Review

1
Review
Developmental Needs Lifespan
Question and Answer
2
1. A new mother asks the RN how best to
encourage development of social skills in her
newborn. Which should the RNs reply include
based on Eriksons Theory of Psychosocial
Development?

1. Allow the baby to learn self-amusement
2. Enroll the infant in an infant-play group
3. Meet the physical needs and cuddle and comfort
4. Show the mother the newborn reflexes

3
1. A new mother asks the RN how best to
encourage development of social skills in her
newborn. Which should the RNs reply include
based on Eriksons Theory of Psychosocial
Development?

• Allow the baby to learn self-amusement
• Enroll the infant in an infant-play group
• Meet the physical needs and cuddle and comfort
• Show the mother the newborn reflexes

C. In the Trust vs Mistrust stage, meeting the
childs needs develops trust and prepares the
infant for progression to higher levels of
psychosocial development.
4
2. A 6-month-old infant is brought to the
well-baby clinic weighing 9 pounds, 2 ounces.
The babys birth weight was 5 pounds, 15 ounces.
What is the correct analysis of the data?
A. Baby is gaining less weight than expected B.
Baby is gaining weight at an expected rate C.
Baby is a candidate for overfeeding D. Baby is
a candidate for failure to thrive
5
2. A 6-month-old infant is brought to the
well-baby clinic weighing 9 pounds, 2 ounces.
The babys birth weight was 5 pounds, 15 ounces.
What is the correct analysis of the data?
A. Baby is gaining less weight than expected B.
Baby is gaining weight at an expected rate C.
Baby is a candidate for overfeeding D. Baby is
a candidate for failure to thrive
A. Normal weight gain is approximately 1½ pounds
per month up to 6 months of age.
6
3. Which statement from the parent of a
6-month-old child would be of concern to the
nurse?

• A. We still have to provide support when the
  baby is sitting up.
• Im giving the baby rice cereal at bedtime.
• Im so glad the soft spot on the top of the head
  is gone.
• The baby has two lower front teeth.
  
  
  

7
3. Which statement from the parent of a
6-month-old child would be of concern to the
nurse?

• A. We still have to provide support when the
  baby is sitting up.
• Im giving the baby rice cereal at bedtime.
• Im so glad the soft spot on the top of the head
  is gone.
• The baby has two lower front teeth.

C. The anterior fontanel normally does not close
completely until 12 to 18 months of age. The
posterior fontanel closes approx. 6 to 8 weeks
after birth. The other choices indicate normal
developmental patterns.
8
4. Which behaviors indicate the infant is ready
to wean from breastfeeding to a cup?

1. Taking pureed foods from a spoon
2. Sleeping 8 hours during the night
3. Decreasing nursing time
4. Breastfeeding on a regular schedule

9
4. Which behaviors indicate the infant is ready
to wean from breastfeeding to a cup?

• Taking pureed foods from a spoon
• Sleeping 8 hours during the night
• Decreasing nursing time
• Breastfeeding on a regular schedule

C. When the infant decreases time spent nursing,
it indicates increasing independence and probably
readiness to wean. The other behaviors may also
be present, but they are not necessarily evidence
of readiness to wean.
10
5. The nurse educates parents of a healthy
6-month-old infant about ways to stimulate
language development. Select the most effective
approach.

• A. Suggest the parents talk regularly to the
  baby
• Have the parents keep the radio turned on next to
  the babys playpen
• Encourage the parents to play CDs of various
  childrens songs during the day
• Urge the parents to schedule an evaluation of the
  infant by a speech therapist
  
  
  

11
5. The nurse educates parents of a healthy
6-month-old infant about ways to stimulate
language development. Select the most effective
approach.

• A. Suggest the parents talk regularly to the
  baby
• Have the parents keep the radio turned on next to
  the babys playpen
• Encourage the parents to play CDs of various
  childrens songs during the day
• Urge the parents to schedule an evaluation of the
  infant by a speech therapist

A. Listening to how words are expressed by the
parents and other caregivers, greatly influences
the infants language development. Parents have
familiar voices and are up close and personal
with the infant on a regular basis.
12
6. A two month old infant is admitted to the
Pediatric ICU with vomiting and drowsiness. A
few minutes after admission, the child has a
tonic-clonic seizure. Fontanels are bulging and
a right retinal hemorrhage is noted. The CT scan
shows subdural hemorrhage. Which intervention
has priority?

1. Report findings to social services
2. Institute seizure precautions
3. Confront the parents about recent disciplinary
   actions
4. Role model speaking softly to the child and
   handling the child gently

13
6. A two month old infant is admitted to the
Pediatric ICU with vomiting and drowsiness. A
few minutes after admission, the child has a
tonic-clonic seizure. Fontanels are bulging and
a right retinal hemorrhage is noted. The CT scan
shows subdural hemorrhage. Which intervention
has priority?

• Report findings to social services
• Institute seizure precautions
• Confront the parents about recent disciplinary
  actions
• Role model speaking softly to the child and
  handling the child gently

• A. These symptoms are very suspicious for child
  abuse (shaken baby syndrome). The other choices
  will be appropriate at some point but are not the
  priority at this time.

14
7. An 8-month-old infant is to be catheterized
to obtain a sterile specimen. Which response by
the nurse is most appropriate when the infant's
mother expresses concern that the procedure could
traumatize the infant psychologically?
A. The procedure may be somewhat uncomfortable,
but it should not have any lasting traumatic
effect. B. You are right to be concerned. I
will obtain the urine by 'clean-catch' rather
than do a catheterization. C. Your concerns
are unrealistic, but you do have the right to
refuse catheterization. D. Your worries are
appropriate, but the need for a sterile urine
specimen is more important at this time.
15
7. An 8-month-old infant is to be catheterized
to obtain a sterile specimen. Which response by
the nurse is most appropriate when the infant's
mother expresses concern that the procedure could
traumatize the infant psychologically?
A. The procedure may be somewhat uncomfortable,
but it should not have any lasting traumatic
effect. B. You are right to be concerned. I
will obtain the urine by 'clean-catch' rather
than do a catheterization. C. Your concerns
are unrealistic, but you do have the right to
refuse catheterization. D. Your worries are
appropriate, but the need for a sterile urine
specimen is more important at this time.
A. Although the procedure may cause some
discomfort in the child, the mother's concerns
are unrealistic. Procedures such as
catheterizations have not been shown to have any
long term negative effects.
16
8. In strict monitoring of an infant's output,
which intervention is best for the nurse to use?

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

17
8. In strict monitoring of an infant's output,
which intervention is best for the nurse to use?

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

B. Weighing the diapers will provide the most
accurate output measurement.
18
9. Which developmental parameter would the nurse
consider important when making a room assignment
for a 10-month-old child?

1. Regression is a normal response
2. Will want to be with other infants about the same
   age
3. May have underlying fear of body mutilation
4. Primary caretaker is important

19
9. Which developmental parameter would the nurse
consider important when making a room assignment
for a 10-month-old child?

• Regression is a normal response
• Will want to be with other infants about the same
  age
• May have underlying fear of body mutilation
• Primary caretaker is important

• D. The primary care giver is most important to a
  10-month-old. Regression is normal in toddlers.
  Older school-aged children and adolescents are
  concerned about being with peers and preschoolers
  fear mutilation.

20
10. What statement by the parent would indicate
more teaching was needed about bottle feeding?

• Putting my baby to bed with a bottle makes
  bedtime easier.
• I am beginning to wean my 11-month-old baby to a
  cup.
• I should use a cup instead of a bottle for
  juice.
• When I use a pacifier, it should never have
  anything sweet on it.

21
10. What statement by the parent would indicate
more teaching was needed about bottle feeding?

• Putting my baby to bed with a bottle makes
  bedtime easier.
• I am beginning to wean my 11-month-old baby to a
  cup.
• I should use a cup instead of a bottle for
  juice.
• When I use a pacifier, it should never have
  anything sweet on it.

• A. Putting a baby to bed with a bottle may
  contribute to bottle mouth caries.

22
11. An adolescent mother is observed interacting
with her infant the day before discharge. The
infant was admitted with poor weight gain and
diagnosed with nonorganic failure to thrive.
Which indicates the family needs close follow-up
after discharge?

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

23
11. An adolescent mother is observed interacting
with her infant the day before discharge. The
infant was admitted with poor weight gain and
diagnosed with nonorganic failure to thrive.
Which indicates the family needs close follow-up
after discharge?

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

• C. Feedings should not be structured. The other
  choices are appropriate for infant care.

24
12. What would the nurse advise parents of a
toddler to do when the toddler repeatedly says,
NO to everything?

1. Offer the toddler many choices for every activity
2. Say no to the toddler in response to his no
3. Use time out to extinguish the negativistic
   behavior
4. Reduce opportunities for no answers

25
12. What would the nurse advise parents of a
toddler to do when the toddler repeatedly says,
NO to everything?

• Offer the toddler many choices for every activity
• Say no to the toddler in response to his no
• Use time out to extinguish the negativistic
  behavior
• Reduce opportunities for no answers

• D. Negativism is normal in toddlers. Suggest
  the parent offer two appropriate choices such Do
  you want to wear the blue or pink pajamas?, not
  Do you want to go to bed now?

26
13. Which finding during the well-child visit of
a 2-year-old would require further evaluation?

1. Lordosis
2. Broad-based gait
3. Unilateral bowleg
4. Fused anterior fontanel

27
13. Which finding during the well-child visit of
a 2-year-old would require further evaluation?

• Lordosis
• Broad-based gait
• Unilateral bowleg
• Fused anterior fontanel

• C. Asymmetry of body parts is usually a sign of
  a problem. The other findings are normal.

28
14. What normal behavioral characteristic of a 2
1/2-year-old child presents the greatest
potential for injury?

1. Engaging in parallel play
2. Adhering to rituals
3. Exploring the environment
4. Throwing a temper tantrum

29
14. What normal behavioral characteristic of a 2
1/2-year-old child presents the greatest
potential for injury?

• Engaging in parallel play
• Adhering to rituals
• Exploring the environment
• Throwing a temper tantrum

• C. Left unsupervised, toddlers will get into
  things where they can get hurt due to their
  normal curiosity.

30
15. A parent states the 2-year-old child doesnt
seem to want to eat much anymore. How can the
nurse best respond?

1. The brain is developing and so the child must be
   made to eat high quality protein foods.
2. Try offering small amounts of food frequently
   instead of only 3 meals a day.
3. If the child doesnt want to eat, give milk in a
   bottle to get enough calories.
4. It is normal for the appetite to decrease, but
   make sure the child eats plenty of carbohydrates.

31
15. A parent states the 2-year-old child doesnt
seem to want to eat much anymore. How can the
nurse best respond?

• The brain is developing and so the child must be
  made to eat high quality protein foods.
• Try offering small amounts of food frequently
  instead of only 3 meals a day.
• If the child doesnt want to eat, give milk in a
  bottle to get enough calories.
• It is normal for the appetite to decrease, but
  make sure the child eats plenty of
  carbohydrates.

• B. Frequent small meals will provide for
  nutritional needs. The majority of calories
  should come from solid foods with plenty of
  protein, but do not force a child to eat.

32
16. Which statement best describes a toddlers
play preferences?

1. Likes to play with games that have rules.
2. Shares toys and plays cooperatively most of the
   time
3. Imitates observed adult behaviors
4. Can paint and draw independently

33
16. Which statement best describes a toddlers
play preferences?

• Likes to play with games that have rules.
• Shares toys and plays cooperatively most of the
  time
• Imitates observed adult behaviors
• Can paint and draw independently

• C. Likes to imitate observed adult behavior such
  as cooking, cleaning, or lawn mowing. Play is
  mostly solitary and sees all toys as mine. Can
  not yet play games, paint, or draw well.

34
17. The most common dislocation injury in
children from 1 to 4 years of age is dislocation
of the head of the radius. To prevent this
injury, parents should be advised to avoid which
situation?

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

35
17. The most common dislocation injury in
children from 1 to 4 years of age is dislocation
of the head of the radius. To prevent this
injury, parents should be advised to avoid which
situation?

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

A. The cause of the subluxation of the head of
the radius in the elbow is jerking the child
upward while the arm is in an extended position
36
18. In discussing dental health with parents of a
toddler, which activity would the nurse encourage?
A. You may use a finger wrapped in gauze to
clean the teeth more thoroughly. B. The first
dental visit should be scheduled about a year
after all 20 primary teeth have erupted. C.
Encourage your child to brush teeth twice daily
to optimize cleaning. D. You will need to do
the flossing to remove debris from between the
childs teeth.
37
18. In discussing dental health with parents of a
toddler, which activity would the nurse encourage?
A. You may use a finger wrapped in gauze to
clean the teeth more thoroughly. B. The first
dental visit should be scheduled about a year
after all 20 primary teeth have erupted. C.
Encourage your child to brush teeth twice daily
to optimize cleaning. D. You will need to do
the flossing to remove debris from between the
childs teeth.
D. Parents should be directly involved in both
the brushing and flossing of the childs teeth.
A dental visit is recommended after the first
teeth erupt, or about one year of age.
38
19. The parent of a toddler asks the nurse about
the best way to discipline the child at this age
when misbehavior occurs. What is the best
response?

1. Put the child in bed for a nap.
2. Scold the child for the behavior.
3. Offer the child candy to stop the behavior.
4. Say NO and move the child to another activity.

39
19. The parent of a toddler asks the nurse about
the best way to discipline the child at this age
when misbehavior occurs. What is the best
response?

• Put the child in bed for a nap.
• Scold the child for the behavior.
• Offer the child candy to stop the behavior.
• Say NO and move the child to another activity.

• D. Consistently reinforcing rules helps the
  child understand the rules. Changing activities
  neither rewards nor reinforces the negative
  behavior.

40
20. A 3-year-old child is off the unit having a
chest X-ray when the parents approach the nurse
and say, Were leaving for the night now.
Identify the best nursing response.

1. Good night well see you tomorrow.
2. Please wait to tell your child good-bye before
   you leave.
3. Go ahead and leave Im sure your child wont
   mind.
4. Ill tell your child you had to leave.

41
20. A 3-year-old child is off the unit having a
chest X-ray when the parents approach the nurse
and say, Were leaving for the night now.
Identify the best nursing response.

• Good night well see you tomorrow.
• Please wait to tell your child good-bye before
  you leave.
• Go ahead and leave Im sure your child wont
  mind.
• Ill tell your child you had to leave.

• B. Separation anxiety often occurs in this age
  group. This may be seen as abandonment by the
  child. This encourages teaching to the parents.
  A, C and D ignore the client problem and C is
  untruthful.

42
21. What would be an example of behavior seen
when a 3-year-old child, hospitalized due to an
accident, regresses?

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

43
21. What would be an example of behavior seen
when a 3-year-old child, hospitalized due to an
accident, regresses?

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

B. Regression is returning to an earlier form of
behavior for feelings of safety and security.
44
22. How would the RN best intervene when a
2-year-old is having a temper tantrum?

1. Firmly reason with the child
2. Ignore the childs behavior
3. Threaten the child with punishment
4. Move the child to a private area

45
22. How would the RN best intervene when a
2-year-old is having a temper tantrum?

• Firmly reason with the child
• Ignore the childs behavior
• Threaten the child with punishment
• Move the child to a private area

• B. Reasoning and threatening are not appropriate
  because the child isnt able to listen during a
  tantrum. Moving the child might cause injury.

46
23. A 2-year-old client is admitted to the
pediatric unit with a fractured femur. When
interviewing the parent, which statement by the
parent would serve as a signal for further
suspicion of child abuse?

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

47
23. A 2-year-old client is admitted to the
pediatric unit with a fractured femur. When
interviewing the parent, which statement by the
parent would serve as a signal for further
suspicion of child abuse?

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

A. A "special" child is often selected in a
family as an object to be abused, with the
"something different" increasing the child's
vulnerability.
48
24. What is the emergency department nurses best
statement to a child who is suspected of being
abused and will not speak?

• A. The nurses and doctors are all here to help
  you.
• You need to face what has happened and talk
  about it.
• Coming to the emergency department can be scary.
  Maybe in a little while we can talk.
• Im right here with you and promise I wont
  leave anytime soon.
  
  
  

49
24. What is the emergency department nurses best
statement to a child who is suspected of being
abused and will not speak?

• A. The nurses and doctors are all here to help
  you.
• You need to face what has happened and talk
  about it.
• Coming to the emergency department can be scary.
  Maybe in a little while we can talk.
• Im right here with you and promise I wont
  leave anytime soon.

C. This acknowledges feelings the child may be
experiencing, without making promises the nurse
may not be able to keep (choice D).
50
25. While evaluating a school-age child, the
school nurse begins to suspect sexual abuse at
home. Which behavior would make the nurse
suspect abuse?

1. Plays with peers of the same sex and ignores the
   opposite sex
2. Discusses sexual matters and displays seductive
   mannerisms
3. Displays curiosity about reproduction with other
   students
4. Daydreams in class but gets assignments completed
   on time

51
25. While evaluating a school-age child, the
school nurse begins to suspect sexual abuse at
home. Which behavior would make the nurse
suspect abuse?

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

• B. This is a defense mechanism and the child is
  really displaying adult behavior.

52
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
• Give child a glass of lemon juice to drink
• Take child to the pediatrician immediately
• Take child to the hospital immediately

53
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
• Give child a glass of lemon juice to drink
• Take child to the pediatrician immediately
• 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.
54
27. Which symptom would indicate poisoning by
hydrocarbon ingestion?

1. Symptoms of shock
2. Gastrointestinal symptoms
3. Hepatic failure
4. Respiratory distress

55
27. Which symptom would indicate poisoning by
hydrocarbon ingestion?

• Symptoms of shock
• Gastrointestinal symptoms
• Hepatic failure
• 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.

56
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?

1. Elevated serum bilirubin
2. Decreased blood urea nitrogen
3. Elevated white blood cell count
4. Decreased serum calcium

57
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?

• Elevated serum bilirubin
• Decreased blood urea nitrogen
• Elevated white blood cell count
• Decreased serum calcium

• A. Acetaminophen (Tylenol) is lethal to the
  liver and will cause an elevation of the
  bilirubin and liver enzymes.

58
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
• Educate parents regarding safe storage of the
  family supply of aspirin
• Comfort and reassure child after treatment
• Discuss methods for disciplining the child

59
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
• Educate parents regarding safe storage of the
  family supply of aspirin
• Comfort and reassure child after treatment
• 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.
60
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
61
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
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.
62
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
• The child is displaying intuitive reasoning
  typical for the age
• There is a developmental delay in the childs
  intellectual processes
• The parents are allowing the child to stay up too
  late for adequate sleep

63
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
• The child is displaying intuitive reasoning
  typical for the age
• There is a developmental delay in the childs
  intellectual processes
• 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.
64
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?

1. Children at this age act negatively for no
   reason. Just ignore the stuttering.
2. Your child will need speech therapy, but its
   more successful with older children.
3. Do either of you stutter? Its often
   inherited.
4. Stuttering is common at this age. We can
   evaluate later if it continues.

65
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?

• Children at this age act negatively for no
  reason. Just ignore the stuttering.
• Your child will need speech therapy, but its
  more successful with older children.
• Do either of you stutter? Its often
  inherited.
• 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.

66
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
67
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. 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.
68
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
• Resting apical pulse rate of 100 beats per minute
• Abdominal movement with respirations
• Standing position is bowlegged (genu varum)
  
  
  

69
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
• Resting apical pulse rate of 100 beats per minute
• Abdominal movement with respirations
• 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.
70
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
• Tie shoelaces
• Part and comb hair
• Cut the meat at dinner
  
  
  

71
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
• Tie shoelaces
• Part and comb hair
• 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.
72
36. What statement would most accurately describe
the pre-school child?

1. Will play games but does not like to follow rules
2. Does not like acting or role playing yet
3. Plays only with others of the same sex
4. Has a strong desire to win and will cheat to do so

73
36. What statement would most accurately describe
the pre-school child?

• Will play games but does not like to follow rules
• Does not like acting or role playing yet
• Plays only with others of the same sex
• 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.

74
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, Ill talk about how to deal with
  strangers.
• Its okay to use regular car seat belts with
  most children once they reach age eight or nine.
• The desire to explore is strong in young
  children, and consequently accidents are common.
• I need to be especially watchful when my child
  is playing outdoors by the pool.
  
  
  

75
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, Ill talk about how to deal with
  strangers.
• Its okay to use regular car seat belts with
  most children once they reach age eight or nine.
• The desire to explore is strong in young
  children, and consequently accidents are common.
• 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.
76
38. A student nurse is preparing to teach first
graders about safety after school. Which of
these is not appropriate to teach?

1. If the parents are not home, tell the caller the
   parents are busy and will call back later
2. If a severe storm comes up and you are home
   alone, go to the basement
3. If you are going to warm up a snack, the
   microwave is safest
4. Always lock the door when you are home alone

77
38. A student nurse is preparing to teach first
graders about safety after school. Which of
these is not appropriate to teach?

• If parents are not home, tell the caller the
  parents are busy and will call back later
• If a severe storm comes up and you are home
  alone, go to the basement
• If you are going to warm up a snack, the
  microwave is safest
• 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.

78
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
• Crying uncontrollably the entire time the parents
  are absent
• Cooperation with the nursing staff in the
  parents' absence
• Inability to play with other children while their
  parents are present
  
  
  
  

79
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
• Crying uncontrollably the entire time the parents
  are absent
• Cooperation with the nursing staff in the
  parents' absence
• 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.
80
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?

1. 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
2. Utilize the numeric Pain Scale and plan on giving
   2.3 mg of morphine
3. Encourage the parent to let the nurse know when
   the child is in pain and then give 1.9 mg. of
   morphine
4. 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

81
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?

• 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
• Utilize the numeric Pain Scale and plan on giving
  2.3 mg of morphine
• Encourage the parent to let the nurse know when
  the child is in pain and then give 1.9 mg. of
  morphine
• 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.

82
41. Using Piagets theory, what task does the
nurse expect of the normal 10-year-old child?

1. Asks simple hypothetical questions and explores
   possible solutions
2. Makes up complicated games with imaginary friends
3. Enjoys toys with bright colors and moving parts
4. Establishes beginning reading skills appropriate
   for age level

83
41. Using Piagets theory, what task does the
nurse expect of the normal 10-year-old child?

• Asks simple hypothetical questions and explores
  possible solutions
• Makes up complicated games with imaginary friends
• Enjoys toys with bright colors and moving parts
• Establishes beginning reading skills appropriate
  for age level

• A. The developmental task for this age is
  inductive reasoning and beginning logic.

84
42. The nurse is assessing the skill level of a
7-year-old child. Which area would not yet be
fully developed?

1. Accurately reads time on a clock
2. Can explain meaning of abstract concepts
3. Is able to imitate others actions
4. Follows basic rules of conduct

85
42. The nurse is assessing the skill level of a
7-year-old child. Which area would not yet be
fully developed?

• Accurately reads time on a clock
• Can explain meaning of abstract concepts
• Is able to imitate others actions
• 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.

86
43. Which toy would the nurse consider
appropriate for a 6-year-old client in a spica
cast?

• Deck of playing cards
• Game of checkers
• Set of building blocks
• Coloring book and crayons

87
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

D. The coloring book and crayons would be the
best option, considering the age of the client
and the limitation in mobility.
88
44. Which would most likely be a risk factor for
drug/alcohol experimentation in the school-age
child?

1. Disturbed parent/child attachment related to
   parental terminal illness
2. Self-esteem disturbance related to delayed onset
   of puberty
3. Impaired social interaction related to chronic
   illness with frequent hospitalization
4. Disturbed family coping related to parental
   substance abuse

89
44. Which would most likely be a risk factor for
drug/alcohol experimentation in the school-age
child?

• Disturbed parent/child attachment related to
  parental terminal illness
• Self-esteem disturbance related to delayed onset
  of puberty
• Impaired social interaction related to chronic
  illness with frequent hospitalization
• 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.

90
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?

1. Use a drawing to show where the defect is located
   and how it will be repaired
2. Use a doll and show where the incision and the
   tubes will be placed during surgery
3. Take the client to the operating room for a visit
4. Let the client visit with someone of the same age
   who has had the surgery

91
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?

• Use a drawing to show where the defect is located
  and how it will be repaired
• Use a doll and show where the incision and the
  tubes will be placed during surgery
• Take the client to the operating room for a visit
• 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.

92
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.
93
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.
D. This is the most honest, yet reassuring
response.
94
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
• Interpersonal isolation
• Resistance to all parental orders
• Use of drugs and alcohol
  
  
  

95
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
• Interpersonal isolation
• Resistance to all parental orders
• 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.
96
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.
97
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.
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.
98
49. What behaviors indicate that adolescents are
becoming more adult-like physically and
emotionally?

1. Have slow, steady gain of height and weight
2. Spend time hanging out with members of both
   sexes
3. May be weak and awkward when playing sports
4. Daily need for calories is reduced from 3500

99
49. What behaviors indicate that adolescents are
becoming more adult-like physically and
emotionally?

• Have slow, steady gain of height and weight
• Spend time hanging out with members of both
  sexes
• May be weak and awkward when playing sports
• 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.

100
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?

1. Send the child to a BRAT camp
2. Encourage open discussion and mutually
   established goals
3. Set arbitrary rules and enforce them consistently
4. Schedule a family counseling session

101
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?

• Send the child to a BRAT camp
• Encourage open discussion and mutually
  established goals
• Set arbitrary rules and enforce them consistently
• 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.

102
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.

1. Family support and attention
2. Adolescents abstract reasoning ability
3. Reactions of adolescents peer group
4. Nurses ability to empathize with the adolescent

103
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.

• Family support and attention
• Adolescents abstract reasoning ability
• Reactions of adolescents peer group
• Nurses ability to empathize with the adolescent

• C. Peers are the norming group against which the
  adolescent gauges personal behavior.

104
52. Identify the activity that indicates that a
young adult has successfully achieved an
age-appropriate developmental task.

• A. Has attained socioeconomic consolidation
• Is concerned that taking prescription medications
  alters body image
• Established a long-term loving relationship with
  one other individual
• Actively interacted with classmates from high
  school
  
  
  

105
52. Identify the activity that indicates that a
young adult has successfully achieved an
age-appropriate developmental task.

• A. Has attained socioeconomic consolidation
• Is concerned that taking prescription medications
  alters body image
• Established a long-term loving relationship with
  one other individual
• Actively interacted with classmates from high
  school
  
  
  

C. One of Eriksons task for the young adult is
intimacy vs. isolation and involves a shift of
relationship from the group to one individual.
106
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?

1. Autonomy vs Shame and Doubt
2. Ego Integrity vs Despair
3. Intimacy vs Isolation
4. Identity vs Role Confusion

107
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?

• Autonomy vs Shame and Doubt
• Ego Integrity vs Despair
• Intimacy vs Isolation
• 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.

108
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.
• I have recently, finally, achieved economic
  independence for myself.
• I think I have done a pretty good job with my
  children now that they are off on their own.

109
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.
• I have recently, finally, achieved economic
  independence for myself.
• 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.
110
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
• Presence of gynecomastia
• Biceps reflex 1 bilaterally
• Anteroposterior-to-transverse thoracic diameter
  equal
  
  
  

111
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
• Presence of gynecomastia
• Biceps reflex 1 bilaterally
• 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.
112
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?

1. Serum calcium levels are decreased
2. Diet is deficient in Vitamin B6 and folate
3. Client has family history of osteoporosis
4. The nurse notes dorsal kyphosis and loss of height

113
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?

• Serum calcium levels are decreased
• Diet is deficient in Vitamin B6 and folate
• Client has family history of osteoporosis
• 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 wh