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PEDIATRIC NURSING WITH RATIONALE

PEDIATRIC NURSING WITH RATIONALE
1.) Which achievement best characterizes the physical development of a 3-month-old infant?
A.) A strong Moro reflex
B.) A strong tonic-neck reflex
C.) The ability to roll over intentionally
D.) The ability to lift the head and chest from a prone position

Ans: D
R: Infant developmental milestone, generally grouped in 3-month increments, include the gain or loss of certain reflexes and the mastery of increasingly sophisticated motor skills. The ability to lift the head and chest from a prone position is characteristic of a 3-month old infant and demonstrates a cephalocaudal principle of growth and development---that is, the infant’s ability to raise his head, then his chest, and then his trunk. The moro and tonic-neck reflexes usually begin fading at 3 months; a persistently strong Moro or tonic-neck reflex is abnormal. Rolling over also occurs incrementally: The infant begins by rolling from back to side, then from side to back, and then over completely. Rolling over intentionally usually occurs at ages 5-6 months.

2.) Birth weight typically triples by the end of the first
A.) 4 months
B.) 6 months
C.) 8 months
D.) 12 months

Ans: D
R: Birth weight typically doubles by 6 months, triples by 12 months and quadruples by 30 months

3.) Which statements best characterizes the normal state of mutuality between an infant and his primary caregiver during the first few months?
A.) The caregiver immediately responds to the infant’s cries
B.) The caregiver understand the infant’s distress signals
C.) The infant learns that the caregiver will feed him when he is hungry and reposition him when he is restless
D.) The caregiver recognizes the infant’s signal for restlessness, and the infant quiets when the caregiver repositions him

Ans: D
R: All these statements demonstrate positive development in the infant-caregiver relationship, but only the last one exemplifies the concept of mutuality: the special sensing—mutual exchange of unique cues and responses—between an infant and his caregiver that cannot be replicated with a substitute caregiver, such as a nurse. For mutuality to occur, the caregiver must think of the infants as an active participant in the relationship, not as a passive vessel.

4.) At which age does an infant learn to distinguish himself from his caregivers?
A.) 3 moths
B.) 6 months
C.) 9 months
D.) 12 months

Ans: C
R: Individuation—the process whereby an infant realizes he is a distinct individual with a will of his own—usually occurs at age 8 or 9 months, after the infant has established a trusting relationship with his caregivers. This realization appears to be related to cognitive development.

5.) Which behavior indicates that an infant distinguishes himself from his primary caregiver?
A.) Smiling at his caregiver
B.) Putting his fingers in his caregiver’s mouth
C.) Crying when his caregiver leaves
D.) Crawling away from his caregiver

Ans. C
R: Stranger anxiety (also called 8-month anxiety) is the most important criterion in determining an infant’s ability to distinguish himself from his primary caregiver. Typically, the infant experiencing this type of anxiety cries when the caregiver leaves or a stranger approaches. This behavior usually dissipates by the end of the first year but reappears to a stronger degree at 18 months.

6.) By which age can most children wash their hands and brush their teeth with only minimal supervision
A.) Age 2
B.) Age 3
C.) Age 6
D.) Age 8

Ans: B
R: Between ages 2 and 3, most children undergo significant changes in the development of fine motor skills. According to studies based on results of the Denver Developmental Screening Test (DDST), approximately 90% of US children are capable of washing their hands and brushing their teeth with minimal supervision by age 3.

7.) Which situation best demonstrates the parallel play typical of toddlers?
A.) Two toddlers sharing crayons to color separate pictures
B.) Two toddlers playing a board game with the play therapist
C.) Two toddlers seated next to each other playing with separate dolls
D.) A toddler seated on the play therapist’s lap playing with a music box

Ans: C
R: Parallel play refers to noninteractive, side-by-side play in which toddlers engage, as exemplified by two toddlers seated next to each other playing with separate dolls. The situations involving two toddlers sharing crayons or playing a board game do not demonstrate this behavior because toddlers typically do not share and cooperate and because such activity connotes interaction. Also, in the case of two toddlers playing a board game with the play therapist, the play involves interaction with an adult. The situation involving a toddler playing with a music box while seated on the play therapist’s lap also does not demonstrate parallel play because the play involves only one toddler, who is interacting with an adult.

8.) Which toy would be most appropriate for a 3-month-old infant?
A.) A soft cube with different textures on each side
B.) A picture book of baby animals
C.) An activity box placed in the infant’s crib
D.) A set of wooden blocks

Ans: A
R: A young infant enjoys feeling various textures and is capable of holding a lightweight object, such as a soft cube. A book would hold little interest for an infant so young. An activity box and wooden blocks are too sophisticated for a 3-month old infant, who has not yet developed the fine and gross motor skills needed for reaching, holding, pulling, and stacking.

9.) Which toy would be most appropriate for a 2-year-old-child
A.) A bicycle with training wheels
B.) A pull toy that makes noise
C.) A miniature car or truck
D.) A 10-piece wooden puzzle

Ans: B
R: Toddlers expend most of their energy walking and enjoy pulling things behind them. A 2-year-old child lacks the gross motor skills necessary to ride a bicycle. Miniature cars require fine motor coordination and are more appropriate for a preschooler. A 10-piece puzzle requires fine motor coordination and higher cognitive development and is therefore too complex for a 2 year old child.

10.) Which question effectively elicits information about a caregiver’s knowledge of toilet training?
A.) “Have you had any experience with toilet training?”
B.) “Has your child shown any interest in toilet training?”
C.) “What do you know about toilet training?”
D.) “Why do you want to toilet train your child?”

Ans: C
R: The initial step in health education involves assessing an individual’s needs, motivation, developmental level, knowledge base, and learning ability. BY asking such open-ended questions as, “What do you know about toilet training?” the nurse can elicit information and provide a basis for more specific questions that can lead to teaching. Questions involving the caregiver’s previous experience and motivation and the child’s readiness for toilet training should be part of the assessment phase, but these questions are too specific to be of value initially.

11.) All of the following statements about toilet training are true except:
A.) The child should be given detailed instructions and explanations about elimination
B.) Toilet-training sessions should last no longer than 10 minutes
C.) Using negative control may hinder toilet training
D.) placing a stool below the toilet serves as a footrest and provides greater stability for the child

Ans: A
R: Toddlers require simple, clear, and nondetailed instructions and explanations to complete a task. Toilet-training sessions should last no longer than 10minutes because the toddler’s attention span typically ranges from 5 to 10 minutes. Praise for cooperation or successful elimination is more effective than using negative control such as spanking, which may hinder toilet-training efforts. A stool stability and sense of security for the child.

12.) Which of the following is the normal order of sexual maturity in girls?
A.) Appearance of pubic hair, menarche, breast enlargement
B.) Menarche, breast enlargement, appearance of pubic hair, menarche
C.) Breast enlargement, appearance of pubic hair, menarche
D.) Appearance of pubic hair, breast enlargement, menarche

Ans: C
R: Although individuals mature sexually at different rates, most follow a normal development rhythm and order. The typical order of female sexual maturity---breast enlargement, followed by appearance of pubic hair, and, finally, menarche—commonly occur between ages 9 and 17

13.) The first sign of sexual development in boys usually is:
A.) Growth of pubic hair
B.) Testicular enlargement
C.) Nocturnal emissions
D.) Deepening voice

Ans: B
R: Male sexual development commonly occurs between ages 10 and 17, characteristically beginning with testicular enlargement and scrotal skin reddening. Pubic hair development,, nocturnal emissions, and deepening voice—the most notable changes during adolescence—typically follow

14.) Piaget’s sensorimotor stage is characterized by all of the following except:
A.) Reflexive behavior
B.) Intentional reaching or grasping for an object
C.) Habitual repetitive behavior
D.) Regarding inanimate objects as alive

Ans: D
R: Regarding inanimate objects as alive (animism) is characteristic of Piaget’s preoperational stage of cognitive development, which occurs between ages 2 and 7, reflexive behavior, intentional reaching or grasping, and habitual, repetitive behavior are characteristic of the sensorimotor stage, which occurs from birth to about age 2

15.) Menarche usually occurs:
A.) At the onset of puberty
B.) In Tanner’s stage II
C.) In Tanner’s stage IV
D.) At the onset of senescence

Ans: C
R: Menarche usually occurs in Tanner’s stage IV, a latent stage of puberty, characterized in girls by protrusion of the areola and nipple, presence of axillary hair, growth of pubic hair, and beginning of menses (menarche). It does not occur at the onset of puberty or senescence, the stage associated with old age. Tanner’s stage II, the stage of early puberty, is marked by the beginning development of secondary sex characteristics, such as breast buds and early pubic hair.

16.) Tanner’s stage I of male sexual maturation is characterized by:
A.) Increased testicular size
B.) Onset of penile growth and pubic hair development
C.) Increased genital development and increased growth of pubic and axillary hair
D.) Fully mature genitalia and pubic hair

Ans: C
R: Tanner’s stage IV is characterized in boys by increased genital development thicker and coarser pubic hair, and increased axillary hair. Stage II is characterized by increased testicular size, as noted by an increased pendulous appearance of the scrotum and the onset of penile growth and pubic hair development. Stage V is marked by fully mature genitalia and pubic hair.

17.) Receptive language problems’ are associated with
A.) Poor grammar
B.) Speech pattern or sound alterations
C.) Environmental deprivation
D.) Problems with decoding

Ans: D
R: A child with a receptive language problem has trouble decoding information because he does not understand verbal symbols. He also may have limited comprehension and ability to organize ideas. Poor grammar, speech pattern and sound alterations, and environmental deprivation are associated with expensive speech difficulties

18.) The inability to process symbols and abstract ideas results from:
A.) Aphasia
B.) Articulation errors
C.) Dysfluency
D.) Voice rhythm disorder

Ans: A
R: The inability to process symbols and abstract ideas usually results from aphasia, a central nervous system dysfunction commonly caused by trauma or inadequate language development. Expressive language problems, such as articulation defects, dysfluency (speech hesitancy), and voice disorders; are symptoms

19.) Stuttering is the most common form of
A.) Articulation error
B.) Dysfluency
C.) Voice disorder
D.) Decoding problems

Ans: B
R: Stuttering is the most common form of dysfluency (speech hesitancy), a normal characteristic of speech development during the preschool years. More common in boys, stuttering typically occurs because the child’s vocabulary does not keep pace with his advancing mental ability and comprehension level. In many cases a child under age 3 is unaware that he is stuttering. Stuttering that persists beyond age 5 usually requires caregiver assistance, such as reinforcement of fluent speech periods that occur with singing or repeating nursery rhymes. With proper attention, dysfluency can be reversed early in the child’s development. An articulation error involves the incorrect pronunciation of a sound or the omission of a sound, particularly at the end of a word. A voice disorder involves a deviation in the pitch; loudness, or quality of speech. A decoding problem involves difficulty processing and interpreting information in the brain.


20.) All of the following are classic signs of hearing impairment in infants and young children except:
A.) Unresponsiveness to noise or simple oral commands
B.) Gesturing rather than speaking
C.) Continuing babbling
D.) Avoidance of social interaction

Ans: C
R: Continuous babbling is not an indication of hearing impairment in an infant or a young child. Hearing impairment usually becomes noticeable when the child exhibits a problem in one or more of the following areas: orientation responses (such as unresponsiveness to simple oral commands), vocalization and sound production (such as absence of babbling or vocal play by age 7 months), visual attentiveness (such as avoidance of social interaction), and emotional behaviors (such as frequent stubbornness or inattentiveness).

1 comments:

Anonymous said...

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