Infant
Which approaches should the nurse use to facilitate better feeding? Select all that apply.
A. Turn on the television during feeding.
B. Place the infant in a face-to-face position.
C. Force the infant to feed even when he seems finished.
D. Provide positive comments while the infant is feeding.
E. Establish a basic length of the feeding period.
F. Watch for diminished sucking at the beginning of the feeding.
ANSWER: B, D, E
A. The television should be turned off during feeding to decrease sensory stimulation and to avoid distracting the child.
B. Placing the infant in a face-to-face position allows the caregiver to watch for the infant’s signals and allows the infant to see the caregiver’s positive reactions.
C. Forcing the infant to feed even when he seems finished is inappropriate. Encouraging additional intake is all right.
D. Providing positive comments while the infant is feeding should help the feeding process after a while. The tone of the caregiver’s voice is important, as is the message delivered.
E. Establishing a basic length of the feeding period, such as 30 minutes, is appropriate.
F. Watching for diminished sucking toward the end of the feeding often lets the nurse know that the infant is full or no longer interested in feeding.
What is the leading cause of death in children over the age of 1 year?
A. Drowning
B. Burns
C. Motor vehicle accidents
D. Cancer
Answer: C
A. Drowning is the second leading cause of death in children over the age of 1 year.
B. Burns cause fewer deaths than motor vehicle accidents in children over the age of 1 year.
C. Motor vehicle accidents are the leading cause of death in children over the age of 1 year.
D. Cancer causes fewer deaths than motor vehicle accidents in children over the age of 1 year.
The nurse performs an assessment on a 6 month old infant and documents the posterior fontanel is open and palpable. The charge nurse is completing a chart review and flags the findings. What is the concern?
ANSWER:
Posterior fontanel closes at 6-8 weeks.
The nurse educator in a pediatric hospital is conducting an orientation for a group of new pediatric nurses. The main topic for today’s session is family-centered care of the child during illness and hospitalization. A variety of aspects of this topic will be discussed.
After talking about the variety of stressors that children can experience during hospitalization, the nurse educator explains in detail the greatest stress imposed by hospitalization during early childhood. Teaching by the educator has been effective if the attendees choose which stressor?
A. Pain or comfort issues
B. Different toileting arrangements
C. Wearing unusual clothing
D. Separation anxiety
Answer: D
Separation anxiety is the greatest stress imposed by hospitalization during early childhood. If separation is avoided, young children have a tremendous capacity to withstand any other stress.
The nurse makes sure that a toddler has a teddy bear and that a night-light is on in the hospital room at bedtime.
What concept would these nursing actions demonstrate?
A. Nonmaleficence
B. Justice
C. Atraumatic care
D. Advocacy
Answer: C
A. Nonmaleficence is the obligation to minimize or prevent harm; there is no situation present that would require this.
B. Justice is the concept of fairness and is not applicable to this situation.
C. Atraumatic care is the provision of therapeutic care in settings, by personnel, and through the use of interventions that eliminate or minimize the psychological and physical distress experienced by children and their families in the health care system. In this case, it is making sure that the toddler has a teddy bear and that a night-light is on to prevent a dark environment.
D. Advocacy involves ensuring that families are aware of all available health services, adequately informed of treatments and procedures involved in the child’s care, and encouraged to change or support existing health care practices.
A mother asks why it is important for her 3-month-old daughter to be checked on when she cries really loudly. What answer by the nurse is best?
A. “This lets the baby know you love her.”
B. “You can prevent diaper rash if she is wet.”
C. “It gives you peace of mind that she’s okay.”
D. “It is the beginning of your daughter learning to trust.”
ANSWER: D
A. It is too early for the infant to understand love. The infant deals with comfort by being fed, being warm and comfortable, and being dry.
B. Prevention of diaper rash is a minute part of the infant’s care.
C. Checking on the infant focuses on the infant’s safety, not the mother’s peace of mind.
D. Establishment of basic trust dominates the first year of life and describes all of the child’s satisfying experiences at this age. Trust is the first and most important attribute to develop for a healthy personality.
The pediatric nurse is conducting classes on growth and development for a group of first-time parents at a clinic.
One of the parents asks about sleep patterns for her 14-month-old toddler.
What information about the sleep patterns would be correct?
A. The toddler should be sleeping throughout the night without any naps during the day.
B. The toddler should be awakening only once during the night and be taking one nap during the day.
C. The toddler should be sleeping throughout the night and have one or two nap periods during the day.
D. The toddler may still be having very erratic sleep patterns at night with two nap periods during the day.
ANSWER: C
A. This toddler should be sleeping through the night and may take one or two naps during the day. By the time they are 12 to 18 months old, most children have eliminated the second nap.
B. The toddler should not routinely be awakening during the night and would have one nap period, or possibly two nap periods, during the day.
C. During the latter part of the first year, most children sleep through the night and take one or two naps during the day. By the time they are 12 to 18 months old, most children have eliminated the second nap.
D. Erratic sleep patterns at this age are not usual. The toddler will nap once during the day, or possibly twice.
What information should the nurse remember in order to work effectively with parents of a failure-to-thrive infant?
A. A trust relationship needs to be established for the best success when working with the parents.
B. The parents need to be watched constantly when they are interacting with the infant.
C. Teaching the parents how to play with the infant is essential before successful feeding can occur.
D. Only the parents should know about the techniques of successful feeding and infant care.
ANSWER: A
A. A trust relationship needs to be established for the best success when working with the parents. Parents of failure-to-thrive children are often uneasy around professionals. Treating the parents with kindness as well as acknowledging how difficult parenting can be often is a starting point for interaction between the nurse and the parents.
B. The parents should not be watched constantly when they are interacting with the infant. They need watching when evaluation of their interactions with the infant, as well as how they follow instructions after interventions, has been started.
C. Teaching the parents how to play with the infant is important if they do not know how to do this, but it has nothing to do with successful feeding patterns.
D. In this situation, the grandmother, who takes care of the infant while the parents are at work, needs to be included in the instruction and return demonstrations covering feeding, play, and general infant care.
A mother mentions her son has breath-holding tantrums and that they frighten her. What explanation by the nurse is best?
A. Physical harm is rare because the breathing mechanism in the body will be triggered.
B. Make sure that you do not let your son faint from a low level of oxygen in his body.
C. Consistency is important during a tantrum, so both parents should react in the same way.
D. Pick your son up and let him have his tantrum on a soft surface like the bed.
ANSWER: A
A. Physical harm is rare because the breathing mechanism in the body will be triggered. When the carbon dioxide levels rise to a certain point, respirations will be stimulated. Even if the toddler faints, the only damage that could occur would be from hitting his head because breathing would start again.
B. Physical harm is rare because the breathing mechanism in the body will be triggered. When the carbon dioxide levels rise to a certain point, respirations will be stimulated. Even if the toddler faints, the only damage that could occur would be from hitting his head because breathing would start again.
C. Consistency is important during a tantrum, so both parents should react in the same way, but this is not the best response to the mother’s concern that the temper tantrums are frightening her. Consistency is needed before a tantrum occurs as well. Refer to the explanations in the rationales for A and B.
D. Picking the son up and letting him have his tantrum on a soft surface like the bed calls too much attention to the tantrum. He should be watched so he does not get hurt.
One of the attendees at a pediatric nursing education session asks whether therapeutic play and play therapy are the same because they almost have the same words. Which explanation by the nurse educator provides the most accurate differentiation?
A. Play therapy is nondirective play that allows children freedom of expression and can be tremendously therapeutic.
B. Therapeutic play is a psychological technique reserved for use by trained and qualified therapists as an interpretative method with emotionally disturbed children.
C. Tension release can be facilitated by the use of play therapy. Activities such as tossing beanbags at a target or using a pounding board can be helpful for young patients.
D. Therapeutic play is nondirective play that allows children freedom of expression. Painting a picture or hitting a punching bag because of being angry about being sick are two activities that can be used.
ANSWER: D
A. Therapeutic play is nondirective play that allows children freedom of expression and can be tremendously therapeutic.
B. Play therapy is a psychological technique reserved for use by trained and qualified therapists as an interpretative method with emotionally disturbed children.
C. Tension release can be facilitated by the use of therapeutic play. Activities such as tossing beanbags at a target or using a pounding board can be helpful for young patients.
D. The best explanation is this one: Therapeutic play is nondirective play that allows children freedom of expression. Painting a picture or hitting a punching bag because of being angry about being sick are two activities that can be used.
The nurse is examining a 7-month-old female full-term infant and notices the diaper is soiled and the perianal area is extremely red with satellite pustules on the surrounding skin. The child’s vital signs include a temperature of 98.2 F (26. C), pulse of 100 beats/min and respirations of 30 breaths/min. The mother states the infant is eating well. The mother states the rash occurred after she changed the brand of diapers she was using. The child is alert and responsive to the nurse’s voice. Based on the assessment findings, what priority actions would the nurse recommend to the mother at this time?
Select all that apply.
A. Using a hair dryer blow warm air on rash area
B. Apply a skin barrier paste such as zinc oxide.
C. Keep skin surface irritants such as urine and stool off skin.
D. Expose skin to air.
E. Use only cloth diapers.
F. Educate the mother on how to treat the rash
ANSWER: B, C, D, F
A. Use of a hair dryer is not recommended because these devices can cause burns
B. Ointments such as zinc oxide protect the skin especially if skin is very red or has moist open areas
C. Change the diaper as soon as it becomes wet/soiled eliminates a large part of the problem
D. Exposure to air facilitates healing
E. Use of cloth diaper alone do not prevent diaper dermatitis
F. Educating the mother will facilitate healing and help to prevent further diaper dermatitis
A 2½-year-old toddler’s mother is due to have a baby within the next month. The mother has been a stay-at-home mother for the past 3 months, wanting to spend extra time with her son. The nurse at the obstetrician’s office asks the mother if she has any questions.
The mother mentions that her son has been more resistant to use his potty chair as her belly has been expanding. Which explanation by the nurse is best?
A. This behavior indicates your child may be a little stressed by the unknown events.
B. Most children go through periods of regression at some time in their lives.
C. You need to keep insisting that he continues using his potty chair.
D. Tell him he needs to be a big boy because he will soon become a big brother.
ANSWER: A
A. This behavior is an example of regression, which indicates the child may be a little stressed by the unknown events, such as the mother’s belly getting bigger, discussion about a baby in the house, and maybe even physical changes such as getting a room ready for the baby.
B. Although many children go through periods of regression at some time in their lives, this response does not answer the mother’s question.
C. The mother needs to keep encouraging her son to use his potty chair, but she should also expect some regression.
D. Telling him he needs to be a big boy because he will soon become a big brother does not mean much to him at this point. Children this age do not understand abstract ideas.
A 4-month-old male weighed 8 pounds, 4 ounces at birth and now weighs 11 pounds, 7 ounces. He has been on a demand feeding schedule and gradually has been consuming less formula at each feeding and periodically vomits. He does not show much of a social smile. He has just been admitted for evaluation to determine any underlying problems and for rehydration. He is cared for by his grandmother when his parents are at work.
When assigning nursing staff to this infant, which concept should be followed?
A. Assign nurses who look most like his mother.
B. Assign a different nurse each day to assess the infant.
C. Assign the same nurse as much as possible.
D. Assign a nurse who is much older than his mother.
ANSWER C:
A. Assigning nurses who look most like his mother is not important.
B. Assigning a different nurse each day to assess the infant would decrease the continuity in this infant’s care. It is essential to have a core of primary nurses so observations can be validated among a small group of caregivers.
C. Assigning the same nurse as much as possible to provide continuity of care is essential. The primary group of nurses caring for the child can learn to perceive the child’s cues and reverse the cycle of dissatisfaction, especially in the area of feeding.
D. Assigning a nurse who is much older than his mother would not affect the infant.
A graduate nurse is being oriented to the pediatric department and is attending classes that include an overview of health promotion information about children as well as the philosophy of the pediatric department, which includes the roles of parents while their child is hospitalized and what the child and parents can expect from the nurses and other staff members during hospitalization.
Which topics should the nurse discuss with the parents of a young child to promote health in their child? Select all that apply.
A. Getting the child immunized at the appropriate ages
B. Obtaining a dental checkup after the baby teeth erupt
C. Helping the child maintain a normal body weight
D. Placing the child in an appropriate car seat or restraint system
E. Allowing the child to be in a small child’s swimming pool without supervision
F. Supervising infants when they begin to become mobile
ANSWER: A, B, C, D, F
A. Immunizations have made a major impact in the prevention of disease in children. The nurse should review individual immunization records at every clinic visit, avoid missing opportunities to vaccinate, and encourage parents to keep immunizations current.
B. Dental caries are the single most common chronic disease of childhood and may begin before the first birthday.
C. Childhood obesity is the most common nutritional problem among American children and is associated with type 2 diabetes. It is important to help parents understand how to help their child maintain a normal body weight.
D. Children younger than 1 year of age have the highest rate of death from motor vehicle accidents, primarily from a failure to use car restraints properly.
E. Children do not understand the hazards associated with water and need supervision at all times.
F. Crawling infants, who have a natural tendency to place objects in their mouths, are at risk for aspiration or poisoning.
The topic of appropriate toys for parents to bring to the hospital is being discussed. What points should the educator make to cover a broad range of patient ages? Select all that apply.
A. New toys that the child has been wanting are the best ones for the parents to bring.
B. Comfort toys such as stuffed animals and blankets work well.
C. The toys should be washable if the child is coughing and sneezing because of safety and infection concerns.
D. Having more toys provides the child with a variety from which to choose.
E. Toys that are fun, engaging, and promote parental interaction
Answer: B, C, E
A. Toys that are familiar and provide a link with home and the world outside the hospital are best.
B. Comfort toys such as stuffed animals and blankets work well. These items need to be checked for safety and cleanliness as well.
C. The toys should be washable if the child is coughing and sneezing because of safety and infection concerns.
D. Having large numbers of toys can often confuse and frustrate small children. A highly successful diversion for a child who is hospitalized for a length of time and whose parents are unable to visit frequently is having the parents bring a box with several small, inexpensive, brightly wrapped items with a different day of the week printed on the outside of each package.
E. Toys that promote family-centered engagement will help the child navigate the stressors of hospitalization