look for when the baby starts to teethe. What should the nurse explain to the mother? A) The child's gum line will be tender. B) The child will have a high temperature. C) The child will not play or eat for 2 days. D) The child will be constipated for 2 days. Ans: A Feedback: Gums are sore and tender before a new tooth breaks the surface. As soon as the Page 18 tooth is through, the tenderness passes. A high temperature is not a normal expectation with teething and should be reported to the health care provider. The child may resist chewing because of the sore gum; however, it may not last for 2 days. Playing may or may not be affected. Constipation is not an expectation with teething. 13. During a home visit, the nurse observes a 9-month-old child bang his head against the headboard of the crib at naptime. What should the nurse explain to the mother about this observation? A) The child is eating too much protein. B) The child is not getting enough to eat. C) This action is normal up until preschool age. D) The child needs to be seen immediately by a health care provider. Ans: C Feedback: Head banging that begins during the second half of the first year of life and continuing through to the preschool period, associated with naptime or bedtime, and lasting under 15 minutes can be considered normal. Children use this measure to relax and fall asleep. Head banging does not mean that the child is eating too much protein or is not getting enough to eat. The child does not need to be seen immediately by a health care provider. 14. The nurse observes a new mother provide a bath to her 9-month-old baby. Which observation indicates that the experience is positive for both mother and infant? A) The baby is crying and screaming. B) The baby is reaching for the mother. C) The baby is moving the arms and hand and smiling. D) The baby is trying to keep the legs from touching the water. Ans: C Feedback: Bath time should be fun for an infant and can serve many functions. Especially during the second half of the first year, a child enjoys poking at soap bubbles on the surface of the water or playing with bath toys. Bath time also helps an infant learn different textures and sensations and provides an opportunity to exercise and kick as well as a good opportunity for a parent to touch and communicate with the child. Crying, screaming, reaching for the mother, and trying to avoid touching the water indicates that the bath experience is not positive for the baby or the mother. 15. The nurse is concerned that a 9-month-old baby is gaining too much weight. What should the nurse instruct the parents to help control the baby's weight gain? A) Use skim milk for feedings. B) Provide whole-grain cereal for one feeding. C) Provide one bottle a day of diluted gelatin mix. D) Feed the baby a serving of pudding once a day. Page 19 Ans: B Feedback: A way to prevent obesity is to add a source of fiber such as whole-grain cereal to the infant's diet. This prolongs the stomach-emptying time and helps reduce food intake. Nonfat milk should not be given because it contains little essential fatty acids and will not ensure cell growth. The baby should not be given refined sugars such as diluted gelatin or pudding because this will encourage weight gain. 1. When assessing the oral cavity of a 2.5-year-old toddler, which finding is expected? A) 12 deciduous teeth B) 20 deciduous teeth C) 16 deciduous and 2 permanent teeth D) 6 deciduous and 12 permanent teeth Ans: B Feedback: All 20 deciduous teeth are generally present by 2.5 to 3.0 years of age. 2. The nurse is preparing a community educational program for the parents of toddlers. Which topics should the nurse include that address the 2020 National Health Goals for safety? (Select all that apply.) A) Using age-appropriate car seats B) Securing poisonous items out of reach C) Eliminating lead-based paint in the home D) Removing pets from the home environment E) Obtaining foot stools for use during toilet training Ans: A, B, C Feedback: The 2020 National Health Goals for toddlers focus on safety. The nurse can help the nation achieve these goals by educating parents about the importance of using car seats and childproofing the home against poisoning and lead poisoning. The National Health Goals do not address pets in the home. Foot stools for toilet training are not a safety concern. 3. The parents of a toddler want to assist the child achieve the developmental task of autonomy. Which approach should the nurse suggest to the parents? A) Teach the child how to count. B) Allow the child to make simple decisions. C) Give the child small household chores to do. D) Urge the child to put on clothes independently. Ans: B Feedback: To develop a sense of autonomy is to develop a sense of independence. A healthy level of autonomy is achieved when parents are able to balance independence with Page 20 consistently sound rules for safety. Allowing the child to make simple decisions helps the child achieve autonomy in a safe setting. Teaching how to count will not help develop autonomy in the child. Providing the child with chores will not develop autonomy. The child is not developmentally prepared to be able to put on clothes independently. 4. A mother is concerned that her 2-year-old child is having seizures when he holds his breath until he passes out when he wants something his mother does not want him to have. What should the nurse respond to this mother's concern? A) Seizures rarely occur in toddlers. B) With seizures, cyanosis rarely develops. C) Seizures are not provoked; temper tantrums are. D) Seizures typically occur with fever; temper tantrums do not. Ans: C Feedback: Some children hold their breath as part of a temper tantrum until they become cyanotic. Breath holding occurs when a child is provoked; the child develops a distended chest, often has air-filled cheeks, and shows increasing distress as the body registers oxygen want. A seizure cannot be provoked. Seizures can occur in all ages. Cyanosis can occur with seizures. Seizures can occur in those with neurologic problems and not just with a fever. 5. The nurse had instructed the family of a toddler on home safety during a previous visit. During this current visit, what observation indicates that instruction has been effective? A) Prescribed medication sitting on countertop B) House plant on a small table next to the sofa C) Small bowl of mixed nuts on the coffee table D) All windows in the home have locked screens. Ans: D Feedback: To prevent falls, the parents should keep the house windows closed or keep secure screens in place. Prescribed medication should be stored in a locked cabinet and not left out on a table because this could cause accidental poisoning. House plants should not be within reach of the toddler because this could cause an accidental poisoning or injury if the plant is pulled on top of the child. Nuts could cause accidental choking and should not be within the child's reach. 6. The parents of a toddler plan to begin toilet training. Which instruction should the nurse provide to the parents at this time? A) Toilet training is a 12-month process. B) Bowel training is easier than urine training. C) All children should be toilet trained by age 2 years. Page 21 D) Children can remain dry during the night before they can do so during the day. Ans: B Feedback: Training should begin with defecation training because this is an easier concept for the child to grasp. There is no time limit regarding the amount of time it takes to toilet train a toddler. Even though theoretically a child can begin toilet training once able to walk, the child needs to reach specific milestones before being able to successfully toilet train. Children are more likely to remain dry during the day than during the night. 7. The nurse is determining a toddler's language development. What is an expected finding for language development in a 2-year-old? A) Able to count out loud to 20 B) Speaks 20 nouns and 4 pronouns C) Speaks two words plus “ma-ma” and “da-da” D) Speaks in two-word sentences using a noun and a verb Ans: D Feedback: A 2-year-old child should be speaking in simple two-word sentences using a noun and a verb. Any 2-year-old child who does not talk in two-word, noun–verb simple sentences needs a careful assessment to determine the cause because this is beyond a point of normal development. Counting is not an expectation for a 2-year-old child. The child will not be able to speak 20 nouns and 4 pronouns. 8. The nurse observes a toddler riding a tricycle and decides that the parents need additional safety education. What did the nurse observe? A) Toddler wearing a helmet B) Toddler wearing long pants C) Toddler wearing tennis shoes D) Toddler not wearing a helmet Ans: D Feedback: Toddlers need to wear a helmet as soon as they begin riding a tricycle. Parents are not as conscientious about using helmets as they are for bicycle riding so this is an area where health teaching is necessary. Wearing a helmet would be expected, and the nurse would not need to provide additional safety education for the parents. Long pants and tennis shoes do not pose a safety issue. 9. The mother of a toddler is frustrated because no matter what she asks of the child, the response is “no.” What can the nurse suggest to the mother to assist with this problem? A) Pretend she does not hear the child. B) Ask no further questions to the child. C) Tell the child to never to say “no” again. Page 22 D) Give the child secondary, not primary, choices. Ans: D Feedback: A toddler needs experience in making choices, and to provide the opportunity to do this, a parent could give a secondary choice. Pretending not to hear the child, asking no further questions, and telling the child to never say “no” again will not help with the toddler's obstinacy. 10. The mother of a toddler is frustrated because the toddler insists on brushing his own teeth and being left alone in the bathtub. What advice should the nurse provide to the mother about these expectations? A) Helping with toothbrushing encourages autonomy. B) It is unusual for a 2-year-old to have such strong opinions. C) The mother should continue to give full care in all aspects. D) Leaving alone in the bathtub is a good way to encourage autonomy. Ans: A Feedback: Toddlers need a toothbrush they recognize as their own. Toward the end of the toddler period, they can begin to do the brushing themselves under supervision; although, almost all children need some supervision until about age 8 years. It is not unusual for a toddler to have opinions and want to do things themselves. The mother needs to permit the child to perform autonomous acts with supervision. The child is too young to be permitted in the bathtub alone. This is a safety hazard. 11. The mother of a toddler is concerned because the child has taken the wheels off of a toy truck and placed them in a sandbox as stepping stones to walk. What should the nurse explain about this child's behavior? A) This is assimilation. B) The child does not like toy trucks. C) The number of toys should be limited. D) This is abnormal and needs to be evaluated. Ans: A Feedback: At the end of the toddler period, children enter a second major period of cognitive development termed preoperational thought and begin to use a process termed assimilation. This is when the child learns to change a situation and is what causes toddlers to use toys in the “wrong” way such as taking the wheels off of a truck and using them as stepping stones. The child has changed the toy's use to fit his or her thoughts or used assimilation. This behavior does not mean that the child does not like toy trucks. The number of toys does not need to be limited. This behavior is not abnormal but expected. 12. The mother of a toddler observes the child play next to another child but not Page 23 with the child. What should the nurse explain to the mother about this type of play behavior? A) This is peer play and is abnormal. B) This is parallel play and is expected. C) This is premature play and should be stopped. D) This is adjacent play and is only seen in school-age children. Ans: B Feedback: All during the toddler period, children play beside children next to them, not with them. This side-by-side play called parallel play is not unfriendly but is a normal developmental sequence that occurs during the toddler period. This is not peer, adjacent, or premature play. This behavior is not abnormal, does not need to be stopped, and is not seen in school-age children. 13. The nurse is preparing to assess a toddler during a routine health maintenance visit. Which assessment will the nurse perform to determine the child's growth milestone? A) Blood pressure B) Urine specimen C) Hemoglobin level D) Height and weight Ans: D Feedback: Growth milestones are assessed at every health maintenance visit and are determined by measuring height and weight. Blood pressure does not assess a growth milestone. A urine specimen would be done at specific times. A hemoglobin level would be determined during specific times. Urine specimens and hemoglobin levels do not measure growth milestones. 14. A mother brings a 15-month-old child to the clinic for a routine health maintenance visit. Which immunization should the nurse prepare to administer to this child? A) MMR B) Rinne test C) Oral polio D) Hepatitis A Ans: A Feedback: The measles-mumps-rubella (MMR) vaccine is administered at either the 12- month or 15-month visit. Rinne test is not an immunization but rather a test for hearing. The oral polio vaccination is not listed as an immunization needed for toddlers. Hepatitis A vaccination is given at either the 12-month or 18-month visit. Page 24 15. The mother of a 2-year-old child tells the nurse that she is constantly scolding the child for having wet pants. The child was toilet trained at 12 months, but since walking, the child wets all of the time. Which nursing diagnosis should the nurse use guide instruction for the mother? A) Total urinary incontinence related to delayed toilet training B) Excess fluid volume related to inability to control urination C) Ineffective coping related to lack of self-control of 2-year-old D) Deficient parental knowledge related to inappropriate method for toilet training Ans: D Feedback: The mother is having difficulty understanding the principles of toilet training. The diagnosis of deficient parental knowledge about toilet training is the most appropriate for the nurse to use to guide instruction for the mother. The child is not experiencing total urinary incontinence. The child does not have an excess in fluid volume. The mother is not demonstrating ineffective coping. 16. The parents of a toddler are worried that the child is not eating enough because food is always left on the child's plate. What should the nurse encourage the parents to do? A) Place smaller amount on the child's plate. B) Reinforce that the child is to eat everything on the plate. C) Discipline the child for not eating by removing a toy from play. D) Feed the child if refusing to eat the food on the plate independently. Ans: A Feedback: Because the actual amount of food eaten daily varies, the parents should be instructed to place a small amount of food on a plate and allow their child to eat it and ask for more rather than serve a large portion the child cannot finish. Cleaning a plate gives a child a feeling of independent functioning, whereas leaving food uneaten suggests parents expected something more. Allowing self-feeding is a major way to both strengthen independence in a toddler and improve the amount of food consumed. Most toddlers insist on feeding themselves and generally will resist eating if a parent insists on feeding them. An individual child may react to repeated attempts at being fed by refusing to eat at all. The child does not need discipline. 1. The nurse is identifying outcomes for a family with a preschool-age child who has broken fluency. Which outcome would be the most appropriate for this family? A) The parents will not call attention to the child's broken fluency. B) The mother will encourage the child to practice speaking in the home. C) The other children will help the child by finishing words and sentences. D) The mother will correct the child only when other family members are absent. Ans: A Feedback: Calling attention to broken fluency can make the situation worse. The child should not be encouraged to speak if he or she does not want to. The parents should Page 25 intercept any children who desire to finish the child with broken fluency's words or sentences. The child should not be punished or corrected for broken fluency because this is a normal part of speech development. 2. The nurse is helping parents develop the developmental task of initiative in their preschool-age child. Which activity should the nurse suggest the parents implement? A) Teach the child street-crossing safety. B) Help the child learn how to follow rules. C) Allow the child to experiment with molding clay. D) Provide the child with clothes that snap rather than button. Ans: C Feedback: To gain a sense of initiative, preschoolers need exposure to a wide variety of play materials so they can learn as much about how things work as possible. The parents should be urged to provide play materials that encourage creative play such as modeling clay. Any experience with free-form play is helpful. Street-crossing safety, following rules, and providing clothes that snap will not support the developmental task of initiative as much as providing a substance to experiment during play. 3. The nurse is preparing an educational program for parents of preschool-age children to promote personal safety. Which information should the nurse include in this program? (Select all that apply.) A) Reducing the intake of fast-food items B) Limiting exposure to household chores C) Chewing food thoroughly before swallowing D) Explaining who police are and what they look like E) Teaching to never talk with or accept a ride from a stranger Ans: D, E Feedback: To promote personal safety in the preschool-age child, the nurse should instruct families to explain the role and purpose of police to the child and teach to never talk to or accept a ride from a stranger. Reducing the intake of fast-food items will help with weight control. Limiting exposure to household chores has no identified value. Chewing food thoroughly before swallowing can help with digestion and weight control. 4. The nurse is caring for a preschool-age child who needs a CT scan. Which action should the nurse use to best prepare the child for this diagnostic test? A) Tell the child to follow directions to avoid being hurt. B) Help the child to pretend that the CT scan machine is a camera. C) Explain that the child must behave because the technician is busy. D) Tell the child that the CT scan is a picture of the dark parts inside the body. Ans: B Feedback: