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Chapter 12: Health Promotion of the Toddler and Family

 

MULTIPLE CHOICE

  1. What factor is most important in predisposing toddlers to frequent infections?

a.

Respirations are abdominal.

b.

Pulse and respiratory rates in toddlers are slower than those in infants.

c.

Defense mechanisms are less efficient than those during infancy.

d.

Toddlers have short, straight internal ear canals and large lymph tissue.

ANS:  D

Toddlers continue to have the short, straight internal ear canals of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose toddlers to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy.

DIF:    Cognitive Level: Analyzing             REF:   p. 490            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Physiological Integrity

  1. What do the psychosocial developmental tasks of toddlerhood include?

a.

Development of a conscience

b.

Recognition of sex differences

c.

Ability to get along with age mates

d.

Ability to delay gratification

ANS:  D

If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that toddlers are concerned with is the ability to delay gratification. Development of a conscience and recognition of sex differences occur during the preschool years. The ability to get along with age mates develops during the preschool and school-age years.

DIF:    Cognitive Level: Understanding       REF:   p. 490            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Psychosocial Integrity

  1. The developmental task with which the child of 15 to 30 months is likely to be struggling is a sense of which?

a.

Trust

b.

Initiative

c.

Intimacy

d.

Autonomy

ANS:  D

Autonomy versus shame and doubt is the developmental task of toddlers. Trust versus mistrust is the developmental stage of infancy. Initiative versus guilt is the developmental stage of early childhood. Intimacy and solidarity versus isolation is the developmental stage of early adulthood.

DIF:    Cognitive Level: Remembering        REF:   p. 490            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. Parents of an 18-month-old boy tells the nurse that he says “no” to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. What is the nurse’s best interpretation of this behavior?

a.

This is normal behavior for his age.

b.

This is unusual behavior for his age.

c.

He is not effectively coping with stress.

d.

He is showing he needs more attention.

ANS:  A

Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and use of the word “no.” Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old.

DIF:    Cognitive Level: Understanding       REF:   p. 491            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. A 17-month-old child should be expected to be in which stage, according to Piaget?

a.

Preoperations

b.

Concrete operations

c.

Tertiary circular reactions

d.

Secondary circular reactions

ANS:  C

A 17-month-old is in the fifth stage of the sensorimotor phase, tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. Concrete operations is the cognitive stage associated with school-age children. The secondary circular reaction stage lasts from about ages 4 to 8 months.

DIF:    Cognitive Level: Understanding       REF:   p. 491            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. Although a 14-month-old girl received a shock from an electrical outlet recently, her parent finds her about to place a paper clip in another outlet. Which is the best interpretation of this behavior?

a.

Her cognitive development is delayed.

b.

This is typical behavior because toddlers are not very developed.

c.

This is typical behavior because of toddlers’ inability to transfer remembering to new situations.

d.

This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

ANS:  C

During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. This is typical behavior for a toddler, who is only somewhat aware of a causal relation between events. Her cognitive development is appropriate for her age.

DIF:    Cognitive Level: Understanding       REF:   p. 491            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. A toddler, age 16 months, falls down a few stairs. He gets up and “scolds” the stairs as if they caused him to fall. What is this an example of?

a.

Animism

b.

Ritualism

c.

Irreversibility

d.

Delayed cognitive development

ANS:  A

Animism is the attribution of lifelike qualities to inanimate objects. By scolding the stairs, the toddler is attributing human characteristics to them. Ritualism is the need to maintain sameness and reliability. It provides a sense of comfort to toddlers. Irreversibility is the inability to reverse or undo actions initiated physically. The toddler is acting in an age-appropriate manner.

DIF:    Cognitive Level: Analyzing             REF:   p. 493            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. What is a characteristic of a toddler’s language development at age 18 months?

a.

Vocabulary of 25 words

b.

Use of holophrases

c.

Increasing level of understanding

d.

Approximately one third of speech understandable

ANS:  C

During the second year of life, the understanding and understanding of speech increase to a level far greater than the child’s vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages. An 18-month-old child has a vocabulary of approximately 10 words. At this age, the child does not use the one-word sentences that are characteristic of 1-year-old children. The child has a very limited vocabulary of single words that are comprehensible.

DIF:    Cognitive Level: Understanding       REF:   p. 493            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. Which characteristic best describes the gross motor skills of a 24-month-old child?

a.

Skips

b.

Broad jumps

c.

Rides tricycle

d.

Walks up and down stairs

ANS:  D

A 24-month-old child can go up and down stairs alone with two feet on each step. Skipping and broad jumping are skills acquired at age 3 years. Tricycle riding is achieved at age 4 years.

DIF:    Cognitive Level: Understanding       REF:   p. 514            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. What developmental characteristic does not occur until a child reaches age 2 1/2 years?

a.

Birth weight has doubled.

b.

Anterior fontanel is still open.

c.

Primary dentition is complete.

d.

Binocularity may be established.

ANS:  C

Usually by age 30 months, the primary dentition of 20 teeth is complete. Birth weight doubles at approximately ages 5 to 6 months. The anterior fontanel closes at ages 12 to 18 months. Binocularity is established by age 15 months.

DIF:    Cognitive Level: Understanding       REF:   p. 499            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. Which statement is correct about toilet training?

a.

Bladder training is usually accomplished before bowel training.

b.

Wanting to please the parent helps motivate the child to use the toilet.

c.

Watching older siblings use the toilet confuses the child.

d.

Children must be forced to sit on the toilet when first learning.

ANS:  B

Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please the parent by holding on rather than pleasing him- or herself by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

DIF:    Cognitive Level: Understanding       REF:   p. 500            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. The parents of a newborn say that their toddler “hates the baby. . . . He suggested that we put him in the trash can so the trash truck could take him away.” What is the nurse’s best reply?

a.

“Let’s see if we can figure out why he hates the new baby.”

b.

“That’s a strong statement to come from such a small boy.”

c.

“Let’s refer him to counseling to work this hatred out. It’s not a normal response.”

d.

“That is a normal response to the birth of a sibling. Let’s look at ways to deal with this.”

ANS:  D

The arrival of a new infant represents a crisis for even the best prepared toddler. Toddlers have their entire schedules and routines disrupted because of the new family member. The nurse should work with the parents on ways to involve the toddler in the newborn’s care and to help focus attention on the toddler. The toddler does not hate the infant. This is an expected, normal response to the changes in routines and attention that affect the toddler. The toddler can be provided with a doll to imitate parents’ behaviors. The child can care for the doll’s needs at the same time the parent is performing similar care for the newborn.

DIF:    Cognitive Level: Understanding       REF:   p. 502            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Psychosocial Integrity          

  1. A toddler’s parent asks the nurse for suggestions on dealing with temper tantrums. What is the most appropriate recommendation?

a.

Punish the child.

b.

Explain to child that this is wrong.

c.

Leave the child alone until the tantrum is over.

d.

Remain close by the child but without eye contact.

ANS:  D

The best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common during this age group as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The presence of the parent is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

DIF:    Cognitive Level: Understanding       REF:   p. 503            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. A parent asks the nurse about negativism in toddlers. What is the most appropriate recommendation?

a.

Punish the child.

b.

Provide more attention.

c.

Ask child not to always say “no.”

d.

Reduce the opportunities for a “no” answer.

ANS:  D

The nurse should suggest to the parent that questions should be phrased with realistic choices rather than yes or no answers. This provides a sense of control for the toddler and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young to comply with requests not to say “no.”

DIF:    Cognitive Level: Analyzing             REF:   p. 503            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. The parents of a 2-year-old child tell the nurse they are concerned because the toddler has started to use “baby talk” since the arrival of their new baby. What should the nurse recommend?

a.

Ignore the baby talk.

b.

Tell the toddler frequently, “You are a big kid now.”

c.

Explain to the toddler that baby talk is for babies.

d.

Encourage the toddler to practice more advanced patterns of speech.

ANS:  A

Baby talk is a sign of regression in the toddler. Often toddlers attempt to cope with a stressful situation by reverting to patterns of behavior that were successful in earlier stages of development. It should be ignored while the parents praise the child for developmentally appropriate behaviors. Regression is children’s way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism.

DIF:    Cognitive Level: Applying               REF:   p. 504            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. Parents tell the nurse that their toddler eats little at mealtime, only sits at the table with the family briefly, and wants snacks “all the time.” What should the nurse recommend?

a.

Give her nutritious snacks.

b.

Offer rewards for eating at mealtimes.

c.

Avoid snacks so she is hungry at mealtimes.

d.

Explain to her in a firm manner what is expected of her.

ANS:  A

Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirements associated with the slower growth rate. Parents should assist the child in developing healthy eating habits. Toddlers are often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should be not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat non-nutritious foods in response. A toddler is not able to understand explanations of what is expected of her and comply with the expectations.

DIF:    Cognitive Level: Applying               REF:   p. 505            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is what?

a.

A sign the child is spoiled

b.

An attempt to exert unhealthy control

c.

Regression, which is common at this age

d.

Ritualism, an expected behavior at this age

ANS:  D

The child is exhibiting the ritualism, which is characteristic at this age. Ritualism is the need to maintain sameness and reliability. It provides a sense of structure and comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. This does not indicate the child has unreasonable expectations but rather is part of normal development. Ritualism is not regression, which is a retreat from a present pattern of functioning.

DIF:    Cognitive Level: Analyzing             REF:   p. 491            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. The nurse is discussing with a parent group the importance of fluoride for healthy teeth. What should the nurse recommend?

a.

Determine whether the water supply is fluoridated.

b.

Use fluoridated mouth rinses in children older than 1 year.

c.

Give fluoride supplements to infants beginning at age 2 months.

d.

Brush teeth with fluoridated toothpaste unless the fluoride content of water supply is adequate.

ANS:  A

The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount. It is difficult to teach toddlers to spit out mouthwash. Swallowing fluoridated mouthwashes can contribute to fluorosis. Fluoride supplementation is not recommended until after age 6 months and then only if the water is not fluoridated. Fluoridated toothpaste is still indicated if the fluoride content of the water supply is adequate, but very small amounts are used.

DIF:    Cognitive Level: Analyzing             REF:   p. 510            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. Which is an appropriate recommendation in preventing tooth decay in young children?

a.

Substitute raisins for candy.

b.

Substitute sugarless gum for regular gum.

c.

Use honey or molasses instead of refined sugar.

d.

When sweets are to be eaten, select a time not during meals.

ANS:  B

Regular gum has high sugar content. When the child chews gum, the sugar is in prolonged contact with the teeth. Sugarless gum is less cariogenic than regular gum. Raisins, honey, and molasses are highly cariogenic and should be avoided. Sweets should be consumed with meals so that the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth.

DIF:    Cognitive Level: Analyzing             REF:   p. 511            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. What is the leading cause of death during the toddler period?

a.

Injuries

b.

Infectious diseases

c.

Childhood diseases

d.

Congenital disorders

ANS:  A

Injuries are the most common cause of death in children ages 1 through 4 years. It is the highest rate of death from injuries of any childhood age group except adolescence. Congenital disorders are the second leading cause of death in this age group. Infectious and childhood diseases are less common causes of death in this age group.

DIF:    Cognitive Level: Understanding       REF:   p. 512             TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

  1. The parent of 16-month-old child asks, “What is the best way to keep my child from getting into our medicines at home?” What should the nurse advise?

a.

“All medicines should be locked securely away.”

b.

“The medicines should be placed in high cabinets.”

c.

“Your child just needs to be taught not to touch medicines.”

d.

“Medicines should not be kept in the homes of small children.”

ANS:  A

The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. Toddlers can climb using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize that all the different forms of medications in the home may be dangerous. Keeping medicines out of the homes of small children is not feasible because many parents require medications for chronic or acute illnesses. Parents must be taught safe storage for their home and when they visit other homes.

DIF:    Cognitive Level: Applying               REF:   p. 512            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. Parents are switching their toddler, who has met the weight requirement, from a rear-facing car seat to a forward-facing seat. The nurse should recommend the parents place the seat where in the car?

a.

In the front passenger seat

b.

In the middle of the rear seat

c.

In the rear seat behind the driver

d.

In the rear seat behind the passenger

ANS:  B

Children 0 to 3 years of age riding properly restrained in the middle of the backseat have a 43% lower risk of injury than children riding in the outboard (window) seat during a crash.

DIF:    Cognitive Level: Applying               REF:   p. 514            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. What is the most common type of burn in the toddler age group?

a.

Electric burn from electrical outlets

b.

Flame burn from playing with matches

c.

Hot object burn from cigarettes or irons

d.

Scald burn from high-temperature tap water

ANS:  D

Scald burns are the most common type of thermal injury in children, especially 1- and 2-year-old children. Temperature should be reduced on the hot water in the house and hot liquids placed out of the child’s reach. Electric burns from electrical outlets and hot object burns from cigarettes or irons are both significant causes of burn injury. The child should be protected by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electrical outlets when not in use. Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age group but not one of the most common types of burn.

DIF:    Cognitive Level: Understanding       REF:   p. 515             TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

  1. The nurse is assessing a 20-month-old toddler during a well-child visit and notices tooth decay. The nurse should understand that early childhood caries are caused by what?

a.

Allowing the child to eat citrus foods at bedtime

b.

A hereditary factor that cannot be prevented

c.

Poor fluoride supply in the drinking water

d.

Giving the child a bottle of juice or milk at naptime

ANS:  D

One cause of early childhood caries is allowing the child to go to sleep with a bottle of milk or juice; as the sweet liquid pools in the mouth, the teeth are bathed for several hours in this cariogenic environment. Eating citrus fruit at bedtime and poor fluoride supply in drinking water do not cause early childhood caries. The problem is not hereditary and can be prevented with proper education.

DIF:    Cognitive Level: Understanding       REF:   p. 511            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. The nurse is providing guidance strategies to a group of parents with toddlers at a community outreach program. Which statement by a parent indicates a correct understanding of the teaching?

a.

“I should expect my 24-month-old child to express some signs of readiness for toilet training.”

b.

“I should be firm and structured when disciplining my 18-month-old child.”

c.

“I should expect my 12-month-old child to start to develop a fear of darkness and to need a security blanket.”

d.

“I should expect my 36-month-old child to understand time and proximity of events.”

ANS:  A

A 24-month-old toddler starts to show readiness for toilet training; it is important for the parent to be aware of this and be ready to start the process. At 18 months of age, a child needs consistent but gentle discipline because the child cannot yet understand firmness and structure with discipline. Development of fears and need for security items usually occurs at the end of the 18- to 24-month stage. A 36-month-old child does not yet understand time and proximity of events, so the parent needs to understand that the toddler cannot “hurry up or we will be late.”

DIF:    Cognitive Level: Applying               REF:   p. 518            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. The nurse is assessing a toddler’s visual acuity. Which visual acuity is considered acceptable during the toddler years?

a.

20/20

b.

20/40

c.

20/50

d.

20/60

ANS:  B

Visual acuity of 20/40 is considered acceptable during the toddler years.

DIF:    Cognitive Level: Analyzing             REF:   p. 488            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. The nurse is teaching parents about toilet training. What should the nurse include in the teaching session?

a.

Bladder training is accomplished before bowel training.

b.

The mastery of skills required for toilet training is present at 18 months.

c.

By 12 months, the child is able to retain urine for up to 2 hours or longer.

d.

The physiologic ability to control the sphincters occurs between 18 and 24 months.

ANS:  D

The physiologic ability to control the sphincters occurs somewhere between ages 18 and 24 months. Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The mastery of skills required for training are not present before 24 months of age. By 14 to 18 months of age, the child is able to retain urine for up to 2 hours or longer.

DIF:    Cognitive Level: Applying               REF:   p. 489            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. The nurse is planning care for a hospitalized toddler. What is the rationale for planning to continue the toddler’s rituals while hospitalized?

a.

To provide security

b.

To prevent regression

c.

To prevent dependency

d.

To decrease negativism

ANS:  A

Ritualism, the need to maintain sameness and reliability, provides a sense of security and comfort. It will not prevent regression or dependency or decrease negativism.

DIF:    Cognitive Level: Applying               REF:   p. 491             TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

  1. A nurse is observing children playing in the playroom. What describes parallel play?

a.

A child playing a video game

b.

Two children playing a card game

c.

Two children watching a movie on a television

d.

A child playing with blocks next to a child playing with trucks

ANS:  D

Parallel play is when a toddler plays alongside, not with, other children. A child playing with blocks next to a child playing with trucks is descriptive of parallel play. The child playing a video game is descriptive of solitary play. Two children playing cards is descriptive of cooperative play. Two children watching a television is descriptive of associative play.

DIF:    Cognitive Level: Analyzing             REF:   p. 497            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. Parents ask the nurse for strategies to help their toddler adjust to a new baby. What should the nurse suggest?

a.

Start talking about the baby very early in the pregnancy.

b.

Move the toddler to a new bed after the baby comes home.

c.

Tell the toddler that a new playmate will be coming home soon.

d.

Alert visitors to the new baby to include the toddler in the visit.

ANS:  D

Parents can minimize sibling rivalry by alerting visitors to the toddler’s needs, having small presents on hand for the toddler, and including the child in the visits as much as possible. Time is a vague concept for toddlers. A good time to start talking about the new baby is when the toddler becomes aware of the pregnancy and the changes occurring in the home in anticipation of the new member. To avoid additional stresses when the newborn arrives, parents should perform anticipated changes, such as moving the toddler to a different room or bed, well in advance of the birth. Telling the toddler that a new playmate will come home soon sets up unrealistic expectations.

DIF:    Cognitive Level: Applying               REF:   p. 502            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. Parents ask the nurse, “How should we deal with our toddler’s regression since our new baby has come home?” The nurse should give the parents which response?

a.

“Introduce new areas of learning.”

b.

“Use time-out as punishment when regression occurs.”

c.

“Ignore the behavior and praise appropriate behavior.”

d.

“Explain to the toddler that the behavior is not acceptable.”

ANS:  C

When regression does occur, the best approach is to ignore it while praising existing patterns of appropriate behavior. It is advisable not to introduce new areas of learning when an additional crisis is present or expected, such as beginning toilet training shortly before a sibling is born or during a brief hospitalization. Time-out should not be used as a punishment, and the toddler does not have the cognitive ability to understand an explanation that the behavior is not acceptable.

DIF:    Cognitive Level: Applying               REF:   p. 504            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. The nurse understands that which guideline should be followed to determine serving sizes for toddlers?

a.

1/2 tbsp of solid food per year of age

b.

1 tbsp of solid food per year of age

c.

2 tbsp of solid food per year of age

d.

2 1/2 tbsp of solid food per year of age

ANS:  B

To determine serving sizes for young children, the guideline to follow is 1 tbsp of solid food per year of age. One-half tbsp per year of age would not be adequate. Two or 2 1/2 tbsp per year of age would be excessive.

DIF:    Cognitive Level: Understanding       REF:   p. 505            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. The nurse is teaching parents about avoiding accidental burns with their toddler. What water heater setting should the nurse recommend to the parents?

a.

120° F

b.

130° F

c.

140° F

d.

150° F

ANS:  A

The water heater should be set to limit household water temperatures to less than 49° C (120° F). At this temperature, it takes 10 minutes for exposure to the water to cause a full-thickness burn. Conversely, water temperatures of 54° C (130° F), the usual setting of most water heaters, expose household members to the risk of full-thickness burns within 30 seconds.

DIF:    Cognitive Level: Applying               REF:   p. 516            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. To avoid a fall from a crib, the nurse recommends to parents that their toddler should sleep in a bed rather than a crib when reaching what height?

a.

30 in

b.

35 in

c.

40 in

d.

45 in

ANS:  B

When children reach a height of 89 cm (35 in), they should sleep in a bed rather than a crib.

DIF:    Cognitive Level: Applying               REF:   p. 517            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

  1. The nurse is preparing a staff education program about growth and development of an 18-month-old toddler. Which characteristics should the nurse include in the staff education program? (Select all that apply.)

a.

Eats well with a spoon and cup

b.

Runs clumsily and can walk up stairs

c.

Points to common objects

d.

Builds a tower of three or four blocks

e.

Has a vocabulary of 300 words

f.

Dresses self in simple clothes

ANS:  A, B, C, D

Tasks accomplished by an 18-month-old toddler include eating well with a spoon and cup, running clumsily, walking up stairs, pointing to common objects such as shoes, and building a tower with three or four blocks. An 18-month-old toddler has a vocabulary of only 10 words, not 300. Toddlers cannot dress themselves in simple clothing until 24 months of age.

DIF:    Cognitive Level: Applying               REF:   p. 490            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. A parent asks the nurse, “When will I know my child is ready for toilet training?” The nurse should include what in the response? (Select all that apply.)

a.

The child should be able to stay dry for 1 hour.

b.

The child should be able to sit, walk, and squat.

c.

The child should have regular bowel movements.

d.

The child should express a willingness to please.

ANS:  B, C, D

Signs of toilet training readiness include physical and psychological readiness. The ability to sit, walk, and squat and having regular bowel movements are physical readiness signs. Expressing a willingness to please is a sign of psychological readiness. The child should be able to stay dry for 2 hours, not 1.

DIF:    Cognitive Level: Applying               REF:   p. 500            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. The nurse is teaching parents of a toddler how to handle temper tantrums. What should the nurse include in the teaching? (Select all that apply.)

a.

Provide realistic expectations.

b.

Avoid using rewards for good behavior.

c.

Ensure consistency among all caregivers in expectations.

d.

During tantrums, ignore the behavior and continue to be present.

e.

Use time-outs for managing temper tantrums, starting at 12 months.

ANS:  A, C, D

The best approach toward tapering temper tantrums requires consistency and developmentally appropriate expectations and rewards. Ensuring consistency among all caregivers in expectations, prioritizing what rules are important, and developing consequences that are reasonable for the child’s level of development help manage the behavior. During tantrums, ignore the behavior, provided the behavior is not injurious to the child, such as violently banging the head on the floor. Continue to be present to provide a feeling of control and security to the child after the tantrum has subsided. Starting at 18 months, time-outs work well for managing temper tantrums, but not at 12 months.

DIF:    Cognitive Level: Applying               REF:   p. 503            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. What preventive measures should the nurse teach parents of toddlers to prevent early childhood caries? (Select all that apply.)

a.

Avoid using a bottle as a pacifier.

b.

Eliminate bedtime bottles completely.

c.

Place juice in a bottle for the child to drink.

d.

Wean from the bottle by 18 months of age.

e.

Avoid coating pacifiers in a sweet substance.

ANS:  A, B, E

Prevention of dental caries involves eliminating the bedtime bottle completely, feeding the last bottle before bedtime, substituting a bottle of water for milk or juice, not using the bottle as a pacifier, and never coating pacifiers in sweet substances. Juice in bottles, especially commercially available ready-to-use bottles, is discouraged; these beverages are especially damaging because the sugar is more readily converted to acid. Juice should always be offered in a cup to avoid prolonging the bottle-feeding habit. Toddlers should be encouraged to drink from a cup at the first birthday and weaned from a bottle by 14 months of age, not 18 months.

DIF:    Cognitive Level: Applying               REF:   p. 512            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. A toddler is in the sensorimotor, tertiary circular reactions stage of cognitive development. What behavior should the nurse expect to assess? (Select all that apply.)

a.

Refers to self by pronoun

b.

Gestures “up” and “down”

c.

Able to insert round object into a hole

d.

Can find hidden objects but only in the first location

e.

Uses future-oriented words, such as “tomorrow”

ANS:  B, C, D

Children in the sensorimotor, tertiary circular reactions stage of cognitive development show the behaviors of gesturing “up” and “down,” have the ability to insert round objects into a hole, and can find hidden objects but only in the first location. The behaviors of referring to oneself by pronoun and using future-oriented words such as “tomorrow” are seen in the preoperational stage of cognitive development.

DIF:    Cognitive Level: Applying               REF:   p. 492            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. The nurse is teaching a parent of an 18-month-old about developmental milestones associated with feeding. What should the nurse include in the teaching? (Select all that apply.)

a.

The child will begin to use a fork.

b.

The child will be able use a straw and cup.

c.

The child will be able to hold a cup with both hands.

d.

The child will be able to drink from a cup with a lid.

e.

The child will begin to use a spoon but may turn it before reaching the mouth.

ANS:  C, D, E

An 18-month-old child can hold a cup with both hands, is able to drink from a cup with a lid, and begins to use a spoon but may turn it before reaching the mouth. Using a fork is a developmental milestone of a 36-month-old child. Using a straw and cup is a milestone seen at 24 months.

DIF:    Cognitive Level: Applying               REF:   p. 505            

TOP:   Integrated Process: Teaching/Learning                             

MSC:  Client Needs: Health Promotion and Maintenance

  1. The nurse is preparing to administer some iron drops to a toddler. Which factor can increase iron absorption? (Select all that apply.)

a.

Vitamin A

b.

Acidity (low pH)

c.

Phosphates (milk)

d.

Malabsorptive disorders

e.

Ascorbic acid (Vitamin C)

ANS:  A, B, E

Factors that increase iron absorption are vitamin A, acidity (low pH), and ascorbic acid (vitamin C). Phosphates (milk) and malabsorptive disorders decrease absorption of iron.

DIF:    Cognitive Level: Applying               REF:   p. 508            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. A parent tells the nurse, “My toddler tries to undo the car seat harness and climb out of the seat.” What strategies should the nurse recommend to the parent to encourage the child to stay in the seat? (Select all that apply.)

a.

Allow your child to hold a favorite toy.

b.

Allow your child out of the seat occasionally.

c.

Avoid using rewards to encourage cooperative behavior.

d.

When child tries to unbuckle the seat harness, firmly say, “No.”

e.

It may be necessary to stop the car to reinforce the expected behavior.

ANS:  A, D, E

Strategies to encourage a child to stay in a car seat include allowing the child to hold favorite toy, firmly saying “No” if the child begins to undo the harness, and stopping the car to reinforce the expected behavior. Rewards, such as stars or stickers, can be used to encourage cooperative behavior. The child should stay in the car seat at all times, even for short trips.

DIF:    Cognitive Level: Analyzing             REF:   p. 512            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. What child behavior indicates to the nurse that temper tantrums have become a problem? (Select all that apply.)

a.

The child is 2 to 3 years old

b.

Tantrums occur at bedtime

c.

Tantrums occur past 5 years of age

d.

Tantrums last longer than 15 minutes

e.

Tantrums occur more than five times a day

ANS:  C, D, E

Temper tantrums are common during the toddler years and essentially represent normal developmental behaviors. However, temper tantrums can be signs of serious problems. Temper tantrums that occur past 5 years of age, last longer than 15 minutes, or occur more than five times a day are considered abnormal and may indicate a serious problem. A popular time for a tantrum is before bedtime.

DIF:    Cognitive Level: Analyzing             REF:   p. 503            

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

COMPLETION

  1. A health care provider prescribes sodium fluoride drops, 0.25 mg PO daily. The medication label states: “Sodium fluoride drops 0.5 mg/1 ml.” The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using one decimal place.

________________

ANS: 

0.5

Follow the formula for dosage calculation.

Desired

———– ´ Volume = ml per dose

Available

0.25 mg

———– ´ 1 ml = 0.5 ml

0.5 mg

DIF:    Cognitive Level: Applying               REF:   p. 510            

TOP:   Nursing Process: Implementation     MSC:  Client Needs: Physiological Integrity

MATCHING

Match the type of vegetarianism to its description.

a.

Lacto-ovo vegetarians

b.

Lactovegetarians

c.

Pure vegetarians (vegans)

d.

Macrobiotics

e.

Semi-vegetarians

  1. Eliminate all foods of animal origin, including milk and eggs, allowing only a few types of fruits, vegetables, and legumes
  1. Eliminate all foods of animal origin, including milk and eggs
  1. Exclude meat from their diet but consume dairy products and rarely fish
  1. Exclude meat and eggs but drink milk
  1. Exclude meat from their diet but consumes dairy products with some fish and poultry
  1. ANS:  D                    DIF:    Cognitive Level: Understanding       REF:   p. 507

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. ANS:  C                    DIF:    Cognitive Level: Understanding       REF:   p. 507

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. ANS:  A                    DIF:    Cognitive Level: Understanding       REF:   p. 507

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. ANS:  B                    DIF:    Cognitive Level: Understanding       REF:   p. 507

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

  1. ANS:  E                    DIF:    Cognitive Level: Understanding       REF:   p. 507

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Health Promotion and Maintenance

Chapter 11: The Ill Child in the Hospital and Other Care Settings

 

Test Bank

 

MULTIPLE CHOICE

 

  1. In which situation should the nurse address anxiety as a priority problem in planning care for the child and family?

a.

Twenty-four hour observation

b.

Emergency hospitalization

c.

Outpatient admission

d.

Rehabilitation admission

 

 

ANS:  B

Emergency hospitalization involves (1) limited time for preparation both for the child and family, (2) situations that cause fear for the family that the child may die or be permanently disabled, and (3) a high level of activity, which can foster further anxiety. Although preparation time may be limited with a 24-hour observation, this situation does not usually involve the acuteness of the situation and the high levels of anxiety associated with emergency admission. Outpatient admission generally involves preparation time for the family and child. Because of the lower level of acuteness in these settings, anxiety levels are not as high. Rehabilitation admission follows a serious illness or disease. This type of unit may resemble a home environment, which decreases the child’s and family’s anxiety.

 

DIF:    Cognitive Level: Application           REF:   p. 232            

OBJ:   Nursing Process Step: Planning        MSC:  Safe and Effective Care Environment

 

  1. What is the primary disadvantage associated with outpatient and day facility care?

a.

Increased cost

b.

Increased risk of infection

c.

Lack of physical connection to the hospital

d.

Longer separation of the child from the family

 

 

ANS:  C

Outpatient and day facility care do not provide extended care; therefore, a child requiring extended care would have to be transferred to the hospital, causing increased stress to the child and parents. Outpatient and day facility care decreases cost, decreases the risk of infection, and minimizes separation of the child from the family.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 232            

OBJ:   Nursing Process Step: Implementation                             

MSC:  Safe and Effective Care Environment         

 

  1. In planning care, the nurse recognizes that which child should have the most difficulty with separation from family during hospitalization?

a.

A 5-month-old infant

b.

A 15-month-old toddler

c.

A 4-year-old child

d.

A 7-year-old child

 

 

ANS:  B

Separation is the major stressor for children hospitalized between the ages of 6 and 30 months. Infants younger than 6 months of age will generally adapt to hospitalization if their basic needs for food, warmth, and comfort are met. Although separation anxiety occurs in hospitalized preschoolers, it is usually less obvious and less serious than that experienced by the toddler. The school-age child is accustomed to separation from parents. Although hospitalization is a stressor, the 7-year-old child will have less separation anxiety than a 15-month-old toddler.

 

DIF:    Cognitive Level: Application           REF:   p. 235            

OBJ:   Nursing Process Step: Planning        MSC:  Psychosocial Integrity

 

  1. A 2-year-old child has been hospitalized for 4 days. The nurse notes the child is quiet and withdrawn. Which is the best explanation for this behavior?

a.

The child is protesting because of separation from caregivers.

b.

The child has adjusted to the hospitalization.

c.

The child is experiencing the despair stage of separation.

d.

The child has reached the stage of detachment.

 

 

ANS:  C

In the despair stage of separation, the child exhibits signs of hopelessness and becomes quiet, withdrawn, and apathetic. The detachment stage occurs after prolonged separation. During this phase, the child becomes interested in the environment and begins to play. In the protest stage, the child would be agitated, crying, resistant to caregivers, and inconsolable. Toddlers do not readily “adjust” to hospitalization and separation from caregivers.

 

DIF:    Cognitive Level: Analysis                REF:   p. 235            

OBJ:   Nursing Process Step: Assessment   MSC:  Psychosocial Integrity

 

  1. A 3-year-old child cries, kicks, and clings to the father when the parents try to leave the hospital room. What is the nurse’s best response to the parents about this behavior?

a.

“Your child is showing a normal response to the stress of hospitalization.”

b.

“Your child is not coping effectively with hospitalization. We’ll need to get a psychological consult from the doctor.”

c.

“It is helpful for parents to stay with children during hospitalization.”

d.

“You can avoid this if you wait to leave after your child falls asleep.”

 

 

ANS:  A

The child is exhibiting a healthy attachment to the father. The child’s behavior represents the protest stage of separation and does not represent maladaptive behavior. Suggesting that the parents stay during hospitalization places undue stress and guilt on the parents. It fosters the child’s mistrust when the parent waits to leave after the child falls asleep.

 

DIF:    Cognitive Level: Application           REF:   p. 236            

OBJ:   Nursing Process Step: Implementation                              MSC:  Psychosocial Integrity

 

  1. A preschool aged child tells the nurse “I was bad, that’s why I got sick.” Which is the best rationale for this child’s statement?

a.

The child has a fear that mutilation will lead to death.

b.

The child’s imagination is very active, and he may believe the illness is a result of something he did.

c.

The child has a general understanding of body integrity at this age.

d.

The child will not have fear related to an IV catheter initiation but will have fear of an impending surgery.

 

 

ANS:  B

The child has imaginative thoughts at this stage of growth and development. The child may believe that an illness occurred as a result of some personal deed or thought or perhaps because he touched something or someone. Preschoolers do not have the cognitive ability to connect mutilation to death and do not have a sound understanding of body integrity. The preschooler fears all types of intrusive procedures whether undergoing a simple procedure such as an IV start or something more invasive such as surgery.

 

DIF:    Cognitive Level: Analysis                REF:   p. 236            

OBJ:   Nursing Process Step: Evaluation     MSC:  Health Promotion and Maintenance

 

  1. A nurse caring for a hospitalized adolescent should implement which most developmentally appropriate intervention?

a.

Encouraging peers to call and visit when the adolescent’s condition allows

b.

Being sure the adolescent wears a hospital gown or pajamas throughout the hospitalization

c.

Discouraging questions and concerns about the effects of the illness on the adolescent’s appearance

d.

Asking the parents how the adolescent usually copes in new situations

 

 

ANS:  A

The peer group is important to the adolescent’s sense of belonging and identity; therefore, separation from friends is a major source of anxiety for the hospitalized adolescent. Adolescents should be encouraged to wear their own clothes to foster their sense of identity. Questions and concerns about the adolescent’s appearance and the effects of illness on appearance should be encouraged. How the adolescent copes should be asked directly of the adolescent.

 

DIF:    Cognitive Level: Application           REF:   p. 238            

OBJ:   Nursing Process Step: Implementation                              MSC:  Psychosocial Integrity

 

  1. The nurse is discussing toddler development with the mother of a 2 1/2-year-old child. Which statement by the mother indicates she has an understanding of the toddler’s developmental task?

a.

“I always help my daughter complete tasks to help her achieve a sense of accomplishment.”

b.

“I provide many opportunities for my daughter to play with other children her age.”

c.

“I consistently stress the difference between right and wrong to my daughter.”

d.

“I encourage my daughter to do things for herself when she can.”

 

 

ANS:  D

The toddler’s developmental task is to achieve autonomy. Encouraging toddlers to do things for themselves assists with this developmental task. Toddlers participate in parallel play. They play next to rather than with age mates. Excessive stress on the differences between right and wrong can stifle autonomy in the toddler and foster shame and doubt.

 

DIF:    Cognitive Level: Analysis                REF:   p. 236            

OBJ:   Nursing Process Step: Evaluation     MSC:  Health Promotion and Maintenance

 

  1. Which interventions would best help a hospitalized toddler feel a sense of control?

a.

Assign the same nurse to care for the child.

b.

Put a cover over the child’s crib.

c.

Require parents to stay with the child.

d.

Follow the child’s usual routines for feeding and bedtime.

 

 

ANS:  D

Familiar rituals and routines are important to toddlers and give the child a sense of control. Following the child’s usual routines during hospitalization minimizes feelings of loss of control. Providing consistent caregivers is most applicable for the very young child, such as the neonate and infant. Placing a cover over the child’s crib may increase feelings of loss of control. Parents are encouraged, rather than expected, to stay with the child during hospitalization.

 

DIF:    Cognitive Level: Application           REF:   p. 236            

OBJ:   Nursing Process Step: Implementation                              MSC:  Psychosocial Integrity

 

  1. Parents ask the nurse why observation for 24 hours in an acute-care setting is often appropriate for children. Which is the best response by the nurse?

a.

“Longer hospital stays are more costly.”

b.

“Children become ill quickly and recover quickly.”

c.

“Children feel less separation anxiety when hospitalized for just 24 hours.”

d.

“Families experience less disruption during short hospital stays.”

 

 

ANS:  B

Children become ill quickly and recover quickly; therefore, they can require acute care for a shorter period of time. A child’s state of wellness, rather than cost, determines the length of stay. Separation anxiety is primarily a factor of the stage of development not the length of the hospital stay. Family disruption is a secondary outcome of a child’s hospitalization; it does not determine length of stay.

 

DIF:    Cognitive Level: Application           REF:   p. 232            

OBJ:   Nursing Process Step: Teaching and Learning                    MSC:  Physiological Integrity

 

  1. The nurse is aware that separation is the major stressor for which age group?

a.

Newborns and infants

b.

Infants and toddlers

c.

Toddlers and preschoolers

d.

Preschoolers and school-age children

 

 

ANS:  B

Separation anxiety is at its peak during the infant and toddler ages. Newborns feel little separation anxiety as long as their comfort needs are met. Preschoolers are most fearful of injury and pain. Loss of control is the primary stressor for school-age children.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 235            

OBJ:   Nursing Process Step: Assessment   MSC:  Psychosocial Integrity

 

  1. The nurse recognizes that the stress of hospitalization is increased by an active imagination during unfamiliar experiences for which age group?

a.

Toddlers

b.

Preschoolers

c.

School-age children

d.

Adolescents

 

 

ANS:  B

Active imagination is a primary characteristic of preschoolers. A toddler’s primary response to hospitalization is separation anxiety. School-age children experience stress with loss of control. Adolescents experience stress from separation from their peers.

 

DIF:    Cognitive Level: Comprehension     REF:   pp. 236-237   

OBJ:   Nursing Process Step: Planning        MSC:  Health Promotion and Maintenance

 

  1. Which play activity should the nurse implement to enhance deep breathing exercises for a toddler?

a.

Blowing bubbles

b.

Throwing a Nerf ball

c.

Using a spirometer

d.

Keeping a chart of deep breathing

 

 

ANS:  A

Age-appropriate play for a toddler to enhance deep breathing would be blowing bubbles. Throwing a Nerf ball would not enhance deep breathing. Using a spirometer and keeping a chart of deep breathing are more appropriate for a school-age child.

 

DIF:    Cognitive Level: Application           REF:   p. 242            

OBJ:   Nursing Process Step: Implementation                              MSC:  Physiological Integrity

 

  1. The nurse should plan to explain procedures and encourage selection of their own meals from hospital menus for which age group of patients?

a.

Toddlers

b.

Preschoolers

c.

School-age children

d.

Adolescents

 

 

ANS:  C

School-age children are developmentally ready to accept detailed explanations. They can select their own menus and become actively involved in other areas of their care. Toddlers need routine and parent involvement for coping. Preschoolers need simple explanations of procedures. Detailed explanations and support of peers help adolescents cope.

 

DIF:    Cognitive Level: Application           REF:   p. 238|p. 240            

OBJ:   Nursing Process Step: Implementation                              MSC:  Psychosocial Integrity

 

  1. What is the best action for the nurse to take when a 5-year-old child cries, screams, and resists having his IV restarted because an IV antibiotic is due?

a.

Exit the room and leave the child alone until he stops crying.

b.

Tell the child big boys and girls “don’t cry.”

c.

Let the child decide which color arm board to use with his IV.

d.

Proceed quickly with the IV insertion to decrease stress.

 

 

ANS:  C

Giving the preschooler some choice and control, while maintaining boundaries of treatment, supports the child’s coping skills. Leaving the child alone robs the child of support when a coping difficulty exists. Crying is a normal response to stress. The child needs time to adjust and support to cope with unfamiliar and painful procedures during hospitalization.

 

DIF:    Cognitive Level: Application           REF:   p. 237|p. 240            

OBJ:   Nursing Process Step: Implementation                              MSC:  Psychosocial Integrity

 

  1. What is the best nursing response to the mother of a 4-year-old child who asks what she can do to help the child cope with a sibling’s repeated hospitalizations?

a.

Recommend that the child be sent to visit the grandmother until the sibling returns home.

b.

Inform the parent that the child is too young to visit the hospital.

c.

Assume the child understands that the sibling will soon be discharged because the child asks no questions.

d.

Help the mother give the child a simple explanation of the treatment and encourage the mother to have the child visit the hospitalized sibling.

 

 

ANS:  D

Needs of a sibling will be better met with factual information and contact with the ill child. Separation from family and home may intensify fear and anxiety. Parents are experts on their children and need to determine when their child can visit a hospital. Children may have difficulty expressing questions and fears and need the support of parents and other caregivers.

 

DIF:    Cognitive Level: Application           REF:   p. 247            

OBJ:   Nursing Process Step: Implementation                              MSC:  Psychosocial Integrity

 

  1. Parents are expressing concerned about their preschooler’s current sleep habits, which were disrupted by a recent hospitalization, stating that the child now awakens frequently at night. Which response by the nurse best addresses this problem?

a.

Regressive behavior after a hospitalization is normal and is usually short term.

b.

The child is probably expressing anger.

c.

Egocentric behavior often manifests itself when the child is left alone to sleep.

d.

The child is probably feeling pain and needs further evaluation.

 

 

ANS:  A

Regression is manifested in a variety of ways, is normal, and usually is short term. Nighttime waking is not associated with anger. Egocentric behavior is not an explanation for nighttime waking. More information is needed before an assessment of pain can be made.

 

DIF:    Cognitive Level: Application           REF:   p. 237            

OBJ:   Nursing Process Step: Implementation                              MSC:  Physiological Integrity

 

  1. Which nursing intervention is appropriate for the hospitalized neonate?

a.

Assign the neonate to a room with other neonates.

b.

Provide play activities in the hospital room.

c.

Offer the neonate a pacifier between feedings.

d.

Request that parents bring a security object from home.

 

 

ANS:  C

The neonate needs opportunities for nonnutritive sucking and oral stimulation with a pacifier. The neonate is not aware of other children. The choice of roommate will not affect the neonate socially. It is important for older children to room with similar-age children. Formal play activities would not be relevant for the neonate. Having parents bring a security object from home is applicable to older children.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 240            

OBJ:   Nursing Process Step: Implementation                              MSC:  Physiological Integrity

 

  1. Which approach will best help a 7-year-old child cope with a lengthy course of intravenous antibiotic therapy?

a.

Arrange for the child to go to the playroom daily.

b.

Ask the child to draw you a picture about himself.

c.

Allow the child to participate in injection play.

d.

Give the child stickers for cooperative behavior.

 

 

ANS:  C

Injection play is an appropriate intervention for the child who has to undergo frequent blood work, injections, intravenous therapy, or any other therapy involving syringes and needles. The hospitalized child should have opportunities to go to the playroom each day if his condition warrants. This free play does not have any specific therapeutic purpose. Children can express their thoughts and beliefs through drawing. Asking the child to draw a picture of himself may not elicit the child’s feelings about his treatment. Rewards such as stickers may enhance cooperative behavior. They will not address coping with painful treatments.

 

DIF:    Cognitive Level: Application           REF:   p. 242            

OBJ:   Nursing Process Step: Implementation                              MSC:  Psychosocial Integrity

 

  1. A 6-year-old child tells the nurse that she does not like the food at the hospital. A review of intake reveals she has eaten very little for the past 2 days. Which intervention is appropriate for the nursing diagnosis: Imbalanced Nutrition: Less than body requirements?

a.

Select nutritious foods on the menu for the child.

b.

Permit the child to eat junk foods at snack times.

c.

Arrange the child’s meal tray with generous portions of food.

d.

Encourage family members to bring foods from home.

 

 

ANS:  D

Having the parents bring foods that the child likes and is familiar with will increase the likelihood that she will eat. A 6-year-old child should be permitted to make her own menu selections with the assistance of an adult as needed. Allowing the child to select foods gives the child control and provides an opportunity to select foods that the child likes. Junk foods have little or no nutritional value. If the child is permitted to eat junk food, she may refuse to eat nutritious food at mealtimes. Meals served to children should contain small portions. Children may feel overwhelmed by large portions and refuse to eat any of the food.

 

DIF:    Cognitive Level: Application           REF:   p. 244            

OBJ:   Nursing Process Step: Planning        MSC:  Physiological Integrity

 

  1. A 3 1/2-year-old child who is toilet trained has had several “accidents” since hospital admission. What is the nurse’s best action in this situation?

a.

Find out how long the child has been toilet trained at home.

b.

Tell the parent it is necessary to begin toilet training again.

c.

Explain how to use a bedpan and place it close to the child.

d.

Follow home routines of elimination.

 

 

ANS:  D

Cooperation will increase and anxiety will decrease if the child’s normal routine and rituals are maintained. Some regression to previous behaviors is normal during hospitalization, even when the child has been practicing the skill for some time. Hospitalization is a stressful experience and is not an appropriate time to learn or relearn a skill. Developmentally, the 3 1/2-year-old child cannot use a bedpan independently.

 

DIF:    Cognitive Level: Application           REF:   p. 240            

OBJ:   Nursing Process Step: Implementation                              MSC:  Psychosocial Integrity

 

  1. Which question would most likely elicit information about how a family is coping with a child’s hospitalization?

a.

“Was this admission an emergency?”

b.

“How has your child’s hospitalization affected your family?”

c.

“Who is taking care of your other children while you are here?”

d.

“Is this the child’s first hospitalization?”

 

 

ANS:  B

Open-ended questions encourage communication. Ensuring a positive outcome from the hospital experience can be optimized by the nurse addressing the health needs of family members as well as the needs of the child. “Was this admission an emergency?,” “Who is taking care of your other children while you are here?,” and “Is this the child’s first hospitalization?” are closed-ended questions. The nurse would have to ask other questions to gather additional information.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 246            

OBJ:   Nursing Process Step: Assessment   MSC:  Psychosocial Integrity

 

  1. What would the nurse advise the mother of a 4-year-old child to bring for the child on the day of outpatient surgery?

a.

Snacks

b.

Fruit juice boxes

c.

All of the child’s medications

d.

One of the child’s favorite toys

 

 

ANS:  D

A familiar toy can be effective in decreasing a child’s stress in an unfamiliar environment. The child will be NPO before surgery; therefore, including snacks for the child is contraindicated, however unnecessary stress will result when the child is denied the juice. It is not necessary to bring all medications on the day of surgery. The medication the child has been receiving should have been noted during the preoperative workup. The parent should be knowledgeable concerning which medications the child has been taking if further information is necessary.

 

DIF:    Cognitive Level: Application           REF:   p. 245            

OBJ:   Nursing Process Step: Implementation                             

MSC:  Health Promotion and Maintenance           

 

MULTIPLE RESPONSE

 

  1. Which developmental approaches should the nurse implement for the hospitalized adolescent? Select all that apply.

a.

Expect regression.

b.

Provide privacy.

c.

Encourage peers to call.

d.

Answer questions with simple concrete explanations.

e.

Encourage questions about appearance.

 

 

ANS:  B, C, E

The developmental appropriate approaches for an adolescent include providing privacy for care and visiting, encouraging questions about appearance and the effects of illness, and encouraging peers to call and visit if the adolescent’s condition can tolerate this action. The adolescent requires the use of scientific terminology and detailed explanations; answering questions with simple concrete explanations is appropriate for the preschool age. Regression occurs for the school age and younger child, but is not common in the adolescent.

 

DIF:    Cognitive Level: Application           REF:   p. 240            

OBJ:   Nursing Process Step: Implementation                             

MSC:  Health Promotion and Maintenance           

 

  1. Parents of a school-age child ask the nurse about services provided by school-based clinics. Which statement made by the nurse is accurate with regard to school-based clinic services? Select all that apply.

a.

Vision, hearing, and growth screening are provided.

b.

Education about health-related topics is provided to children and parents.

c.

Minor outpatient surgical procedures can be performed.

d.

Emergency first aid treatment is provided.

e.

Casts can be applied to broken bones.

 

 

ANS:  A, B, D

School-based clinics provide screening, emergency care, healthcare education, and immunization services. They are primary care clinics and cannot perform outpatient surgical procedures or apply casts to broken bones.

 

DIF:    Cognitive Level: Application           REF:   p. 233            

OBJ:   Nursing Process Step: Implementation                             

MSC:  Health Promotion and Maintenance           

Ball, Child Health Nursing, 3/E
Chapter 9

 

Question 1

Type: MCSA

During the visit to the pediatric office, a nurse observes the mother frequently looking at and massaging her infant. Based on these observations, the nurse’s conclusion should be:

  1. That the mother is displaying positive maternal-infant attachment.
  2. That the mother is trying to show the nurse that she can be affectionate to the infant.
  3. That there is insufficient data to assess the mother-infant relationship.
  4. That the mother might be overwhelmed by the demands of infant care.

Correct Answer: 1

Rationale 1: These behaviors are characteristic of a positive maternal-infant attachment.

Rationale 2: The mother might be trying to show the affection, but the more global answer is that the massaging and looking at the infant indicate positive maternal-infant attachment.

Rationale 3: These are behaviors indicative of positive attachment and sufficient to assess the mother-infant relationship at this time.

Rationale 4: There is no information indicating the mother might be overwhelmed.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9-1

 

Question 2

Type: MCMA

Which activities should the nurse in the newborn unit perform prior to discharge from the birth hospital?

Standard Text: Select all that apply.

  1. Perform a heel stick to obtain blood for the newborn screen.
  2. Monitor the mother as she performs the first newborn bath to remove blood and amniotic fluids.
  3. Administer a folic acid injection to the infant to prevent bleeding.
  4. Perform a hearing screening.
  5. Monitor feeding behaviors.

Correct Answer: 1,4,5

Rationale 1: The infant should be screened for state-mandated tests prior to discharge. One such test is for PKU, which is required by all 50 states. PKU should be screened 48 hours after the first formula feeding. If the child is discharged early, the blood will be drawn for screening before discharge and then the test will be repeated at an appropriate time.

Rationale 2: The nurse, not the mother, performs the first bath to remove blood and amniotic fluids. This is a prime opportunity to complete a head-to-toe assessment.

Rationale 3: Vitamin K, not folic acid, is administered. Vitamin K is given prophylactically to prevent bleeding due to vitamin K deficiency.

Rationale 4: A hearing screening is performed on all newborn infants prior to discharge.

Rationale 5: The nurse should assess feeding behaviors of the infant whether the infant is breastfed or bottle-fed.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-2

 

Question 3

Type: MCSA

A mother who is bottle-feeding her newborn requests to be discharged 24 hours post-delivery, because the mother also has twin two-year-olds at home. The nurse should schedule the follow-up visit for the newborn on which of these days?

  1. Within 48 hours of discharge
  2. When the infant is one month old
  3. Within two weeks of discharge
  4. Within one week of discharge

Correct Answer: 1

Rationale 1: Newborns discharged before 48 hours old should be seen within 48 hours of discharge.

Rationale 2: A health supervision visit is routinely scheduled at one month of age regardless of age at time of discharge. Newborns should be monitored for jaundice, weight gain, umbilicus healing, and other problems; they should be evaluated 48 hours after early discharge.

Rationale 3: For an infant discharged at 24 hours, waiting two weeks after discharge increases the chance that several common newborn conditions can go undiagnosed (e.g., jaundice and failure to gain weight).

Rationale 4: Waiting one week after discharge of a 24-hour-old increases the chance that several common newborn conditions can go undiagnosed (e.g., jaundice and failure to gain weight).

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 9-4

 

Question 4

Type: MCMA

The nurse in the newborn nursery is admitting a neonate. In order to determine the health and development of the newborn, what will the nurse assess?

Standard Text: Select all that apply.

  1. Head and chest circumference
  2. Weight and length
  3. Body fat determination
  4. Presence of newborn reflexes
  5. Gestational age of the infant

Correct Answer: 1,2,4,5

Rationale 1: The head circumference of a newborn should be larger than the chest circumference. Chest circumference greater than head circumference is associated with microcephaly and other problems.

Rationale 2: Weight and length should be plotted on a growth chart along with gestational age to determine if intrauterine growth was within the normal range.

Rationale 3: Body fat determination is not a measure that is used during the newborn assessment.

Rationale 4: The newborn reflexes can be an indicator of a number of problems, including injuries to the extremities or the brain.

Rationale 5: Gestational age of the infant can predict health issues that can develop.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9-4

 

Question 5

Type: MCSA

An infant weighs 9 pounds, 3 ounces at birth. When the infant is seven days old, the mother calls the pediatrician’s office worried about her child’s weight loss. What is the lowest acceptable weight the infant should be at this age?

  1. 9 pounds
  2. 8 pounds, 12 ounces
  3. 8 pounds, 2 ounces
  4. 7 pounds, 12 ounces

Correct Answer: 3

Rationale 1: An infant would not be expected to lose only 3 ounces during the first week of life.

Rationale 2: 8 pounds, 12 ounces is less than the expected one-tenth weight loss after birth.

Rationale 3: In the first week of life, most infants lose about one-tenth of their birth weight; therefore, this infant’s weight should be 8 pounds, 2 ounces at seven days of age.

Rationale 4: 7 pounds, 12 ounces would be too much weight loss for this infant.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-4

 

Question 6

Type: MCSA

A nurse observes an infant in a crib lying still, without facial movements except for occasional sucking movements. At this time, the nurse will avoid:

  1. Assessing heart and respiratory rate.
  2. Attempts to feed the infant.
  3. Skin assessment.
  4. Repositioning the head of the infant.

Correct Answer: 2

Rationale 1: There is no contraindication to assessing the heart and respiratory rate.

Rationale 2: This infant is in a quiet, deep sleep. Attempts to feed the infant should not be made until the infant is in a lighter sleeping pattern because the infant will be unresponsive to attempts at arousal and might be at risk for aspiration.

Rationale 3: There is no contraindication to assessing the infant’s skin.

Rationale 4: Repositioning the head of the infant is acceptable to do while the infant is in a deep sleep.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-4

 

Question 7

Type: MCSA

An infant is born at 28 weeks’ gestational age. A nurse should inform the parents that the infant should be expected to reach developmental milestones about how many weeks later than would a full-term infant?

  1. 8
  2. 6
  3. 12
  4. 16

Correct Answer: 3

Rationale 1: This does not apply to the corrected age based on the infant being 12 weeks early.

Rationale 2: This is only half the time needed to adjust to the corrected age.

Rationale 3: Preterm infants are evaluated according to the “corrected age.” This infant, born at 28 weeks’ gestational age, is 12 weeks premature. Therefore, the infant should be expected to reach developmental milestones about 12 weeks later than would an infant who was born full-term.

Rationale 4: This is more than the correction needed to determine the corrected age for this infant.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-6

 

Question 8

Type: MCSA

The recommendation for an infant’s sleeping position is now “back to sleep.” Which nursing intervention is needed to prevent flattening of the occipital bones?

  1. Place an infant hat on the head of the infant during sleep for the first three months of life.
  2. Allow the infant to sleep on his abdomen while an adult is present and observing the infant during sleep.
  3. Alternate the head position from left to right during sleep.
  4. Wrap the occipital portion of the infant’s head with an ace bandage for 20 minutes each day.

Correct Answer: 3

Rationale 1: An infant hat will not keep the occipital bones from flattening.

Rationale 2: The infant should not be allowed to sleep on his abdomen even when observed.

Rationale 3: Changing the position of the infant’s head while sleeping, especially during the first three months of life, will help alleviate the flattening of the occipital bone due to supine positioning during sleep.

Rationale 4: It is not necessary to wrap the infant’s occipital portion of the infant’s head.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-6

 

Question 9

Type: MCMA

The nurse is providing anticipatory guidance instructions to the parents of a newborn. Which of these instructions should the nurse give as disease/injury prevention strategies?

Standard Text: Select all that apply.

  1. SIDS risk reduction
  2. Fall prevention
  3. Formula safety
  4. Immunization schedule
  5. Risk of poisoning

Correct Answer: 1,2,3,4

Rationale 1: SIDS is a major concern of infancy, and information on SIDS prevention, including back sleeping and the use of fans for air movement, should be provided.

Rationale 2: Anticipatory guidance should be given about fall prevention. Newborns are incapable of protecting themselves from falls and must always be placed in a secure environment, including the use of bed rails and safety straps when appropriate.

Rationale 3: Parents must be instructed on safe handling of formula including preparation and storage guidelines.

Rationale 4: It is important for parents to understand the recommended vaccination schedules and to comply with these standards to protect their child from childhood illnesses.

Rationale 5: It is too early for a discussion on the risk of poisoning. Until the child is mobile, poisoning is not a high priority for client teaching.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-6

 

Question 10

Type: MCSA

A mother asks the nurse about feeding her infant. The nurse’s best response that includes the recommendation made by the American Academy of Pediatrics (AAP) concerning feeding infants is:

  1. Introduce solid foods beginning at four months of age.
  2. Introduce table foods only after tooth eruption.
  3. Breastfeed exclusively for the first year of life.
  4. Following birth, begin exclusive breastfeeding with no water, juice, or other foods.

Correct Answer: 4

Rationale 1: A variety of solid foods should not be introduced at four months of age since the infant cannot digest many foods.

Rationale 2: Solid infant foods can be introduced at six months of age regardless of the status of tooth eruption since the foods are all pureed.

Rationale 3: The AAP does not recommend exclusive breastfeeding for the first year of life. These infants would be at risk for experiencing nutritional deficiencies.

Rationale 4: Breast milk is the preferred method of feeding infants in the first six months of life.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-8

 

Question 11

Type: MCSA

A pregnant woman is planning to breastfeed. The nursing intervention that will promote breastfeeding in the new mother is:

  1. Facilitating breastfeeding within the first 30 to 60 minutes of life.
  2. Telling the mother that the physician strongly advises new mothers to breastfeed their newborns.
  3. Encouraging the mother to attend breastfeeding classes before discharge from the hospital.
  4. Giving the woman literature on breastfeeding as soon as she enters the labor room.

Correct Answer: 1

Rationale 1: The literature shows that the mother who has the opportunity to breastfeed her infant within the first 30 to 60 minutes after birth facilitates breastfeeding later.

Rationale 2: The mother will make the decision based on her feelings, not on what the physician says.

Rationale 3: While this is a good intervention to prepare the mother, the best intervention occurs after the infant is born, while the mother is focused on the newborn.

Rationale 4: The mother in labor is not going to be able to focus on learning to breastfeed.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-8

 

Question 12

Type: MCSA

Prior to discharge from the birth hospital, the new mother asks the nurse about the use of a mobile over the crib. The nurse would explain to the mother that the mobile should be placed about 10 inches above the level of the baby. The nurse would explain that this placement:

  1. Is based on the fact that newborns can focus at a distance of 8 to 12 inches.
  2. Will prevent the infant from being injured by the mobile.
  3. Is most convenient for the parents.
  4. Is for decoration only. The newborn does not have vision sufficient to see the mobile.

Correct Answer: 1

Rationale 1: This is correct information. In addition, the infant prefers the human face and black and white geometric patterns.

Rationale 2: There is no danger to the infant when the mobile is placed at this height, but that is not the reason for the placement.

Rationale 3: The purpose of the mobile is visual stimulation of the infant, not the convenience of the parents.

Rationale 4: This is incorrect information. The newborn does not have visual acuity equal to an adult but can focus at this distance.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-7

 

Question 13

Type: MCSA

The nurse overhears the new parents discussing the care of the newborn. The father is heard to say, “We want to be careful not to spoil the baby by holding him too much.” The nurse will want to provide anticipatory guidance and might respond by saying:

  1. “You are so right. A spoiled baby is hard to manage. Only pick the baby up when he needs to be fed.”
  2. “It is important that the baby learns to soothe himself, so wait at least 15 minutes before you respond to his cries.”
  3. “When the baby cries, offer him the bottle. If that doesn’t work, put him in his bed to cry it out.”
  4. “Don’t worry about spoiling the baby by holding him. You will find both the baby and you will be better satisfied if you respond to the baby’s cries quickly and soothe him with your presence, voice, and touch.

Correct Answer: 4

Rationale 1: This is incorrect information. A baby cannot be spoiled by being held in the first six months of life.

Rationale 2: There is no reason to delay responding to the infant’s needs.

Rationale 3: This is incorrect information. Young infants cry for a purpose and will need adult intervention to resolve the issue.

Rationale 4: This is correct information.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-6

 

Question 14

Type: MCSA

During a prenatal visit, the pregnant mother asks the nurse if she should have her baby’s cord blood collected and stored. The best response by the nurse would be:

  1. “If I were pregnant, I would certainly bank by baby’s cord blood.”
  2. “You wonder if you should have your baby’s cord blood banked?”
  3. “Let’s discuss the pros and cons of cord blood banking.”
  4. “What does the baby’s father think about cord blood banking?”

Correct Answer: 3

Rationale 1: It is inappropriate for the nurse to discuss her own decision about cord blood storage.

Rationale 2: This is a reflective answer used to get at the mother’s emotions. This is not an emotional situation. The mother is asking for information.

Rationale 3: By starting the conversation with this statement, you are providing her with information so she can make an informed decision.

Rationale 4: While this may be brought into the discussion, it is not the best answer.

Global Rationale:

 

Cognitive Level: Applying

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-5

 

Question 15

Type: SEQ

A newborn is admitted to the nursery from the delivery room. All of the activities must be performed. Place the activities in order of performance from first to last.

Standard Text: Click and drag the options below to move them up or down.

Choice 1. Administer a vitamin K injection.

Choice 2. Take vital signs.

Choice 3. Place in an overbed warmer.

Choice 4. Administer eye prophylaxis.

Choice 5. Administer an admission bath.

Correct Answer: 3,2,4,1,5

Rationale 1: Vitamin K should be administered after eye prophylaxis for ease of administration.

Rationale 2: If the infant is showing signs of distress, admission procedures would be minimized to the essential to allow the newborn to transition.

Rationale 3: Cold stress is a main concern for newborns. They are wet from delivery and should be quickly dried and body heat maintained. While doing the head to toe assessment and monitoring the transition, the baby can best be observed if left uncovered and the external heat source of an overbed warmer provided.

Rationale 4: Eye prophylaxis should be performed within one hour of birth. It should precede the vitamin K injection.

Rationale 5: The admission bath is not administered until the baby’s vital signs have stabilized from birth and body temperature is within the normal range.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-6

 

Question 16

Type: MCMA

While breastfeeding is recommended by the American Academy of Pediatrics, there are maternal and infant conditions that should be evaluated as being possible contraindications to breastfeeding. Some of these contraindications include:

Standard Text: Select all that apply.

  1. The mother has heart disease.
  2. The mother is infected with HIV.
  3. The infant has been diagnosed with galactosemia.
  4. The mother has small breasts.
  5. The mother takes medications for a chronic health condition.

Correct Answer: 2,3,5

Rationale 1: While mothers who have heart disease may not be able to tolerate breastfeeding due to the added work load for the heart, it is not a contraindication.

Rationale 2: Since the AIDS virus is transmitted by blood and body fluid, breastfeeding would be contraindicated in this case.

Rationale 3: The infant with galactosemia cannot metabolize galactose, which is found in formula and breast milk.

Rationale 4: The size of the breasts do not serve as a contraindication to breastfeeding. Many women with small breasts successfully breastfeed.

Rationale 5: Most medications will appear in the breast milk. Therefore, each case should be considered individually. Until approved by the pediatrician, medication use should be a contraindication.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need:

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 9-8

 

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