Test Bank Questions for Introduction to Maternity

Question 1 / 21

A nurse is assisting a group of parents of adolescents to develop skills that will improve communication. The nurse hears one parent state "my son knows he better do what I say." Which of the following parenting styles is he exhibiting?

A. Authoritarian

B. Permissive

C. Authoritative

D. Passive

Rationale

The parent is exhibiting an authoritarian parenting style characterized by demanding obedience without explanation.
Authoritarian parenting is a style defined by high demands and low responsiveness. Parents who employ this approach expect unquestioning obedience from their children and typically enforce rules through punishment or the threat of punishment rather than through discussion or reasoning. The statement "my son knows he better do what I say" perfectly exemplifies this parenting style because it emphasizes power, control, and compliance without any mention of explanation, negotiation, or consideration of the child's perspective. Authoritarian parents value obedience as a virtue itself and believe children should follow rules simply because they are the parents, not because they understand the reasoning behind expectations. This parenting style was first systematically described by developmental psychologist Diana Baumrind in the 1960s and has been extensively studied in relation to child outcomes.
A) Authoritarian
This parenting style is characterized by high demandingness and low responsiveness. Authoritarian parents establish strict rules and expectations but provide little warmth, feedback, or explanation for their demands. They value obedience, respect for authority, and traditional structure. Communication in authoritarian households tends to be one-way, flowing from parent to child without opportunity for discussion or negotiation. Research has shown that children raised by authoritarian parents may develop obedience and conformity but may also struggle with self-esteem, social competence, and internalizing behavioral standards. The parent's statement reflects the authoritarian belief that children should comply simply because the parent has issued a command, with no need for further justification. This matches perfectly with the definition of authoritarian parenting, making this the correct identification.
B) Permissive
Permissive parenting, also described by Baumrind, is characterized by high responsiveness but low demandingness. Permissive parents are warm, nurturing, and accepting but place few demands or controls on their children. They often avoid confrontation, allow considerable self-regulation, and may act more like friends than authority figures. A permissive parent might say something like "I'd prefer if you did what I ask, but it's your choice" or "Whatever makes you happy." The statement "my son knows he better do what I say" reflects none of the warmth, flexibility, or child-directed decision-making characteristic of permissive parenting. Instead, it emphasizes parental authority and expectation of compliance, which contradicts the permissive approach. Therefore, this option does not match the parent's expressed attitude.
C) Authoritative
Authoritative parenting combines high demandingness with high responsiveness. This parenting style, which research has consistently associated with the most positive child outcomes, involves setting clear expectations and boundaries while also providing warmth, explanation, and opportunities for discussion. Authoritative parents enforce rules but are willing to explain the reasoning behind them and consider their child's perspective. A parent using this style might say "I expect you to follow this rule because it keeps you safe, and I'm happy to explain why." The statement in the question demonstrates no warmth, explanation, or openness to discussion. It presents a pure power dynamic without the balanced approach that defines authoritative parenting. While the authoritarian and authoritative styles both involve setting expectations, the authoritative style includes the crucial elements of reasoning and mutual respect that are absent from the parent's statement.
D) Passive
Passive parenting, while not one of Baumrind's original three styles, is sometimes used to describe parents who are disengaged, uninvolved, or neglectful. This style, which later researchers such as Maccoby and Martin labeled as uninvolved or neglectful parenting, is characterized by low demandingness and low responsiveness. Passive parents may be emotionally detached, preoccupied with their own concerns, or simply absent from their children's lives. They set few expectations and provide minimal support or guidance. A passive parent would be unlikely to make any definitive statement about expecting compliance because they typically do not establish clear expectations at all. The parent in the question is actively engaged in setting expectations for behavior, even if doing so through an authoritarian approach. This active stance makes passive parenting an inaccurate description of the style being exhibited.
Conclusion:
The parent's statement "my son knows he better do what I say" clearly demonstrates an authoritarian parenting style, which emphasizes unquestioning obedience, strict control, and one-way communication without explanation or warmth. Permissive parenting, characterized by warmth but few demands, does not match this authoritative stance. Authoritative parenting, while also setting expectations, includes explanation and mutual respect that are absent from the parent's statement. Passive parenting involves disengagement and lack of expectations, which contradicts the parent's active demand for compliance. Therefore, authoritarian is the correct identification of this parenting style based on the parent's expressed attitude toward communication with his adolescent son.

Question 2 / 21

A nurse is checking the vital signs of a 3-year-old during a well child visit. Which of the following findings should the nurse report to the provider?

A. temperature 37.2°C (99.0°F)

B. Heart rate of 106/min

C. Respirations 30/min

D. Blood pressure 88/54 mmHg

Rationale

A respiratory rate of 30/min in a 3-year-old child is above the expected reference range and should be reported to the provider.
Normal vital sign parameters vary significantly across pediatric age groups due to developmental and physiological differences. For a 3-year-old preschool-age child, expected vital sign ranges are established based on extensive research and clinical data. Respiratory rate in particular decreases gradually from infancy through childhood as lung capacity increases and respiratory control matures. At age 3, the expected respiratory rate is typically between 20 and 25 breaths per minute, with some variation among reference sources but generally not exceeding 25-28 at the upper limit. A rate of 30 breaths per minute represents tachypnea for this age group and warrants further investigation to determine the underlying cause. Tachypnea can indicate respiratory conditions such as infection, asthma, or foreign body aspiration, as well as non-respiratory conditions including fever, metabolic disorders, or cardiac problems. The nurse should assess for associated signs such as nasal flaring, retractions, grunting, or decreased oxygen saturation.
A) temperature 37.2Â°C (99.0Â°F)
This temperature reading is within normal limits for a 3-year-old child and does not require reporting to the provider. Normal body temperature in children varies throughout the day, with typical ranges from 36.5Â°C to 37.5Â°C (97.7Â°F to 99.5Â°F) depending on measurement method, time of day, activity level, and individual variation. The measurement of 37.2Â°C (99.0Â°F) falls well within the expected range and does not indicate fever, which is generally defined as a temperature of 38Â°C (100.4Â°F) or higher in children. This temperature could be normal for this child, especially if measured in the afternoon when body temperature naturally peaks, or after activity. The nurse would document this finding as within normal limits and continue with the well child assessment. No reporting is necessary for this value.
B) Heart rate of 106/min
A heart rate of 106 beats per minute is within the expected reference range for a 3-year-old child and does not require reporting. Normal heart rates in children decrease progressively from infancy through adolescence. For a preschool-age child of 3 years, the expected resting heart rate typically ranges from 70 to 110 beats per minute, with some variation among reference sources. The rate of 106 falls within this range, particularly if the child was anxious, active, or recently playing, all of which can elevate heart rate temporarily. The nurse should consider the context of the measurement, including whether the child was calm at the time of assessment. Even at the upper end of normal, this value alone does not indicate pathology and would not warrant reporting. The nurse would continue monitoring and document the finding.
C) Respirations 30/min
A respiratory rate of 30 breaths per minute exceeds the expected reference range for a 3-year-old child and should be reported. Normal respiratory rates decrease with age: newborns may breathe 30-60 times per minute, while by age 3, the rate has typically slowed to 20-25 breaths per minute. A rate of 30 represents tachypnea for this age group. Tachypnea can be an early sign of respiratory distress, lower respiratory tract infection such as pneumonia, asthma exacerbation, metabolic acidosis, or cardiac conditions. The nurse should conduct a thorough respiratory assessment including observation for work of breathing (nasal flaring, retractions, grunting), auscultation of breath sounds, pulse oximetry measurement, and assessment of color and mental status. The child's position, recent activity, and emotional state should be considered, but a sustained rate of 30 in a calm child requires evaluation. Reporting this finding to the provider ensures appropriate follow-up and identification of any underlying condition.
D) Blood pressure 88/54 mmHg
This blood pressure reading is within normal limits for a 3-year-old child and does not require reporting. Normal blood pressure in children increases gradually with age, height, and weight. For a 3-year-old, expected systolic blood pressure typically ranges from 86 to 106 mmHg, and diastolic from 44 to 67 mmHg, with significant variation based on the child's size and percentile. The reading of 88/54 falls within these parameters and would be considered normal, especially for a child of smaller stature. Blood pressure norms in children are established using percentiles based on age, sex, and height. Without concerning symptoms or signs of hypertension or hypotension, this reading represents an expected finding. The nurse would document this value as part of the well child assessment without need for provider notification.
Conclusion:
When assessing vital signs in a 3-year-old child, the nurse should report a respiratory rate of 30/min to the provider as this exceeds the expected reference range of approximately 20-25 breaths per minute for this age group. The temperature of 37.2Â°C (99.0Â°F) is within normal limits and does not indicate fever. The heart rate of 106/min falls within the expected range of 70-110 for a 3-year-old. The blood pressure of 88/54 mmHg is within normal parameters for this age. Therefore, only the respiratory rate of 30/min represents an abnormal finding requiring provider notification for further evaluation.

Question 3 / 21

A nurse is performing a neurological assessment on an adolescent. Which of the following is an appropriate reaction by the adolescent when the nurse checks the trigeminal cranial nerve? (select all that apply)

A. Clenching the teeth together tightly

B. Recognizing a sour taste

C. Identifying smells through each nostril

D. Detecting facial touches when eyes closed

Rationale

When assessing the trigeminal cranial nerve (CN V), appropriate reactions include clenching the teeth together tightly and detecting facial touches when eyes are closed.
The trigeminal nerve is the fifth cranial nerve and has both sensory and motor functions. It is the largest cranial nerve and provides sensory innervation to the face through three main branches: the ophthalmic branch (V1) innervating the forehead and anterior scalp, the maxillary branch (V2) innervating the mid-face including cheeks and upper jaw, and the mandibular branch (V3) innervating the lower jaw and chin. The motor component of the trigeminal nerve innervates the muscles of mastication, including the masseter, temporalis, and pterygoid muscles. Comprehensive assessment of the trigeminal nerve therefore includes both sensory testing of facial sensation and motor testing of jaw movement and strength. The sensory evaluation involves testing light touch, pain, and temperature perception in all three branches, while motor evaluation assesses the strength of the temporalis and masseter muscles through palpation during clenching and assessment of jaw opening against resistance.
A) Clenching the teeth together tightly
Clenching the teeth together tightly is an appropriate response when assessing the motor component of the trigeminal nerve. This action requires contraction of the masseter and temporalis muscles, both of which are innervated by the mandibular branch (V3) of the trigeminal nerve. To assess motor function, the nurse palpates the masseter and temporalis muscles while the patient clenches the teeth, evaluating the strength and symmetry of muscle contraction. The nurse may also ask the patient to open the mouth against resistance or move the jaw side to side, which tests the pterygoid muscles also innervated by V3. Strong, symmetric muscle contraction indicates intact motor function of the trigeminal nerve. Weakness or asymmetry may indicate dysfunction of the nerve or its motor nucleus. Therefore, teeth clenching is a correct and expected response during trigeminal nerve assessment.
B) Recognizing a sour taste
Recognizing a sour taste is not a function of the trigeminal nerve and would not be an appropriate response during its assessment. Taste sensation, including sour, sweet, salty, and bitter, is mediated primarily by three cranial nerves: the facial nerve (CN VII) carries taste from the anterior two-thirds of the tongue, the glossopharyngeal nerve (CN IX) carries taste from the posterior one-third of the tongue, and the vagus nerve (CN X) carries taste from the epiglottis and pharynx. While the trigeminal nerve does provide general sensation to the tongue, it does not mediate taste perception. Assessment of taste would be part of evaluating CN VII, CN IX, and CN X, not the trigeminal nerve. Therefore, this response is not relevant to trigeminal nerve testing.
C) Identifying smells through each nostril
Identifying smells through each nostril is a function of the olfactory nerve (CN I), not the trigeminal nerve. The olfactory nerve is responsible for the sense of smell, with specialized olfactory receptors in the nasal epithelium detecting odor molecules and transmitting signals to the olfactory bulb. Assessment of CN I involves presenting familiar, non-irritating odors to each nostril separately while the other nostril is occluded, asking the patient to identify the smell. The trigeminal nerve does contribute to detection of irritant sensations in the nasal cavity (such as the burning sensation from ammonia), but this is a protective reflex rather than true smell perception. Identification of specific odors is purely an olfactory function. Therefore, this response is not appropriate during trigeminal nerve assessment.
D) Detecting facial touches when eyes closed
Detecting facial touches with eyes closed is an appropriate response when assessing the sensory component of the trigeminal nerve. This tests the ability to perceive light touch stimuli, which is mediated by all three branches of the trigeminal nerve. During assessment, the nurse asks the patient to close their eyes and then lightly touches various areas of the face corresponding to the ophthalmic (forehead), maxillary (cheeks), and mandibular (chin) distributions. The patient indicates when and where they feel the touch. This evaluates the afferent sensory pathways of the trigeminal nerve. In addition to light touch, the nurse may also assess pain perception (using a clean pin or broken tongue blade) and temperature perception (using tubes of hot and cold water). Accurate detection of facial touches indicates intact sensory function of the trigeminal nerve. Therefore, this is a correct and expected response during trigeminal nerve assessment.
E) Looking down and in with the eyes
Looking down and in with the eyes is a function of the trochlear nerve (CN IV) and would not be an appropriate response during trigeminal nerve assessment. The trochlear nerve innervates the superior oblique muscle, which is responsible for depression, intorsion, and abduction of the eye. When the eye is adducted (turned in), the superior oblique becomes the primary depressor, allowing the eye to look down and in. This specific movement is tested during assessment of extraocular movements and cranial nerves III, IV, and VI. The trigeminal nerve has no role in eye movement. Eye movements are controlled by the oculomotor (CN III), trochlear (CN IV), and abducens (CN VI) nerves. Therefore, this response is not relevant to trigeminal nerve testing.
Conclusion:
During neurological assessment of the trigeminal nerve (CN V), appropriate reactions include clenching the teeth together tightly to test the motor function of the muscles of mastication, and detecting facial touches with eyes closed to test the sensory function of all three branches. Recognizing sour taste is a function of the facial and glossopharyngeal nerves. Identifying smells is mediated by the olfactory nerve. Looking down and in with the eyes is controlled by the trochlear nerve. Therefore, the correct selections for trigeminal nerve assessment are clenching teeth together tightly and detecting facial touches when eyes are closed.

Question 4 / 21

A nurse is conducting a well-baby visit with a 4-month-old infant. Which of the following immunizations should the nurse plan to administer? (select all that apply)

A. MMR

B. IPV

C. PCV

D. Varicella

Rationale

At the 4-month well-baby visit, the nurse should plan to administer IPV (inactivated poliovirus vaccine), PCV (pneumococcal conjugate vaccine), and RV (rotavirus vaccine) according to the recommended childhood immunization schedule.
The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) publish an annually updated childhood immunization schedule that specifies the recommended ages for vaccine administration. This schedule is designed to provide protection against vaccine-preventable diseases at the ages when children are most vulnerable and when vaccines are most effective. The 4-month visit is a key time for vaccine administration, representing the second dose in several vaccine series that began at 2 months. Following the recommended schedule ensures optimal immune response and timely protection. At 4 months, infants should receive the second doses of vaccines that were initiated at 2 months, including IPV, PCV, and RV. Some vaccines, such as DTaP (diphtheria, tetanus, and acellular pertussis) and Hib (Haemophilus influenzae type b), are also due at 4 months but were not listed as options in this question.
A) MMR
MMR (measles, mumps, and rubella) vaccine is not recommended for administration at 4 months of age. According to the standard childhood immunization schedule, the first dose of MMR is recommended at 12 through 15 months of age. This timing is based on several factors including the presence of maternal antibodies that can interfere with vaccine effectiveness in younger infants, the maturation of the infant's immune system, and the epidemiology of these diseases. Measles, mumps, and rubella are generally not threats to young infants in the United States due to herd immunity, and the vaccines are most effective when given after maternal antibody levels have declined. In some circumstances, such as international travel or outbreak situations, MMR may be given as early as 6 months, but this is an exception rather than routine practice. At 4 months, MMR is not indicated and should not be administered.
B) IPV
IPV (inactivated poliovirus vaccine) should be administered at the 4-month well-baby visit. The polio vaccination series consists of four doses, with the first dose recommended at 2 months, the second dose at 4 months, the third dose at 6 through 18 months, and the fourth dose at 4 through 6 years. The 4-month visit represents the timing for the second dose in this series. IPV is an inactivated vaccine, meaning it contains killed poliovirus and cannot cause polio. It is administered by injection and provides protection against all three types of poliovirus. Administering the second dose at 4 months helps ensure that the infant develops adequate immunity before exposure to poliovirus could occur. This vaccine is safe and well-tolerated, with common side effects limited to local reactions at the injection site. Therefore, IPV is correctly included in the 4-month immunization schedule.
C) PCV
PCV (pneumococcal conjugate vaccine) should be administered at the 4-month well-baby visit. The pneumococcal vaccine series protects against Streptococcus pneumoniae bacteria, which can cause serious infections including pneumonia, meningitis, and bacteremia. The recommended schedule for PCV includes four doses: at 2 months, 4 months, 6 months, and 12 through 15 months. The 4-month visit represents the timing for the second dose. PCV is a conjugate vaccine that links pneumococcal polysaccharides to a carrier protein, enhancing the immune response in young infants who do not respond well to polysaccharide antigens alone. This vaccine has dramatically reduced the incidence of invasive pneumococcal disease in children since its introduction. Administering the second dose at 4 months continues the primary series and helps ensure protective antibody levels. Therefore, PCV is correctly included in the 4-month immunization schedule.
D) Varicella
Varicella (chickenpox) vaccine is not recommended for administration at 4 months of age. According to the standard childhood immunization schedule, the first dose of varicella vaccine is recommended at 12 through 15 months of age. This timing allows for the decline of maternal antibodies that could interfere with vaccine effectiveness and ensures that the infant's immune system is mature enough to mount a protective response. Varicella vaccine is a live attenuated vaccine, meaning it contains weakened live virus, and is not recommended for infants younger than 12 months due to safety and efficacy considerations. In some situations, such as lack of evidence of immunity in older children, varicella vaccine may be given at older ages, but it is not part of the 4-month schedule. Therefore, varicella vaccine should not be administered at this visit.
E) RV
RV (rotavirus vaccine) should be administered at the 4-month well-baby visit. Rotavirus vaccine protects against rotavirus infection, which is a leading cause of severe gastroenteritis in infants and young children, causing significant diarrhea, vomiting, and dehydration. Unlike the other vaccines discussed, rotavirus vaccine is administered orally rather than by injection. There are two rotavirus vaccines available in the United States: RV5 (RotaTeq), which is given in a three-dose series at 2, 4, and 6 months, and RV1 (Rotarix), which is given in a two-dose series at 2 and 4 months. Regardless of which product is used, the 4-month visit represents the timing for the second dose. Rotavirus vaccine has a maximum age for administration of the first dose (14 weeks 6 days) and for the final dose (8 months 0 days) due to safety considerations regarding intussusception risk. At 4 months, rotavirus vaccine is safe and recommended. Therefore, RV is correctly included in the 4-month immunization schedule.
Conclusion:
At the 4-month well-baby visit, the nurse should plan to administer IPV (second dose), PCV (second dose), and RV (second dose) according to the recommended childhood immunization schedule. MMR and varicella vaccines are not due until 12 through 15 months of age and should not be administered at 4 months. Therefore, the correct selections for immunizations at the 4-month visit are IPV, PCV, and RV.

Question 5 / 21

A nurse is performing a developmental screening on an 18-month-old. Which of the following skills should the toddler be able to perform? (select all that apply)

A. Build a tower with 6 blocks

B. Throw a ball overhead

C. Walk up and down stairs

D. Draw circles

Rationale

At 18 months of age, a toddler should be expected to throw a ball overhead and use a spoon without rotation as part of typical gross and fine motor development.
Developmental screening at 18 months assesses progress across multiple domains including gross motor, fine motor, language, and social-emotional skills. The toddler period, from 12 to 36 months, is characterized by rapid acquisition of new abilities as the child gains independence and explores the environment. At 18 months, specific motor skills emerge that reflect increasing coordination, strength, and control. Throwing a ball overhead demonstrates gross motor development including balance, coordination, and upper body strength. Using a spoon without rotation represents fine motor development and self-feeding skills, showing that the toddler can bring food to the mouth while keeping the spoon relatively level, without the rotating motion seen in younger children who turn the spoon over as they bring it to their mouth. These skills should be present in a typically developing 18-month-old and are appropriate to screen for at this age.
A) Build a tower with 6 blocks
Building a tower with 6 blocks is an advanced skill for an 18-month-old and is not typically expected until 24 months or later. Block play development follows a predictable sequence. At 12 to 15 months, toddlers may hold and mouth blocks or bang them together. At 15 to 18 months, they may begin to stack two blocks but often with limited success. By 18 months, most toddlers can stack 3 to 4 blocks. The ability to consistently stack 6 blocks requires refined hand-eye coordination, steady hands, and the cognitive understanding of balance and placement that develops closer to 2 years of age. While some advanced 18-month-olds might stack 5 or 6 blocks occasionally, this is not a reliable milestone for this age. Expecting a 6-block tower would overestimate the typical ability of an 18-month-old. Therefore, this skill is not expected and would not be included in developmental screening for this age.
B) Throw a ball overhead
Throwing a ball overhead is an expected gross motor skill for an 18-month-old. Gross motor development during the second year shows dramatic progress as toddlers gain mobility and stability. By 18 months, toddlers have typically mastered independent walking and are beginning to add more complex motor skills. Throwing a ball represents an important milestone that combines balance, coordination, and purposeful movement. At this age, the throw is typically an overhead, stiff-armed motion without much body rotation or weight shift, but the ability to release the ball in the direction of intent is present. This skill emerges around 15 to 18 months and is well-established by 18 months. The toddler may also enjoy kicking a ball, though with less accuracy than throwing. Assessing throwing ability provides information about upper body strength, coordination, and the ability to combine multiple motor actions. Therefore, this is an appropriate skill to expect at 18 months.
C) Walk up and down stairs
Walking up and down stairs is not an expected skill at 18 months without significant assistance. While stair negotiation develops gradually during the toddler period, independent stair walking typically emerges later. At 18 months, most toddlers can walk up stairs with assistance, such as holding a railing or an adult's hand, but they usually bring both feet to each step before proceeding (marking time) rather than alternating feet. Walking down stairs is even more challenging and typically develops later due to the balance and coordination demands and the fear factor. Independent stair walking, even with both feet per step, usually emerges around 24 months for going up and later for going down. At 18 months, the toddler may crawl up stairs or creep down backward, but walking up and down independently is not expected. Expecting this skill would overestimate typical development for this age.
D) Draw circles
Drawing circles is a fine motor and visual-motor skill that is not expected at 18 months and typically emerges between 2 and 3 years of age. Scribbling begins around 12 to 15 months, with the toddler making random marks on paper. By 18 months, the toddler may enjoy scribbling but the marks are typically uncontrolled lines and dots without recognizable shapes. The ability to imitate or copy a circle requires more advanced visual-motor integration, hand control, and cognitive understanding of shapes. Most children begin to imitate a circle around 24 to 30 months and can copy a circle consistently around 3 years. Expecting circle drawing at 18 months would significantly overestimate typical development. At this age, the focus should be on the child's interest in holding a crayon and making marks, not on producing specific shapes.
E) Use a spoon without rotation
Using a spoon without rotation is an expected self-feeding skill at 18 months. Self-feeding develops progressively during the second year. At 12 months, the toddler may hold a spoon but has difficulty getting food to the mouth without spilling. At 15 months, the toddler can usually get some food to the mouth but may rotate the spoon, causing food to fall. By 18 months, the toddler typically can use a spoon without rotating it, meaning they can bring the spoon to the mouth while keeping it relatively level, reducing spillage. However, some spillage is still expected, and the toddler may still prefer using fingers for part of the meal. This skill represents important fine motor development and increasing independence. The ability to use utensils without rotation indicates improved hand control, coordination, and practice with self-feeding. Therefore, this is an appropriate skill to expect at 18 months and should be assessed during developmental screening.
Conclusion:
During developmental screening of an 18-month-old toddler, expected skills include throwing a ball overhead as a gross motor milestone and using a spoon without rotation as a fine motor/self-feeding skill. Building a tower with 6 blocks is advanced for this age, with 3-4 blocks being more typical. Walking up and down stairs independently is not expected, though the toddler may manage stairs with assistance. Drawing circles is a skill that emerges closer to 2-3 years of age. Therefore, the correct selections for skills expected at 18 months are throwing a ball overhead and using a spoon without rotation.

Question 6 / 21

A nurse is providing teaching to the parent of a preschool-age child about methods to promote sleep. Which of the following statements by the parent indicates an understanding of the teaching?

A. "I will sleep in the bed with my child if she wakes up during the night."

B. "I will let my child stay up an additional 2 hours on weekend nights."

C. "I will let my child watch television for 30 minutes just before bedtime each night."

D. "I will keep a dim lamp on in my child's room during the night."

Rationale

The parent demonstrates understanding of sleep promotion methods by stating they will keep a dim lamp on in the child's room during the night.
Preschool-age children, typically ages 3 to 6 years, often experience sleep challenges related to their developmental stage. At this age, children have active imaginations that can lead to fears of the dark, monsters, or being alone. These fears are a normal part of cognitive development as children begin to distinguish fantasy from reality but still struggle with this distinction. Keeping a dim lamp on in the child's room addresses the common fear of darkness without creating a sleep-disruptive environment. A dim light provides enough illumination to reduce anxiety about imagined threats while still promoting the darkness necessary for melatonin production and restful sleep. This approach acknowledges the child's fears without reinforcing them or creating dependence on the parent's presence. It represents a balanced strategy that supports the child's developing ability to self-soothe and return to sleep independently.
A) "I will sleep in the bed with my child if she wakes up during the night."
This statement indicates misunderstanding of appropriate sleep promotion strategies for a preschool-age child. While responding to nighttime waking with comfort is important, routinely sleeping in the child's bed can create dependence that interferes with the child's ability to develop self-soothing skills. Preschoolers are capable of learning to return to sleep independently after normal nighttime awakenings, which occur in all sleep cycles. When parents consistently respond to waking by joining the child's bed, the child may come to expect and require this intervention to return to sleep, creating a cycle of disrupted sleep for both parent and child. More effective strategies include brief reassurance, checking that the child is safe, reminding the child of coping strategies (such as a nightlight or transitional object), and then leaving the child to settle independently. The parent's plan to sleep in the child's bed does not promote the child's developing autonomy and self-regulation skills.
B) "I will let my child stay up an additional 2 hours on weekend nights."
This statement demonstrates lack of understanding about the importance of consistent sleep schedules for preschoolers. Maintaining a regular bedtime and wake time, even on weekends, supports healthy sleep by regulating the child's circadian rhythm. Significant variations in sleep schedule disrupt this rhythm, making it harder for the child to fall asleep at bedtime and wake at the desired time. Allowing a 2-hour later bedtime on weekends creates a pattern similar to "social jet lag," where the child's internal clock becomes misaligned with the schedule required for school or other activities. This can lead to difficulty waking on Monday morning, daytime sleepiness, irritability, and behavior problems. Consistent routines provide security and predictably that help preschoolers feel safe and regulate their behavior. The parent's plan to allow significantly later bedtimes on weekends would undermine healthy sleep patterns.
C) "I will let my child watch television for 30 minutes just before bedtime each night."
This statement reflects misunderstanding of appropriate pre-sleep activities for preschoolers. Screen time immediately before bedtime is counterproductive to sleep promotion for multiple reasons. The blue light emitted by screens suppresses melatonin production, the hormone that signals the body to prepare for sleep. The content of television programs, even those designed for children, can be stimulating or anxiety-provoking, activating the child's mind when it should be winding down. The passive nature of screen viewing does not promote the relaxation that facilitates sleep onset. Additionally, establishing screen time as part of the bedtime routine creates dependence on this stimulus, making it harder for the child to fall asleep without it. Recommended pre-bedtime activities include quiet play, reading books, bath time, and other calming routines that signal the transition to sleep. The parent's plan to include television immediately before bedtime would likely interfere with, rather than promote, healthy sleep.
D) "I will keep a dim lamp on in my child's room during the night."
This statement demonstrates appropriate understanding of sleep promotion for a preschool-age child. A dim lamp addresses the common developmental fear of darkness that emerges during the preschool years. Unlike a bright overhead light, which would suppress melatonin and interfere with sleep quality, a dim nightlight provides enough illumination to reduce anxiety while still supporting the physiological processes of sleep. This approach acknowledges the child's emotional needs without creating dependence on parental presence for reassurance. The dim light serves as a transitional object of sorts, helping the child feel safe enough to relax and fall asleep independently. If the child wakes during the night, the familiar, dimly lit environment helps them orient themselves and return to sleep without needing parental intervention. This strategy is recommended by sleep specialists as an appropriate intervention for children who experience nighttime fears. The parent's plan reflects understanding of this developmentally appropriate approach.
Conclusion:
The parent demonstrates understanding of sleep promotion methods for a preschool-age child by planning to keep a dim lamp on in the child's room during the night, addressing common fears of darkness without disrupting sleep physiology. Sleeping in the child's bed upon nighttime waking would create dependence rather than promoting independent self-soothing. Allowing an additional 2 hours of staying up on weekends disrupts the consistent sleep schedule essential for regulating the child's circadian rhythm. Television viewing immediately before bedtime introduces stimulating content and blue light that interfere with sleep onset. Therefore, only the statement about keeping a dim lamp on reflects accurate understanding of the teaching provided.

Question 7 / 21

A nurse is assessing a 2.5-year-old toddler at a well-child visit. Which of the following findings should the nurse report to the provider?

A. Height increased by 7.5 cm (3 inches) in the past year

B. Head circumference exceeds chest circumference

C. Anterior and posterior fontanels are closed

D. Current weight equals four times the birth weight

Rationale

The finding that head circumference exceeds chest circumference in a 2.5-year-old toddler should be reported to the provider as this represents a deviation from expected developmental norms.
During infancy and early childhood, the relationship between head circumference and chest circumference changes in a predictable pattern as the child grows. At birth, an infant's head circumference is typically larger than chest circumference by approximately 2-3 cm. This reflects the rapid brain growth that occurs during fetal development and continues after birth. As the child grows, the chest circumference gradually catches up and then exceeds head circumference. By approximately 1 to 2 years of age, chest circumference typically becomes equal to or greater than head circumference. By 2.5 years, chest circumference should normally exceed head circumference. When head circumference remains larger than chest circumference beyond this age, it may indicate macrocephaly (abnormally large head) or conditions associated with increased head size such as hydrocephalus, intracranial masses, or certain genetic disorders. This finding warrants further evaluation to determine the underlying cause.
A) Height increased by 7.5 cm (3 inches) in the past year
This finding represents normal linear growth for a toddler and does not require reporting. During the toddler period (12 to 36 months), growth rate slows compared to infancy but remains steady. Average height increase during the second year is approximately 10-12 cm (4-5 inches), and during the third year is approximately 7-8 cm (3 inches). An increase of 7.5 cm (3 inches) between ages 1.5 and 2.5 years falls within expected parameters. Growth occurs in a nonlinear pattern with periods of faster and slower growth, and individual variation is normal. As long as the child is following their growth curve and not crossing percentiles, this amount of growth is appropriate. The nurse would plot the measurement on a growth chart to confirm consistent progress but would not need to report this expected finding.
B) Head circumference exceeds chest circumference
This finding is abnormal for a 2.5-year-old and should be reported to the provider. The normal developmental progression of head-to-chest relationship is well-established. At birth, head circumference is approximately 2-3 cm larger than chest circumference. By 5 to 6 months, head and chest circumferences are often equal. By 1 to 2 years, chest circumference typically equals or exceeds head circumference. By 2.5 years, chest circumference should clearly exceed head circumference in normally developing children. When head circumference remains larger, it suggests possible macrocephaly or increased intracranial content. Conditions to consider include hydrocephalus (accumulation of cerebrospinal fluid), subdural hematoma, brain tumors, or genetic macrocephaly syndromes. The nurse should also assess for other signs of increased intracranial pressure such as bulging fontanel (if still open), sunsetting eyes, irritability, vomiting, or developmental delays. This finding requires prompt evaluation to identify and address any underlying pathology.
C) Anterior and posterior fontanels are closed
This finding is normal for a 2.5-year-old and does not require reporting. Fontanel closure follows a predictable developmental timeline. The posterior fontanel, located at the junction of the parietal and occipital bones, typically closes by 2 to 3 months of age. The anterior fontanel, the larger diamond-shaped soft spot at the junction of the frontal and parietal bones, typically closes between 12 and 18 months of age, though closure as late as 24 months can be within normal range. By 2.5 years, both fontanels should be completely closed in all children. Continued patency of the anterior fontanel beyond 24 months would be abnormal and could indicate conditions such as hypothyroidism, hydrocephalus, rickets, or increased intracranial pressure. However, closure by this age is expected and represents normal development. The nurse would document closed fontanels as an expected finding.
D) Current weight equals four times the birth weight
This finding represents appropriate weight gain for a 2.5-year-old and does not require reporting. Weight gain during the first years of life follows predictable patterns based on normative data. Infants typically double birth weight by 4 to 6 months, triple birth weight by 12 months, and quadruple birth weight by approximately 2 to 2.5 years. The exact timing of reaching four times birth weight varies among children based on birth weight, growth pattern, and individual factors, but achievement by 2.5 years is within the expected range. For example, a child born at 3.4 kg (7.5 lbs) would weigh approximately 13.6 kg (30 lbs) at 2.5 years, which is appropriate. The nurse would plot the measurement on a growth chart to ensure the child is following their established percentile, but the weight itself represents normal progression and does not warrant reporting.
Conclusion:
When assessing a 2.5-year-old toddler, the finding that head circumference exceeds chest circumference should be reported to the provider as this represents a deviation from the expected developmental pattern where chest circumference should exceed head circumference by this age. Height increase of 7.5 cm (3 inches) in the past year is normal for this age. Closed anterior and posterior fontanels are expected by 2.5 years. Weight equaling four times birth weight represents appropriate weight gain for this age. Therefore, only the finding of head circumference exceeding chest circumference requires further evaluation and provider notification.

Question 8 / 21

A nurse is discussing prepubescence and preadolescence with a group of parents of school-age children. Which of the following information should the nurse include in the discussion?

A. Initial physiologic changes appear during early childhood.

B. Changes in height and weight occur slowly during this period.

C. Growth differences between boys and girls become evident.

D. Signs of sexual maturation become highly visible in boys.

Rationale

The nurse should include that growth differences between boys and girls become evident during prepubescence and preadolescence.
Prepubescence and preadolescence, typically spanning ages 9 to 12 years for girls and 10 to 13 years for boys, represent the period immediately preceding the onset of puberty. During this time, important physical changes begin to occur as the body prepares for the dramatic transformations of puberty. One significant characteristic of this period is the emergence of visible differences in growth patterns between boys and girls. Prior to this time, school-age children of both sexes grow at similar rates and have similar body proportions. During prepubescence, however, girls typically experience their growth spurt earlier than boys, leading to a period where many girls are taller and heavier than same-age boys. Boys' growth spurt occurs later but is more pronounced, ultimately resulting in greater average adult height and muscle mass. These emerging differences reflect the activation of different hormonal influences and are a normal part of development that parents should understand and anticipate.
A) Initial physiologic changes appear during early childhood.
This statement is incorrect and should not be included in the discussion. The initial physiologic changes associated with sexual maturation do not appear during early childhood. Early childhood, typically defined as ages 3 to 6 years, is a period of relatively stable growth without the hormonal activation that characterizes puberty. During early childhood, the hypothalamic-pituitary-gonadal axis is quiescent, and there are no significant changes related to sexual maturation. The prepubescent period, which occurs during late school age (approximately 9-12 years), is when initial physiologic changes begin to appear. These include the beginning of breast development in girls (thelarche) and testicular enlargement in boys, along with the early growth of pubic hair. Presenting information that these changes appear in early childhood would be inaccurate and could cause parents unnecessary concern about normal development.
B) Changes in height and weight occur slowly during this period.
This statement is inaccurate for the prepubescent and preadolescent period. While growth during middle childhood (ages 6-9 years) is relatively slow and steady, the prepubescent period marks the beginning of the growth spurt that characterizes puberty. During prepubescence and preadolescence, growth rate begins to accelerate in preparation for the pubertal growth spurt. Girls typically experience their peak growth velocity around age 12, while boys peak around age 14. The period just before these peaks is characterized by accelerating growth, not slow growth. Parents may notice that their children seem to be "shooting up" during this time, and clothing sizes may change rapidly. Telling parents that growth changes occur slowly during this period would be misleading and would not prepare them for the actual rapid changes their children will experience.
C) Growth differences between boys and girls become evident.
This statement accurately describes a key characteristic of prepubescence and preadolescence that should be included in parent education. During the school-age years prior to this period, boys and girls are similar in size and growth patterns. However, as prepubescence begins, distinct differences emerge. Girls typically begin their growth spurt earlier than boys, resulting in a period where many girls are taller and heavier than their male peers. Girls also begin to develop different body composition, with a higher percentage of body fat, while boys begin to develop more lean muscle mass. These differences reflect the influence of estrogen in girls and testosterone in boys, which become increasingly active during this period. Parents should understand that these emerging differences are normal and that the earlier growth of girls does not indicate any abnormality in either sex. This understanding helps parents support their children through this transitional period without unnecessary concern about developmental timing.
D) Signs of sexual maturation become highly visible in boys.
This statement is inaccurate for the prepubescent and preadolescent period. While signs of sexual maturation do begin during this time, they are not "highly visible" in boys during the early stages. In fact, one of the challenges in discussing male puberty is that the earliest signs are not readily observable. The first sign of sexual maturation in boys is testicular enlargement, which typically begins around age 11-12 but is not externally visible. Pubic hair appears somewhat later, and significant voice changes and facial hair growth occur even later, typically in mid-puberty. In contrast, the early signs of female puberty, particularly breast budding (thelarche), are more readily observable. Telling parents that signs of sexual maturation become highly visible in boys during prepubescence would create unrealistic expectations and might lead them to be concerned when they do not observe obvious changes. The nurse should accurately describe the more subtle early signs in boys.
Conclusion:
When discussing prepubescence and preadolescence with parents of school-age children, the nurse should include that growth differences between boys and girls become evident during this period, with girls typically beginning their growth spurt earlier than boys. The statement that initial physiologic changes appear during early childhood is incorrect, as these changes begin during prepubescence. The assertion that changes in height and weight occur slowly is inaccurate, as growth accelerates during this period. The claim that signs of sexual maturation become highly visible in boys is misleading, as early signs in boys are subtle and not readily observable. Therefore, only the statement about emerging growth differences between sexes should be included in the discussion.

Question 9 / 21

A nurse is providing teaching about expected changes during puberty to a group of parents of early adolescent girls. Which of the following statements by one of the parents indicates an understanding of the teaching?

A. "Girls usually stop growing about 2 years after menarche."

B. "Girls are expected to gain about 65 pounds during puberty."

C. "Girls experience menstruation prior to breast development."

D. "Girls typically grow more than 10 inches during puberty."

Rationale

The parent demonstrates understanding of pubertal changes by stating that girls usually stop growing about 2 years after menarche.
Menarche, the onset of menstruation, is a significant milestone in female puberty that typically occurs around age 12-13 years, though the range of normal is wide (9-16 years). An important aspect of the relationship between menarche and growth is that the peak height velocity (the period of fastest growth) occurs before menarche. Girls typically experience their growth spurt early in puberty, around age 9-12 years, before menstruation begins. After menarche, growth continues but at a slower rate, with most girls gaining only an additional 2-3 inches (5-7.5 cm) after their first period. Growth typically ceases completely about 2 to 2.5 years after menarche when the epiphyseal plates close under the influence of estrogen. Understanding this timeline helps parents recognize that their daughter's growth is nearing completion after menstruation begins and that significant additional height is not expected. This knowledge can alleviate concerns if a daughter appears to stop growing shortly after menarche.
A) "Girls usually stop growing about 2 years after menarche."
This statement accurately reflects the relationship between menarche and growth cessation. After menarche, estrogen promotes the closure of the epiphyseal plates in long bones, ending longitudinal growth. This process typically takes approximately 2 to 2.5 years, after which no further increase in height occurs. The peak growth velocity precedes menarche, with girls growing most rapidly in the year or two before their first period. Understanding this timeline is important for several reasons. It helps parents have realistic expectations about their daughter's growth after menstruation begins. It also helps in interpreting growth patterns; if a girl has not yet reached her desired height and has already passed menarche, there is limited time for additional growth. This knowledge can guide discussions with healthcare providers if there are concerns about stature. The parent's correct statement indicates successful learning from the teaching provided.
B) "Girls are expected to gain about 65 pounds during puberty."
This statement does not accurately reflect typical weight gain during female puberty and suggests a misunderstanding of the teaching. While significant weight gain does occur during puberty as part of normal development, the figure of 65 pounds is an overestimate. During the pubertal years, girls typically gain approximately 15-55 pounds total, with wide variation based on individual factors. The average weight gain during the pubertal growth spurt is about 8-10 pounds per year during the peak growth period. The total gain depends on the timing and duration of puberty, as well as genetic and environmental factors. The 65-pound figure might be more appropriate for total weight gain from prepuberty through the completion of growth, but even then it would be at the high end of the range. This statement suggests the parent has not retained accurate information about expected weight changes.
C) "Girls experience menstruation prior to breast development."
This statement reverses the actual sequence of pubertal events and indicates misunderstanding of the teaching. Thelarche, or breast development, is typically the first sign of puberty in girls, occurring on average between ages 8 and 13 years. This is followed by the growth spurt, then pubic hair development (pubarche), and finally menarche, which usually occurs approximately 2 to 2.5 years after breast development begins. Menarche is a relatively late event in the sequence of female puberty, typically occurring at Tanner stage 4, after breast development is well underway. Experiencing menstruation before any breast development would be highly unusual and might indicate a hormonal abnormality requiring evaluation. The parent's incorrect sequencing suggests they did not understand or retain this important information about the normal progression of puberty.
D) "Girls typically grow more than 10 inches during puberty."
This statement overestimates typical height gain during female puberty. While significant linear growth does occur during the pubertal growth spurt, the average total height gain from the beginning to the end of the pubertal growth period is approximately 8-10 inches (20-25 cm) for girls. The statement "more than 10 inches" suggests growth exceeding 10 inches, which would be above average. Most girls grow about 3-4 inches per year during their peak growth velocity, and the entire pubertal growth period contributes about 8-10 inches total. Factors such as the timing of puberty, genetic potential, and nutritional status influence actual growth. While some girls may grow slightly more than 10 inches, this is not the typical expectation, and stating "more than 10 inches" as the norm could lead parents to have unrealistic expectations or become concerned if their daughter grows less.
Conclusion:
The parent demonstrates understanding of teaching about expected changes during puberty by correctly stating that girls usually stop growing about 2 years after menarche. The statement about gaining 65 pounds overestimates typical weight gain. The claim that menstruation occurs prior to breast development reverses the actual sequence of pubertal events. The assertion that girls typically grow more than 10 inches overestimates average height gain. Therefore, only the statement about growth cessation 2 years after menarche reflects accurate understanding of the teaching provided.

Question 10 / 21

A nurse is teaching a class about puberty in boys. Which of the following should the nurse include as the first manifestation of sexual maturation?

A. Pubic hair growth

B. Vocal changes

C. Testicular enlargement

D. Facial hair growth

Rationale

The nurse should include that testicular enlargement is the first manifestation of sexual maturation in boys.
Puberty in boys, like in girls, follows a predictable sequence of physical changes triggered by hormonal activation of the hypothalamic-pituitary-gonadal axis. This process typically begins between ages 9 and 14 years, with considerable individual variation. The first sign of pubertal onset in males is testicular enlargement, specifically an increase in testicular volume to greater than 3-4 mL or length greater than 2.5 cm. This enlargement reflects the response of the testes to increasing levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary gland. The testes begin to produce testosterone, which then drives the other physical changes of puberty including penile growth, pubic hair development, voice changes, and the growth spurt. Understanding this sequence helps parents and healthcare providers accurately assess pubertal progression and identify deviations from normal development.
A) Pubic hair growth
Pubic hair growth, also known as pubarche, is an early sign of puberty but is not the very first manifestation in boys. Pubic hair development is driven by androgens, primarily testosterone produced by the testes and adrenal androgens from the adrenal glands. While pubic hair typically appears early in puberty, it usually follows testicular enlargement. In the Tanner staging system for male puberty, testicular enlargement defines Stage 2, while pubic hair may appear concurrently or slightly later. Some boys may develop pubic hair before significant testicular enlargement is evident, which can represent premature adrenarche (early activation of adrenal androgen production) rather than true central puberty. However, in typical central puberty, testicular enlargement is the initiating event. Therefore, while pubic hair is an early sign, it is not the first manifestation.
B) Vocal changes
Vocal changes, specifically the deepening of the voice, occur relatively late in male puberty and are not the first manifestation of sexual maturation. Voice change results from growth of the larynx and lengthening and thickening of the vocal cords under the influence of testosterone. This process typically occurs during Tanner Stage 3 or 4, well after testicular enlargement and pubic hair development have begun. The voice change is often gradual, with the characteristic "cracking" occurring as the boy adjusts to his changing vocal apparatus. Because voice change occurs relatively late in the sequence, it cannot be the first manifestation. Presenting it as such would misrepresent the typical progression of male puberty.
C) Testicular enlargement
Testicular enlargement is correctly identified as the first manifestation of sexual maturation in boys. This initial change reflects the direct effect of gonadotropins on the testes and marks the onset of central puberty. The testes begin to increase in size, typically reaching a volume of 4 mL or more (measured using an orchidometer or by comparison to standard models) before other changes become apparent. This enlargement usually occurs between ages 9 and 14 years. Following testicular enlargement, the scrotal skin thins, reddens, and becomes more textured. Penile growth begins later, typically about one year after testicular enlargement starts. Recognizing testicular enlargement as the first sign is important for accurate assessment of pubertal onset. If a boy shows other signs of puberty without testicular enlargement, it may indicate a different condition such as premature adrenarche or an adrenal disorder. Therefore, this is the correct information to include in teaching about puberty in boys.
D) Facial hair growth
Facial hair growth is a late sign of male puberty and is not the first manifestation. Facial hair typically appears in a predictable sequence, starting with hair at the corners of the upper lip, then spreading to the upper lip, cheeks, chin, and neck. This process usually occurs during Tanner Stage 4 or 5, well after testicular enlargement, pubic hair development, penile growth, and the growth spurt. Many boys do not develop significant facial hair until several years after other pubertal changes have begun, and full facial hair development may continue into early adulthood. Presenting facial hair as the first manifestation would be completely inaccurate and would mislead parents and boys about what to expect during early puberty.
Conclusion:
When teaching about puberty in boys, the nurse should include that testicular enlargement is the first manifestation of sexual maturation, typically beginning between ages 9 and 14 years. Pubic hair growth occurs early but usually follows testicular enlargement. Vocal changes occur relatively late in puberty. Facial hair growth is a late sign that appears well after other changes have occurred. Therefore, testicular enlargement is the correct first manifestation to include in the teaching.

Question 11 / 21

A nurse is teaching a parent of an infant about administration of oral medications. Which of the following should the nurse include in the teaching? (select all that apply)

A. Use a universal dropper for medication administration

B. Ask the pharmacy to add flavoring to the medication

C. Add the medication to a formula bottle before feeding

D. Use the nipple of a bottle to administer the medication

Rationale

When teaching a parent about administration of oral medications to an infant, the nurse should include asking the pharmacy to add flavoring to the medication, using the nipple of a bottle to administer the medication, and holding the infant in a semireclining position.
Oral medication administration to infants requires special techniques to ensure safety, accuracy, and acceptance. Infants cannot swallow pills and may resist taking liquid medications due to taste or texture. Parents need practical guidance on how to administer medications effectively while minimizing the risk of aspiration and ensuring the full dose is received. Key principles include positioning the infant safely, using appropriate administration devices, and making the medication more palatable when appropriate. The techniques recommended should be evidence-based and align with current pediatric medication administration guidelines. Proper education helps parents feel confident in administering medications and improves adherence to treatment regimens.
A) Use a universal dropper for medication administration
This instruction should not be included because using a universal dropper is unsafe and inaccurate. Universal droppers, which may come with different medications or be used across multiple medications, are not standardized and can lead to dosing errors. The dropper that comes with a specific medication is calibrated for that medication's concentration and should be used exclusively with that medication. Using a different dropper can result in an incorrect dose, either underdosing (leading to ineffective treatment) or overdosing (potentially causing toxicity). Additionally, universal droppers may not be properly cleaned between uses, leading to contamination or mixing of medications. The nurse should teach parents to always use the measuring device that came with the medication and to use oral syringes or droppers specifically designed for medication administration. Therefore, this instruction is incorrect and should not be included.
B) Ask the pharmacy to add flavoring to the medication
This instruction is appropriate to include in parent teaching. Many liquid medications have unpleasant tastes that can make administration difficult with infants. Pharmacies can often add flavoring agents to medications to improve palatability without affecting the medication's effectiveness. Common flavors include grape, cherry, bubble gum, and other sweet options that appeal to children. Parents should be instructed to ask about this service when picking up prescriptions. Some medications may not be suitable for flavoring due to stability concerns, so this should be verified with the pharmacist. Improving the taste of medication can significantly reduce resistance and make the administration process less stressful for both parent and infant. This strategy supports medication adherence and positive experiences with medication administration.
C) Add the medication to a formula bottle before feeding
This instruction should not be included because adding medication to a formula bottle is unsafe and can lead to inaccurate dosing. When medication is mixed into a full bottle of formula, there is no guarantee the infant will drink the entire bottle, making it impossible to know how much medication was actually consumed. If the infant drinks only part of the bottle, the parent cannot determine the dose received or how much remains. This can result in underdosing and ineffective treatment. Additionally, some medications may interact with formula components, affecting stability or absorption. Mixing medication into a bottle also teaches the infant that formula has an unusual taste, potentially creating negative associations with feeding. The correct approach is to administer medication separately from feedings, using an oral syringe or dropper, and then offer the bottle. Therefore, this instruction is incorrect and should not be included.
D) Use the nipple of a bottle to administer the medication
This instruction is appropriate to include as one method for administering oral medication to infants. Using the nipple of a bottle (without the bottle attached) can be an effective technique for infants who accept this method. The parent places the medication in the nipple and allows the infant to suck it out, similar to drinking from a bottle. This method takes advantage of the infant's natural sucking reflex and can be less threatening than a syringe. The nipple should be clean and dedicated to medication use if this method is employed regularly. It is important that the parent ensures the infant swallows all the medication and does not allow it to pool in the mouth. While this method works well for some infants, parents should be taught to use it with attention to ensuring the full dose is administered. This is a valid technique that can be included in parent teaching.
E) Hold the infant in a semireclining position
This instruction is essential to include in parent teaching about oral medication administration. The semireclining position, with the infant's head slightly elevated and supported, is the safest position for administering oral medications. This position uses gravity to help the medication flow toward the stomach and reduces the risk of aspiration, which could occur if the infant is lying flat. The parent should hold the infant in a comfortable but secure position, supporting the head and neck. The medication should be directed toward the inner cheek, not the back of the throat, which could trigger gagging or choking. This position allows the infant to swallow naturally and safely. Never should medication be administered with the infant lying flat or with the head tipped back, as this increases aspiration risk. Therefore, teaching about proper positioning is a critical component of medication administration education.
Conclusion:
When teaching a parent about administering oral medications to an infant, the nurse should include instructions to ask the pharmacy about adding flavoring to improve palatability, use the bottle nipple as one administration method, and hold the infant in a semireclining position for safety. Using a universal dropper is unsafe due to dosing inaccuracy. Adding medication to a formula bottle risks incomplete dosing and should be avoided. Therefore, the correct selections for inclusion in the teaching are asking for flavoring, using the bottle nipple, and holding the infant in a semireclining position.

Question 12 / 21

A nurse is completing a pain assessment of an infant. Which of the following pain scales should the nurse use?

A. FACES

B. FLACC

C. Oucher

D. Non-communicating children's pain checklist

Rationale

The nurse should use the FLACC pain scale when assessing pain in an infant.
Pain assessment in infants presents unique challenges because infants cannot self-report pain verbally. Healthcare providers must rely on behavioral and physiological indicators to evaluate pain. Several pain assessment tools have been developed for use in non-verbal populations, each with specific age ranges and applications. The FLACC scale (Face, Legs, Activity, Cry, Consolability) is specifically designed and validated for assessing pain in children between 2 months and 7 years of age, including infants. This scale assigns scores of 0-2 for each of five categories, with total scores ranging from 0 to 10. The FLACC scale is widely used in clinical settings, has good reliability and validity, and is practical for bedside use. Its behavioral focus makes it appropriate for infants who cannot communicate their pain experience verbally. The nurse can observe the infant's facial expression, leg movement, activity level, cry, and response to comforting to generate a pain score that guides treatment decisions.
A) FACES
The FACES pain scale, also known as the Wong-Baker FACES Pain Rating Scale, is not appropriate for infants. This scale uses a series of faces showing expressions ranging from smiling to crying, and the patient points to the face that best represents their pain level. This tool requires the ability to understand the concept of the scale, make a selection, and communicate that choice. These cognitive and communication skills are beyond the capabilities of infants. The FACES scale is typically used with children aged 3 years and older who can understand the instructions and point to a face. While some versions may be used with younger children, infants cannot participate in this type of self-report. Therefore, the FACES scale is not appropriate for infant pain assessment.
B) FLACC
The FLACC scale is the correct choice for infant pain assessment. This tool was specifically developed and validated for use in young children who cannot self-report pain, including infants. The FLACC scale assesses five categories: Face (facial expression), Legs (leg movement or tension), Activity (general activity level or body movements), Cry (presence and quality of crying), and Consolability (response to comforting). Each category is scored 0, 1, or 2 based on specific descriptors, with total scores ranging from 0 (no pain) to 10 (worst possible pain). The scale can be used in various clinical situations, including postoperative pain assessment and procedural pain. It has been extensively studied and found to have good inter-rater reliability and validity. The FLACC scale is practical for bedside use and provides objective criteria that guide pain management decisions. Therefore, this is the appropriate scale for infant pain assessment.
C) Oucher
The Oucher scale is not appropriate for infants. The Oucher is a pain assessment tool that combines a numeric rating scale (0-10) with photographs of children's faces showing different levels of pain distress. It was designed for children aged 3-12 years who can either use the numeric scale or point to the face that matches their pain. Like the FACES scale, the Oucher requires the child to understand the concept and make a selection, which infants cannot do. The photographic faces depict older children, not infants, and the scale is not validated for infant use. While there are versions of the Oucher for different ethnic groups to improve cultural appropriateness, it remains a self-report tool unsuitable for pre-verbal children. Therefore, the Oucher is not appropriate for infant pain assessment.
D) Non-communicating children's pain checklist
The Non-communicating Children's Pain Checklist (NCCPC) is not the most appropriate choice for a general infant pain assessment. This tool was specifically developed for children with severe cognitive impairments who cannot communicate verbally. It includes items such as vocalizations, social behaviors, facial expressions, activity, body movements, and physiological signs. While the NCCPC could potentially be used with some infants, it is more complex and less practical for routine clinical use than the FLACC scale. It was designed for a specific population (non-communicating children with intellectual disabilities) and is longer and more detailed than necessary for typical infant pain assessment. The FLACC scale is simpler, faster, and specifically validated for the general infant population. Therefore, while the NCCPC might have applications in certain situations, the FLACC scale is the preferred and most appropriate choice for routine infant pain assessment.
Conclusion:
When completing a pain assessment of an infant, the nurse should use the FLACC scale, which is specifically designed and validated for assessing pain in children who cannot self-report, including infants. The FACES scale requires self-report and cognitive abilities beyond infant capabilities. The Oucher scale is also a self-report tool unsuitable for infants. The Non-communicating Children's Pain Checklist is designed for children with cognitive impairments and is more complex than needed for routine infant assessment. Therefore, the FLACC scale is the correct choice for infant pain assessment.

Question 13 / 21

A nurse is planning care for an infant who is experiencing pain. Which of the following interventions should the nurse include in the plan of care? (select all that apply)

A. Offer a pacifier

B. Use of guided imagery

C. Use swaddling

D. Initiate a behavioral contract

Rationale

When planning care for an infant experiencing pain, the nurse should include offering a pacifier, using swaddling, and encouraging kangaroo care as appropriate non-pharmacological interventions.
Pain management in infants should include both pharmacological and non-pharmacological approaches to provide comprehensive comfort care. Non-pharmacological interventions are particularly important for infants because they can be implemented quickly, have no side effects, and support the infant's self-regulatory abilities. These interventions work through various mechanisms including providing comfort through familiar sensations, promoting relaxation, reducing environmental stress, and facilitating parent-infant attachment. The interventions chosen must be developmentally appropriate for infants, who cannot participate in cognitive or behavioral techniques that require understanding or cooperation. Simple sensory and comforting interventions that leverage the infant's natural regulatory mechanisms are most effective. These interventions can be used alone for mild pain or in combination with analgesics for moderate to severe pain.
A) Offer a pacifier
Offering a pacifier is an appropriate non-pharmacological intervention for infant pain management. Non-nutritive sucking has been shown to have calming and pain-reducing effects in infants through multiple mechanisms. Sucking is a natural, self-regulatory behavior that provides comfort and may trigger the release of endogenous opioids. Pacifier use has been demonstrated to reduce behavioral distress and physiological indicators of pain during procedures such as heel sticks and immunizations. The pacifier may be used alone or dipped in sucrose solution, which provides additional analgesic effect through sweet taste-mediated endogenous opioid release. For infants who accept pacifiers, this intervention provides immediate, accessible comfort with no adverse effects. Therefore, offering a pacifier should be included in the pain management plan.
B) Use of guided imagery
Guided imagery is not an appropriate intervention for an infant experiencing pain. Guided imagery is a cognitive-behavioral technique that requires the individual to use imagination to create calming mental images, redirecting attention away from pain. This technique requires cognitive abilities, language comprehension, and the capacity for symbolic thought that are beyond the developmental level of infants. Infants cannot understand instructions for guided imagery or voluntarily shift their attention in this way. Guided imagery may be appropriate for older children, adolescents, and adults, but it has no application in infant pain management. Therefore, this intervention should not be included in the plan of care for an infant.
C) Use swaddling
Swaddling is an appropriate non-pharmacological intervention for infant pain management. Swaddling involves wrapping the infant snugly in a blanket to provide containment and gentle pressure throughout the body. This technique mimics the confined environment of the uterus and promotes feelings of security and comfort. Swaddling has been shown to reduce behavioral distress and physiological stress responses during painful procedures. It helps the infant maintain a calm, flexed position and may reduce startle responses that can exacerbate distress. Swaddling also helps with temperature regulation and can facilitate sleep. For infants who respond well to swaddling, this intervention provides comfort and may reduce pain perception. Therefore, swaddling should be included in the pain management plan.
D) Initiate a behavioral contract
Initiating a behavioral contract is not an appropriate intervention for an infant experiencing pain. Behavioral contracts are cognitive-behavioral techniques used with older children, adolescents, and adults to establish agreements about behavior in exchange for rewards or consequences. These contracts require the individual to understand the terms, remember the agreement, and have the cognitive capacity to make choices about their behavior. Infants lack these cognitive and language abilities entirely. Behavioral contracts have no role in infant pain management. For infants, interventions must be provided by caregivers without any expectation of the infant's active participation in decision-making or behavior change. Therefore, this intervention should not be included.
E) Encourage kangaroo care
Encouraging kangaroo care is an appropriate non-pharmacological intervention for infant pain management. Kangaroo care involves skin-to-skin contact between the infant and parent, typically with the infant placed on the parent's bare chest. This intervention provides multiple benefits including temperature regulation, physiologic stabilization, and pain reduction. The close physical contact promotes release of oxytocin, which has calming and pain-modulating effects. The familiar smell, heartbeat, and warmth of the parent provide comfort and reduce stress. Research has demonstrated that kangaroo care reduces pain responses during procedures such as heel sticks in both preterm and term infants. This intervention also supports parent-infant attachment and gives parents an active role in comforting their infant. Therefore, kangaroo care should be included in the pain management plan.
Conclusion:
When planning care for an infant experiencing pain, the nurse should include offering a pacifier for non-nutritive sucking comfort, using swaddling to provide containment and security, and encouraging kangaroo care for skin-to-skin contact and parental comfort. Guided imagery requires cognitive abilities beyond infant capacity. Behavioral contracts are developmentally inappropriate for infants. Therefore, the correct interventions to include are offering a pacifier, using swaddling, and encouraging kangaroo care.

Question 14 / 21

A nurse on a pediatric unit is caring for a toddler. Which of the following behaviors is an effect of hospitalization? (select all that apply)

A. Believes the experience is a punishment

B. Experiences separation anxiety

C. Displays intense emotions

D. Exhibits regressive behaviors

Rationale

Effects of hospitalization in a toddler include experiencing separation anxiety, displaying intense emotions, and exhibiting regressive behaviors.
Hospitalization is a significant stressor for children of all ages, but the specific effects vary based on the child's developmental stage. Toddlers, typically ages 1 to 3 years, are particularly vulnerable to the stresses of hospitalization due to their developmental characteristics. They are in Erikson's stage of autonomy versus shame and doubt, striving for independence, and have strong attachments to parents. They have limited understanding of why they are in the hospital and what is happening to them. Common effects of hospitalization in toddlers include separation anxiety when separated from parents, intense emotional responses such as protest and despair, and regression to earlier developmental behaviors as a coping mechanism. Understanding these expected responses helps nurses provide developmentally appropriate care and support for both the toddler and family.
A) Believes the experience is a punishment
Believing that hospitalization is punishment is more characteristic of preschool-age children, not toddlers. Preschoolers, with their magical thinking and developing conscience, often interpret illness and hospitalization as punishment for real or imagined misdeeds. They may believe they are in the hospital because they were "bad." Toddlers, however, have a less developed sense of cause and effect and are less likely to make this cognitive connection. Their responses to hospitalization are more focused on the immediate sensory and emotional experiencesâ€”pain, separation from parents, unfamiliar surroundingsâ€”rather than on abstract concepts of punishment. While a toddler may feel distressed and frightened, they are unlikely to formulate the belief that this is punishment. Therefore, this behavior is not typically an effect of hospitalization in toddlers.
B) Experiences separation anxiety
Experiencing separation anxiety is a major effect of hospitalization in toddlers. Separation anxiety is a normal developmental phenomenon that peaks during the toddler period, when children have strong attachments to parents but limited understanding of time and object permanence. Hospitalization often involves separation from parents due to visiting restrictions, parents' need to attend to other responsibilities, or the child being in an intensive care unit. Toddlers respond to separation with predictable stages: protest (crying, searching for parents, rejecting comfort), despair (withdrawal, sadness, hopelessness), and detachment (superficial adjustment, appearing to accept separation but with emotional blunting). These responses are highly stressful and can have lasting effects if not addressed. Minimizing separation through rooming-in, flexible visiting, and consistent caregivers is essential for toddler care. Therefore, separation anxiety is correctly identified as an effect of hospitalization.
C) Displays intense emotions
Displaying intense emotions is a common effect of hospitalization in toddlers. Toddlers have limited emotional regulation abilities even in normal circumstances, and the stress of hospitalization overwhelms their coping capacities. They may display intense distress through prolonged crying, screaming, tantrums, or aggressive behaviors such as hitting or biting. These intense emotional displays are expressions of fear, frustration, and overwhelm, not simply "bad behavior." The toddler may also show intense attachment to parents and intense fear of healthcare providers. Recognizing these emotional responses as normal reactions to the stress of hospitalization helps nurses respond with empathy and appropriate interventions rather than frustration. Providing comfort, maintaining routines, and supporting parents helps the toddler regulate these intense emotions. Therefore, intense emotions are correctly identified as an effect of hospitalization.
D) Exhibits regressive behaviors
Exhibiting regressive behaviors is a common effect of hospitalization in toddlers. Regression involves returning to behaviors characteristic of an earlier developmental stage as a coping mechanism when current demands feel overwhelming. A toddler who was toilet trained may start having accidents. One who was sleeping through the night may begin waking and crying. A child who was feeding independently may want to be fed. These regressive behaviors are not intentional or manipulative; they represent the child's attempt to return to a time when they felt safer and more secure. Regression is a normal coping response to stress and should be met with acceptance rather than criticism. The nurse should reassure parents that regression is expected and temporary, and should encourage them to provide comfort while gently maintaining expectations as the child recovers. Therefore, regressive behaviors are correctly identified as an effect of hospitalization.
E) Manifests disturbance in body image
Manifesting disturbance in body image is not typically an effect of hospitalization in toddlers. Body image concerns require a sense of self and awareness of one's body that develops later in childhood. Toddlers are just developing body awareness and do not have the cognitive capacity for body image disturbance as it is typically understood. Concerns about body image, changes in appearance, or alterations in body function become more prominent in school-age children and adolescents, who have more developed self-concepts and greater awareness of social norms. While a toddler may be distressed by physical changes such as IV lines, dressings, or surgical incisions, this distress is related to the sensory experience and interference with activity rather than to body image per se. Therefore, this is not typically an effect of hospitalization in toddlers.
Conclusion:
When caring for a hospitalized toddler, effects of hospitalization include experiencing separation anxiety due to separation from attachment figures, displaying intense emotions as a result of overwhelmed coping capacities, and exhibiting regressive behaviors as a coping mechanism. Believing hospitalization is punishment is more characteristic of preschoolers. Manifesting disturbance in body image develops later in childhood. Therefore, the correct selections for effects of hospitalization in a toddler are separation anxiety, intense emotions, and regressive behaviors.

Question 15 / 21

A nurse is caring for a child who is dying. Which of the following are findings of impending death? (select all that apply)

A. Heightened sense of hearing

B. Tachycardia

C. Difficulty swallowing

D. Sensation of being cold

Rationale

Findings of impending death in a child include difficulty swallowing and Cheyne-Stokes respirations.
The dying process involves predictable physiological changes as the body gradually shuts down. Recognizing these signs helps nurses provide appropriate comfort care and prepare families for what to expect. Near the end of life, multiple body systems are affected. Difficulty swallowing (dysphagia) occurs as the muscles involved in swallowing weaken and the gag reflex diminishes. This can lead to accumulation of secretions in the throat, sometimes producing audible breathing sounds often called the "death rattle." Cheyne-Stokes respirations are a characteristic breathing pattern seen in the dying process, consisting of cycles of gradually deepening breaths, then gradually shallower breaths, followed by periods of apnea (cessation of breathing). These cycles reflect the brain's decreasing responsiveness to carbon dioxide levels. Understanding these signs as normal parts of the dying process helps nurses provide reassurance to families and implement appropriate comfort measures.
A) Heightened sense of hearing
Heightened sense of hearing is not typically described as a finding of impending death. In fact, sensory changes near death usually involve decreased sensation and responsiveness. While some anecdotal reports suggest that hearing may be one of the last senses to diminish, this is not typically described as "heightened." The more accurate understanding is that hearing may remain present even when the person appears unresponsive, which is why families and caregivers are encouraged to continue speaking to the dying person. However, this is different from heightened acuity. The statement as written suggests increased sensitivity, which is not characteristic of the dying process. Therefore, this is not correctly identified as a finding of impending death.
B) Tachycardia
Tachycardia (rapid heart rate) is not typically a finding of impending death. In fact, as death approaches, heart rate usually slows rather than accelerates. The dying process involves decreasing cardiac output and progressive bradycardia (slowing heart rate). Heart rate may become irregular, weak, and difficult to palpate. Tachycardia would be more characteristic of other conditions such as fever, pain, dehydration, or anxiety, not of the terminal phase. While heart rate may vary during the dying process, the overall trend is toward slowing, not increasing. Therefore, tachycardia is not correctly identified as a finding of impending death.
C) Difficulty swallowing
Difficulty swallowing is correctly identified as a finding of impending death. As the body shuts down, muscles throughout the body weaken, including those involved in swallowing. The swallowing reflex diminishes, and the ability to manage oral secretions decreases. This can lead to accumulation of saliva and mucus in the oropharynx, producing gurgling sounds with breathing (often called the death rattle). The child may be unable to swallow medications, food, or even their own saliva. This finding has important implications for care: the nurse should stop oral feedings to prevent aspiration, provide mouth care to keep the mouth moist and comfortable, and consider medications to reduce secretions if the death rattle causes distress. Explaining this to families helps them understand why their child can no longer eat or drink and how to provide comfort through other means.
D) Sensation of being cold
Sensation of being cold is not typically described as a finding of impending death, and the phrasing is somewhat ambiguous. As death approaches, peripheral circulation decreases as blood is shunted to core organs. This results in the extremities (hands and feet) becoming cool to the touch and possibly appearing mottled or bluish. However, this is an objective finding observed by others, not necessarily a sensation reported by the dying person, who may have decreased awareness and sensation. The phrasing "sensation of being cold" suggests the person feels cold, which may or may not be accurate. The objective finding of cool extremities is indeed a sign of impending death, but the option as written is imprecise. Additionally, dying individuals may actually feel warm to the core even as extremities cool. Given the specific wording, this is not the best choice among the options.
E) Cheyne-Stokes respirations
Cheyne-Stokes respirations are correctly identified as a finding of impending death. This breathing pattern is characterized by cycles of gradually increasing depth of respirations, followed by gradually decreasing depth, then a period of apnea (no breathing). The cycles may last from 30 seconds to 2 minutes. This pattern reflects the brain's decreasing sensitivity to carbon dioxide and the dysfunction of respiratory control centers. Cheyne-Stokes respirations are common in the final hours to days of life. While this pattern can occur in other conditions such as heart failure or brain injury, in the context of terminal illness it is recognized as a sign that death is approaching. The nurse should explain this finding to families, reassuring them that it is a normal part of the dying process and does not indicate that the child is suffering or struggling to breathe.
Conclusion:
When caring for a dying child, findings of impending death include difficulty swallowing due to muscle weakness and diminished reflexes, and Cheyne-Stokes respirations due to changes in respiratory control. Heightened sense of hearing is not characteristic. Tachycardia is not typical as heart rate usually slows. Sensation of being cold is imprecisely worded and not the best choice. Therefore, the correct selections for findings of impending death are difficulty swallowing and Cheyne-Stokes respirations

Question 16 / 21

A nurse often cares for children who are dying. Which of the following are appropriate actions for the nurse to take to maintain professional effectiveness? (select all that apply)

A. Remain in contact with the family after their loss

B. Develop a professional support system

C. Take time off from work

D. Suggest that a hospital representative attend the funeral

Rationale

To maintain professional effectiveness when caring for dying children, the nurse should develop a professional support system and take time off from work.
Nurses who frequently care for dying children are at high risk for compassion fatigue, burnout, and secondary traumatic stress. The cumulative emotional toll of witnessing suffering and death, supporting grieving families, and confronting their own feelings about mortality can significantly impact nurses' well-being and professional effectiveness. Maintaining professional effectiveness requires intentional self-care strategies and support systems. Developing a professional support system, such as through formal debriefing sessions, peer support groups, or mentorship relationships, provides a space to process emotions and experiences with colleagues who understand the unique challenges of pediatric end-of-life care. Taking time off from work allows for rest, recovery, and engagement in activities that replenish emotional reserves. These strategies help nurses sustain their capacity to provide compassionate, competent care over the long term.
A) Remain in contact with the family after their loss
While maintaining contact with bereaved families may be appropriate in some circumstances and can be meaningful for both families and nurses, it is not primarily a strategy for maintaining the nurse's professional effectiveness. Contact with families after a child's death should be guided by professional boundaries, facility policies, and the nurse's personal comfort level. For some nurses, ongoing contact may provide a sense of closure or meaning; for others, it may complicate the grieving process or blur professional boundaries. This action is more about supporting the family and the nurse's personal fulfillment than about maintaining professional effectiveness through self-care. It should not be presented as a recommended strategy for all nurses. Therefore, this is not an appropriate action specifically for maintaining professional effectiveness.
B) Develop a professional support system
This action is appropriate and essential for maintaining professional effectiveness. A professional support system provides a safe space for nurses to process their experiences, share feelings, and receive validation and support from colleagues who understand the unique challenges of pediatric end-of-life care. This may include formal mechanisms such as structured debriefing sessions after difficult deaths, participation in Schwartz Rounds or similar programs, or informal peer support among trusted colleagues. Professional support helps prevent isolation, normalizes emotional responses, and provides opportunities to develop coping strategies. It also allows nurses to learn from each other's experiences and approaches. Research consistently identifies professional support as a key factor in preventing burnout and compassion fatigue. Therefore, this action should be included.
C) Take time off from work
This action is appropriate and necessary for maintaining professional effectiveness. Regular time away from work allows nurses to rest, recharge, and engage in activities that support their physical, emotional, and spiritual well-being. The intense emotional demands of caring for dying children require periods of recovery. Taking vacation days, using personal time, and ensuring adequate time off between shifts are all important. Nurses who do not take sufficient time off are at increased risk for burnout, compassion fatigue, and decreased quality of care. Time off provides distance from work stressors, opportunities for renewal, and perspective that supports continued effectiveness. Therefore, this action should be included.
D) Suggest that a hospital representative attend the funeral
This action is not primarily about maintaining the nurse's professional effectiveness and may not be appropriate or feasible. Whether a hospital representative attends a child's funeral is typically determined by facility policy, family wishes, and the nature of the relationship between staff and family. Some families appreciate this gesture, while others may prefer privacy. This action is more about supporting the family and representing the institution than about maintaining the individual nurse's professional effectiveness. Suggesting this as a strategy for the nurse to maintain effectiveness could create additional stress or obligation. Therefore, this is not an appropriate action to include for the purpose of maintaining professional effectiveness.
E) Demonstrate feelings of sympathy toward the family
Demonstrating sympathy toward families is part of providing compassionate care, but it is not a strategy for maintaining the nurse's own professional effectiveness. In fact, without proper boundaries and self-care, intense emotional engagement with grieving families can contribute to compassion fatigue. The question specifically asks about actions the nurse takes to maintain their own professional effectiveness, not about how they interact with families. While appropriate emotional expression with families can be therapeutic for both parties, this is a clinical skill rather than a self-care strategy. Presenting it as a way to maintain professional effectiveness could be misleading. Therefore, this is not the correct selection for this question.
Conclusion:
To maintain professional effectiveness when caring for dying children, the nurse should develop a professional support system to process experiences with colleagues and take time off from work to rest and recharge. Remaining in contact with families after loss is not primarily a self-care strategy. Suggesting hospital attendance at funerals is not about individual professional effectiveness. Demonstrating sympathy is part of clinical care, not self-care. Therefore, the correct actions for maintaining professional effectiveness are developing a professional support system and taking time off from work.

Question 17 / 21

A nurse is reviewing cerebrospinal fluid analysis for a client who has suspected meningitis. Which of the following findings should the nurse identify as indicating viral meningitis? (select all that apply)

A. Negative Gram stain

B. Normal glucose content

C. Cloudy color

D. Decreased WBC count

Rationale

Findings indicating viral meningitis include negative Gram stain, normal glucose content, and normal protein count.
Cerebrospinal fluid (CSF) analysis is essential for diagnosing meningitis and distinguishing between bacterial and viral etiologies. Lumbar puncture is performed to obtain CSF, which is then analyzed for cell count, protein, glucose, and examined microscopically with Gram stain and culture. The pattern of findings differs significantly between bacterial and viral meningitis. Viral meningitis typically shows a lymphocytic predominance with mildly elevated white blood cell count (usually 10-1000 cells/ÂµL), normal or slightly elevated protein (often <150 mg/dL), normal glucose (usually >50% of serum glucose), and negative Gram stain and culture. Bacterial meningitis, in contrast, shows neutrophilic predominance with markedly elevated white blood cell count (often >1000 cells/ÂµL), elevated protein, decreased glucose, and positive Gram stain and culture. Understanding these differences helps guide initial treatment while awaiting culture results.
A) Negative Gram stain
A negative Gram stain is consistent with viral meningitis and helps distinguish it from bacterial meningitis. In bacterial meningitis, Gram stain of CSF is positive in 60-90% of untreated cases, revealing the causative organism. In viral meningitis, no bacteria are visible on Gram stain because viruses cannot be seen with this technique. A negative Gram stain does not rule out bacterial meningitis entirely, as some cases may have low organism burden or prior antibiotic treatment, but it is one piece of evidence supporting viral etiology. Therefore, this finding should be identified as indicating viral meningitis.
B) Normal glucose content
Normal glucose content in CSF is characteristic of viral meningitis and helps distinguish it from bacterial meningitis. In bacterial meningitis, glucose is typically decreased (hypoglycorrhachia) due to several mechanisms: bacteria and inflammatory cells consume glucose, and altered glucose transport across the blood-brain barrier occurs. CSF glucose is usually less than 40% of serum glucose in bacterial meningitis. In viral meningitis, glucose is typically normal (greater than 50-60% of serum glucose) because viruses do not metabolize glucose in the same way and the inflammatory response is less intense. Therefore, normal glucose content indicates viral rather than bacterial meningitis.
C) Cloudy color
Cloudy or turbid CSF indicates the presence of increased white blood cells, bacteria, or protein and is characteristic of bacterial meningitis, not viral meningitis. Normal CSF is clear and colorless. In bacterial meningitis, the high neutrophil count (often in the thousands) makes the CSF appear cloudy or purulent. In viral meningitis, the cell count is typically lower (usually 10-1000 cells/ÂµL) and the fluid may appear clear or only slightly hazy. Cloudy color would suggest bacterial etiology and should not be identified as indicating viral meningitis. Therefore, this finding is incorrect.
D) Decreased WBC count
"Decreased WBC count" is not an accurate description of CSF findings in viral meningitis. In viral meningitis, the white blood cell count is typically elevated, though to a lesser degree than in bacterial meningitis. The expected finding is a mild to moderate pleocytosis (increased cells), usually with a lymphocytic predominance. The term "decreased" would imply lower than normal, which is incorrect. Normal CSF has very few white blood cells (0-5 cells/ÂµL). In viral meningitis, the count is elevated above normal. The question may be testing knowledge that viral meningitis has lower counts than bacterial meningitis, but the phrasing "decreased" is inaccurate. In the context of the options, this finding should not be selected as indicating viral meningitis.
E) Normal protein count
Normal or only mildly elevated protein is characteristic of viral meningitis and helps distinguish it from bacterial meningitis. In viral meningitis, protein is typically normal or slightly elevated, usually less than 150 mg/dL. In bacterial meningitis, protein is markedly elevated, often >150 mg/dL and sometimes >500 mg/dL, due to inflammatory exudate and breakdown of the blood-brain barrier. Therefore, normal protein count supports viral rather than bacterial etiology. This finding should be identified as indicating viral meningitis.
Conclusion:
When reviewing CSF analysis for suspected meningitis, findings that indicate viral meningitis include negative Gram stain (no bacteria visible), normal glucose content, and normal protein count. Cloudy color indicates bacterial meningitis with high cell count. Decreased WBC count is inaccurate, as viral meningitis typically shows elevated (though lower than bacterial) WBC count. Therefore, the correct selections for viral meningitis are negative Gram stain, normal glucose, and normal protein.

Question 18 / 21

A nurse is developing an inservice about viral and bacterial meningitis. The nurse should include that the introduction of which of the following immunizations decreased the incidence of bacterial meningitis in children? (select all that apply)

A. IPV

B. PCV

C. DTaP

D. Hib

Rationale

The introduction of PCV (pneumococcal conjugate vaccine) and Hib (Haemophilus influenzae type b vaccine) decreased the incidence of bacterial meningitis in children.
Bacterial meningitis is a serious infection of the meninges that can cause significant morbidity and mortality in children. Before the availability of effective vaccines, Haemophilus influenzae type b (Hib) was the leading cause of bacterial meningitis in children under 5 years. Streptococcus pneumoniae (pneumococcus) was also a major cause. The introduction of conjugate vaccines targeting these organisms has dramatically reduced the incidence of bacterial meningitis. The Hib vaccine, introduced in the late 1980s and incorporated into routine childhood immunization in the 1990s, reduced Hib meningitis by more than 99%. The pneumococcal conjugate vaccine (PCV), introduced in 2000, has similarly reduced pneumococcal meningitis. These vaccines represent one of the greatest public health achievements in pediatric infectious disease prevention.
A) IPV
IPV (inactivated poliovirus vaccine) protects against poliovirus, which causes poliomyelitis, not bacterial meningitis. Poliovirus is an enterovirus that can cause aseptic (viral) meningitis, but IPV does not prevent bacterial meningitis. Polio itself has been largely eradicated in the United States through vaccination, and viral meningitis caused by poliovirus is extremely rare. However, IPV is not among the vaccines that reduced bacterial meningitis incidence. Therefore, this should not be included.
B) PCV
PCV (pneumococcal conjugate vaccine) should be included as a vaccine that decreased bacterial meningitis incidence. Streptococcus pneumoniae is a leading cause of bacterial meningitis in children, and the introduction of PCV (initially PCV7, then PCV13) has substantially reduced pneumococcal meningitis cases. The vaccine targets the serotypes most commonly associated with invasive disease. Since routine PCV vaccination began, rates of pneumococcal meningitis in children have declined dramatically. Therefore, this vaccine should be included in the inservice.
C) DTaP
DTaP (diphtheria, tetanus, and acellular pertussis vaccine) protects against diphtheria, tetanus, and pertussis (whooping cough). While these are serious bacterial diseases, none of them causes bacterial meningitis. Diphtheria causes respiratory illness, tetanus causes neuromuscular toxicity, and pertussis causes severe coughing. DTaP does not prevent meningitis. Therefore, this should not be included.
D) Hib
Hib (Haemophilus influenzae type b vaccine) should be included as a vaccine that decreased bacterial meningitis incidence. Before the vaccine, Hib was the most common cause of bacterial meningitis in children under 5, accounting for about two-thirds of cases. The vaccine has been so effective that Hib meningitis is now rare in vaccinated populations. This represents one of the most dramatic successes of pediatric vaccination. Therefore, this vaccine should be included in the inservice.
E) TIV
TIV (trivalent influenza vaccine) protects against influenza virus, which causes respiratory illness. While influenza can lead to complications including pneumonia and can be associated with secondary bacterial infections, influenza vaccine does not directly prevent bacterial meningitis. Influenza itself can cause viral meningitis in rare cases, but TIV is not among the vaccines that reduced bacterial meningitis incidence. Therefore, this should not be included.
Conclusion:
When developing an inservice about viral and bacterial meningitis, the nurse should include that the introduction of PCV (pneumococcal conjugate vaccine) and Hib (Haemophilus influenzae type b vaccine) decreased the incidence of bacterial meningitis in children. IPV prevents polio, DTaP prevents diphtheria, tetanus, and pertussis, and TIV prevents influenzaâ€”none of these directly prevent bacterial meningitis. Therefore, the correct selections are PCV and Hib.

Question 19 / 21

A nurse is providing teaching to the parent of a child who is to have an EEG. Which of the following responses should the nurse include in the teaching?

A. "Decaffeinated beverages should be offered on the morning of the procedure."

B. "Do not wash your child's hair the night before the procedure."

C. "Withhold all foods the morning of the procedure."

D. "Give your child an analgesic the night before the procedure."

Rationale

The nurse should include that decaffeinated beverages should be offered on the morning of the EEG procedure.
An electroencephalogram (EEG) records the brain's electrical activity through electrodes placed on the scalp. For accurate results, certain preparations are necessary. Caffeine and other stimulants can affect brain wave patterns and should be avoided before the procedure because they can alter the EEG reading. If the child typically has caffeinated beverages, offering decaffeinated versions ensures the child can have familiar drinks without affecting the test results. The nurse should instruct parents to avoid all sources of caffeine, including coffee, tea, colas, and chocolate, for at least 8-12 hours before the EEG. This helps ensure that the recorded brain activity reflects the child's baseline state and is not influenced by stimulants.
A) "Decaffeinated beverages should be offered on the morning of the procedure."
This instruction is correct and should be included. Caffeine is a central nervous system stimulant that can alter brain wave patterns and potentially invalidate EEG results. If the child usually consumes caffeinated beverages, parents should offer decaffeinated versions instead. This maintains the child's routine while avoiding the confounding effects of caffeine. The nurse should also advise avoiding other sources of caffeine such as chocolate, tea, and some sodas. Therefore, this instruction is appropriate.
B) "Do not wash your child's hair the night before the procedure."
This instruction is incorrect and opposite of what should be taught. For an EEG, the child's hair should be clean and free of oils, sprays, gels, or conditioners that can interfere with electrode adhesion and signal transmission. Parents should wash the child's hair the night before or morning of the procedure using plain shampoo, and avoid applying any hair products afterward. Clean hair helps ensure good contact between electrodes and the scalp, reducing artifact and improving recording quality. Therefore, the correct instruction is to wash, not avoid washing, the hair.
C) "Withhold all foods the morning of the procedure."
This instruction is incorrect for a routine EEG. Fasting is not typically required for EEG, and withholding food could cause hypoglycemia, which might affect brain wave patterns. In fact, for some EEG studies, maintaining normal blood glucose is important for accurate results. If the EEG is being performed to evaluate for certain conditions, such as seizures related to hypoglycemia, specific instructions might be given, but routine EEG does not require fasting. The child should eat normally unless otherwise instructed. Therefore, this instruction should not be given.
D) "Give your child an analgesic the night before the procedure."
This instruction is incorrect and unnecessary. Analgesics (pain medications) are not indicated for EEG preparation because the procedure itself is painless. Giving analgesics unnecessarily could potentially affect brain wave patterns or cause sedation that might interfere with the study. Some EEGs may be performed during sleep, but this is achieved through natural sleep or sleep deprivation, not medication. Unless specifically ordered by the provider for another reason, analgesics should not be administered. Therefore, this instruction should not be given.
Conclusion:
When teaching the parent of a child scheduled for an EEG, the nurse should include that decaffeinated beverages should be offered on the morning of the procedure to avoid caffeine's effects on brain wave patterns. Washing the child's hair is recommended, not avoided. Withholding food is not required and could affect results. Analgesics are not indicated. Therefore, the correct instruction is about offering decaffeinated beverages.

Question 20 / 21

A nurse is in the emergency department assessing a child following a motor vehicle crash. The child is unresponsive, has spontaneous respirations of 22/min, and has a laceration of the forehead that is bleeding. Which of the following nursing actions should be first?

A. Stabilize the neck first

B. Cleanse the child's laceration with soap and water

C. Implement seizure precautions for the child

D. Initiate IV access for the child

Rationale

The first nursing action should be to stabilize the neck.
In any trauma situation, particularly following a motor vehicle crash, cervical spine injury must be assumed until proven otherwise. The child is unresponsive and therefore cannot report neck pain or numbness, and the mechanism of injury (motor vehicle crash) places them at high risk for spinal cord injury. Any movement of an unstable cervical spine could cause or worsen spinal cord damage, potentially leading to permanent paralysis or death. The priority is to immobilize the cervical spine to prevent further injury. This is consistent with the ABCs of trauma care, where cervical spine stabilization is considered part of airway management (maintaining spinal alignment during airway interventions). Before any other assessments or interventions, the nurse or another team member must manually stabilize the child's head and neck in a neutral position until a cervical collar can be applied.
A) Stabilize the neck first
This is the correct first action. The child's mechanism of injury (motor vehicle crash) and unresponsive status indicate high risk for cervical spine injury. Manual stabilization of the head and neck in a neutral, inline position must be initiated immediately and maintained until the spine is cleared or the child is appropriately immobilized with a cervical collar and backboard. This action prevents manipulation of the spine during subsequent assessments and interventions, protecting the child from iatrogenic spinal cord injury. Therefore, this is the priority.
B) Cleanse the child's laceration with soap and water
Cleansing the forehead laceration is not the priority action. While the wound requires attention to prevent infection and control bleeding, it does not take precedence over cervical spine stabilization. The laceration, though bleeding, is unlikely to be immediately life-threatening. The nurse or another team member can apply direct pressure to control bleeding while maintaining cervical spine precautions, but cleansing should wait until the spine is stabilized and the child's condition is assessed more fully. Therefore, this is not the first action.
C) Implement seizure precautions for the child
Implementing seizure precautions is not the priority action. While the child's unresponsiveness could be due to head injury and seizures are a possible complication, there is no indication that the child is actively seizing or at immediate risk for seizures. Seizure precautions (such as padding side rails and having suction available) are important but can be implemented after life threats are addressed. They do not take precedence over cervical spine stabilization. Therefore, this is not the first action.
D) Initiate IV access for the child
Initiating IV access is an important intervention for fluid resuscitation, medication administration, and potential blood transfusion in a trauma patient. However, it is not the first action. IV access can be obtained after the cervical spine is stabilized and the airway and breathing are assessed. Attempting to start an IV before stabilizing the neck could involve moving the child's extremities or positioning that might inadvertently move the spine. The sequence of trauma care prioritizes stabilization, then assessment and intervention. Therefore, this is not the first action.
Conclusion:
In a child following a motor vehicle crash who is unresponsive with spontaneous respirations and a bleeding forehead laceration, the first nursing action should be to stabilize the neck to prevent spinal cord injury from manipulation of an unstable cervical spine. Cleansing the laceration, implementing seizure precautions, and initiating IV access are important subsequent actions but do not take priority over cervical spine stabilization. Therefore, stabilizing the neck first is the correct action.

Question 21 / 21

A nurse is assessing a child who has a concussion. Which of the following findings should the nurse expect? (select all that apply)

A. Amnesia

B. Systemic hypertension

C. Bradycardia

D. Respiratory depression

Rationale

In a child with a concussion, expected findings include amnesia, bradycardia, respiratory depression, and confusion.
A concussion is a type of traumatic brain injury caused by a blow to the head or body that causes the brain to move rapidly within the skull. It results in temporary neurological dysfunction without structural damage visible on conventional imaging. The pathophysiology involves disruption of neurotransmitter release, ionic shifts, and impaired cerebral metabolism. Clinical manifestations reflect this temporary dysfunction and include cognitive, physical, and behavioral symptoms. Amnesia (especially for events surrounding the injury), confusion, and other cognitive changes are hallmark features. Physiological changes can include bradycardia and respiratory depression as part of the body's response to brain injury, though these are more common in more severe injuries. The findings listed as A, C, D, and E are consistent with concussion and the body's response to brain trauma.
A) Amnesia
Amnesia is an expected finding in concussion. The child may not remember the event that caused the injury (retrograde amnesia) or may have difficulty remembering new information after the injury (anterograde amnesia). Amnesia reflects temporary disruption of memory formation and retrieval processes in the brain. The presence and duration of amnesia can help gauge injury severity. Therefore, this finding should be expected.
B) Systemic hypertension
Systemic hypertension is not an expected finding in an isolated concussion. Hypertension, along with bradycardia and respiratory depression, forms Cushing's triad, which is a sign of significantly increased intracranial pressure and brainstem compression. This occurs in more severe brain injuries such as intracranial hemorrhage or cerebral edema, not in uncomplicated concussion. In concussion, vital signs are typically normal. Therefore, this finding should not be expected.
C) Bradycardia
Bradycardia can be an expected finding in concussion as part of the physiological response to brain injury. While Cushing's triad (hypertension, bradycardia, respiratory depression) is classically associated with severe increased ICP, milder bradycardia can occur in concussion due to autonomic nervous system dysfunction. The heart rate may be lower than expected for the child's age and condition. Therefore, this finding may be expected.
D) Respiratory depression
Respiratory depression can be an expected finding in concussion as part of the neurological response to injury. Breathing patterns may be affected by disruption of brainstem respiratory centers, even in milder injuries. Respiratory rate may be decreased or irregular. More significant respiratory depression would indicate more severe injury, but some degree of respiratory change can occur in concussion. Therefore, this finding may be expected.
E) Confusion
Confusion is an expected finding in concussion. The child may be disoriented to time, place, or person; have difficulty answering questions; appear dazed; or show slowed thinking and responses. Confusion reflects the temporary disruption of cognitive function caused by the injury. This is one of the most common and recognizable symptoms of concussion. Therefore, this finding should be expected.
Conclusion:
When assessing a child with a concussion, expected findings include amnesia (memory disruption), bradycardia (autonomic effect), respiratory depression (brainstem effect), and confusion (cognitive effect). Systemic hypertension is not expected in uncomplicated concussion and would suggest more severe injury with increased ICP. Therefore, the correct expected findings are amnesia, bradycardia, respiratory depression, and confusion.

TEST BANK QUESTIONS FOR INTRODUCTION TO MATERNITY AND PEDIATRIC NURSING

A nurse is assisting a group of parents of adolescents to develop skills that will improve communication. The nurse hears one parent state "my son knows he better do what I say." Which of the following parenting styles is he exhibiting?

A. Authoritarian B. Permissive C. Authoritative D. Passive

A nurse is checking the vital signs of a 3-year-old during a well child visit. Which of the following findings should the nurse report to the provider?

A. temperature 37.2°C (99.0°F) B. Heart rate of 106/min C. Respirations 30/min D. Blood pressure 88/54 mmHg

A nurse is performing a neurological assessment on an adolescent. Which of the following is an appropriate reaction by the adolescent when the nurse checks the trigeminal cranial nerve? (select all that apply)

A. Clenching the teeth together tightly B. Recognizing a sour taste C. Identifying smells through each nostril D. Detecting facial touches when eyes closed

A nurse is conducting a well-baby visit with a 4-month-old infant. Which of the following immunizations should the nurse plan to administer? (select all that apply)

A. MMR B. IPV C. PCV D. Varicella

A nurse is performing a developmental screening on an 18-month-old. Which of the following skills should the toddler be able to perform? (select all that apply)

A. Build a tower with 6 blocks B. Throw a ball overhead C. Walk up and down stairs D. Draw circles

A nurse is providing teaching to the parent of a preschool-age child about methods to promote sleep. Which of the following statements by the parent indicates an understanding of the teaching?

A nurse is assessing a 2.5-year-old toddler at a well-child visit. Which of the following findings should the nurse report to the provider?

A. Height increased by 7.5 cm (3 inches) in the past year B. Head circumference exceeds chest circumference C. Anterior and posterior fontanels are closed D. Current weight equals four times the birth weight

A nurse is discussing prepubescence and preadolescence with a group of parents of school-age children. Which of the following information should the nurse include in the discussion?

A. Initial physiologic changes appear during early childhood. B. Changes in height and weight occur slowly during this period. C. Growth differences between boys and girls become evident. D. Signs of sexual maturation become highly visible in boys.

A nurse is providing teaching about expected changes during puberty to a group of parents of early adolescent girls. Which of the following statements by one of the parents indicates an understanding of the teaching?

A. "Girls usually stop growing about 2 years after menarche." B. "Girls are expected to gain about 65 pounds during puberty." C. "Girls experience menstruation prior to breast development." D. "Girls typically grow more than 10 inches during puberty."

A nurse is teaching a class about puberty in boys. Which of the following should the nurse include as the first manifestation of sexual maturation?

A. Pubic hair growth B. Vocal changes C. Testicular enlargement D. Facial hair growth

A nurse is teaching a parent of an infant about administration of oral medications. Which of the following should the nurse include in the teaching? (select all that apply)

A. Use a universal dropper for medication administration B. Ask the pharmacy to add flavoring to the medication C. Add the medication to a formula bottle before feeding D. Use the nipple of a bottle to administer the medication

A nurse is completing a pain assessment of an infant. Which of the following pain scales should the nurse use?

A. FACES B. FLACC C. Oucher D. Non-communicating children's pain checklist

A nurse is planning care for an infant who is experiencing pain. Which of the following interventions should the nurse include in the plan of care? (select all that apply)

A. Offer a pacifier B. Use of guided imagery C. Use swaddling D. Initiate a behavioral contract

A nurse on a pediatric unit is caring for a toddler. Which of the following behaviors is an effect of hospitalization? (select all that apply)

A. Believes the experience is a punishment B. Experiences separation anxiety C. Displays intense emotions D. Exhibits regressive behaviors

A nurse is caring for a child who is dying. Which of the following are findings of impending death? (select all that apply)

A. Heightened sense of hearing B. Tachycardia C. Difficulty swallowing D. Sensation of being cold

A nurse often cares for children who are dying. Which of the following are appropriate actions for the nurse to take to maintain professional effectiveness? (select all that apply)

A. Remain in contact with the family after their loss B. Develop a professional support system C. Take time off from work D. Suggest that a hospital representative attend the funeral

A nurse is reviewing cerebrospinal fluid analysis for a client who has suspected meningitis. Which of the following findings should the nurse identify as indicating viral meningitis? (select all that apply)

A. Negative Gram stain B. Normal glucose content C. Cloudy color D. Decreased WBC count

A nurse is developing an inservice about viral and bacterial meningitis. The nurse should include that the introduction of which of the following immunizations decreased the incidence of bacterial meningitis in children? (select all that apply)

A. IPV B. PCV C. DTaP D. Hib

A nurse is providing teaching to the parent of a child who is to have an EEG. Which of the following responses should the nurse include in the teaching?

A. "Decaffeinated beverages should be offered on the morning of the procedure." B. "Do not wash your child's hair the night before the procedure." C. "Withhold all foods the morning of the procedure." D. "Give your child an analgesic the night before the procedure."

A nurse is in the emergency department assessing a child following a motor vehicle crash. The child is unresponsive, has spontaneous respirations of 22/min, and has a laceration of the forehead that is bleeding. Which of the following nursing actions should be first?

A. Stabilize the neck first B. Cleanse the child's laceration with soap and water C. Implement seizure precautions for the child D. Initiate IV access for the child

A nurse is assessing a child who has a concussion. Which of the following findings should the nurse expect? (select all that apply)

A. Amnesia B. Systemic hypertension C. Bradycardia D. Respiratory depression

RN Exams

A. Authoritarian

B. Permissive

C. Authoritative

D. Passive

A. temperature 37.2°C (99.0°F)

B. Heart rate of 106/min

C. Respirations 30/min

D. Blood pressure 88/54 mmHg

A. Clenching the teeth together tightly

B. Recognizing a sour taste

C. Identifying smells through each nostril

D. Detecting facial touches when eyes closed

A. MMR

B. IPV

C. PCV

D. Varicella

A. Build a tower with 6 blocks

B. Throw a ball overhead

C. Walk up and down stairs

D. Draw circles

A. Height increased by 7.5 cm (3 inches) in the past year

B. Head circumference exceeds chest circumference

C. Anterior and posterior fontanels are closed

D. Current weight equals four times the birth weight

A. Initial physiologic changes appear during early childhood.

B. Changes in height and weight occur slowly during this period.

C. Growth differences between boys and girls become evident.

D. Signs of sexual maturation become highly visible in boys.

A. "Girls usually stop growing about 2 years after menarche."

B. "Girls are expected to gain about 65 pounds during puberty."

C. "Girls experience menstruation prior to breast development."

D. "Girls typically grow more than 10 inches during puberty."

A. Pubic hair growth

B. Vocal changes

C. Testicular enlargement

D. Facial hair growth

A. Use a universal dropper for medication administration

B. Ask the pharmacy to add flavoring to the medication

C. Add the medication to a formula bottle before feeding

D. Use the nipple of a bottle to administer the medication

A. FACES

B. FLACC

C. Oucher

D. Non-communicating children's pain checklist

A. Offer a pacifier

B. Use of guided imagery

C. Use swaddling

D. Initiate a behavioral contract

A. Believes the experience is a punishment

B. Experiences separation anxiety

C. Displays intense emotions

D. Exhibits regressive behaviors

A. Heightened sense of hearing

B. Tachycardia

C. Difficulty swallowing

D. Sensation of being cold

A. Remain in contact with the family after their loss

B. Develop a professional support system

C. Take time off from work

D. Suggest that a hospital representative attend the funeral

A. Negative Gram stain

B. Normal glucose content

C. Cloudy color

D. Decreased WBC count

A. IPV

B. PCV

C. DTaP

D. Hib

A. "Decaffeinated beverages should be offered on the morning of the procedure."

B. "Do not wash your child's hair the night before the procedure."

C. "Withhold all foods the morning of the procedure."

D. "Give your child an analgesic the night before the procedure."

A. Stabilize the neck first

B. Cleanse the child's laceration with soap and water

C. Implement seizure precautions for the child

D. Initiate IV access for the child

A. Amnesia

B. Systemic hypertension

C. Bradycardia

D. Respiratory depression