Chapter 20: Caring for the Developing Child Nursing School Test Banks

Chapter 20: Caring for the Developing Child

MULTIPLE CHOICE

1. The pediatric nurse explains to a new mother that two factors, nature and nurture, may influence the formation of her childs essence. Which factor among the following would be considered nature?
A. Cultural aspects
B. Parenting skills
C. The era in which the child develops
D. Traits inherent in the infant
ANS: D
Nature describes the traits inherent in the infantbiologically imposed idiosyncratic factors that create what and how each person is. Nurture, on the other hand, refers to the influence of external events like parenting received, culture, or the times in which a child lives.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

2. The pediatric nurse teaches the parents of a 3-month-old baby the principles of growth and development that will occur in their childs lifetime. Which statement accurately describes one of these principles?
A. Each child progresses through predictable stages within a predictable timeframe.
B. Growth and development begin in infancy and continue until the adult years.
C. Growth refers to the ongoing process of adapting throughout the life span.
D. Within each child, body systems develop at the same rate.
ANS: A
Growth refers to the continuous adjustment in the size of the child internally and externally. Development, on the other hand, refers to the ongoing process of adapting throughout the life span. Growth and development are continuous processes from conception to death. Although development advances in an orderly sequence, each child progresses through the predictable stages within a predictable timeframe. The established guidelines are only guidelines that have been developed through observation over time, and within each individual body systems develop at differing rates.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

3. A pediatric nurse works with the family of twins at designated stages in their lives to help the parents anticipate and move through the periods of disequilibrium. What is the model of child development that focuses on disruptive periods of development?
A. Bowlbys attachment theory of development
B. Brazeltons touchpoints model of development
C. Eriksons stages of development
D. Freuds stages of psychosexual development
ANS: B
Brazelton described touchpoints as periods during the first 3 years of life during which childrens spurts in development resulted in pronounced disruption in the family system. The touchpoints perspective assumes, among other things, that parents know their children better than they know anyone else, and with that in mind, the nurse works with the family at the various touchpoints to help them anticipate and move through the periods of disequilibrium. Bowlby focuses on the impact of separation from mothers seen in infants. Ericksons theory focuses on the influence of social interaction on development. Freuds theory regards the impact of psychosexual instincts as most important in development.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

4. During a well-child visit, the pediatric nurse assesses a 2-year-old child for language development. Which developmental domain is the nurse assessing?
A. Cognitive
B. Family development
C. Moral/spiritual
D. Psychosocial
ANS: A
Developmental domain refers to a way of understanding the total child in relation to the mind, body, and spirit. These domains include: physical, psychosocial (emotional, psychological, and social), cognitive (including language and intelligence), moral/spiritual, and family development.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

5. A mother takes her 10-year-old son to the pediatrician for a sprained wrist. During the medical history, the pediatric nurse listens to the mother describe her son as busy playing basketball all day long with the other boys in the neighborhood. Based on the nurses assessment, which stage of Freuds psychosocial development is this child experiencing?
A. Anal stage
B. Genital stage
C. Latency stage
D. Phallic stage
ANS: C
In the latency stage (6 to 12 years) Freud believed that the child takes a break psychosexually. This allows the child to focus more intently on other aspects of growth and learning, such as spending time with same-gender friends or excelling in sports or video games. At this age, the child presumably has little interest in issues of sexuality. The oral stage occurs from birth to 1 year, and the infant is fascinated with oral curiosity. The genital stage occurs between 12 and 18, and sexuality and relationships are the focus. The phallic stage occurs from 3 to 6 years, during which sexual differences are discovered.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

6. A pediatric nurse examines a 7-year-old at a well-child visit. Based on Eriksons theory, which basic task does the nurse anticipate for this child?
A. Balance independence and self-sufficiency against uncertainty and misgiving.
B. Develop a sense of confidence through mastery of different tasks.
C. Develop resourcefulness to achieve and learn new things without self-reproach.
D. Recognize there are people in his or her life who can be trusted to take care of basic needs.
ANS: B
In the trust vs. mistrust stage (birth to 1 year), the task is for the child to recognize that there are people in his or her life (parents) who can be trusted to take care of his or her basic needs. In the autonomy vs. shame and doubt stage (1 to 3 years), the task is for the child to balance independence and self-sufficiency against the predictable sense of uncertainty and misgiving when placed in lifes situations. In the initiative vs. guilt stage (3 to 6 years), the childs task is to develop resourcefulness to achieve and learn new things without receiving self-reproach. In the accomplishment/industry vs. inferiority stage (6 to 12 years), the child develops a sense of confidence through mastery of tasks.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

7. A 15-year-old adolescent tells the school nurse that he is busy preparing for a forensics competition and would like to be a lawyer one day. According to Piagets stages of development, the adolescent is in which stage of cognitive development?
A. Concrete operational stage
B. Formal operational stage
C. Preoperational stage
D. Sensorimotor stage
ANS: B
Piagets final stage of cognitive development is the formal operational stage, during which the 11- to 15-year-old child uses abstract reasoning to handle difficult concepts and to analyze both sides of an issue. In the concrete operational stage, the 7- to 11-year-old child is much more able to organize thought in a logical order. The child is able to categorize and label objects. It is also possible at this stage for the child to solve concrete problems. In the preoperational stage, the child is still not capable of logical thinking, but due to an increased ability to use words and actions together, the child is increasingly able to connect cognitively with the world. The sensorimotor stage is the initial stage, from birth to age 2, in which primary cognition takes place through the senses.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

8. A 7-year-old hospitalized for a fracture following a car crash tells the pediatric nurse God is in heaven with his angels and is looking down on me. Which stage of Fowlers spiritual development is this child exhibiting?
A. Intuitive-projective stage
B. Mythical-literal stage
C. Synthetic-convention stage
D. Undifferentiated stage
ANS: B
In stage 0undifferentiated (infancy)the infant is learning a fund of basic trust and the relational experience of mutuality with the one(s) providing primary love and care. In stage 1intuitive-projective (ages 2 to 6 or 7)beliefs and faith are unquestioning. It is a time of fantasy and magical thinking. In stage 2mythical-literal (ages 6 to 11)the child retells the spiritual stories and takes them literally and concretely. In stage 3synthetic-convention (typically begins around 12 or 13 years)the young person begins to personalize beliefs.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

9. A young couple brings their 20-month-old daughter to the pediatricians office for immunizations. The mother tells the nurse that she is going back to work and is looking for a day-care center in the vicinity of the clinic. What assessment is priority before recommending a day-care center that would help the parent and child adapt to the experience?
A. Available financial assets
B. Available support people
C. Potty-training status
D. The childs temperament
ANS: D
During a normal daily routine, the child may be exposed to a variety of settings and to several people in a day-care center or while visiting extended family, visiting a physicians office, or in public places in the community. Understanding an infants temperament is essential in the care of the child to help both the parent and child adapt to these experiences. Although the other options are certainly considerations, they are not nearly as important as assessing the childs temperament.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

10. The pediatric nurse is examining a newborn infant and notes a turning in of the foot and turning out of the toes when the sole of the foot is stroked. Which action by the nurse is most appropriate?
A. Arrange a consultation with a developmental specialist.
B. Assess the parents family histories for genetic defects.
C. Document the findings in the patients chart.
D. Instruct the parents on required follow-up care.
ANS: C
The newborn is exhibiting the Babinski reflex, one of the normal primitive reflexes that should disappear by 9 months of age. Documentation is all that is required.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS: 1

11. A mother has brought her 3-year-old child in to the clinic over concern about the childs lack of development in the last 3 months. Which information is the most appropriate for the nurse to provide to this mother?
A. Children should continue their growth and development uninterrupted.
B. Periods of growth and development are often followed by periods of rest.
C. There is no need for concern unless no changes are seen for 1 year.
D. A 3-year-old often does not exhibit changes in growth and development.
ANS: B
Periods of growth and development are often followed by a period of rest. The periods of rest allow the child to incorporate the new growth or the newly developed skill into his or her personal repertoire more completely before attempting the next level. The other statements are in accurate.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

12. A student nurse asks a pediatric nurse what cephalocaudal development means. Which response by the nurse is most accurate?
A. Growth that occurs from bottom to top
B. Growth that occurs from midline outward
C. Growth that occurs from outside to midline
D. Growth that occurs from top to bottom
ANS: D
Growth in infants occurs in a cephalocaudal direction, that is, from head to toe (top to bottom). Growth that occurs from midline outward is termed proximodistal. Growth does not occur from bottom to top or from the periphery to the midline.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

13. A parent is frustrated that her toddler cannot button a shirt on his own. Which teaching point is most appropriate for the nurse to provide to this parent?
A. A toddler is incapable of buttoning his own shirt, and the parent should stop pushing.
B. Developing large muscle groups has to occur before developing small muscle groups.
C. The parent should select toys and games that will help the child develop and master this skill.
D. The child has not met a major milestone and needs a developmental consultation.
ANS: B
A concept in development is that gross motor skills must be developed first and used as the foundation for fine motor skills. The larger muscle groups develop first. Buttoning a shirt requires fine motor skills that this child has not yet mastered. It is too early to expect this activity from the child. Telling the parent to stop pushing the child is disrespectful and does not teach the parent information related to growth and development. Appropriate games and toys can help children with growth and development, but this child is too young to master the skill. The child does not need a developmental consultation.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

14. A nurse observes several preschool-aged children during play and overhears one of them say My mommy wont let me do that. What conclusion is the most appropriate by the nurse regarding this childs development?
A. The child has developed a superego according to Freud.
B. The child has mastered Banduras concept of self-mastery.
C. The child is behind in moral reasoning and development.
D. The child is in Eriksons autonomy versus shame and doubt phase.
ANS: A
According to Freud, between the ages of 3 and 6, children begin to develop a superego, which serves to regulate behavior. The child who knows there are limits to behavior is demonstrating this development. Banduras concept of self-mastery occurs due to the influence of several factors. This child is too young to have developed this. According to Erikson, the stage of autonomy versus shame and doubt typically occurs between the ages of 1 and 3. The child is also too young to have mastered the tasks involved in moral reasoning, and so one cannot say he is behind.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

15. A parent is frustrated that her toddler wants to do everything on his own and in my way. The parent wants to know the appropriate way to discipline the child for not obeying and allowing the parent to dress him quickly in the morning. Which response by the nurse is most appropriate?
A. At this stage in life, discipline is not very effective and will frustrate you both more.
B. I know its frustrating, but being independent is a very important job at this age.
C. Put him in a time-out, and because he is 2 years old, have him in time-out for 2 minutes.
D. You really need to allow your child to be independent as much as possible.
ANS: B
According to Eriksons theory, between 1 and 3 years of age, children are in the stage of autonomy versus shame and doubt. It is the time for the child to establish willpower, determination, and a can-do attitude about self. Discipline can be effective at this age. The parent should not be instructed to put the child in time-out for developmentally appropriate behavior. Simply telling the parent she should let the child be independent does nothing to reduce frustration, as the parent does not know the rationale behind it.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

16. A 10-year-old child who has been hospitalized frequently and for long periods of time has the nursing diagnosis of delayed growth and development. Which action by the child would demonstrate that outcomes for this diagnosis have been met?
A. Able to play harmoniously with peers
B. Does own homework independently
C. Seeks out parental approval for activities
D. Selects age-appropriate games and toys
ANS: B
A 10-year-old child is in the Erikson stage of industry versus inferiority. Mastery of tasks leads to self-confidence. Industry is apparent when the child feels capable of doing homework or other assigned tasks independently. This shows resolution of the nursing diagnosis, as appropriate developmental tasks have been accomplished. The other actions do not show resolution of this task.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Evaluation
Difficulty: Moderate

PTS: 1

17. A hospitalized 11-year-old child turns down opportunities to play or engage in diversionary activities. When questioned, the child states Im bad at that or I cant do anything. What action by the nurse is best?
A. Arrange a pediatric psychology consultation.
B. Assess the child for emotional abuse at home.
C. Consult the child developmental specialist.
D. Document the statements in the childs chart.
ANS: C
This 11-year-old child is in the Erikson stage of industry versus inferiority, and it seems he or she has not mastered tasks and developed a sense of self-confidence. Illness can frequently disrupt growth and behavior, and the child developmental specialist is a vital resource in meeting the developmental needs of the hospitalized child. Documentation should always be accurate and thorough, but simply documenting the statements will not help resolve the problem. The child may or may not need a psychology consultation or an abuse assessment, but the focus is on helping the child meet developmental milestones.

Reference: Nursing Care Plan: Delayed Growth and Development
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Intervention
Difficulty: Moderate

PTS: 1

18. A 12-year-old child is in the hospital for an extended period of time. Which action by the nurse would most promote the childs sense of self-esteem?
A. Allow the child to set a daily schedule for activities.
B. Encourage the childs friend to come and visit.
C. Have the child choose food from the menu.
D. Let the parents have unlimited visitation time.
ANS: A
A schedule enhances normalcy, and allowing the child to participate in setting the schedule will help boost self-esteem. The other actions are all good nursing interventions, but giving the child some control and encouraging participation will help self-esteem.

Reference: Nursing Care Plan: Delayed Growth and Development
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Implementation
Difficulty: Easy

PTS: 1

19. A nurse notes that when an infant is startled, she looks at her mother. What conclusion can the nurse make about this infants development?
A. The child is slow to adapt and is distressed over small changes.
B. The developmental needs of the child are not being met.
C. The infant can develop other relationships because he is secure.
D. The infant has an unstable home environment and is insecure.
ANS: C
According to John Bowlbys theory of attachment, the infant becomes attached to the mother as a way to survive the vulnerabilities of infancy. When the attachment is secure, the mother is seen as home base. When the child becomes startled or frightened, he or she will look to the mother for security. Knowing that home base is secure allows the child to go on to develop other relationships. The other statements are not accurate.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Evaluation
Difficulty: Difficult

PTS: 1

20. A nurse is observing infants at a day-care center to determine how their behavior fits into attachment theories. The nurse notes a wide variety of attachment behaviors. What other assessment is appropriate for the nurse to make?
A. Cultural background
B. Fussiness of the babies
C. Time dropped off
D. Time spent in day care
ANS: A
Cultural background plays an important role in behavior, including demonstrations of attachment. Infants will show attachment in a manner consistent with their culture. The nurse should note the cultural background of the observed infants. The other information may be useful, but is not as important in judging attachment as is cultural background.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

21. A nurse is working with a child at a nutrition site. The father is not in the childs life, and the mother has been in and out of jail, resulting in a series of caregivers for the child, who appears malnourished. Using Banduras theory of growth and development, what should the nurse assess as a priority?
A. Bonding
B. Industry
C. School success
D. Self-esteem
ANS: D
According to Bandura, lack of positive modeling leads to poor self-esteem, and the child has no opportunity to master developmental tasks and skills. Bonding, industry, and school success are not directly related to Banduras theory, although correlations can be made.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

22. A nurse has assessed a 14-year-old hospitalized patient over several days and notes that the child has difficulty with abstract concepts and is unable to appreciate diverse points of view. According to Piaget, how would the nurse categorize this childs development?
A. Ahead in development
B. Behind in development
C. Development is normal
D. Not applicable to development
ANS: B
According to Piaget, children age 11 to 15 should be in the formal operational stage, in which they are able to use abstract reasoning and can consider both sides of an issue.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

23. A mother brings her child to the well-child clinic. She is distraught because the child tested well below normal on a school-administered intelligence (IQ) test. Which action by the nurse is the most appropriate?
A. Advise the mother to have the test repeated next year.
B. Assess cultural background and economic status.
C. Facilitate a referral to a developmental specialist.
D. Reassure the mother that IQ tests are often wrong.
ANS: B
Many IQ tests have been criticized for not considering the impact of culture or socioeconomic status. The nurse should assess these factors before proceeding further. Simply reassuring the mother that IQ tests are often wrong does nothing to help her with her concern and sounds paternalistic. That statement could also cause confusion; as the school administered the test, the mother might not believe the nurse.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

24. A couple brings their child to the well-child clinic for guidance in improving the childs school performance. The nurse assesses the child and finds that favorite activities are running, playing basketball, and building models. Which conclusion is most appropriate for the nurse to make based on the assessment findings?
A. Hyperactive and may need medication
B. Learns best through bodily activity
C. Needs firm structure for completing schoolwork
D. Normal activity; school performance will improve with time
ANS: B
According to Howard Gardner, there are eight forms of intelligence: bodily-kinesthetic, interpersonal, intrapersonal, linguistic, logical-mathematical, musical, naturalistic, and spatial. Although children possess all eight forms, they typically develop one to a greater degree. Using this form of intelligence is best to help the child learn. By assessing the childs hobbies and interests, the nurse gains insight into which form a child uses. This child prefers the bodily-kinesthetic form of intelligence, and using bodily motion in learning activities will improve learning. The other answers are not accurate.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

25. A father is frustrated that his child frequently disobeys well-established rules and then attempts to excuse the action by stating Well I just thought . . . . The father asks for guidance with discipline. What information is most appropriate for the nurse to provide?
A. Ensure the child knows the rules.
B. Habitual rule breaking is problematic.
C. This is a normal developmental stage.
D. Time-outs are ineffective for lying.
ANS: C
According to Kohlberg, a child passes through three stages when learning to make moral decisions. In the first (preconventional) stage, a child may not see an action as wrong if he or she can justify the action in his or her mind. The best response by the nurse would be to explain this to the father and help him develop strategies to work with this. Ensuring the child knows the rules is important before inflicting consequences for behavior. Stating that rule breaking is problematic does not help the father deal with the problem. Time-outs can be effective disciplinary strategies.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

26. A nurse educator is presenting developmental theories to a group of students. Which statement encompasses the impact that Carol Gilligan had on developmental theories?
A. Helped define moral development in women as unique from men
B. Described the seven stages of religious/faith development
C. Identified nine temperamental traits present at birth in all children
D. Viewed the status of the familys oldest child as the marker for transition
ANS: A
Carol Gilligans work focused on the differences in moral development in women. The seven stages of faith/religious development was the work of James Fowler. The nine temperamental traits was the work of Thomas, Chess, and Birch. The family development theory that uses the oldest child as the marker for transition within a family is the work of Duvall.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

27. The nurse is providing care to a newborn client and family during a well-baby checkup. Using Duvalls family development theory, which question is most appropriate for the nurse to ask?
A. Do you plan to have more children?
B. How far apart are your closest children?
C. How many children do you have?
D. How old is your oldest child?
ANS: D
Duvalls family development theory uses the oldest child as the marker for transitions within the family. The nurse should inquire about the age of the oldest child. The other questions are not directly related to Duvalls theory.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

28. A nurse is working at a community health-screening event. A woman tells the nurse that her oldest child is leaving home in a month and that this change is making her feel stressed and unneeded. What response by the nurse is the most appropriate?
A. At your age you need to start coping with losses.
B. Lucky you; I cant wait til my kids leave home!
C. This is a great time to refocus on your marriage.
D. Your other children will need help with separating.
ANS: C
According to Duvalls theory of family development, the activities of the oldest child in a family are the marker for family transition. As the oldest child prepares to leave home (family launching young adult stage), the marriage needs to become a major area for focus. This activity starts in the stage in which the oldest child is an adolescent and looking to launch in the future. The role of the older family is to start coping with loss. The statement that the woman is lucky is disrespectful and does not address her needs. Helping children with separation is the task of the family with preschool children.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

29. A mother brings her 1-year-old child to the pediatric clinic and appears frustrated and stressed. During the assessment, the mother states she tries to give her child exposure to new situations and people several times a week, but the outings always end with the child screaming and crying. Which response by the nurse is the most appropriate?
A. Keep trying; new situations are so stimulating for children.
B. Stop taking your child to new places and meeting new people.
C. Use an established routine and add new experiences slowly.
D. Your child will soon become used to such daily activity.
ANS: C
This child displays difficulty with adapting to new situations. The mothers attempts to provide new experiences are antagonizing the childs natural temperament. According to the temperament theory of Thomas, Chess, and Birch, the mother should provide structure with limited variation in this slow-to-adapt childs daily activities.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

30. A mother and 1-year-old child are being seen in the well-child clinic. The mother asks the nurse for guidance in setting an appropriate bedtime for the child. She and her husband have tried several different times and cant seem to agree on the right time. Which response by the nurse is the most appropriate?
A. As long as its consistent, it doesnt matter when bedtime is.
B. At this age, your child needs 10 to 12 hours of sleep each night.
C. Children get sleepy when warm, so dress your child heavily for bed.
D. What sleepy behaviors does your child show when tired?
ANS: D
The parents should note any signs of fatigue in a child, such as rubbing eyes, temper tantrums, yawning, or fussiness. They should use this information to help set a routine bedtime. At this age, children need between 12 and 16 hours of sleep a night. Consistency is important, but the bedtime needs to be early enough to ensure adequate sleep. Children, especially infants, should not be over-warm when sleeping.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

31. A father brings his 10-month-old infant to the well-baby clinic and expresses frustration that his child puts everything in her mouth and gets into everything, then cries when objects are taken away. In providing anticipatory guidance, what action by the nurse is the most appropriate?
A. Advise the father that crying indicates fatigue and the child should rest.
B. Explain that objects may be dirty and should not be put in the mouth.
C. Give the father written material on effective disciplinary techniques.
D. Teach the father that this behavior is normal and not misbehaving.
ANS: D
At this age, exploration and crying are normal behaviors. Children in this age group do not misbehave, and so discipline needs to be focused on redirection to keep the child safe. Crying may also indicate frustration in this preverbal child. Making a blanket statement that objects are dirty and should not be in the childs mouth does not provide guidance on age-appropriate behaviors and reasonable responses.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

32. A nurse is providing anticipatory guidance to the parents of a toddler. Which information is most important for the nurse to include regarding typical toddler behaviors?
A. Children at this age rarely lie about misbehaving and want to please their parents.
B. Competing and winning are important, so rewards for good behavior are great tools.
C. Toddlers need constant supervision, because they dont understand what consequences can occur.
D. Time-out for misbehavior works well if the child is placed quietly in his or her own room.
ANS: C
The toddler is actively exploring his or her world, and with this increasing sense of mastery and lack of knowledge of consequences, toddlers often end up in situations in which their safety is compromised. Keeping the child safe becomes increasingly challenging. At this point language is developing and is focused on the childs needs. Competing and winning are important in the early childhood years (ages 69). Locations for time-outs need to be safe, which means in a location the parent can monitor and see.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

33. A mother is worried that her 3-month-old child is not holding her own head up. Which action by the nurse is most appropriate?
A. Explain that sturdy head control occurs around 6 months.
B. Document the findings and alert the health-care provider.
C. Reassure the mother that her baby is completely normal.
D. Teach the mother that head control is evident at 9 months.
ANS: A
Sturdy head control occurs around 6 months of age. The findings should be documented, but there is no need to alert the health-care provider because this is a normal finding for a 3-month-old. Simply reassuring the mother does not give her the information she needs.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

34. A home health-care nurse sees several pediatric patients who have the nursing diagnosis of delayed growth and development. Which action by a child would indicate that outcomes have been met?
A. A 3-year-old child walks backward.
B. A 4-year-old child plays video games.
C. A 5-year-old child can unscrew items.
D. A 7-year-old child uses scissors to cut an outline figure.
ANS: A
The ability to walk backward is accomplished in the toddler stage (13 years). The ability to play video games is more likely seen in the adolescent stage. Screwing and unscrewing objects is appropriate for a toddler. Using scissors to accurately cut a figure from an outline is a milestone of the early childhood stage (36 years).

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Evaluation
Difficulty: Moderate

PTS: 1

35. A nurse is assessing a 1-year-old child who weighed 7 lb, 8 oz at birth. Todays weight is 23 lb. What conclusion can the nurse make about the childs weight?
A. The child is at an expected weight.
B. The child is over expected weight.
C. The child is seriously overweight.
D. The child is seriously underweight.
ANS: A
A childs weight should triple by 12 months, so a child born at 7 lb, 8 oz should weigh around lb at 1 year.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

36. A nurse is assessing several children during a shift at the well-child clinic. Which child demonstrates successful resolution of the Erikson stage of autonomy versus shame and doubt?
A. A 15-month-old playing on the floor with supervision
B. An 18-month-old being consistently consoled by her father
C. A 20-month-old using building blocks with her grandfather
D. A 24-month-old being allowed to independently dress himself
ANS: D
The Erikson stage of autonomy versus shame and doubt occurs during the ages of 1 to 3. During this stage, the child develops a can-do attitude and wishes to be independent. A child who does not successfully meet the tasks of this stage will suffer from self-doubt later on. The most independent child in the options is the 24-month-old dressing independently. This child is mastering the tasks of this developmental stage.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Evaluation
Difficulty: Moderate

PTS: 1

37. A 2-year-old is seen for a well-child visit and is scheduled to receive immunizations. The child weighed 22 lb (9.97 kg) at 1 year of age (1 year ago). Today the child weighs 23 lb (10.4 kg). Which conclusion is most appropriate for the nurse to make regarding this assessment data?
A. The child is at an expected weight.
B. The child is over expected weight.
C. The child is seriously overweight.
D. The child is underweight for age.
ANS: D
A toddler should gain 46 lb each year from the ages of 1 to 3. This child should now weigh somewhere between 26 and 28 lb, so he or she is underweight.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Evaluation
Difficulty: Moderate

PTS: 1

38. Which outcome is most appropriate for a 3-year-old with the nursing diagnosis of delayed growth and development related to chronic illness?
A. Child will attain age-appropriate milestones in 3 months.
B. Child will attain normal weight and height in 2 months.
C. Child will draw using large crayons in 2 months.
D. Child will have fewer tantrums in 3 months.
ANS: C
All outcomes might be good starts, but an outcome needs to be measurable, be specific, and have a timeframe. The outcome that best fits this description is the one that has a specific age-appropriate activity associated with it. Attain age-appropriate milestones, attain normal weight and height, and fewer tantrums are all vague.

Reference: Nursing Care Plan: Delayed Growth and Development
Cognitive Level: Evaluation
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Evaluation
Difficulty: Moderate

PTS: 1

MULTIPLE RESPONSE

1. A nurse uses Urie Bronfenbrenners theory to guide practice. In order to determine a childs microsystem, which items should the nurse assess? (Select all that apply.)
A. Dynamics between school and home
B. Family
C. Peer group
D. Parental job status
E. School
ANS: B, C, E
According to Bronfenbrenner, a childs microsystem includes systems in which the child is actively involved and typically includes family, peer group, and school. The dynamics between school and home make up the mesosystem. A parents job would be part of the exosystem.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

2. A nurse educator is discussing developmental theories with a student. What information is appropriate for the educator to provide regarding Lev Vygotskys theory? (Select all that apply.)
A. Children learn best with assistance from someone else.
B. Culture plays a vital role in language development.
C. Intelligence cannot be accurately measured.
D. The ecological approach emphasizes three important systems.
E. Motor skills are developed and refined in the preoperational stage.
ANS: A, B
Vygotsky posited that learning takes place in a zone of proximal development, which means that children learn best when assisted by another person. He also thought culture had a profound impact on language. Howard Gardner argued that intelligence cannot be measured by a single number from an IQ test. The ecological theory of Urie Bronfenbrenner emphasized three systems in a childs life (microsystem, mesosystem, exosystem). The preoperational stage is part of Jean Piagets work.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Development
Integrated Process: Teaching/Learning
Difficulty: Difficult

PTS: 1

3. The pediatric nurse teaches the mother of a toddler how to choose appropriate toys/activities to stimulate growth and development of her child. Which activities are appropriate for the nurse to include in the teaching session? (Select all that apply.)
A. Board games
B. Large crayons
C. Sliding down a slide
D. Tricycle
E. Watercolor pencils
ANS:
As fine and gross motor skills develop, the toddler enjoys practicing skills such as coloring, turning pages, stacking objects, pushing and pulling toys, molding Play-Doh, running, jumping, and climbing. Around age 3, the toddler may learn to ride a tricycle. The toddler can hold a pencil or a large crayon appropriately and make artwork that is more representative of the object he or she is trying to depict. The toddler does not play interactively with other children; therefore, board games are more appropriate for preschool- and school-age children. Watercolor pencils require fine motor coordination and are more appropriate for a preschool-age child.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

4. A mother brings her 8-year-old son into the clinic for a well-child visit. She is concerned because her son does not take responsibility for completing and handing in his school assignments on time, and his teacher has given him several warnings for missing homework. Which responses are appropriate for the nurse to this childs mother? (Select all that apply.)
A. A good discipline strategy for this stage of development is a time-out in a specific location, which could include focusing on homework at this time.
B. As a parent, you should refrain from rescuing your child from the consequences of his behaviors and allow him to learn a valuable lesson from them.
C. At 8, children can internalize rules, so its important to allow him to be responsible for his actions and to accept the consequences of his behavior.
D. Eight-year-old children are not ready to accept the consequences of their actions and need to be constantly reminded of their responsibilities.
E. Natural consequences are important, and removing privileges, especially time with friends, is often a successful technique at this age.
ANS: B, C
Because the child in this stage of development is beginning to internalize rules, it is important to allow the child more independence and, thus, more awareness of the natural consequences of behavior. An effective parenting technique is to refrain from rescuing the child from the consequences of his or her behavior. Time-outs are more appropriate for preschool-age children. Grounding or restricting privileges is a more appropriate discipline measure for a school-age child, and restricting time with friends is a good technique for adolescents.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

5. A school nurse is working with high school students. The nurse wants to influence these teenagers to make healthy decisions. Which actions are most appropriate by the school nurse to influence health decisions? (Select all that apply.)
A. Discouraging questioning rules
B. Discussing without judging
C. Encouraging critical thought
D. Listening carefully to the teen
E. Paying attention to nonverbal cues
ANS: B, C, D, E
A teenager is able to think abstractly and can be led to think critically and solve problems. At this level of emotional development an adolescent can take responsibility for his or her own actions and is beginning to internalize a personal set of values. Therefore, guiding them, but being an open communicator, is appropriate per their development. Adolescence is a time of great questioning, and this should not be discouraged.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

6. A nurse is providing anticipatory guidance to the parents of a school-age child. What information is appropriate for the nurse to include for school-age children? (Select all that apply.)
A. Discuss physical changes related to puberty.
B. Discuss smoking and substance abuse.
C. Provide simple explanations for questions.
D. Read short stories daily to help language.
E. School-age children require 8 to 12 hours of sleep each night.
ANS: A, B, E
Appropriate anticipatory guidance for a school-age child is to discuss physical changes that will occur in puberty (before they happen), discuss smoking and substance abuse (hopefully before they are exposed to it), and inform parents that children this age still need 8 to 12 hours of sleep a night. Simple explanations and short stories are more appropriate for toddlers.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

7. A toddler has been adopted from a foreign country and has the nursing diagnosis of delayed growth and development related to poor nutrition. Which activities should the nurse include in the plan of care to assist the child to meet outcomes? (Select all that apply.)
A. Allow the toddler to use a fork and knife with supervision.
B. Allow toddler to choose foods within appropriate parameters.
C. Consult with a dietician to provide a high-calorie, high-protein diet.
D. Force the toddler to eat if he or she chooses not to at mealtime.
E. Provide only foods that the toddler can eat with the fingers.
ANS: B, C
At the toddler stage, the child can use a cup and a spoon and is able to verbalize food preferences. A dietary consult is appropriate to help plan high-protein, high-calorie meals and snacks that are preferred by the child. A toddler is not dexterous enough for a knife and fork. Eating should not be forced. Finger foods are a good choice for eating, but in the toddler stage, foods should not be limited to only finger foods because the child should be able to use a spoon.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult

PTS: 1

8. A nurse is working with a child who has a chronic illness requiring medication and frequent hospitalizations. The parents refuse to allow the child to go to the playroom, fearing germs from other children will harm their child. Which actions by the nurse are most appropriate? (Select all that apply.)
A. Allow the parents to voice their concerns without being judgmental.
B. Consult with a child developmental specialist for appropriate in-room activities.
C. Document the parents choice on the patient record and inform the staff.
D. Help the parents see the ways their child is normal while having an illness.
E. Tell the parents that the playroom and all its objects are disinfected often.
ANS: A, D
The nurse should first listen to the parents concerns in an open, nonjudgmental way to promote communication. Parents of ill children should be helped to see their child as a child with an illness, rather than a sick child. This viewpoint allows the child more freedom to participate in age-appropriate activities that stimulate growth and development and a sense of self-esteem. If this approach is not successful, a consultation for in-room activities would be beneficial. Of course the outcome should be noted on the chart, but this alone does not help this problem. Educating the parents about the ways in which infection control is practiced in the playroom is a helpful strategy, but this in itself is insufficient and dismissive of their concerns.

Reference: Nursing Care Plan: Delayed Growth and Development
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult

PTS: 1

9. A nurse is providing anticipatory guidance to the parents of a 5-month-old baby. Which nursing statements are appropriate by the nurse to these parents? (Select all that apply.)
A. Do not leave the child alone on the changing table.
B. Until the age of 3, falls are common due to large head size.
C. Peek-a-boo is an appropriate game for this age.
D. Wrap up mini-blind ties so the child cant reach them.
E. You need to childproof all your cabinets now.
ANS: A, C
An infant begins to roll over by the age of 6 months and could easily fall off a changing table with this newfound skill. Infants respond strongly to peek-a-boo games due to the development of object permanence. Head size matches torso size by about 1 year of age. Wrapping up mini-blind cords and childproofing cabinets can be done at any time, but those are activities more appropriate for the family with an increasingly mobile toddler.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

10. The nurse is preparing to educate the parents of an 8-year-old child about normal growth and development. Which information should the nurse include? (Select all that apply.)
A. Boys and girls play equally with each other.
B. Children frequently have best friends at this age.
C. Peer approval is not yet important, but will be for teens.
D. Puberty changes should be discussed before they occur.
E. Typical weight gain is 46 lb (1.82.7 kg)/year.
ANS: B, D, E
School-age children typically gain 46 lb/year. This is an appropriate time to begin discussing changes that occur during puberty because those changes can be frightening and the child should be prepared for them. Friends, especially best friends, which become apparent at this age, are usually of the same gender. Peer approval is becoming increasingly important at this stage.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

11. The nurse is preparing to provide information to the parents of a 14-year-old who is within normal limits for growth and development. What information is appropriate for the nurse to include? (Select all that apply.)
A. Children of this age can anticipate long-term consequences of choices.
B. Growth, although slowed, can still be significant.
C. The child of this age may be able to give informed consent in some situations.
D. The child of his age is not normally worried about sexual identity.
E. Peer group influence is often stronger than family influence.
ANS: A, B, C, E
Adolescents are in the stage of formal operations and can think abstractly. They are able to anticipate long-term consequences of choices. Growth continues during this period and, although slower than in other stages, can still be significant. Depending on state law and the teens age, a teen may be able to give informed consent in situations such as seeking birth control or assistance with substance abuse. Establishing a sexual identity is one of the three main tasks of this age group. Peers often have more influence over the teen than family.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

12. A nurse is teaching parents about appropriate discipline for their toddler. Which information is appropriate for the nurse to include in the session? (Select all that apply.)
A. Be firm and specific but respectful.
B. Deliver consequences immediately.
C. Tie consequences to the action if possible.
D. Time-outs are 5 minutes for each year of life.
E. Try to anticipate and avoid tantrums.
ANS: A, B, C, E
Effective discipline involves parents being firm and specific. They should be respectful and speak as they would want to be spoken to. The most effective consequences are delivered immediately and are tied to the action in a logical way. If parents can recognize triggers for temper tantrums, they can avoid them (e.g., a child who is tired needs a nap or bedtime). A rule of thumb for time-out is 1 minute for each year of life.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

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