Post by Nursing Board 101 on Aug 18, 2010 13:07:40 GMT -5
1. A neonate’s failure to pass meconium within the first 24 hours after birth could indicate:
a. Intussusception
b. Dehydration
c. Celiac disease
d. Hirschprung’s disease
Ans: D - a newborn’s failure to pass meconium within the first 24 h after birth may indicate Hirschsprung’s disease, a congenital disorder of the large intestine. It is characterized by absence or marked reduction of parasympathetic ganglion cells in the intestinal wall. This impairs the intestinal motility and causes severe constipation. Without prompt treatment, a neonate will develop bowel obstruction and may die within 24 h. Hirschsprung’s disease is believed to be a familial, congenital defect, occurring more often in males than in females. Clinical manifestations usually appear shortly after birth, but mild symptoms may not be recognized until later in childhood or during adolescence. The newborn with Hirschsprung’s disease commonly fails to pass meconium within 24 to 48 h, shows signs of bowel obstruction, abdominal distention, irritability, poor sucking reflex, refusal to take feedings, failure to –thrive, dehydration, and liquid stools. Surgical treatment is necessary, but is delayed until the infant is at least 10 months old. Management until surgery consists of daily colonic lavages to empty the bowel. If total obstruction is present in the newborn, a temporary colostomy or ileostomy is necessary to decompress the bowel. Intussusception is when the bowel turns back into itself (telescoping). Intussusception is most common in infants and occurs three times more often in males than in females. Signs and symptoms of intussusception are intermittent attacks of colicky pain; vomiting of stomach content, “ currant jelly” stools, which contain a mixture of blood and mucus; tender distended abdomen, with a palpable, sausage-shaped abdominal mass. Dehydration will not cause a failure to pass meconium. Celiac disease is characterized by poor food absorption and intolerance for gluten, a protein in wheat and wheat products. With treatment such as eliminating gluten from the client’s diet, prognosis is good. The cause is unknown, but females are affected more often than males. This disorder produces the following clinical manifestations; recurrent attacks of diarrhea, steatorrhea (fat in stool), abdominal distention, stomach without cramps, weakness, anorexia, and increased appetite without weight gain. Symptoms develop during the first year of life when gluten is introduced in the child’s diet as cereal. Treatment requires permanent elimination or reduction of gluten from the client’s diet. Supportive treatment may include supplemental iron, vitamin B12, folic acid, reversal of electrolyte imbalances (by IV infusion, if necessary), corticosteroids (prednisone or hydrocortisone), and vitamin K for hypoprothrombinemia.
2. Three-week-old Billy is admitted to the hospital with a history of “spitting up” since he was 1 week old. His mother says, “Billy’s spitting has now increased to what I would call forceful vomiting.” The most likely diagnosis for Billy would be:
a. Hirshprung’s disease
b. Celiac disease
c. Pyloric stenosis
d. Intussusception
Ans: C-when a 3-week-old baby continues to spit up large amounts of formula and then forceful vomiting, pyloric stenosis may be indicated. Obstruction of the sphincter is one of the most common surgical disorders of early infancy. This disorder is usually seen soon after birth, with vomiting becoming progressively more severe and projectile. It is five times more common in male infants than in female infants. The cause of pyloric stenosis is unknown. Diagnosis is made by upper GI x-ray studies.
3. A 10-year-old female client is diagnosed with insulin-dependent diabetes mellitus. She asks the nurse why she cannot take a pill her Aunt Jessie does, rather than insulin shots. The most correct response by the nurse would be:
a. The pill stimulates cells in the pancreas to produce insulin, and your cells are not able to produce insulin
b. The pills will stimulate insulin production in the adult pancreas but will not in the child’s pancreas
c. When you are able to cut down on the amount of sweets you eat, then maybe you can start taking the pill
d. Your doctor, makes that decision, ask him
Ans: A- when a child has insulin dependent diabetes mellitus (IDDM), the beta cells of the pancreas can no longer produce insulin. The patient must like insulin by subcutaneous (SC) injection, and will have to take insulin for the rest of his or her life. A patient with noninsulin dependent diabetes mellitus (NIDDM) will have some active beta cells; an oral hypoglycemic medication will stimulate these beta cells to produce insulin. The statements, “ The pills will stimulate insulin production in the adult pancreas but will not in child,” is an incorrect statement. Oral hypoglycenmic medication will stimulate live beta cells to produce insulin in a child’s pancreas or an adult pancreas in a child. These option are incorrect as seen in rationale (A).
4. A 2-year-old female client is brought to the emergency room after waking up with a bark-like cough and stridor. On arrival to the ER, she has respiratory distress and is a febrile. The diagnosis is croup. The nurse instructs the parents to:
a. Perform percussion and postural drainage before putting the patient to bed and before meals
b. Encourage frequent coughing and deep breathing
c. Run a cool mist vaporizer in patient’s room during the day
d. Follow a schedule of postural drainage and increase fluid intake
Ans: C- the nurse should instruct the parents of a child with croup to run a cool mist vaporizer in the child’s room at night and during the day, and take the child into the shower with them in an acute care situation. Croup is a severe inflammation and obstruction of the upper airway, occurring as laryngotracheobroinchitis (most common), laryngitis, and acute spasmodic laryngitis. Croup is a childhood disease-affecting males more often than females (typically between 3 months and 3 years), usually during the winter months. Croup usually results from a viral infection, but can be caused by bacteria. Most children are sued at home with rest, cool humidification during sleep, and antipyretics (such as acetaminophen) to relieve symptoms. In an acute case, taking the child into a shower will provide the child with a more humid atmosphere. These options are incorrect as seen in rationale (C).
5. The symptoms most commonly seen in croup are:
a. Wheezing, colicky pain and vomiting
b. Stridor, rapid pulse and bark-like cough
c. Drooling, rapid pulse and occasional hoarse cry
d. Fever, vomiting and abdominal retractions on inspiration
Ans: B-the symptoms most commonly as seen in croup are stridor (labored breathing with retractions), rapid pulse, and a bark-like cough. These options are incorrect as seen in rationale (B).
6. Which of the following is the most threatening to a hospitalized toddler’s autonomy?
a. Frequent visits by parents and friends of the family
b. Participation in playroom activities with other children
c. Complete bed rest
d. Riding to the x-ray department in a wheelchair in a hospital gown
Ans: C- one of the most threatening things to a hospitalized toddler’s autonomy is complete bedrest. The toddler is just beginning to assert independence and is very active, and does not want to be kept in bed. Bedrest is very threatening to a toddler who does not understand the reason for it. Frequent visits may parents and friends help the child feel safe and not abandoned. This is not threat to the child’s autonomy. A toddler loves to play with other children, even if they do not known them. This encourages autonomy (not threatens it); normally, toddlers make friends easily. Riding to x-ray in a wheelchair could be fun for a child, not a threat to autonomy.
7. Which one of the following phrases most accurately describes myelomeningocele?
a. The incomplete fusion of the vertebrae at one level that may have an overlying dimple or tuft of hair
b. Herniation of a portion of the spinal cord and meninges into a cyst
c. The incomplete fusion of one or more of the vertebral laminae
d. A cyst formation containing CSF, blood and meninges
Ans: B- myelomenigocele is the most severe “ neural tube defect” (NTD), involving protruding sac-like structure tat contains meninges, spinal fluid, and neural tissue. The spinal nerve roots, may terminate in the sac, significantly affecting motor and sensory function below that point. The incomplete fusion of the vertebrae at one level with An overlying dimple of turf protrusion of the spinal tissue is called spina bifida cystica. This type of defect is usually in the lumbosacral area. There are two classifications of spinal bifida cystica; myelomeningocele and meningocele. Spina bifida cystica is a general classification for these disorders; therefore, this is an incorrect option. Meningocele is the formation of a sac-like cyst. Which contains meninges and spinal fluid that produces through a defect in the bony spine.
8. When explaining how to correctly collect specimen for identification of pin worms, the nurse should tell the mother to:
a. Bring in a fresh stool specimen
b. Administer a laxative the night prior to collection of a specimen
c. Place a tongue blade covered with tape over the child’s anus
d. Have the child defecate and then smear a small amount of stool on a slide
Ans: C- to collect a specimen for the identification of pin worms, a tongue blade covered with tape is placed over the child’s anus during the night for a specimen. The sticky side of the tape is placed on the rectum. During the right, the worms crawl into the anus and lay their eggs. The eggs will stick to the tape on the tongue blade. A fresh stool specimen may not have any pin worms in it, but the child may still have pin worms. Fresh specimens are best for revealing parasites or larvae; therefore, a collected specimen should be taken directly to the laboratory for examination. These options are incorrect as seen in rationale (C) and (A).
9. Activated charcoal is administered to the child who has ingested a poison substance in order to:
a. Induce vomiting
b. Increase the effectiveness of ipecac
c. Increase movement through the GI tract
d. Absorb the compound
Ans: D- activated charcoal is administered to the child who has ingested a poisonous substance to absorb the compound. Activated charcoal effectively absorbs most poisons, with the exception of cyanide. It also absorbs ipecac syrup; therefore, the emetic should be given and be allowed to exert its effect before the charcoal is given. Charcoal, however, is most effective if administered within 30 min of ingesting the poison. These options are incorrect as seen in rationale (D).
10. When giving parents anticipatory guidance about accident prevention for toddlers, the nurse tells the parents:
a. If the toddler feels the heat, he learns that a stove is hot
b. Falls are not as great a danger now as they were during infancy
c. Areas previously childproofed may now be accessible to toddler
d. Toddlers understand the word “NO” and will listen to parental rules
Ans: C- when giving parents anticipatory guidance for toddlers, the nurse tells the parents that “areas previously child-proofed may now be accessible to the toddler.” Anticipatory guidance is the ideal way to handle a problem. Prevent it deal with it before it becomes a problem. Parents know what to expect will be prepared for a problem when it appears. The statement , “ If the toddler feels the heat, she learns that the stive is hot,” is incorrect. The child does not have to experience every danger to prevent it from happening. If a parent waits for a child to be burned, the burn could be fatal. The statement, “ Falls are not as great a danger now as during infancy,” is not true. Falls continue to be a great danger throughout life. The statement, “ Toddlers understand the word ‘no’ and will listen to parental rules,” is a false statement. Toddlers tend to ignore the word ‘no’ and find it very difficult to obey their parents. They are interested in establishing their autonomy.
11. A mother brings her 3-year-old son and her 8-month-old daughter to the health center. She states that her son enjoys pouring and playing with water. The water safety rule for the bathroom is reviewed with the mother. The only correct rule given here is:
a. Never leave children alone in the bathtub
b. Never leave a child in the bathtub unless an older child is in with them
c. Have the child test the water temperature with his hand
d. It is safe to leave children alone in bathtub if there is one 12 inches of water
Ans: A- a water safety rule given to parents should be to NEVER leave children alone in the bathtub. A 3-year-old child is to young to take care of any child in bathtub, this is not a safety rule. The adult’s responsibility is to check the temperature of there is only 12 inches of water; they can turn on the faucet and fill the tub or drown in 12 inches of water. Note: The safety rules are many but the only one given in this situation is option (A).
12. The nursing diagnosis appropriate for health promotion of a well toddler is:
a. Potential for injury related to increased mobility
b. Activity intolerance related to rapid growth
c. Alteration in growth and development related to rapid growth
d. Alteration in bowel elimination related to interest in playing, not drinking
Ans: A- the nursing diagnosis appropriate to health promotion of the well toddler is potential for injury related to increased mobility. A well toddler does not intolerance to activity; they love activity. This nursing diagnosis is incorrect. A well toddler does not have an alteration in growth and development. This nursing diagnosis is incorrect. A well toddler normally does not have an alteration in bowel elimination. This nursing diagnosis is incorrect.
13. A mother brings her 2-year-old son to the clinic for his measles, mumps and rubella vaccine (MMR). Prior to giving the vaccine, it is important for the nurse to ask if he has:
a. Recently been checked for anemia
b. Ever experienced an allergic reaction to eggs
c. Been in close contact with anyone with rubella (German measles)
d. Been in close contact with a pregnant relative or baby sitter
Ans: B¬- prior to giving a child a vaccine for measles, mumps, and rebulla (MMR), the nurse should ask the parents if the child is allergic to eggs because they vaccinated for measles, mumps, and rebulla. If the child has been in contact with someone who had rebulla (German measles), he or she can still get his or her MMR vaccine. Being exposed to measles would not affect the MMR vaccine given to the child unless the child was exposed 10 to 14 days before scheduled for their first MMR vaccine. Then they would be given gamma and MMR vaccine at a later date. The child being in contact with a pregnant relative or babysitter has no effect on the MMR vaccine given to the child. If the child has rebulla (German measles), should not be around a pregnant woman. If the pregnant, the chance of her child having a birth defect are high. Congenital rubella is by far the most serious form of the disease. Intrauterine rebulla infection, especially during the first trimester, can lead to spontaneous abortion or stillbirth, as well as single and multiple birth defects. As a rule, the earlier the infection occurs during pregnancy, the greater the damage to the fetus.
14. In explaining the use of “time out” as a form of discipline for a 2-year-old child, the nurse tells the parents:
a. To send the child to his or her bedroom for 20 minutes
b. To allow the child to take his or her own favorite toy to the room
c. The total time out should be no more than 2 to 3 minutes
d. To explain to the child why the behavior was bad after( “time out”)
Ans: C-in explaining the use of “time out” as a form of discipline for a 2-year-old child t he nurse tells the parents that the total time out should be no more than 2 to 3 min. a 2-year-old child will forget why they have no remain in a room after a few minutes and will become upset if they are left in their room. This option is incorrect seen in rationale (c). allowing a child a favorite toy in “time out” is not disciplinary action; the child may believe they are put in time out just play for a little while. The parent needs to explain to the child before “time out” why their behavior was not acceptable. A child should not be t old that what they did or did not do is bad because the child may then think of themselves as bad.
15. The behavior that would indicate to parents that a toddler is ready to begin toilet training is:
a. Showing interest in flushing the toilet
b. Staying dry throughout the night
c. Spending time in the bathroom with parents
d. Pulling a wet diapers or taking off wet diapers
Ans: D- the behavior that would indicate to parents that a toddler is ready to begin toilet training is when the toddler pulls off water diapers. The child is uncomfortable wearing a wet diaper and can recognize that they are the one who is wetting them. The parent can tell them, “If you do not like your diaper wet, then you can g (“pee”) in the toilet.” The child may pull off t he wet diaper and ask the mother to take them to the toilet. Flushing the toilet indicates that the toddler likes to hear the water run and has nothing to do with being ready to be toilet trained. Many children stay dry throughout the night long before they are ready to be toilet trained. If they do not their diapers at night, it is probably because they did not drink much fluid before going to bed. Spending time in the bathroom with parents does not indicate that they are ready to begin toilet training. They may just want to be near their parents.
16. A mother of an 18-month-old child tells the nurse that her child is a finicky eater. The best advice that the nurse can give to the mother is:
a. Give small amounts and cut food into small pieces allow for finger feeding
b. Don’t force the child to eat but make sure that the child drinks all of his milk
c. Serve small portions and make the child sit at the table until he eats all of his foods
d. Serve the child in front of the TV to keep his attention
Ans: A- when an 18-month-old toddler is a finicky eater the best advice the nurse can give the mother is, “ Give small amounts and cut food into small pieces that follow for finger feeding.” A toddler is interested in autonomy; allowing the child to feed himself gives the child the autonomy that he is seeking. Children never be forced to eat all of their food or drink all of I their mil because they might aspirate the food or the milk. This method will not encourage them to eat the food. Making a toddler sit at the table until eat all of their food will make the child hate eating. The child may be at the tale for an hour and still not have eaten all of his food. This is punishment that is associated with eating, and certainly will not encourage the child to eat. If a toddler who is finicky eater is served food in front of the TV, the toddler will watch TV and not eat.
17. When toddler says, “NO” to eating a food, they may be:
a. Saying they do not like the food, be testing their parents, be practicing independence
b. Deciding the types of foods they like and dislike
c. Trying to impress on their parents that they will have the right to choose their own food
d. Saying no because they like the word; it has no meaning at all and is just a habit that children develop
Ans: A- when a toddler says “no” to eating a food, they may not like the food, may be testing the parents, or be practicing independence. Toddlers know what foods they like and dislike, but this is not always the reason they say no eating a food. Toddlers do not have the cognition to think abut impressing people. Toddlers say no for many reasons; option (A) covers some of them.
18. When a doctor has a consent form signed for a surgical procedure on a child, the nurse knows that:
a. Only the parent or legal guardian can sign the consent form
b. The person giving consent must be at least 18 years old
c. The risk and benefits of procedures are parts of the consent process
d. A mental age of 7-year-old or older is required for a consent to be considered “informed”
Ans: A- when the doctor is having a consent form signed for a surgical procedure on a child, the nurse knows that only a parent or legal guardian can sign the consent for. These options are incorrect as seen in rationale (A).
19. The nurse is planning how to prepare a 4-year-old child for a diagnostic procedure. Guidelines for preparing this preschooler should include:
a. A plan for a short teaching session of about 35 minutes each day
b. Telling the child that the procedure is not a form of punishment
c. Keeping equipment out of the child’s view
d. Telling the child that the procedure will be simple
Ans: B-the nurse knows that the guidance for preparing a preschooler for diagnostic procedure is to tell the child that the is not a form of punishment. Preschool children believe that diagnosis procedures and treatments are punishments for something they have done. This answer calls for a short teaching session; 35 min is not a sort teaching session. A preschool child will lose interest in a teaching session that last more than a few minutes; dolls or stuffed animals must be used to explain procedures and keep the child’s attention. The child needs to see the equipments that will be used for diagnostic purposes for treatment the day before so that they will be familiar and not be afraid of it. The nurse should not tell the child that the procedure will be simple because the procedure may not be simple to the child. The child will be more afraid when the procedure hurts or causes them some discomfort. The child will not trust the nurse and will be more fearful of the hospital’s treatments and it personnel.
20. The nurse is preparing a 6-year-old child before obtaining a blood specimen by venipuncture. The child tells the nurse that he does not want to lose his blood. The appropriate approach by the nurse would be to:
a. Explain that the process will not be painful and that it will be over quickly
b. Discuss with the child how the body is always in the process of making blood
c. Suggest to the child that he does not have to worry about losing a little bit pf blood because he is old enough now not to be afraid
d. Tell the child that he will not need a Band-Aid after ward because it is such a simple procedure. If he does not watch the nurse draw the blood, it will not hurt
Ans: B- when a nurse is preparing a child for a venipuncture, the nurse needs to understand that 6-year-old child has a great fear of bodily injury. Because children heave an inadequate comprehension of medical events, they have a fear of invasive and /or painful procedures. The nurse should discuss with the child how the body is always in the process of making blood. Discussing the procedure with the child and allowing them to express their feelings will help to reduce their anxiety. If the nurse tells the child that the procedure is not painful and they will not even need a Band-Aid, the nurse is not being honest with the child. When the child then experience pain, he or she will no longer trust nurses and will fear every procedure. A nurse should never tell a child or an adult not to worry; this does not help them cope with their fears and it makes the patient feel as if the nurse is not concerned.
21. When administering a gavage feeding or medication to an infant through a nasogastric tube, the nurse should:
a. Lubricate the tip of the feeding tube with petroleum to facilitate passage
b. Check the placement of the tube by inserting 20 ml of sterile water
c. Administer feedings over a period of 15 to 30 minutes
d. Place the infant on its right side or abdomen for 1 hour after feeding
Ans: D-when administering a gavage feeding or medication through a nasogastric (NG) tube to an infant, the nurse should place the infant on the right side of abdomen for 1 h after the feeding. The stomach is on left side; therefore, the infant should not be laced on the left side as the pressure on the stomach can cause the infant to vomit. If the infant is placed on the right side or on the abdomen and vomits, the vomit come out of the mouth and not be aspirated. Being in this position for 1 h will allow time for the food or medication to leave the stomach. The questions is when administering a gavage feeding. Not when putting an NG tube into the stomach. Read your stem carefully. The placement of the NG tube should not be done with water, because the tube might be in the lungs. The correct procedure for checking NG placement is to push air through the NG tubing with a large syringe while listening over the stomach with a stethoscope. If a bubbling sound (air) is heard, then the nurse knows the NG tube in the stomach, or withdrawn stomach content and check acidity. There is no reason to administer tube feedings over a period of 15 to 30 min. there is an order for continuous tube feeding, then the tube feeding is continuous – not over 15 to 30 min.
22. In preparing to give “enemas until clear results” (colonic lavage) to an 18-month-old child before surgery for Hirschprung’s disease, the nurse would anticipate that the physician would order:
a. Tap water (120 ml)
b. Fleet solution (200 ml)
c. Saline (300 ml)
d. Oil retention (300 ml)
Ans: C- when giving “enemas until clear” to an 18-mnoth-old child surgery for a megacolon (Hirschsprung’s disease), the nurse would anticipate that the physician would order 300 mL saline enema. Hirchsprung’s disease is a congenital disorder of the large intestine, characterized by the absence or marked reduction of parasympathetic ganglion cells. The disorder impairs intestinal motility and causes severe constipation. Before surgery, at least once a day, a large amount of saline is given as an enema (colonic lavage). Enemas given with the standard amount of fluid are not sufficient because the colon is so large and laxatives will not clear the colon adequately. Saline (salt) is used to draw as much fluid as possible into the intestines. These options are incorrect as seen in rationale (C).
23. In relation to growth, the parents of a toddler can expect:
a. A growth spurt at about 18 months of age
b. A 4 to 6 lbs gain of weight between ages 3 and 4
c. Small weight losses and larger gains related to changing appetite
d. Little increase in height before age 3 years
Ans: B- in relation to growth, the parents of a toddler can expect a 4-6 pound gain in weight between ages 3 and 4. these options are incorrect as seen in rationale (B).
24. An 18-month-old child is seen in the clinic for a well-child check-up. While completing the assessment, the nurse notes a protruding abdomen. The nurse’s assessment is that:
a. The child may be constipated
b. Further evaluation is warranted
c. An abdominal tumor must be ruled out
d. This is a normal finding
Ans: D- an 18-month-old child seen in a clinic for a well child assessment will have a protruding abdomen, normal for this age. The abdominal muscles are not yet strong enough to keep the abdomen pulled in, but this will change as the child grows older. These options are incorrect as seen in rationale (D).
25. A premature infant’s dietary intake needs to be particularly sufficient in:
a. Glucose
b. Iron
c. Zinc
d. Vitamin C
Ans: B¬- maternal iron stores are adequate for the first 4 to 5 months of age in the full-term infant, but are reduced considerably in premature infants of multiple births. When exogenous sources of iron are not supplied to meet the infant’s growth demands following depletion of fetal iron store, iron deficiency anemia results. Iron is necessary for hemoglobin synthesis. Hemoglobin is the oxygen carrying molecule on he red blood cells. These options are incorrect as seen in rationale (B).
26. Visual development in an 18-month-old is directly related to parental need for anticipatory guidance related to:
a. Prevention of falls
b. Selection of a dentist
c. Signs of infections and need for glasses
d. High dietary intake of vitamin A
Ans: A- visual development in toddler (18-month0old) is directly related to parental need for anticipatory guidance related to prevention of falls, because the child’s depth perception is not fully developed. These options are incorrect as seen in rationale (A).
27. Toddlers are most interested in play that involves:
a. Watching TV, especially cartoons and playing Nintendo
b. Interaction with other toddlers and playing games with them
c. Active use of small and large muscle groups for climbing and running
d. Adults telling or reading stories for 30 minutes at a time
Ans: C- toddlers are most interested in play that involves the active use of small and large muscle groups for climbing and running. At this age, the toddler is very active and very curious. It is dangerous age because toddlers can climb and get into things. A toddler may enjoy cartoons but will not sit still for very long. The toddler is not old enough to play Nintendo. Toddlers are not interested in playing games with other children. They like to sit beside each other and pay, but not share. Toddlers enjoy having adults read to them, but only for 3 to 5 min at a time; their attention span is very short.
28. The mother of a 2-year-old boy tells the nurse that the child insists on taking a favorite blanket to bed with him at night and at naptime. The mother asks the nurse if she should send the blanket to nursery school with him. The best response by the nurse is:
a. No, this is a good time for him to give it up and grow up
b. No, he doesn’t need it away from home; he will be too busy playing
c. Yes, it will help him feel secure in his new place
d. Yes, it may cause severe emotional problems to take it away now
Ans: C- if the mother tells the nurse that her 2-year-old son insists on taking a favorite blanket to nursery school with him and wants to know if she should allow this, the nurse’s best response is, “Yes, it will help him feel secure in his new place.” Telling a toddler he needs to grow up and removing his security blanket will make the child insecure and afraid. Telling the mother that the child does not need the blanket away from home and that he will be too busy playing to want his blanket is not true. May toddlers have blankets or toys they keep with and carry around all of the time because the objects offers them security. Taking this security away when they are away from home would cause the child to feel insecure and cause emotional upset. To tell a mother that it would cause severe emotional problems if he blanket was taken away is not true; it may serious emotional problems. If something happened to the blanket (it might get lost), then the mother may believe that the child with have been severe emotional problems.
29. Sigmund Freud believed that the major task of a toddler period is:
a. Anxiety over separation from mother
b. Toilet training
c. Development of the superego
d. Developing gender identity
Ans: B Sigmund Freud believed that the major task of the toddler period is toilet training, and he described this stage as the genital stage. Bowel training may be accomplished between ages 18 and 24 months. Bladder training may not be accomplished until ages 3 to 5 years especially night-time control. Erikson’s phase 1 is concerned with acquiring a sense of basic trust while overcoming a sense of mistrust. The trust acquired in infancy is the foundation for all the succeeding phases. Separation anxiety is prominent during the latter half of infancy (8 months) and is still present to some degree when toddlers are 1 to 3 years old, and is even seen in preschool children. Toddlers are more willing to meet strangers and will tolerate longer periods of separation. There is less of the extreme fear of separation that was prominent during the latter half of infancy. Development of superego, or conscience has its beginning toward the end of the toddler years (age 3) and is a major task for the 3 to 5-year-old preschool-age child. Learning right from wrong and good from bad is the beginning of morality. Most children are aware of their gender and the expected set of related behaviors by 1 ½ to 2 ½ years of age. This is called developing gender identity. Although toddlers might be aware of their particular sex, they do not possess the language and cognitive skills to investigate sexual identity as fully as preschool age children. Freud has long recognized this task by describing this period as the genital stage.
30. A mother tells the nurse that at 2 years of age, her daughter is speaking new words almost daily. For the past month, the child has shown little interest in new vocabulary. The nurse should:
a. Explain that the child’s energies now are focused on developing motor skills
b. Suggest that the mother spend an hour reading to the toddler daily
c. Evaluate the possibility of hearing loss and refer for testing
d. Perform a Denver Developmental Screening Test to check for delays in vocabulary development
Ans: A – a mother tells the nurse that at 2 years of age, her daughter was speaking new words almost daily. For the past month, however, she shows little interest in new vocabulary. The nurse should explain that the child’s energies are now focused on developing motor skills.
a. Intussusception
b. Dehydration
c. Celiac disease
d. Hirschprung’s disease
Ans: D - a newborn’s failure to pass meconium within the first 24 h after birth may indicate Hirschsprung’s disease, a congenital disorder of the large intestine. It is characterized by absence or marked reduction of parasympathetic ganglion cells in the intestinal wall. This impairs the intestinal motility and causes severe constipation. Without prompt treatment, a neonate will develop bowel obstruction and may die within 24 h. Hirschsprung’s disease is believed to be a familial, congenital defect, occurring more often in males than in females. Clinical manifestations usually appear shortly after birth, but mild symptoms may not be recognized until later in childhood or during adolescence. The newborn with Hirschsprung’s disease commonly fails to pass meconium within 24 to 48 h, shows signs of bowel obstruction, abdominal distention, irritability, poor sucking reflex, refusal to take feedings, failure to –thrive, dehydration, and liquid stools. Surgical treatment is necessary, but is delayed until the infant is at least 10 months old. Management until surgery consists of daily colonic lavages to empty the bowel. If total obstruction is present in the newborn, a temporary colostomy or ileostomy is necessary to decompress the bowel. Intussusception is when the bowel turns back into itself (telescoping). Intussusception is most common in infants and occurs three times more often in males than in females. Signs and symptoms of intussusception are intermittent attacks of colicky pain; vomiting of stomach content, “ currant jelly” stools, which contain a mixture of blood and mucus; tender distended abdomen, with a palpable, sausage-shaped abdominal mass. Dehydration will not cause a failure to pass meconium. Celiac disease is characterized by poor food absorption and intolerance for gluten, a protein in wheat and wheat products. With treatment such as eliminating gluten from the client’s diet, prognosis is good. The cause is unknown, but females are affected more often than males. This disorder produces the following clinical manifestations; recurrent attacks of diarrhea, steatorrhea (fat in stool), abdominal distention, stomach without cramps, weakness, anorexia, and increased appetite without weight gain. Symptoms develop during the first year of life when gluten is introduced in the child’s diet as cereal. Treatment requires permanent elimination or reduction of gluten from the client’s diet. Supportive treatment may include supplemental iron, vitamin B12, folic acid, reversal of electrolyte imbalances (by IV infusion, if necessary), corticosteroids (prednisone or hydrocortisone), and vitamin K for hypoprothrombinemia.
2. Three-week-old Billy is admitted to the hospital with a history of “spitting up” since he was 1 week old. His mother says, “Billy’s spitting has now increased to what I would call forceful vomiting.” The most likely diagnosis for Billy would be:
a. Hirshprung’s disease
b. Celiac disease
c. Pyloric stenosis
d. Intussusception
Ans: C-when a 3-week-old baby continues to spit up large amounts of formula and then forceful vomiting, pyloric stenosis may be indicated. Obstruction of the sphincter is one of the most common surgical disorders of early infancy. This disorder is usually seen soon after birth, with vomiting becoming progressively more severe and projectile. It is five times more common in male infants than in female infants. The cause of pyloric stenosis is unknown. Diagnosis is made by upper GI x-ray studies.
3. A 10-year-old female client is diagnosed with insulin-dependent diabetes mellitus. She asks the nurse why she cannot take a pill her Aunt Jessie does, rather than insulin shots. The most correct response by the nurse would be:
a. The pill stimulates cells in the pancreas to produce insulin, and your cells are not able to produce insulin
b. The pills will stimulate insulin production in the adult pancreas but will not in the child’s pancreas
c. When you are able to cut down on the amount of sweets you eat, then maybe you can start taking the pill
d. Your doctor, makes that decision, ask him
Ans: A- when a child has insulin dependent diabetes mellitus (IDDM), the beta cells of the pancreas can no longer produce insulin. The patient must like insulin by subcutaneous (SC) injection, and will have to take insulin for the rest of his or her life. A patient with noninsulin dependent diabetes mellitus (NIDDM) will have some active beta cells; an oral hypoglycemic medication will stimulate these beta cells to produce insulin. The statements, “ The pills will stimulate insulin production in the adult pancreas but will not in child,” is an incorrect statement. Oral hypoglycenmic medication will stimulate live beta cells to produce insulin in a child’s pancreas or an adult pancreas in a child. These option are incorrect as seen in rationale (A).
4. A 2-year-old female client is brought to the emergency room after waking up with a bark-like cough and stridor. On arrival to the ER, she has respiratory distress and is a febrile. The diagnosis is croup. The nurse instructs the parents to:
a. Perform percussion and postural drainage before putting the patient to bed and before meals
b. Encourage frequent coughing and deep breathing
c. Run a cool mist vaporizer in patient’s room during the day
d. Follow a schedule of postural drainage and increase fluid intake
Ans: C- the nurse should instruct the parents of a child with croup to run a cool mist vaporizer in the child’s room at night and during the day, and take the child into the shower with them in an acute care situation. Croup is a severe inflammation and obstruction of the upper airway, occurring as laryngotracheobroinchitis (most common), laryngitis, and acute spasmodic laryngitis. Croup is a childhood disease-affecting males more often than females (typically between 3 months and 3 years), usually during the winter months. Croup usually results from a viral infection, but can be caused by bacteria. Most children are sued at home with rest, cool humidification during sleep, and antipyretics (such as acetaminophen) to relieve symptoms. In an acute case, taking the child into a shower will provide the child with a more humid atmosphere. These options are incorrect as seen in rationale (C).
5. The symptoms most commonly seen in croup are:
a. Wheezing, colicky pain and vomiting
b. Stridor, rapid pulse and bark-like cough
c. Drooling, rapid pulse and occasional hoarse cry
d. Fever, vomiting and abdominal retractions on inspiration
Ans: B-the symptoms most commonly as seen in croup are stridor (labored breathing with retractions), rapid pulse, and a bark-like cough. These options are incorrect as seen in rationale (B).
6. Which of the following is the most threatening to a hospitalized toddler’s autonomy?
a. Frequent visits by parents and friends of the family
b. Participation in playroom activities with other children
c. Complete bed rest
d. Riding to the x-ray department in a wheelchair in a hospital gown
Ans: C- one of the most threatening things to a hospitalized toddler’s autonomy is complete bedrest. The toddler is just beginning to assert independence and is very active, and does not want to be kept in bed. Bedrest is very threatening to a toddler who does not understand the reason for it. Frequent visits may parents and friends help the child feel safe and not abandoned. This is not threat to the child’s autonomy. A toddler loves to play with other children, even if they do not known them. This encourages autonomy (not threatens it); normally, toddlers make friends easily. Riding to x-ray in a wheelchair could be fun for a child, not a threat to autonomy.
7. Which one of the following phrases most accurately describes myelomeningocele?
a. The incomplete fusion of the vertebrae at one level that may have an overlying dimple or tuft of hair
b. Herniation of a portion of the spinal cord and meninges into a cyst
c. The incomplete fusion of one or more of the vertebral laminae
d. A cyst formation containing CSF, blood and meninges
Ans: B- myelomenigocele is the most severe “ neural tube defect” (NTD), involving protruding sac-like structure tat contains meninges, spinal fluid, and neural tissue. The spinal nerve roots, may terminate in the sac, significantly affecting motor and sensory function below that point. The incomplete fusion of the vertebrae at one level with An overlying dimple of turf protrusion of the spinal tissue is called spina bifida cystica. This type of defect is usually in the lumbosacral area. There are two classifications of spinal bifida cystica; myelomeningocele and meningocele. Spina bifida cystica is a general classification for these disorders; therefore, this is an incorrect option. Meningocele is the formation of a sac-like cyst. Which contains meninges and spinal fluid that produces through a defect in the bony spine.
8. When explaining how to correctly collect specimen for identification of pin worms, the nurse should tell the mother to:
a. Bring in a fresh stool specimen
b. Administer a laxative the night prior to collection of a specimen
c. Place a tongue blade covered with tape over the child’s anus
d. Have the child defecate and then smear a small amount of stool on a slide
Ans: C- to collect a specimen for the identification of pin worms, a tongue blade covered with tape is placed over the child’s anus during the night for a specimen. The sticky side of the tape is placed on the rectum. During the right, the worms crawl into the anus and lay their eggs. The eggs will stick to the tape on the tongue blade. A fresh stool specimen may not have any pin worms in it, but the child may still have pin worms. Fresh specimens are best for revealing parasites or larvae; therefore, a collected specimen should be taken directly to the laboratory for examination. These options are incorrect as seen in rationale (C) and (A).
9. Activated charcoal is administered to the child who has ingested a poison substance in order to:
a. Induce vomiting
b. Increase the effectiveness of ipecac
c. Increase movement through the GI tract
d. Absorb the compound
Ans: D- activated charcoal is administered to the child who has ingested a poisonous substance to absorb the compound. Activated charcoal effectively absorbs most poisons, with the exception of cyanide. It also absorbs ipecac syrup; therefore, the emetic should be given and be allowed to exert its effect before the charcoal is given. Charcoal, however, is most effective if administered within 30 min of ingesting the poison. These options are incorrect as seen in rationale (D).
10. When giving parents anticipatory guidance about accident prevention for toddlers, the nurse tells the parents:
a. If the toddler feels the heat, he learns that a stove is hot
b. Falls are not as great a danger now as they were during infancy
c. Areas previously childproofed may now be accessible to toddler
d. Toddlers understand the word “NO” and will listen to parental rules
Ans: C- when giving parents anticipatory guidance for toddlers, the nurse tells the parents that “areas previously child-proofed may now be accessible to the toddler.” Anticipatory guidance is the ideal way to handle a problem. Prevent it deal with it before it becomes a problem. Parents know what to expect will be prepared for a problem when it appears. The statement , “ If the toddler feels the heat, she learns that the stive is hot,” is incorrect. The child does not have to experience every danger to prevent it from happening. If a parent waits for a child to be burned, the burn could be fatal. The statement, “ Falls are not as great a danger now as during infancy,” is not true. Falls continue to be a great danger throughout life. The statement, “ Toddlers understand the word ‘no’ and will listen to parental rules,” is a false statement. Toddlers tend to ignore the word ‘no’ and find it very difficult to obey their parents. They are interested in establishing their autonomy.
11. A mother brings her 3-year-old son and her 8-month-old daughter to the health center. She states that her son enjoys pouring and playing with water. The water safety rule for the bathroom is reviewed with the mother. The only correct rule given here is:
a. Never leave children alone in the bathtub
b. Never leave a child in the bathtub unless an older child is in with them
c. Have the child test the water temperature with his hand
d. It is safe to leave children alone in bathtub if there is one 12 inches of water
Ans: A- a water safety rule given to parents should be to NEVER leave children alone in the bathtub. A 3-year-old child is to young to take care of any child in bathtub, this is not a safety rule. The adult’s responsibility is to check the temperature of there is only 12 inches of water; they can turn on the faucet and fill the tub or drown in 12 inches of water. Note: The safety rules are many but the only one given in this situation is option (A).
12. The nursing diagnosis appropriate for health promotion of a well toddler is:
a. Potential for injury related to increased mobility
b. Activity intolerance related to rapid growth
c. Alteration in growth and development related to rapid growth
d. Alteration in bowel elimination related to interest in playing, not drinking
Ans: A- the nursing diagnosis appropriate to health promotion of the well toddler is potential for injury related to increased mobility. A well toddler does not intolerance to activity; they love activity. This nursing diagnosis is incorrect. A well toddler does not have an alteration in growth and development. This nursing diagnosis is incorrect. A well toddler normally does not have an alteration in bowel elimination. This nursing diagnosis is incorrect.
13. A mother brings her 2-year-old son to the clinic for his measles, mumps and rubella vaccine (MMR). Prior to giving the vaccine, it is important for the nurse to ask if he has:
a. Recently been checked for anemia
b. Ever experienced an allergic reaction to eggs
c. Been in close contact with anyone with rubella (German measles)
d. Been in close contact with a pregnant relative or baby sitter
Ans: B¬- prior to giving a child a vaccine for measles, mumps, and rebulla (MMR), the nurse should ask the parents if the child is allergic to eggs because they vaccinated for measles, mumps, and rebulla. If the child has been in contact with someone who had rebulla (German measles), he or she can still get his or her MMR vaccine. Being exposed to measles would not affect the MMR vaccine given to the child unless the child was exposed 10 to 14 days before scheduled for their first MMR vaccine. Then they would be given gamma and MMR vaccine at a later date. The child being in contact with a pregnant relative or babysitter has no effect on the MMR vaccine given to the child. If the child has rebulla (German measles), should not be around a pregnant woman. If the pregnant, the chance of her child having a birth defect are high. Congenital rubella is by far the most serious form of the disease. Intrauterine rebulla infection, especially during the first trimester, can lead to spontaneous abortion or stillbirth, as well as single and multiple birth defects. As a rule, the earlier the infection occurs during pregnancy, the greater the damage to the fetus.
14. In explaining the use of “time out” as a form of discipline for a 2-year-old child, the nurse tells the parents:
a. To send the child to his or her bedroom for 20 minutes
b. To allow the child to take his or her own favorite toy to the room
c. The total time out should be no more than 2 to 3 minutes
d. To explain to the child why the behavior was bad after( “time out”)
Ans: C-in explaining the use of “time out” as a form of discipline for a 2-year-old child t he nurse tells the parents that the total time out should be no more than 2 to 3 min. a 2-year-old child will forget why they have no remain in a room after a few minutes and will become upset if they are left in their room. This option is incorrect seen in rationale (c). allowing a child a favorite toy in “time out” is not disciplinary action; the child may believe they are put in time out just play for a little while. The parent needs to explain to the child before “time out” why their behavior was not acceptable. A child should not be t old that what they did or did not do is bad because the child may then think of themselves as bad.
15. The behavior that would indicate to parents that a toddler is ready to begin toilet training is:
a. Showing interest in flushing the toilet
b. Staying dry throughout the night
c. Spending time in the bathroom with parents
d. Pulling a wet diapers or taking off wet diapers
Ans: D- the behavior that would indicate to parents that a toddler is ready to begin toilet training is when the toddler pulls off water diapers. The child is uncomfortable wearing a wet diaper and can recognize that they are the one who is wetting them. The parent can tell them, “If you do not like your diaper wet, then you can g (“pee”) in the toilet.” The child may pull off t he wet diaper and ask the mother to take them to the toilet. Flushing the toilet indicates that the toddler likes to hear the water run and has nothing to do with being ready to be toilet trained. Many children stay dry throughout the night long before they are ready to be toilet trained. If they do not their diapers at night, it is probably because they did not drink much fluid before going to bed. Spending time in the bathroom with parents does not indicate that they are ready to begin toilet training. They may just want to be near their parents.
16. A mother of an 18-month-old child tells the nurse that her child is a finicky eater. The best advice that the nurse can give to the mother is:
a. Give small amounts and cut food into small pieces allow for finger feeding
b. Don’t force the child to eat but make sure that the child drinks all of his milk
c. Serve small portions and make the child sit at the table until he eats all of his foods
d. Serve the child in front of the TV to keep his attention
Ans: A- when an 18-month-old toddler is a finicky eater the best advice the nurse can give the mother is, “ Give small amounts and cut food into small pieces that follow for finger feeding.” A toddler is interested in autonomy; allowing the child to feed himself gives the child the autonomy that he is seeking. Children never be forced to eat all of their food or drink all of I their mil because they might aspirate the food or the milk. This method will not encourage them to eat the food. Making a toddler sit at the table until eat all of their food will make the child hate eating. The child may be at the tale for an hour and still not have eaten all of his food. This is punishment that is associated with eating, and certainly will not encourage the child to eat. If a toddler who is finicky eater is served food in front of the TV, the toddler will watch TV and not eat.
17. When toddler says, “NO” to eating a food, they may be:
a. Saying they do not like the food, be testing their parents, be practicing independence
b. Deciding the types of foods they like and dislike
c. Trying to impress on their parents that they will have the right to choose their own food
d. Saying no because they like the word; it has no meaning at all and is just a habit that children develop
Ans: A- when a toddler says “no” to eating a food, they may not like the food, may be testing the parents, or be practicing independence. Toddlers know what foods they like and dislike, but this is not always the reason they say no eating a food. Toddlers do not have the cognition to think abut impressing people. Toddlers say no for many reasons; option (A) covers some of them.
18. When a doctor has a consent form signed for a surgical procedure on a child, the nurse knows that:
a. Only the parent or legal guardian can sign the consent form
b. The person giving consent must be at least 18 years old
c. The risk and benefits of procedures are parts of the consent process
d. A mental age of 7-year-old or older is required for a consent to be considered “informed”
Ans: A- when the doctor is having a consent form signed for a surgical procedure on a child, the nurse knows that only a parent or legal guardian can sign the consent for. These options are incorrect as seen in rationale (A).
19. The nurse is planning how to prepare a 4-year-old child for a diagnostic procedure. Guidelines for preparing this preschooler should include:
a. A plan for a short teaching session of about 35 minutes each day
b. Telling the child that the procedure is not a form of punishment
c. Keeping equipment out of the child’s view
d. Telling the child that the procedure will be simple
Ans: B-the nurse knows that the guidance for preparing a preschooler for diagnostic procedure is to tell the child that the is not a form of punishment. Preschool children believe that diagnosis procedures and treatments are punishments for something they have done. This answer calls for a short teaching session; 35 min is not a sort teaching session. A preschool child will lose interest in a teaching session that last more than a few minutes; dolls or stuffed animals must be used to explain procedures and keep the child’s attention. The child needs to see the equipments that will be used for diagnostic purposes for treatment the day before so that they will be familiar and not be afraid of it. The nurse should not tell the child that the procedure will be simple because the procedure may not be simple to the child. The child will be more afraid when the procedure hurts or causes them some discomfort. The child will not trust the nurse and will be more fearful of the hospital’s treatments and it personnel.
20. The nurse is preparing a 6-year-old child before obtaining a blood specimen by venipuncture. The child tells the nurse that he does not want to lose his blood. The appropriate approach by the nurse would be to:
a. Explain that the process will not be painful and that it will be over quickly
b. Discuss with the child how the body is always in the process of making blood
c. Suggest to the child that he does not have to worry about losing a little bit pf blood because he is old enough now not to be afraid
d. Tell the child that he will not need a Band-Aid after ward because it is such a simple procedure. If he does not watch the nurse draw the blood, it will not hurt
Ans: B- when a nurse is preparing a child for a venipuncture, the nurse needs to understand that 6-year-old child has a great fear of bodily injury. Because children heave an inadequate comprehension of medical events, they have a fear of invasive and /or painful procedures. The nurse should discuss with the child how the body is always in the process of making blood. Discussing the procedure with the child and allowing them to express their feelings will help to reduce their anxiety. If the nurse tells the child that the procedure is not painful and they will not even need a Band-Aid, the nurse is not being honest with the child. When the child then experience pain, he or she will no longer trust nurses and will fear every procedure. A nurse should never tell a child or an adult not to worry; this does not help them cope with their fears and it makes the patient feel as if the nurse is not concerned.
21. When administering a gavage feeding or medication to an infant through a nasogastric tube, the nurse should:
a. Lubricate the tip of the feeding tube with petroleum to facilitate passage
b. Check the placement of the tube by inserting 20 ml of sterile water
c. Administer feedings over a period of 15 to 30 minutes
d. Place the infant on its right side or abdomen for 1 hour after feeding
Ans: D-when administering a gavage feeding or medication through a nasogastric (NG) tube to an infant, the nurse should place the infant on the right side of abdomen for 1 h after the feeding. The stomach is on left side; therefore, the infant should not be laced on the left side as the pressure on the stomach can cause the infant to vomit. If the infant is placed on the right side or on the abdomen and vomits, the vomit come out of the mouth and not be aspirated. Being in this position for 1 h will allow time for the food or medication to leave the stomach. The questions is when administering a gavage feeding. Not when putting an NG tube into the stomach. Read your stem carefully. The placement of the NG tube should not be done with water, because the tube might be in the lungs. The correct procedure for checking NG placement is to push air through the NG tubing with a large syringe while listening over the stomach with a stethoscope. If a bubbling sound (air) is heard, then the nurse knows the NG tube in the stomach, or withdrawn stomach content and check acidity. There is no reason to administer tube feedings over a period of 15 to 30 min. there is an order for continuous tube feeding, then the tube feeding is continuous – not over 15 to 30 min.
22. In preparing to give “enemas until clear results” (colonic lavage) to an 18-month-old child before surgery for Hirschprung’s disease, the nurse would anticipate that the physician would order:
a. Tap water (120 ml)
b. Fleet solution (200 ml)
c. Saline (300 ml)
d. Oil retention (300 ml)
Ans: C- when giving “enemas until clear” to an 18-mnoth-old child surgery for a megacolon (Hirschsprung’s disease), the nurse would anticipate that the physician would order 300 mL saline enema. Hirchsprung’s disease is a congenital disorder of the large intestine, characterized by the absence or marked reduction of parasympathetic ganglion cells. The disorder impairs intestinal motility and causes severe constipation. Before surgery, at least once a day, a large amount of saline is given as an enema (colonic lavage). Enemas given with the standard amount of fluid are not sufficient because the colon is so large and laxatives will not clear the colon adequately. Saline (salt) is used to draw as much fluid as possible into the intestines. These options are incorrect as seen in rationale (C).
23. In relation to growth, the parents of a toddler can expect:
a. A growth spurt at about 18 months of age
b. A 4 to 6 lbs gain of weight between ages 3 and 4
c. Small weight losses and larger gains related to changing appetite
d. Little increase in height before age 3 years
Ans: B- in relation to growth, the parents of a toddler can expect a 4-6 pound gain in weight between ages 3 and 4. these options are incorrect as seen in rationale (B).
24. An 18-month-old child is seen in the clinic for a well-child check-up. While completing the assessment, the nurse notes a protruding abdomen. The nurse’s assessment is that:
a. The child may be constipated
b. Further evaluation is warranted
c. An abdominal tumor must be ruled out
d. This is a normal finding
Ans: D- an 18-month-old child seen in a clinic for a well child assessment will have a protruding abdomen, normal for this age. The abdominal muscles are not yet strong enough to keep the abdomen pulled in, but this will change as the child grows older. These options are incorrect as seen in rationale (D).
25. A premature infant’s dietary intake needs to be particularly sufficient in:
a. Glucose
b. Iron
c. Zinc
d. Vitamin C
Ans: B¬- maternal iron stores are adequate for the first 4 to 5 months of age in the full-term infant, but are reduced considerably in premature infants of multiple births. When exogenous sources of iron are not supplied to meet the infant’s growth demands following depletion of fetal iron store, iron deficiency anemia results. Iron is necessary for hemoglobin synthesis. Hemoglobin is the oxygen carrying molecule on he red blood cells. These options are incorrect as seen in rationale (B).
26. Visual development in an 18-month-old is directly related to parental need for anticipatory guidance related to:
a. Prevention of falls
b. Selection of a dentist
c. Signs of infections and need for glasses
d. High dietary intake of vitamin A
Ans: A- visual development in toddler (18-month0old) is directly related to parental need for anticipatory guidance related to prevention of falls, because the child’s depth perception is not fully developed. These options are incorrect as seen in rationale (A).
27. Toddlers are most interested in play that involves:
a. Watching TV, especially cartoons and playing Nintendo
b. Interaction with other toddlers and playing games with them
c. Active use of small and large muscle groups for climbing and running
d. Adults telling or reading stories for 30 minutes at a time
Ans: C- toddlers are most interested in play that involves the active use of small and large muscle groups for climbing and running. At this age, the toddler is very active and very curious. It is dangerous age because toddlers can climb and get into things. A toddler may enjoy cartoons but will not sit still for very long. The toddler is not old enough to play Nintendo. Toddlers are not interested in playing games with other children. They like to sit beside each other and pay, but not share. Toddlers enjoy having adults read to them, but only for 3 to 5 min at a time; their attention span is very short.
28. The mother of a 2-year-old boy tells the nurse that the child insists on taking a favorite blanket to bed with him at night and at naptime. The mother asks the nurse if she should send the blanket to nursery school with him. The best response by the nurse is:
a. No, this is a good time for him to give it up and grow up
b. No, he doesn’t need it away from home; he will be too busy playing
c. Yes, it will help him feel secure in his new place
d. Yes, it may cause severe emotional problems to take it away now
Ans: C- if the mother tells the nurse that her 2-year-old son insists on taking a favorite blanket to nursery school with him and wants to know if she should allow this, the nurse’s best response is, “Yes, it will help him feel secure in his new place.” Telling a toddler he needs to grow up and removing his security blanket will make the child insecure and afraid. Telling the mother that the child does not need the blanket away from home and that he will be too busy playing to want his blanket is not true. May toddlers have blankets or toys they keep with and carry around all of the time because the objects offers them security. Taking this security away when they are away from home would cause the child to feel insecure and cause emotional upset. To tell a mother that it would cause severe emotional problems if he blanket was taken away is not true; it may serious emotional problems. If something happened to the blanket (it might get lost), then the mother may believe that the child with have been severe emotional problems.
29. Sigmund Freud believed that the major task of a toddler period is:
a. Anxiety over separation from mother
b. Toilet training
c. Development of the superego
d. Developing gender identity
Ans: B Sigmund Freud believed that the major task of the toddler period is toilet training, and he described this stage as the genital stage. Bowel training may be accomplished between ages 18 and 24 months. Bladder training may not be accomplished until ages 3 to 5 years especially night-time control. Erikson’s phase 1 is concerned with acquiring a sense of basic trust while overcoming a sense of mistrust. The trust acquired in infancy is the foundation for all the succeeding phases. Separation anxiety is prominent during the latter half of infancy (8 months) and is still present to some degree when toddlers are 1 to 3 years old, and is even seen in preschool children. Toddlers are more willing to meet strangers and will tolerate longer periods of separation. There is less of the extreme fear of separation that was prominent during the latter half of infancy. Development of superego, or conscience has its beginning toward the end of the toddler years (age 3) and is a major task for the 3 to 5-year-old preschool-age child. Learning right from wrong and good from bad is the beginning of morality. Most children are aware of their gender and the expected set of related behaviors by 1 ½ to 2 ½ years of age. This is called developing gender identity. Although toddlers might be aware of their particular sex, they do not possess the language and cognitive skills to investigate sexual identity as fully as preschool age children. Freud has long recognized this task by describing this period as the genital stage.
30. A mother tells the nurse that at 2 years of age, her daughter is speaking new words almost daily. For the past month, the child has shown little interest in new vocabulary. The nurse should:
a. Explain that the child’s energies now are focused on developing motor skills
b. Suggest that the mother spend an hour reading to the toddler daily
c. Evaluate the possibility of hearing loss and refer for testing
d. Perform a Denver Developmental Screening Test to check for delays in vocabulary development
Ans: A – a mother tells the nurse that at 2 years of age, her daughter was speaking new words almost daily. For the past month, however, she shows little interest in new vocabulary. The nurse should explain that the child’s energies are now focused on developing motor skills.