Growth & Development
An 18-year-old with a rash and itching in the groin area is concerned that he has contracted a sexually transmitted disease and does not want his parents to find out. The nurse’s best response is:
1. “We will need to contact your parents to let them know.”
2. “We will not contact your parents regarding this visit.”
3. “Who would you like us to contact about your visit here today?”
4. “We cannot promise that the hospital will not contact your parents.”
What is 2?
An adolescent has every right to privacy as long as the situation is not life threatening.
Which would be the nurse’s priority intervention if a 7-year-old’s mother tells the nurse she has noticed excessive masturbation?
1. Tell her it is normal development for children of this age.
2. Ask the mother if anyone is abusing the child.
3. Talk with the child and find out why she is touching herself down there.
4. Investigate thoroughly the circumstances in which she masturbates.
What is 2?
Masturbation may indicate sexual abuse. It is imperative that the nurses do a thorough investigation if a parent is concerned about a child’s masturbation.
A 10-year-old has undergone cardiac catheterization. At the end of the procedure, the nurse should first assess:
1. Pain.
2. Pulses.
3. Hemoglobin and hematocrit levels.
4. Catheterization report.
What is 2?
Checking for pulses, especially in the canulated extremity, would assure perfusion to that extremity and is the priority post-procedure.
Parents are told they should start taking their toddler to the dentist. They are concerned
their child is too young and that the dentist will be too harsh with the child. The nurse suggests the parents do which of the following before the dental visit?
1. Tell the child it will not hurt.
2. Warn that they will have the dentist give a needle in case of bad behavior.
3. Tell the child they will go along to the dentist so that they can model comfortable, safe behavior.
4. Offer the child a treat for good behavior.
What is 3?
Modeling appropriate behavior for the child by having the child go with a parent creates a positive preparation for attending the dentist.
A nurse is caring for a child with congenital heart disease who is being treated with digoxin (Lanoxin). Which is included in the family’s discharge teaching?
1. Make sure the medication is taken with food.
2. Repeat the dose if the child vomits.
3. Take the child’s pulse prior to administration.
4. Weigh the child daily.
What is 3?
The child’s pulse should be monitored before each dose. The dose should be withheld according to the physician’s parameters.
The nurse is going to give a 6-month-old a dose of Rocephin IM. What must the nurse do when the 1.5-mL dose arrives from the pharmacy?
1. Administer the injection into the deltoid muscle.
2. Divide the dose into two injections.
3. Administer the injection into the dorsogluteal muscle.
4. Give dose as a single injection into the vastus lateralis muscle.
What is 2?
A nurse should not deliver more than 1 mL per IM injection to a 6-month-old.
Expected nursing assessments of a newborn with suspected cystic fibrosis would include:
1. Observe frequency and nature of stools.
2. Provide chest physical therapy.
3. Observe for weight gain.
4. Assess parent’s compliance with fluid restrictions.
What is 1?
Cystic fibrosis is inherited as an autosomal-recessive trait, causing exocrine gland dysfunction. About 7% to 10% of newborns with cystic fibrosis present with meconium ileus, so assessing stool frequency and consistency is important.
Which breathing exercises should the nurse have an asthmatic 3-year-old child do to increase her expiratory phase?
1. Use an incentive spirometer.
2. Breathe into a paper bag.
3. Blow a pinwheel.
4. Take several deep breaths.
What is 3?
Blowing a pinwheel is an excellent means of increasing a child’s expiratory phase. Play is an effective means of engaging a child in therapeutic activities. Blowing bubbles is another method to increase the child’s expiratory phase.
Which is the nurse’s best approach to teach high school students about smoking prevention?
1. Discuss health consequences of smoking.
2. Use scare tactics and point out the negative effects of smoking.
3. Offer alternatives to smoking such as chewing gum or doing activities that distract.
4. Have the adolescents talk with their parents about smoking.
What is 3?
It is always best to focus on the prevention of smoking and take a positive approach to how a teen might resist smoking. Peer support groups work well in redefining the teens’ peer groups and give them tactics to use against smoking.
Which assessment should be a priority to monitor in a child receiving a narcotic for pain relief?
1. Respirations.
2. Bowel sounds.
3. Blood pressure.
4. Oxygen saturation.
What is 1?
The primary purpose of administrating an opioid analgesic is to relieve pain. The adverse effects that place the child at greatest risk are respiratory depression and decreased level of consciousness.
The mother of an adolescent complains that he has had some recent behavioral changes. He comes home from school every day, closes his door, and refrains from interaction with his family. The nurse’s best response to the mother is:
1. “You should speak with your son and ask him directly what is wrong with him.”
2. “You should set limits with your son and tell him that this is unacceptable behavior.”
3. “Your son’s behavior is abnormal, and he is going to need a psychiatric referral.”
4. “Your son’s behavior is normal. You should listen to him without being judgmental.”
What is 4?
The child’s behavior is typical of a teen’s response to developmental and psychosocial changes of adolescence.
Which would be the best response to the mother of a 13-year-old who continues to ask to ride his 16-year-old cousin’s all-terrain vehicle?
1. Emphasize the wearing of safety apparel and adult supervision.
2. Explain that he is developing increased physical skills; if he wears safety apparel and shows maturity, it should be fine.
3. All-terrain vehicles are not recommended for those younger than 16 years of age.
4. This is a stage where the child is seeking independence and should be allowed to participate in new physical activities.
What is 3?
The teen may be at the developmental stage of seeking independence, but adolescents do not yet have the emotional or physical development to operate all-terrain vehicles. The American Academy of Pediatrics states that those younger than 16 years should not operate all-terrain vehicles.
The parent of a 9-month-old calls the ER because his child is choking on a marble.
The parent asks how to help his child while awaiting Emergency Medical Services. Which is the nurse’s best response?
1. “You should administer five abdominal thrusts followed by five back blows.”
2. “You should try to retrieve the object by inserting your finger in your child’s mouth.”
3. “You should perform the Heimlich maneuver.”
4. “You should administer five back blows followed by five chest thrusts.”
What is 4?
The current recommendation for infants younger than 1 year is to administer five back blows followed by five chest thrusts.
Parents are frustrated with toilet-training their 2-year-old. Both parents work fulltime and claim they do not have time to spend on toilet-training. What suggestions can the nurse give the parents to decrease their frustration?
1. “You will have to invest some time if the child is to be toilet-trained.”
2. “A child needs to be both physically and psychologically ready to learn the skills needed to be continent.”
3. “Do you think your child is stubborn?”
4. “Have the child sit on the toilet until the child voids.”
What is 2?
The child is 2 years old and may not be physically, emotionally, or psychologically ready to toilet train.
Which drug is most important in treating an infant with transposition of the great vessels?
1. Digoxin (Lanoxin).
2. Antibiotics.
3. Prostaglandin E.
4. Diuretics.
What is 3?
Prostaglandin E is necessary to maintain patency of the patent ductus arteriosus and improve systemic arterial flow in children with inadequate intracardiac mixing.
The mother of a 15-year-old is frustrated because he spends much of his weekend time sleeping. Which is the nurse’s best response to the mother’s frustration?
1. “Your son may be trying to catch up on the sleep missed during the week.”
2. “Developmental theorists believe that teens require more sleep as they begin to integrate new roles into their lives.”
3. “Teens require more sleep due to the rapid physical growth that is occurring.”
4. “Teens require more sleep due to the increase in their social obligations.”
What is 3?
Teens require more sleep due to the rapid physical growth that occurs during adolescence.
What would be the best response to a mother who tells the nurse that the only way she can get her 2-year-old to take medicine is to call it candy?
1. Tell her that is fine as long as the child takes all of the medicine.
2. Discuss the importance of not calling medicine candy to prevent accidental drug ingestion.
3. Discuss with the mother that the child does not have to take the medicine if she does not want it.
4. Tell the mother her child will have to go to “time-out” if she does not take her medicine.
What is 2?
Medications should never be called candy to prevent the accidental ingestion of medication by children who think it is candy.
A school-age child is admitted to the hospital for a tonsillectomy. During the nurse’s post-operative assessment, the child’s parent tells the nurse that the child is in pain. Which of the following observations would be of most concern to the nurse?
1. The child’s heart rate and blood pressure are elevated.
2. The child complains of having a sore throat.
3. The child is refusing to eat solid foods.
4. The child is swallowing excessively.
What is 4?
Excessive swallowing is a sign that the child is swallowing blood. This should be considered a medical emergency, and the physician should be contacted immediately. The child is likely bleeding and will need to return to surgery.
An 18-month-old, who attends day care, has been having a barking, hoarse-sounding cough that comes in spasms with very noisy respirations for the last 2 nights. The parent is concerned that the child has picked up an infection at day care. The day-care staff indicates the child does not cough during the day, has no fever, and is eating and drinking well. This description is most likely which condition?
1. Laryngotracheobronchitis.
2. Bacterial tracheitis.
3. Asthma.
4. Acute spasmodic laryngitis.
What is 4?
This is the history of a child with acute spasmodic laryngitis. Symptoms of inflammation are absent or mild. Some children are thought to be predisposed to this, with an allergy or psychogenic factors as an underlying cause.
The parents of a child with glomerulonephritis ask how they will know their child is improving after they go home. Which is the nurse’s best response?
1. “Your child’s urine output will increase, and the urine will become less tea-colored.”
2. “Your child will rest more comfortably as lab tests become more normal.”
3. “Your child’s appetite will decrease as urine output increases.”
4. “Your child’s laboratory values will become more normal.”
What is 1?
When glomerulonephritis is improving, urine output increases and the urine becomes less tea-colored. These are signs that can be monitored at home by the child’s parents.
The mother of a 13-year-old girl tells the nurse that she is concerned because her daughter has gained 5 lb since she began puberty. The child’s mother asks the nurse for advice about what to do about her daughter’s weight gain. Which should the nurse do?
1. Provide the child’s mother with some pamphlets on nutrition and healthy eating.
2. Provide the child’s mother with information about a new exercise program for teens.
3. Inform the child’s mother that it is common for teen girls to gain weight during puberty.
4. Inform the child’s mother that her daughter will likely gain another 5 to 10 lb in the next year.
What is 3?
The nurse should tell the child’s mother that this is a normal finding in teenage girls as they enter puberty.
Which would be the best response to a 10-year-old who asks if she can take acetaminophen daily if she gets aches and pains?
1. Tell her it is better not to take medication if she gets aches and pains; she should check with her mother before taking any medication.
2. Teach her that nonprescription drugs like acetaminophen can be a poisoning hazard if too many are taken; it is best for her to check with her mother.
3. Encourage her to keep a log of when she takes acetaminophen to try to establish what is causing her aches and pains.
4. Sometimes it is okay to take acetaminophen daily, but it depends on why she has aches and pains.
What is 4?
If she needs pain medication daily, a
cause needs to be determined.
Which assessment indicates that the parent of a 7-year-old is following the prescribed treatment for congestive heart failure (CHF)?
1. HR of 56 beats per minute.
2. Elevated red blood cell count.
3. 50th percentile height and weight for age.
4. Urine output of 0.5 cc/kg/hr.
What is 3?
The 50th percentile height and weight for age shows good growth and development, indicating good nutrition and perfusion.
The parent of an infant diagnosed with a neuroblastoma asks the nurse what the prognosis is. The nurse’s best response is:
1. Excellent, as a neuroblastoma is always cured.
2. Excellent, as infants with a neuroblastoma have the best prognosis.
3. Poor, as infants with a neuroblastoma rarely survive.
4. Variable, depending on the site of origin.
What is 1?
Infants younger than 1 year have the best prognosis.
The clinical manifestations of minimal change nephrotic syndrome (MCNS) are due to which of the following?
1. Chemical changes in the composition of albumin.
2. Increased permeability of the glomeruli.
3. Obstruction of the capillaries of the glomeruli.
4. Loss of the kidney’s ability to excrete waste and concentrate urine.
What is 2?
Increased permeability of the glomeruli in MCNS allows large substances such as protein to pass through and be excreted in the urine.