Review Developmental Needs Lifespan Developmental Needs Lifespan Question and Answer.

Review Developmental Needs Lifespan Developmental Needs Lifespan Question and Answer

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? A.Allow the baby to learn self-amusement B.Enroll the infant in an infant-play group C.Meet the physical needs and cuddle and comfort D.Show the mother the newborn reflexes A.Allow the baby to learn self-amusement B.Enroll the infant in an infant-play group C.Meet the physical needs and cuddle and comfort D.Show the mother the newborn reflexes

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? A.Allow the baby to learn self-amusement B.Enroll the infant in an infant-play group C.Meet the physical needs and cuddle and comfort D.Show the mother the newborn reflexes A.Allow the baby to learn self-amusement B.Enroll the infant in an infant-play group C.Meet the physical needs and cuddle and comfort D.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.

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. 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. 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. 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

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.” B.“I’m giving the baby rice cereal at bedtime.” C.“I’m so glad the soft spot on the top of the head is gone.” D.“The baby has two lower front teeth.” A. “We still have to provide support when the baby is sitting up.” B.“I’m giving the baby rice cereal at bedtime.” C.“I’m so glad the soft spot on the top of the head is gone.” D.“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. 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.” B.“I’m giving the baby rice cereal at bedtime.” C.“I’m so glad the soft spot on the top of the head is gone.” D.“The baby has two lower front teeth.” A. “We still have to provide support when the baby is sitting up.” B.“I’m giving the baby rice cereal at bedtime.” C.“I’m so glad the soft spot on the top of the head is gone.” D.“The baby has two lower front teeth.”

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

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

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 B.Have the parents keep the radio turned on next to the baby’s playpen C.Encourage the parents to play CDs of various children’s songs during the day D.Urge the parents to schedule an evaluation of the infant by a speech therapist A. Suggest the parents talk regularly to the baby B.Have the parents keep the radio turned on next to the baby’s playpen C.Encourage the parents to play CDs of various children’s songs during the day D.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. 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 B.Have the parents keep the radio turned on next to the baby’s playpen C.Encourage the parents to play CDs of various children’s songs during the day D.Urge the parents to schedule an evaluation of the infant by a speech therapist A. Suggest the parents talk regularly to the baby B.Have the parents keep the radio turned on next to the baby’s playpen C.Encourage the parents to play CDs of various children’s songs during the day D.Urge the parents to schedule an evaluation of the infant by a speech therapist

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? A.Report findings to social services B.Institute seizure precautions C.Confront the parents about recent disciplinary actions D.Role model speaking softly to the child and handling the child gently A.Report findings to social services B.Institute seizure precautions C.Confront the parents about recent disciplinary actions D.Role model speaking softly to the child and handling the child gently

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? A.Report findings to social services B.Institute seizure precautions C.Confront the parents about recent disciplinary actions D.Role model speaking softly to the child and handling the child gently A.Report findings to social services B.Institute seizure precautions C.Confront the parents about recent disciplinary actions D.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.

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. “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. 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. “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.”

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 B.Weighing the diapers C.Estimating the wet area on the diaper D.Using urinary collection bags A. Recording the number of diaper changes B.Weighing the diapers C.Estimating the wet area on the diaper D.Using urinary collection bags

B.Weighing the diapers will provide the most accurate output measurement. 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 B.Weighing the diapers C.Estimating the wet area on the diaper D.Using urinary collection bags A. Recording the number of diaper changes B.Weighing the diapers C.Estimating the wet area on the diaper D.Using urinary collection bags

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

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

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

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

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? A.The mother uses “baby-talk” and allows the baby to play with the nipple during feedings B.The mother prepares the powdered formula 1 scoop in 2 ounces of water C.The mother times the feeding and after 20 minutes removes the bottle and places the baby in the infant seat D.The mother plays pat-a-cake with the infant and giggles while tickling the baby A.The mother uses “baby-talk” and allows the baby to play with the nipple during feedings B.The mother prepares the powdered formula 1 scoop in 2 ounces of water C.The mother times the feeding and after 20 minutes removes the bottle and places the baby in the infant seat D.The mother plays pat-a-cake with the infant and giggles while tickling the baby

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? A.The mother uses “baby-talk” and allows the baby to play with the nipple during feedings B.The mother prepares the powdered formula 1 scoop in 2 ounces of water C.The mother times the feeding and after 20 minutes removes the bottle and places the baby in the infant seat D.The mother plays pat-a-cake with the infant and giggles while tickling the baby A.The mother uses “baby-talk” and allows the baby to play with the nipple during feedings B.The mother prepares the powdered formula 1 scoop in 2 ounces of water C.The mother times the feeding and after 20 minutes removes the bottle and places the baby in the infant seat D.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.

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

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

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

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

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

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

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

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

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

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

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 B.Walking hand in hand with the 2-year-old C.Allowing the 4-year-old to play on the jungle gym D.Hoisting the 3-year-old up with hands in the axillae A. Lifting up the 15-month-old by one hand B.Walking hand in hand with the 2-year-old C.Allowing the 4-year-old to play on the jungle gym D.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 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 B.Walking hand in hand with the 2-year-old C.Allowing the 4-year-old to play on the jungle gym D.Hoisting the 3-year-old up with hands in the axillae A. Lifting up the 15-month-old by one hand B.Walking hand in hand with the 2-year-old C.Allowing the 4-year-old to play on the jungle gym D.Hoisting the 3-year-old up with hands in the axillae

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.” 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. 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.” 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.”

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? A.“Put the child in bed for a nap.” B.“Scold the child for the behavior.” C.“Offer the child candy to stop the behavior.” D.“Say NO and move the child to another activity.” A.“Put the child in bed for a nap.” B.“Scold the child for the behavior.” C.“Offer the child candy to stop the behavior.” D.“Say NO and move the child to another activity.”

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? A.“Put the child in bed for a nap.” B.“Scold the child for the behavior.” C.“Offer the child candy to stop the behavior.” D.“Say NO and move the child to another activity.” A.“Put the child in bed for a nap.” B.“Scold the child for the behavior.” C.“Offer the child candy to stop the behavior.” D.“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.

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. A.“Good night; we’ll see you tomorrow.” B.“Please wait to tell your child good-bye before you leave.” C.“Go ahead and leave; I’m sure your child won’t mind.” D.“I’ll tell your child you had to leave.” A.“Good night; we’ll see you tomorrow.” B.“Please wait to tell your child good-bye before you leave.” C.“Go ahead and leave; I’m sure your child won’t mind.” D.“I’ll tell your child you had to leave.”

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. A.“Good night; we’ll see you tomorrow.” B.“Please wait to tell your child good-bye before you leave.” C.“Go ahead and leave; I’m sure your child won’t mind.” D.“I’ll tell your child you had to leave.” A.“Good night; we’ll see you tomorrow.” B.“Please wait to tell your child good-bye before you leave.” C.“Go ahead and leave; I’m sure your child won’t mind.” D.“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.

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 B.Requests all lights to be left on in the room all night C.Describes details of the accident using grandiose stories D.Refuses to take a bath or perform other hygiene tasks A. Blames a sibling for the accident and hospitalization B.Requests all lights to be left on in the room all night C.Describes details of the accident using grandiose stories D.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. 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 B.Requests all lights to be left on in the room all night C.Describes details of the accident using grandiose stories D.Refuses to take a bath or perform other hygiene tasks A. Blames a sibling for the accident and hospitalization B.Requests all lights to be left on in the room all night C.Describes details of the accident using grandiose stories D.Refuses to take a bath or perform other hygiene tasks

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

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

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.“ B.“This child is in a day care center five days a week.“ C.“This child is a curious child who is always getting into things.“ D.“This child is a middle child.” A. “This child is very different from my other two children.“ B.“This child is in a day care center five days a week.“ C.“This child is a curious child who is always getting into things.“ D.“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. 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.“ B.“This child is in a day care center five days a week.“ C.“This child is a curious child who is always getting into things.“ D.“This child is a middle child.” A. “This child is very different from my other two children.“ B.“This child is in a day care center five days a week.“ C.“This child is a curious child who is always getting into things.“ D.“This child is a middle child.”

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.” B.“You need to face what has happened and talk about it.” C.“Coming to the emergency department can be scary. Maybe in a little while we can talk.” D.“I’m right here with you and promise I won’t leave anytime soon.” A. “The nurses and doctors are all here to help you.” B.“You need to face what has happened and talk about it.” C.“Coming to the emergency department can be scary. Maybe in a little while we can talk.” D.“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). 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.” B.“You need to face what has happened and talk about it.” C.“Coming to the emergency department can be scary. Maybe in a little while we can talk.” D.“I’m right here with you and promise I won’t leave anytime soon.” A. “The nurses and doctors are all here to help you.” B.“You need to face what has happened and talk about it.” C.“Coming to the emergency department can be scary. Maybe in a little while we can talk.” D.“I’m right here with you and promise I won’t leave anytime soon.”

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? A.Plays with peers of the same sex and ignores the opposite sex B.Discusses sexual matters and displays seductive mannerisms C.Displays curiosity about reproduction with other students D.Daydreams in class but gets assignments completed on time A.Plays with peers of the same sex and ignores the opposite sex B.Discusses sexual matters and displays seductive mannerisms C.Displays curiosity about reproduction with other students D.Daydreams in class but gets assignments completed on time

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? A.Plays with peers of the same sex and ignores the opposite sex B.Discusses sexual matters and displays seductive mannerisms C.Displays curiosity about reproduction with other students D.Daydreams in class but gets assignments completed on time A.Plays with peers of the same sex and ignores the opposite sex B.Discusses sexual matters and displays seductive mannerisms C.Displays curiosity about reproduction with other students D.Daydreams in class but gets assignments completed on time B. This is a defense mechanism and the child is really displaying adult behavior.

26. A 2-year-old child has ingested granular automatic dishwasher detergent. The parent calls the poison control center to ask for assistance. What will the parent be told to do? A. Give child a dose of syrup of Ipecac B.Give child a glass of lemon juice to drink C.Take child to the pediatrician immediately D.Take child to the hospital immediately A. Give child a dose of syrup of Ipecac B.Give child a glass of lemon juice to drink C.Take child to the pediatrician immediately D.Take child to the hospital immediately

D. With caustic or corrosive substances, the immediate action is to get the child to the hospital for evaluation and care. 26. A 2-year-old child has ingested granular automatic dishwasher detergent. The parent calls the poison control center to ask for assistance. What will the parent be told to do? A. Give child a dose of syrup of Ipecac B.Give child a glass of lemon juice to drink C.Take child to the pediatrician immediately D.Take child to the hospital Immediately A. Give child a dose of syrup of Ipecac B.Give child a glass of lemon juice to drink C.Take child to the pediatrician immediately D.Take child to the hospital Immediately

27. Which symptom would indicate poisoning by hydrocarbon ingestion? A.Symptoms of shock B.Gastrointestinal symptoms C.Hepatic failure D.Respiratory distress A.Symptoms of shock B.Gastrointestinal symptoms C.Hepatic failure D.Respiratory distress

27. Which symptom would indicate poisoning by hydrocarbon ingestion? A.Symptoms of shock B.Gastrointestinal symptoms C.Hepatic failure D.Respiratory distress A.Symptoms of shock B.Gastrointestinal symptoms C.Hepatic failure D.Respiratory distress D. Hydrocarbons have an inhalant property and cause respiratory problems. There may also be a change in level of consciousness and some nausea and vomiting.

28. A 3-year-old child is admitted to the hospital with a toxic ingestion of acetaminophen (Tylenol). What lab value alteration should be anticipated by the nurse? A.Elevated serum bilirubin B.Decreased blood urea nitrogen C.Elevated white blood cell count D.Decreased serum calcium A.Elevated serum bilirubin B.Decreased blood urea nitrogen C.Elevated white blood cell count D.Decreased serum calcium

28. A 3-year-old child is admitted to the hospital with a toxic ingestion of acetaminophen (Tylenol). What lab value alteration should be anticipated by the nurse? A.Elevated serum bilirubin B.Decreased blood urea nitrogen C.Elevated white blood cell count D.Decreased serum calcium A.Elevated serum bilirubin B.Decreased blood urea nitrogen C.Elevated white blood cell count D.Decreased serum calcium A. Acetaminophen (Tylenol) is lethal to the liver and will cause an elevation of the bilirubin and liver enzymes.

29. A child is treated in the emergency room for acute salicylate poisoning. In preparation for dismissal, which nursing action is most appropriate? A. Allow parents to express feelings regarding circumstances related to poisoning B.Educate parents regarding safe storage of the family supply of aspirin C.Comfort and reassure child after treatment D.Discuss methods for disciplining the child A. Allow parents to express feelings regarding circumstances related to poisoning B.Educate parents regarding safe storage of the family supply of aspirin C.Comfort and reassure child after treatment D.Discuss methods for disciplining the child

B.A major goal in this type of situation is to prevent recurrence of salicylate poisoning, which is best accomplished through parental education. 29. A child is treated in the emergency room for acute salicylate poisoning. In preparation for dismissal, which nursing action is most appropriate? A. Allow parents to express feelings regarding circumstances related to poisoning B.Educate parents regarding safe storage of the family supply of aspirin C.Comfort and reassure child after treatment D.Discuss methods for disciplining the child A. Allow parents to express feelings regarding circumstances related to poisoning B.Educate parents regarding safe storage of the family supply of aspirin C.Comfort and reassure child after treatment D.Discuss methods for disciplining the child

30. A child with lead intoxication is being treated with the chelating agent edetate calcium disodium (calcium EDTA). A parent expresses concern about the drug's effectiveness. By which therapeutic response is the drug evidenced? A. Shift in serum pH B. High lead levels in the urine C. Increased level of alertness D. Decrease in serum calcium

B. EDTA, the major chelating agent used in treating lead poisoning, forms a stable, highly soluble compound that causes free lead to be readily excreted. 30. A child with lead intoxication is being treated with the chelating agent edetate calcium disodium (calcium EDTA). A parent expresses concern about the drug's effectiveness. By which therapeutic response is the drug evidenced? A. Shift in serum pH B. High lead levels in the urine D. Increased level of alertness C. Decrease in serum calcium

31. During a well-child examination of a 4-year-old preschool child, the child states to the nurse, “When it gets dark, I go to bed just like the sun.” What should the nurse conclude about this statement? A. The child is afraid of the dark and needs a light on in the room B.The child is displaying intuitive reasoning typical for the age C.There is a developmental delay in the child’s intellectual processes D.The parents are allowing the child to stay up too late for adequate sleep A. The child is afraid of the dark and needs a light on in the room B.The child is displaying intuitive reasoning typical for the age C.There is a developmental delay in the child’s intellectual processes D.The parents are allowing the child to stay up too late for adequate sleep

B.One of the milestones for the preschool child is the ability to make simple associations between ideas and events, called intuitive reasoning. 31. During a well-child examination of a 4-year-old preschool child, the child states to the nurse, “When it gets dark, I go to bed just like the sun.” What should the nurse conclude about this statement? A. The child is afraid of the dark and needs a light on in the room B.The child is displaying intuitive reasoning typical for the age C.There is a developmental delay in the child’s intellectual processes D.The parents are allowing the child to stay up too late for adequate sleep A. The child is afraid of the dark and needs a light on in the room B.The child is displaying intuitive reasoning typical for the age C.There is a developmental delay in the child’s intellectual processes D.The parents are allowing the child to stay up too late for adequate sleep

32. A parent brings a 5-year-old to the nurse for a kindergarten physical and tells the nurse that the child stutters a lot when excited about something. What should the nurse explain to the parent? A.“Children at this age act negatively for no reason. Just ignore the stuttering.” B.“Your child will need speech therapy, but it’s more successful with older children.” C.“Do either of you stutter? It’s often inherited.” D.“Stuttering is common at this age. We can evaluate later if it continues.” A.“Children at this age act negatively for no reason. Just ignore the stuttering.” B.“Your child will need speech therapy, but it’s more successful with older children.” C.“Do either of you stutter? It’s often inherited.” D.“Stuttering is common at this age. We can evaluate later if it continues.”

32. A parent brings a 5-year-old to the nurse for a kindergarten physical and tells the nurse that the child stutters a lot when excited about something. What should the nurse explain to the parent? A.“Children at this age act negatively for no reason. Just ignore the stuttering.” B.“Your child will need speech therapy, but it’s more successful with older children.” C.“Do either of you stutter? It’s often inherited.” D.“Stuttering is common at this age. We can evaluate later if it continues.” A.“Children at this age act negatively for no reason. Just ignore the stuttering.” B.“Your child will need speech therapy, but it’s more successful with older children.” C.“Do either of you stutter? It’s often inherited.” D.“Stuttering is common at this age. We can evaluate later if it continues.” D. This states true facts and involves sound teaching. A is untruthful and closes discussion, B ignores the problem and shifts topics, and C raises possible guilt feelings.

33. Observation of which activity would indicate appropriate general development in a 5-year-old client? A. Draws the figure of a person B. Obeys two-step commands C. Identifies colors and shapes D. Rides a tricycle in the playroom A. Draws the figure of a person B. Obeys two-step commands C. Identifies colors and shapes D. Rides a tricycle in the playroom

A.Development can be best determined by how proportioned the figure is and how much detail the child puts in the drawing. The other responses indicate abilities that the child has mastered well before five years of age. 33. Observation of which activity would indicate appropriate general development in a 5-year-old client? A. Draws the figure of a person B. Obeys two-step commands C. Identifies colors and shapes D. Rides a tricycle in the playroom A. Draws the figure of a person B. Obeys two-step commands C. Identifies colors and shapes D. Rides a tricycle in the playroom

34. A 4-year-old child is brought to the clinic for a checkup. Which finding would be of concern to the nurse? A. Bronchovesicular breath sounds in upper chest B.Resting apical pulse rate of 100 beats per minute C.Abdominal movement with respirations D.Standing position is bowlegged (genu varum) A. Bronchovesicular breath sounds in upper chest B.Resting apical pulse rate of 100 beats per minute C.Abdominal movement with respirations D.Standing position is bowlegged (genu varum)

D.The bowlegged position is considered “normal” for up to a year after walking is initiated. Knock knees (genu valgum) occur “normally” around 2 to 3 years of age. Choices A, B and C are all normal findings for a 4-year-old. 34. A 4-year-old child is brought to the clinic for a checkup. Which finding would be of concern to the nurse? A. Bronchovesicular breath sounds in upper chest B.Resting apical pulse rate of 100 beats per minute C.Abdominal movement with respirations D.Standing position is bowlegged (genu varum) A. Bronchovesicular breath sounds in upper chest B.Resting apical pulse rate of 100 beats per minute C.Abdominal movement with respirations D.Standing position is bowlegged (genu varum)

35. In planning self-care that would foster independence, the nurse would expect a 4 ½-year-old child to be able to perform which activity? A. Button a shirt B.Tie shoelaces C.Part and comb hair D.Cut the meat at dinner A. Button a shirt B.Tie shoelaces C.Part and comb hair D.Cut the meat at dinner

A.By this age, children need very little help with dressing. Tying shoelaces with bows, parting hair and cutting meat with a table knife are skills of older children. 35. In planning self-care that would foster independence, the nurse would expect a 4 ½-year-old child to be able to perform which activity? A. Button a shirt B.Tie shoelaces C.Part and comb hair D.Cut the meat at dinner A. Button a shirt B.Tie shoelaces C.Part and comb hair D.Cut the meat at dinner

36. What statement would most accurately describe the preschool child? A.Will play games but does not like to follow rules B.Does not like acting or role playing yet C.Plays only with others of the same sex D.Has a strong desire to win and will cheat to do so A.Will play games but does not like to follow rules B.Does not like acting or role playing yet C.Plays only with others of the same sex D.Has a strong desire to win and will cheat to do so

36. What statement would most accurately describe the preschool child? A.Will play games but does not like to follow rules B.Does not like acting or role playing yet C.Plays only with others of the same sex D.Has a strong desire to win and will cheat to do so A.Will play games but does not like to follow rules B.Does not like acting or role playing yet C.Plays only with others of the same sex D.Has a strong desire to win and will cheat to do so D. These children love rules, but may make up their own. They like dressing up and role-playing or acting and they play with other children regardless of gender and may also have an imaginary friend.

37. Which parent statement about safety and young children indicates the need for additional teaching by the nurse? A. “As soon as my child begins elementary school, I’ll talk about how to deal with strangers.” B.“It’s okay to use regular car seat belts with most children once they reach age eight or nine.” C.“The desire to explore is strong in young children, and consequently accidents are common.” D.“I need to be especially watchful when my child is playing outdoors by the pool.” A. “As soon as my child begins elementary school, I’ll talk about how to deal with strangers.” B.“It’s okay to use regular car seat belts with most children once they reach age eight or nine.” C.“The desire to explore is strong in young children, and consequently accidents are common.” D.“I need to be especially watchful when my child is playing outdoors by the pool.”

A.Talks with children regarding strangers should begin at the preschool age, not school age. All other choices are correct. 37. Which parent statement about safety and young children indicates the need for additional teaching by the nurse? A. “As soon as my child begins elementary school, I’ll talk about how to deal with strangers.” B.“It’s okay to use regular car seat belts with most children once they reach age eight or nine.” C.“The desire to explore is strong in young children, and consequently accidents are common.” D.“I need to be especially watchful when my child is playing outdoors by the pool.” A. “As soon as my child begins elementary school, I’ll talk about how to deal with strangers.” B.“It’s okay to use regular car seat belts with most children once they reach age eight or nine.” C.“The desire to explore is strong in young children, and consequently accidents are common.” D.“I need to be especially watchful when my child is playing outdoors by the pool.”

38. A student nurse is preparing to teach first graders about safety after school. Which of these is not appropriate to teach? A.If the parents are not home, tell the caller the parents are busy and will call back later B.If a severe storm comes up and you are home alone, go to the basement C.If you are going to warm up a snack, the microwave is safest D.Always lock the door when you are home alone A.If the parents are not home, tell the caller the parents are busy and will call back later B.If a severe storm comes up and you are home alone, go to the basement C.If you are going to warm up a snack, the microwave is safest D.Always lock the door when you are home alone

38. A student nurse is preparing to teach first graders about safety after school. Which of these is not appropriate to teach? A.If parents are not home, tell the caller the parents are busy and will call back later B.If a severe storm comes up and you are home alone, go to the basement C.If you are going to warm up a snack, the microwave is safest D.Always lock the door when you are home alone A.If parents are not home, tell the caller the parents are busy and will call back later B.If a severe storm comes up and you are home alone, go to the basement C.If you are going to warm up a snack, the microwave is safest D.Always lock the door when you are home alone A. It is better to tell the stranger that the parents are busy and will call back later.

39. Based on an understanding of "normal" behavior of a preschool-aged child, the nurse would expect a 4-year-old client to exhibit which behavior while hospitalized? A. Difficulty sleeping at night, due to self-imposed naps during the day B.Crying uncontrollably the entire time the parents are absent C.Cooperation with the nursing staff in the parents' absence D.Inability to play with other children while their parents are present A. Difficulty sleeping at night, due to self-imposed naps during the day B.Crying uncontrollably the entire time the parents are absent C.Cooperation with the nursing staff in the parents' absence D.Inability to play with other children while their parents are present

C.Preschool-aged children tend to be cooperative during the parents' absence for fear of being abandoned. 39. Based on an understanding of "normal" behavior of a preschool-aged child, the nurse would expect a 4-year-old client to exhibit which behavior while hospitalized? A. Difficulty sleeping at night, due to self-imposed naps during the day B.Crying uncontrollably the entire time the parents are absent C.Cooperation with the nursing staff in the parents' absence D.Inability to play with other children while their parents are present A. Difficulty sleeping at night, due to self-imposed naps during the day B.Crying uncontrollably the entire time the parents are absent C.Cooperation with the nursing staff in the parents' absence D.Inability to play with other children while their parents are present

40. A 4-year-old child who weighs 42 lbs. had an open reduction of a fractured femur. The order for pain medication is morphine 0.1 mg/kilogram/every 3-4 hours. How should the nurse best provide for pain relief? A.Utilize the Pain Faces Scale and plan to give 1.9 mg. of morphine every 3-4 hours routinely the first 24 hours post-op B.Utilize the numeric Pain Scale and plan on giving 2.3 mg of morphine C.Encourage the parent to let the nurse know when the child is in pain and then give 1.9 mg. of morphine D.Utilize the Pain Faces Scale and plan to give 4.2 mg of morphine every 3-4 hours routinely the first 24 hours post-op A.Utilize the Pain Faces Scale and plan to give 1.9 mg. of morphine every 3-4 hours routinely the first 24 hours post-op B.Utilize the numeric Pain Scale and plan on giving 2.3 mg of morphine C.Encourage the parent to let the nurse know when the child is in pain and then give 1.9 mg. of morphine D.Utilize the Pain Faces Scale and plan to give 4.2 mg of morphine every 3-4 hours routinely the first 24 hours post-op

40. A 4-year-old child who weighs 42 lbs. had an open reduction of a fractured femur. The order for pain medication is morphine 0.1 mg/kilogram/every 3-4 hours. How should the nurse best provide for pain relief? A.Utilize the Pain Faces Scale and plan to give 1.9 mg. of morphine every 3-4 hours routinely the first 24 hours post-op B.Utilize the numeric Pain Scale and plan on giving 2.3 mg of morphine C.Encourage the parent to let the nurse know when the child is in pain and then give 1.9 mg. of morphine D.Utilize the Pain Faces Scale and plan to give 4.2 mg of morphine every 3-4 hours routinely the first 24 hours post-op A.Utilize the Pain Faces Scale and plan to give 1.9 mg. of morphine every 3-4 hours routinely the first 24 hours post-op B.Utilize the numeric Pain Scale and plan on giving 2.3 mg of morphine C.Encourage the parent to let the nurse know when the child is in pain and then give 1.9 mg. of morphine D.Utilize the Pain Faces Scale and plan to give 4.2 mg of morphine every 3-4 hours routinely the first 24 hours post-op A. Based on mg/kg of body weight, 1.9 mg is a safe dose of morphine. Children as young as 3-years-old can use the Pain Faces Scale. The Numeric Scale should not be used before 5- years of age.

41. Using Piaget’s theory, what task does the nurse expect of the normal 10-year-old child? A.Asks simple hypothetical questions and explores possible solutions B.Makes up complicated games with imaginary friends C.Enjoys toys with bright colors and moving parts D.Establishes beginning reading skills appropriate for age level A.Asks simple hypothetical questions and explores possible solutions B.Makes up complicated games with imaginary friends C.Enjoys toys with bright colors and moving parts D.Establishes beginning reading skills appropriate for age level

41. Using Piaget’s theory, what task does the nurse expect of the normal 10-year-old child? A.Asks simple hypothetical questions and explores possible solutions B.Makes up complicated games with imaginary friends C.Enjoys toys with bright colors and moving parts D.Establishes beginning reading skills appropriate for age level A.Asks simple hypothetical questions and explores possible solutions B.Makes up complicated games with imaginary friends C.Enjoys toys with bright colors and moving parts D.Establishes beginning reading skills appropriate for age level A. The developmental task for this age is inductive reasoning and beginning logic.

42. The nurse is assessing the skill level of a 7-year-old child. Which area would not yet be fully developed? A.Accurately reads time on a clock B.Can explain meaning of abstract concepts C.Is able to imitate others’ actions D.Follows basic rules of conduct A.Accurately reads time on a clock B.Can explain meaning of abstract concepts C.Is able to imitate others’ actions D.Follows basic rules of conduct

42. The nurse is assessing the skill level of a 7-year-old child. Which area would not yet be fully developed? A.Accurately reads time on a clock B.Can explain meaning of abstract concepts C.Is able to imitate others’ actions D.Follows basic rules of conduct A.Accurately reads time on a clock B.Can explain meaning of abstract concepts C.Is able to imitate others’ actions D.Follows basic rules of conduct B. Understanding of abstract concepts does not occur until the formal operations stage of development (12-15 years). The other choices represent attainable skills by age 7.

43. Which toy would the nurse consider appropriate for a 6-year- old client in a spica cast? A.Deck of playing cards B.Game of checkers C.Set of building blocks D.Coloring book and crayons A.Deck of playing cards B.Game of checkers C.Set of building blocks D.Coloring book and crayons

D.The coloring book and crayons would be the best option, considering the age of the client and the limitation in mobility. 43. Which toy would the nurse consider appropriate for a 6-year- old client in a spica cast? A. Deck of playing cards B. Game of checkers C. Set of building blocks D. Coloring book and crayons A. Deck of playing cards B. Game of checkers C. Set of building blocks D. Coloring book and crayons

44. Which would most likely be a risk factor for drug/alcohol experimentation in the school-age child? A.Disturbed parent/child attachment related to parental terminal illness B.Self-esteem disturbance related to delayed onset of puberty C.Impaired social interaction related to chronic illness with frequent hospitalization D.Disturbed family coping related to parental substance abuse A.Disturbed parent/child attachment related to parental terminal illness B.Self-esteem disturbance related to delayed onset of puberty C.Impaired social interaction related to chronic illness with frequent hospitalization D.Disturbed family coping related to parental substance abuse

44. Which would most likely be a risk factor for drug/alcohol experimentation in the school-age child? A.Disturbed parent/child attachment related to parental terminal illness B.Self-esteem disturbance related to delayed onset of puberty C.Impaired social interaction related to chronic illness with frequent hospitalization D.Disturbed family coping related to parental substance abuse A.Disturbed parent/child attachment related to parental terminal illness B.Self-esteem disturbance related to delayed onset of puberty C.Impaired social interaction related to chronic illness with frequent hospitalization D.Disturbed family coping related to parental substance abuse D. The highest risk comes from inadequate nurturing and lack of appropriate limits. Seeing substance abuse in the parents can socialize the child to the belief that it is acceptable and even desirable.

45. An 8-year-old is admitted to the hospital for repair of a ventricular septal defect. Which teaching method would provide appropriate preoperative education? A.Use a drawing to show where the defect is located and how it will be repaired B.Use a doll and show where the incision and the tubes will be placed during surgery C.Take the client to the operating room for a visit D.Let the client visit with someone of the same age who has had the surgery A.Use a drawing to show where the defect is located and how it will be repaired B.Use a doll and show where the incision and the tubes will be placed during surgery C.Take the client to the operating room for a visit D.Let the client visit with someone of the same age who has had the surgery

45. An 8-year-old is admitted to the hospital for repair of a ventricular septal defect. Which teaching method would provide appropriate preoperative education? A.Use a drawing to show where the defect is located and how it will be repaired B.Use a doll and show where the incision and the tubes will be placed during surgery C.Take the client to the operating room for a visit D.Let the client visit with someone of the same age who has had the surgery A.Use a drawing to show where the defect is located and how it will be repaired B.Use a doll and show where the incision and the tubes will be placed during surgery C.Take the client to the operating room for a visit D.Let the client visit with someone of the same age who has had the surgery B. A child learns better when simple explanations are combined with visualization of what is being discussed. Drawings are too abstract. Peer relationships can be very competitive. Another child may attempt to brag rather than help alleviate fears.

46. A 7-year-old child is scheduled to have surgery and asks the nurse, “Will the surgery hurt?” Select the most appropriate reply. A. “Do not worry about the pain right now. You need to try and relax.” B. “You may feel some pain, but other children your age seem to do fine.” C. “It will not hurt because of the medication used to put you to sleep.” D. “There will be some pain, but we have medicine to make you comfortable.” A. “Do not worry about the pain right now. You need to try and relax.” B. “You may feel some pain, but other children your age seem to do fine.” C. “It will not hurt because of the medication used to put you to sleep.” D. “There will be some pain, but we have medicine to make you comfortable.”

D.This is the most honest, yet reassuring response. 46. A 7-year-old child is scheduled to have surgery and asks the nurse, “Will the surgery hurt?” Select the most appropriate reply. A. “Do not worry about the pain right now. You need to try and relax.” B. “You may feel some pain, but other children your age seem to do fine.” C. “It will not hurt because of the medication used to put you to sleep.” D. “There will be some pain, but we have medicine to make you comfortable.” A. “Do not worry about the pain right now. You need to try and relax.” B. “You may feel some pain, but other children your age seem to do fine.” C. “It will not hurt because of the medication used to put you to sleep.” D. “There will be some pain, but we have medicine to make you comfortable.”

47. According to Erikson, when an individual fails to master the maturational crisis of adolescence, which behavior will most likely be presented? A. Role confusion B.Interpersonal isolation C.Resistance to all parental orders D.Use of drugs and alcohol A. Role confusion B.Interpersonal isolation C.Resistance to all parental orders D.Use of drugs and alcohol

A.The core conflict at this stage is identity versus role confusion. Adolescents are exploring alternatives while attempting to understand “self” as related to peers, family and society. Difficulty with this process may result in role confusion. 47. According to Erikson, when an individual fails to master the maturational crisis of adolescence, which behavior will most likely be presented? A. Role confusion B.Interpersonal isolation C.Resistance to all parental orders D.Use of drugs and alcohol A. Role confusion B.Interpersonal isolation C.Resistance to all parental orders D.Use of drugs and alcohol

48. A 16-year-old adolescent, grounded by parents for smoking in school, tells the school nurse "My friends smoke in school, too, but they aren't grounded. It's just not fair!" Select the most appropriate response by the nurse. A. “Give me the names of your friends, and I will suggest to their parents they, too, should be grounded.“ B. “You need to be responsible for your own actions and sometimes actions result in consequences.“ C. “I will report this to the principal immediately. You may all face suspension from school.“ D. “The fact you are trying to deflect attention to these so- called friends and their behavior is not acceptable.“ A. “Give me the names of your friends, and I will suggest to their parents they, too, should be grounded.“ B. “You need to be responsible for your own actions and sometimes actions result in consequences.“ C. “I will report this to the principal immediately. You may all face suspension from school.“ D. “The fact you are trying to deflect attention to these so- called friends and their behavior is not acceptable.“

B.As adolescents are maturing, it is important they understand taking responsibility for their own actions is expected and that consequences can occur related to these actions. 48. A 16-year-old adolescent, grounded by parents for smoking in school, tells the school nurse "My friends smoke in school, too, but they aren't grounded. It's just not fair!" Select the most appropriate response by the nurse. A. “Give me the names of your friends, and I will suggest to their parents they, too, should be grounded.“ B. “You need to be responsible for your own actions and sometimes actions result in consequences.“ C. “I will report this to the principal immediately. You may all face suspension from school.“ D. “The fact you are trying to deflect attention to these so- called friends and their behavior is not acceptable.“ A. “Give me the names of your friends, and I will suggest to their parents they, too, should be grounded.“ B. “You need to be responsible for your own actions and sometimes actions result in consequences.“ C. “I will report this to the principal immediately. You may all face suspension from school.“ D. “The fact you are trying to deflect attention to these so- called friends and their behavior is not acceptable.“

49. What behaviors indicate that adolescents are becoming more adult-like physically and emotionally? A.Have slow, steady gain of height and weight B.Spend time “hanging out” with members of both sexes C.May be weak and awkward when playing sports D.Daily need for calories is reduced from 3500 A.Have slow, steady gain of height and weight B.Spend time “hanging out” with members of both sexes C.May be weak and awkward when playing sports D.Daily need for calories is reduced from 3500

49. What behaviors indicate that adolescents are becoming more adult-like physically and emotionally? A.Have slow, steady gain of height and weight B.Spend time “hanging out” with members of both sexes C.May be weak and awkward when playing sports D.Daily need for calories is reduced from 3500 A.Have slow, steady gain of height and weight B.Spend time “hanging out” with members of both sexes C.May be weak and awkward when playing sports D.Daily need for calories is reduced from 3500 B. Hanging out with friends helps learn social skills. Teens grow in spurts gaining 10 lbs in some years and so may need up to 3500 calories per day. During growth spurts, teens may be awkward, but strong.

50. The parents of an adolescent who seems to be less interested in previous hobbies are concerned. They ask the RN what they can do to assure their child is making good choices. What is the most appropriate advice? A.Send the child to a BRAT camp B.Encourage open discussion and mutually established goals C.Set arbitrary rules and enforce them consistently D.Schedule a family counseling session A.Send the child to a BRAT camp B.Encourage open discussion and mutually established goals C.Set arbitrary rules and enforce them consistently D.Schedule a family counseling session

50. The parents of an adolescent who seems to be less interested in previous hobbies are concerned. They ask the RN what they can do to assure their child is making good choices. What is the most appropriate advice? A.Send the child to a BRAT camp B.Encourage open discussion and mutually established goals C.Set arbitrary rules and enforce them consistently D.Schedule a family counseling session A.Send the child to a BRAT camp B.Encourage open discussion and mutually established goals C.Set arbitrary rules and enforce them consistently D.Schedule a family counseling session B. Nurturing, providing family-centered activities, allowing for natural changes and development of autonomy, allowing for opportunities to demonstrate trust and setting appropriate limits with mutually agreed upon goals (with punishment to fit the infraction) are principles of good parenting.

51. An adolescent recently diagnosed with diabetes mellitus is having difficulty adhering to the diet and medication regimens. Select the most important factor influencing compliance in this age group. A.Family support and attention B.Adolescents’ abstract reasoning ability C.Reactions of adolescent’s peer group D.Nurse’s ability to empathize with the adolescent A.Family support and attention B.Adolescents’ abstract reasoning ability C.Reactions of adolescent’s peer group D.Nurse’s ability to empathize with the adolescent

51. An adolescent recently diagnosed with diabetes mellitus is having difficulty adhering to the diet and medication regimens. Select the most important factor influencing compliance in this age group. A.Family support and attention B.Adolescents’ abstract reasoning ability C.Reactions of adolescent’s peer group D.Nurse’s ability to empathize with the adolescent A.Family support and attention B.Adolescents’ abstract reasoning ability C.Reactions of adolescent’s peer group D.Nurse’s ability to empathize with the adolescent C. Peers are the norming group against which the adolescent gauges personal behavior.

52. Identify the activity that indicates that a young adult has successfully achieved an age-appropriate developmental task. A. Has attained socioeconomic consolidation B.Is concerned that taking prescription medications alters body image C.Established a long-term loving relationship with one other individual D.Actively interacted with classmates from high school A. Has attained socioeconomic consolidation B.Is concerned that taking prescription medications alters body image C.Established a long-term loving relationship with one other individual D.Actively interacted with classmates from high school

C.One of Erikson’s task for the young adult is intimacy vs. isolation and involves a shift of relationship from the group to one individual. 52. Identify the activity that indicates that a young adult has successfully achieved an age-appropriate developmental task. A. Has attained socioeconomic consolidation B.Is concerned that taking prescription medications alters body image C.Established a long-term loving relationship with one other individual D.Actively interacted with classmates from high school A. Has attained socioeconomic consolidation B.Is concerned that taking prescription medications alters body image C.Established a long-term loving relationship with one other individual D.Actively interacted with classmates from high school

53. A 23-year-old male client has graduated with an Associate Degree in Automotive Repair. He plans to use this degree to find employment to allow him to complete a 4-year degree in business accounting. According to Erikson, he has accomplished which stage of development? A.Autonomy vs Shame and Doubt B.Ego Integrity vs Despair C.Intimacy vs Isolation D.Identity vs Role Confusion A.Autonomy vs Shame and Doubt B.Ego Integrity vs Despair C.Intimacy vs Isolation D.Identity vs Role Confusion

53. A 23-year-old male client has graduated with an Associate Degree in Automotive Repair. He plans to use this degree to find employment to allow him to complete a 4-year degree in business accounting. According to Erikson, he has accomplished which stage of development? A.Autonomy vs Shame and Doubt B.Ego Integrity vs Despair C.Intimacy vs Isolation D.Identity vs Role Confusion A.Autonomy vs Shame and Doubt B.Ego Integrity vs Despair C.Intimacy vs Isolation D.Identity vs Role Confusion D. He has a life plan for employment and work identity but no evidence from this information about a stable relationship with another human being.

54. Which statement made by a 50-year-old man best indicates that Erikson's task of generativity has been accomplished? A. “I love my work so much that it is hard for me to ever think about retiring.“ B. “As I look back over my life, I can see that I have achieved most of the goals that I set for myself.“ C.“I have recently, finally, achieved economic independence for myself.“ D.“I think I have done a pretty good job with my children now that they are off on their own.“ A. “I love my work so much that it is hard for me to ever think about retiring.“ B. “As I look back over my life, I can see that I have achieved most of the goals that I set for myself.“ C.“I have recently, finally, achieved economic independence for myself.“ D.“I think I have done a pretty good job with my children now that they are off on their own.“

D.According to Erikson, important elements in attaining generativity are nurturing the next generation, being productive and creative, and/or contributing something of benefit to the world at large. 54. Which statement made by a 50-year-old man best indicates that Erikson's task of generativity has been accomplished? A. “I love my work so much that it is hard for me to ever think about retiring.“ B. “As I look back over my life, I can see that I have achieved most of the goals that I set for myself.“ C.“I have recently, finally, achieved economic independence for myself.“ D.“I think I have done a pretty good job with my children now that they are off on their own.“ A. “I love my work so much that it is hard for me to ever think about retiring.“ B. “As I look back over my life, I can see that I have achieved most of the goals that I set for myself.“ C.“I have recently, finally, achieved economic independence for myself.“ D.“I think I have done a pretty good job with my children now that they are off on their own.“

55. The nurse is performing a physical assessment of a 65-year- old male client. Which finding is of priority concern? A. Asymmetry of corneal light reflex B.Presence of gynecomastia C.Biceps reflex 1+ bilaterally D.Anteroposterior-to-transverse thoracic diameter equal A. Asymmetry of corneal light reflex B.Presence of gynecomastia C.Biceps reflex 1+ bilaterally D.Anteroposterior-to-transverse thoracic diameter equal

A.Gynecomastia, diminished deep tendon reflexes and an equal anteroposterior-to-transverse thoracic diameter are common with aging. Asymmetry of the light reflex may indicate eye muscle weakness or paralysis. 55. The nurse is performing a physical assessment of a 65-year- old male client. Which finding is of priority concern? A. Asymmetry of corneal light reflex B.Presence of gynecomastia C.Biceps reflex 1+ bilaterally D.Anteroposterior-to-transverse thoracic diameter equal A. Asymmetry of corneal light reflex B.Presence of gynecomastia C.Biceps reflex 1+ bilaterally D.Anteroposterior-to-transverse thoracic diameter equal

56. A 50-year-old female who smokes 2 packs of cigarettes a day and has taken Depo-Provera for 15 years has noticed neck and mid-back pain. When assessing this client, the RN suspects osteoporosis if which finding is present? A.Serum calcium levels are decreased B.Diet is deficient in Vitamin B 6 and folate C.Client has family history of osteoporosis D.The nurse notes dorsal kyphosis and loss of height A.Serum calcium levels are decreased B.Diet is deficient in Vitamin B 6 and folate C.Client has family history of osteoporosis D.The nurse notes dorsal kyphosis and loss of height

56. A 50-year-old female who smokes 2 packs of cigarettes a day and has taken Depo-Provera for 15 years has noticed neck and mid-back pain. When assessing this client, the RN suspects osteoporosis if which finding is present? A.Serum calcium levels are decreased B.Diet is deficient in Vitamin B 6 and folate C.Client has family history of osteoporosis D.The nurse notes dorsal kyphosis and loss of height A.Serum calcium levels are decreased B.Diet is deficient in Vitamin B 6 and folate C.Client has family history of osteoporosis D.The nurse notes dorsal kyphosis and loss of height D. Kyphosis and loss of bone density can lead to decreased height. Choices A and B are not related. A family history might be important but only when other evidence is present.

57. An elderly client knows that the nutritional requirements are less now than when the client was 45. The client wants help in deciding where to cut down on calories. In helping with nutritional planning, it is most important to know which facts? A. Iron requirements are higher in older women B.Caloric intake should be reduced to 2100 calories/day C.Protein requirements remain the same as at age 45 D.Vitamins A and C requirements are lower in older women A. Iron requirements are higher in older women B.Caloric intake should be reduced to 2100 calories/day C.Protein requirements remain the same as at age 45 D.Vitamins A and C requirements are lower in older women

C.The usual daily adult protein intake continues to meet the aging individual's need (15 to 20% of day's total calories). 57. An elderly client knows that the nutritional requirements are less now than when the client was 45. The client wants help in deciding where to cut down on calories. In helping with nutritional planning, it is most important to know which facts? A. Iron requirements are higher in older women B.Caloric intake should be reduced to 2100 calories/day C.Protein requirements remain the same as at age 45 D.Vitamins A and C requirements are lower in older women A. Iron requirements are higher in older women B.Caloric intake should be reduced to 2100 calories/day C.Protein requirements remain the same as at age 45 D.Vitamins A and C requirements are lower in older women

58. An older adult client says to the nurse, “I hate what aging does to the body. If someone could only find the Fountain of Youth!” Which is the most appropriate response? A. “It sounds like you are really distressed.” B.“You look very young compared to your peers.” C.“It is sad, but true, that aging is inevitable.” D.“People who have taken good care of themselves age well.” A. “It sounds like you are really distressed.” B.“You look very young compared to your peers.” C.“It is sad, but true, that aging is inevitable.” D.“People who have taken good care of themselves age well.”

A.This is the only choice that seeks clarification and acknowledges the client’s concern. 58. An older adult client says to the nurse, “I hate what aging does to the body. If someone could only find the Fountain of Youth!” Which is the most appropriate response? A. “It sounds like you are really distressed.” B.“You look very young compared to your peers.” C.“It is sad, but true, that aging is inevitable.” D.“People who have taken good care of themselves age well.” A. “It sounds like you are really distressed.” B.“You look very young compared to your peers.” C.“It is sad, but true, that aging is inevitable.” D.“People who have taken good care of themselves age well.”

59. Which assessment data should alert the RN to the possibility of elder abuse? A.Client with dementia repeatedly calling for help B.Dry flaky skin with fissures in skin folds C.Ecchymosis of right lower arm D.Contusions on lower abdomen and buttocks A.Client with dementia repeatedly calling for help B.Dry flaky skin with fissures in skin folds C.Ecchymosis of right lower arm D.Contusions on lower abdomen and buttocks

59. Which assessment data should alert the RN to the possibility of elder abuse? A.Client with dementia repeatedly calling for help B.Dry flaky skin with fissures in skin folds C.Ecchymosis of right lower arm D.Contusions on lower abdomen and buttocks A.Client with dementia repeatedly calling for help B.Dry flaky skin with fissures in skin folds C.Ecchymosis of right lower arm D.Contusions on lower abdomen and buttocks D. Injuries in the “swim suit” area are often indicative of physical abuse of elders.

60. Which teaching method incorporates knowledge of the physiological changes that occur in older adults? A. Providing background music during teaching sessions B.Scheduling teaching sessions that last about 60 minutes C.Verbalizing all information with an elevated tone of voice D.Using visual aids with large letters in black or red ink A. Providing background music during teaching sessions B.Scheduling teaching sessions that last about 60 minutes C.Verbalizing all information with an elevated tone of voice D.Using visual aids with large letters in black or red ink

D.Black or red ink is usually easy for older people to distinguish (blue and green are more difficult). Sixty minutes is rather long for one session, an elevated tone of voice is not necessary and background music can be too distracting. 60. Which teaching method incorporates knowledge of the physiological changes that occur in older adults? A. Providing background music during teaching sessions B.Scheduling teaching sessions that last about 60 minutes C.Verbalizing all information with an elevated tone of voice D.Using visual aids with large letters in black or red ink A. Providing background music during teaching sessions B.Scheduling teaching sessions that last about 60 minutes C.Verbalizing all information with an elevated tone of voice D.Using visual aids with large letters in black or red ink

61. Select the most appropriate assessment technique for the nurse to use who suspects that an older client may have developed age-related presbycusis. A. Ask a family member or friend if the client is hard of hearing B.Gradually turn the volume up on a radio until the client complains it is too loud C.Ask the client to repeat the words: fair, shout, skies, fun D.While facing the client, clap loudly to see if the client startles A. Ask a family member or friend if the client is hard of hearing B.Gradually turn the volume up on a radio until the client complains it is too loud C.Ask the client to repeat the words: fair, shout, skies, fun D.While facing the client, clap loudly to see if the client startles

C.The first indications of presbycusis are the inability to hear and distinguish high-pitched consonant sounds found in words like fair, shout, skies, sunny, fun, etc. 61. Select the most appropriate assessment technique for the nurse to use who suspects that an elderly client may have developed age-related presbycusis. A. Ask a family member or friend if the client is hard of hearing B.Gradually turn the volume up on a radio until the client complains it is too loud C.Ask the client to repeat the words: fair, shout, skies, fun D.While facing the client, clap loudly to see if the client startles A. Ask a family member or friend if the client is hard of hearing B.Gradually turn the volume up on a radio until the client complains it is too loud C.Ask the client to repeat the words: fair, shout, skies, fun D.While facing the client, clap loudly to see if the client startles

62. What would the RN anticipate the physician to order for an elderly client with acute onset anorexia and delirium? A.CT of the brain B.UA with culture and sensitivity C.Serum creatinine D.Psychiatric evaluation A.CT of the brain B.UA with culture and sensitivity C.Serum creatinine D.Psychiatric evaluation

62. What would the RN anticipate the physician to order for an elderly client with acute onset anorexia and delirium? A.CT of the brain B.UA with culture and sensitivity C.Serum creatinine D.Psychiatric evaluation A.CT of the brain B.UA with culture and sensitivity C.Serum creatinine D.Psychiatric evaluation B. A very common symptom of acute UTI in the elderly client is acute confusion. Other symptoms may include weakness, incontinence, nocturia, or dyspnea.

63. A 76-year-old client is admitted with a diagnosis of renal lithiasis and develops acute dementia. A diagnosis of Relocation Stress Syndrome is made. Which would be the best intervention? A.Ensure adequate fluid intake B.Pain control with non-narcotic analgesic C.Encourage family and friends to visit often D.Request restraints if client becomes agitated A.Ensure adequate fluid intake B.Pain control with non-narcotic analgesic C.Encourage family and friends to visit often D.Request restraints if client becomes agitated

63. A 76-year-old client is admitted with a diagnosis of renal lithiasis and develops acute dementia. A diagnosis of Relocation Stress Syndrome is made. Which would be the best intervention? A.Ensure adequate fluid intake B.Pain control with non-narcotic analgesic C.Encourage family and friends to visit often D.Request restraints if client becomes agitated A.Ensure adequate fluid intake B.Pain control with non-narcotic analgesic C.Encourage family and friends to visit often D.Request restraints if client becomes agitated C. Other helpful strategies include reorienting the client often, bringing familiar things from home, and allowing the client to make appropriate decisions.

Review Developmental Needs Lifespan Developmental Needs Lifespan Question and Answer.

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