Normal Pediatric Nursing
Principles of Pediatric Growth and Development
Overview of Growth and Development:
Growth: Defined as an increase in physical size and cellular structure.
Assessment Basis: Growth evaluation is strictly based on objective quantitative measurements of weight and height, rather than the child's general physical appearance.
Weight Parameters and Calculations:
Normal Birth Weight Range: to .
Metric Conversion: To convert weight from pounds () to kilograms (), divide the weight in pounds by :
Weight Multiplication Milestones:
At : Weight doubles ().
At (): Weight triples ().
At (): Weight quadruples ().
Height Parameters and Calculations:
( to ).
Metric Conversion: To convert height from inches () to centimeters (), multiply or divide using :
Height Increase Milestones:
First : Increases by per month ().
First : Overall height increases by of birth length.
Worked Example Calculation:
Birth length (December 2023): .
Growth from January to June (JFMAMJ) 2024: Increases from to .
Projecting height at 1 year (December 2024):
Physiologic and Nutritional Factors Influencing Growth:
Breast Milk Composition:
Contains essential proteins serving as structural building blocks for bodily tissues.
Transfers maternal antibodies providing natural passive immunity to the infant.
Fluctuations in Height Measurement: Height measurements can exhibit temporary variance (e.g., during mid-year months like July); formal re-evaluation is confirmed when the child reaches of age.
Management to Promote Height Growth (Deep Sleep Protocol):
Growth Hormone Secretion: The anterior pituitary gland synthesizes and secretes growth hormone primarily during deep sleep stages.
Melatonin Stimulation: Encouraging active play followed by milk intake stimulates brain synthesis of melatonin, promoting deep sleep cycles required for maximal growth hormone production.
Developmental Screening Tools and Assessment Criteria
Definition of Development:
Development represents the maturation of organ systems, acquisition of skills, and functional capacity.
Assessment:
Physiologic Domain: Functional evaluation of the physical body (e.g., while growth measures hand length, development measures manual dexterity and motor skills).
Psychosocial Domain: Functional evaluation of behavior, coping mechanisms, and attitude towards others.
Cognitive Domain: Assessment of intellectual capacity and reasoning.
Developmental Milestone: Defined as a specific benchmark or standard achievement in a child's growth and skill acquisition.
Standardized Developmental Screening Tools:
Philippines: Metro Manila Developmental Screening Test (MMDST) is utilized to assess proper child development.
United States: Denver 2 Developmental Screening Test (D2DST / Denver II).
Summary of Developmental Criteria:
Language: At , the infant utters their first word.
Interaction: At , cooing vocalizations begin.
Gross Motor: Involves large muscle groups responsible for locomotion and posture.
Fine Motor: At , a precise pincer grasp is fully established.
Infant Developmental Milestones (Month-by-Month)
:
Hearing is the first sense to fully develop and is extremely sensitive. Best nursing management is to actively talk with the infant. Acute vision also develops. First attempt at communication occurs via cooing.
Social smile appears.
Head lag is still present.
Sleep Positioning: Supine position for sleep. Prone sleeping increases the risk of Sudden Infant Death Syndrome (SIDS).
Awake Positioning: Supine.
High vulnerability to Shaken Baby Syndrome this month
:
Laughing out loud, babbling, and gurgling (salivation prepares the oral structure for speech).
Complete disappearance of head lag. Can sit back with caretaker support.
Sleep Positioning: Supine.
Awake Positioning: Prone position is recommended while awake to foster upper extremity muscle strength and expand visual perspective.
Positioning Care Note: Proper positioning involves placing infants facing the same direction as the caregiver to share the same visual field and perspective. (sit back with the support of caretaker)
:
Vowels sounds produced.
Rolls over from back to abdomen (supine to prone).
Onset of Stranger Anxiety.
Sleep & Posture: Performs self-directed tummy time, sleeps supine, and awakens prone. Consciously holds bottle.
:
Sits securely without caretaker support.
Speaks first word (e.g., "MAMA" or spoken words taught first).
:
Learns to wave "Bye-bye".
Creeps or crawls, increasing fall risks.
Concept of Object Permanence develops (understanding that objects continue to exist even when out of sight; infants enjoy games like Peek-a-boo).
Onset of Separation Anxiety.
Phases of Abandonment Response:
Protest: Loud crying, screaming, and behavioral tantrums.
Despair: Withdrawal, silence, and continuation of activity in a depressed state.
Denial: Ignoring the returning mother or primary caregiver.
Nursing Note: Mothers often attempt to depart by telling the caretaker rather than the infant to minimize crying. The correct management is to speak directly to the infant, inform them of the departure, and assure them: "I will be back."
:
Speaks "Mama" / "Dada".
Standing independently; takes first independent steps; throws objects.
Safety Warning: Use of baby walkers is strongly discouraged because it can cause mechanical injury to the brachial plexus nerve, resulting in upper extremity weakness.
:
Gross Motor: Walks independently with ease.
Gross and Fine Motor Skill Development
Motor Timeline Summary:
: Hands held in clenched "fist-formed" position.
: Hands open; Palmar reflex present.
: Palmar grasp established (holds bottle consciously).
: Pincer grasp fully established.
: Throws objects.
Motor Definitions and Rules:
Palmar Reflex: Involuntary grasping response triggered when an object touches the infant's palm.
Palmar Grasp: Conscious, voluntary holding of an object.
Skill Attempt vs. Acquisition Calculation Rule:
Attempt = (-1) and Additional skills (+1)
Example: at what month does the baby roll over? 6 months. But at what month can the baby attempt to roll over? 5 months. At what month does the baby hold their bottle? 6 months. At what month can the baby transfer the bottle to their other hand? 7 months.
Aspiration Hazard: Achievement of the pincer grasp at 9 months enables picking up small items, creating a direct risk for foreign body aspiration due to the infant's oral exploration tendency.
Management: Strict avoidance of small objects or toys.
Chores & Responsibility: Vocational skill guidance and home work tasks should be taught when children reach adolescence.
Developmental Dynamics and Directional Patterns
Cephalo-caudal Pattern: Head to toe
Proximo-distal Pattern: Development proceeds from the center of the body outward to peripheral extremities (near to far, central to peripheral; major visceral organs develop before distal limb structures).
Symmetrical Pattern: Development occurs at the same rate and direction on both sides of the body simultaneously (e.g., bilateral hand and foot skill acquisition).
Mass to Specific Pattern: Development moves from simple to complex gross to fine motor skills (e.g., involuntary palmar reflex transitions into a deliberate pincer grasp).
Theoretical Frameworks
Sigmund Freud (Psychoanalytic & Psychosexual Theory):
First theorist in growth and development research.
Psychoanalytic Personality Structure:
ID: Governed by the pleasure principle ("Ikaw" / pure instinctual gratification).
EGO: Governed by the reality principle ("Ikaw at iba" / balancing self and environment).
SUPEREGO: Governed by the conscience and moral standard.
Psychosexual (Libido: Sexual desire and Oral-anal)
Oral Stage ( / Infant): Focus on oral stimulation.
Anal Stage ( / Toddler): Focus on bowel/bladder control.
Phallic Stage ( / Preschool): Sexual identification; attachment to opposite-sex parent.
Latency Stage ( / Schooler): Quiescent sexual energy; focus on peer and academic skills.
Genital Stage ( / Adolescence): Mature sexual relationships.
Erik Erikson (Psychosocial Theory):
Asserts that personality synthesis results from Culture + Society.
Failure to navigate a stage successfully results in adopting the negative outcome.
Stages and Management:
Trust vs. Mistrust ( / Infant):
Core Requirement: Infant must develop trust through complete consistency in meeting physical needs.
Management: Cuddle the infant, speak gently, and never raise voice.
Autonomy vs. Shame and Doubt ( / Toddler):
Core Requirement: Fostering independence.
Behavior: Toddlers exhibit negativism ("NO!") to reject external control.
Management: Offer two acceptable choices, allowing the child autonomy within safe boundaries.
Temper Tantrum Management: Tantrums stem from anger and attention-seeking. Ignore the behavior (not the child), ensure physical safety, set firm limits, and utilize time-out protocols ( per year of age, up to a maximum of , facing the wall). Do not give complex verbal explanations as cognitive comprehension is limited.
Initiative vs. Guilt ( / Preschool):
Behavior: Child shows active play initiative, inventing games even without formal toys. Egocentric tendencies present.
Management: Patiently answer all questions.
Industry vs. Inferiority ( / Schooler):
Behavior: Focus on school tasks, writing, drawing, telling time, developing diligence.
Management: Provide positive reinforcement and proper tools so the child does not feel inadequate or left behind.
Identity vs. Role Confusion ( / Adolescence):
Behavior: Identifying personal strengths and future career direction.
Management: Guide career exploration without dictating decisions. Changing college courses indicates ongoing role confusion.
Jean Piaget (Cognitive Theory):
Sensorimotor Stage ( / Infant): Governed by primary reflex actions and sensory-motor exploration (e.g., mouthing objects).
Pre-operational Stage ( / Toddler & Preschooler):
Cognitive Features:
Symbolic Thinking: Assigning fixed meanings (e.g., seeing any vegetable and assuming it tastes bitter).
Systematic Ability: Developing basic classification skills.
Scientific Understanding: Recognizing basic properties (e.g., vegetables contain iron).
Lack of Reversibility: Inability to mentally reverse processes (e.g., does not grasp that melted ice can freeze back into water).
Lack of Conservation: Inability to recognize that quantity remains constant despite physical container changes; believes larger equals more. Clinical Tip: Administer liquid medication in a medicine cup rather than a spoon.
Egocentricity: Present in 4-year-olds.
Imaginary Playmates: Real to the child. Caregivers should accommodate play (e.g., setting an extra plate) while clarifying that the friend is play/pretend, and encourage interaction with real peers.
Concrete Operational Stage ( / Schooler):
Cognitive Features: Possesses reversibility (understands navigation routes home, reverses relationships), conservation, cause-and-effect understanding, and optimal skill for collecting/classifying items ().
Formal Operational Stage ( / Adolescence):
Cognitive Features: Conceptualizes abstract concepts, hypothetical reasoning, scientific method, and time orientation encompassing past, present, and future.
Lawrence Kohlberg (Moral / Spiritual Development Theory):
Pre-conventional Stage ( / Infant, Toddler, Preschooler):
Features: Driven by punishment and obedience. No formal interest in religious concepts; responds to praise ("good boy/girl").
Instrumental Orientation: Actions performed strictly for tangible rewards (e.g., cleaning a room solely for a reward rather than intrinsic duty).
Conventional Stage ( / Schooler):
Features: Driven by social conformity and rule adherence.
Law Conformity: Avoiding wrong actions due to external legal punishment (e.g., an 11-year-old refraining from bad acts for fear of police arrest).
Social Conformity: Adhering to cultural norms and respect markers (e.g., using polite terms like "po" and "opo").
Post-conventional Stage ( / Adolescence):
Features: Governed by social contract ("majority rules") and internalized universal ethical principles (standing firm against peer pressure, such as declining to smoke despite peer involvement).
Comprehensive Post-Test Review Questions and Rationales
Question 1: Growth and development in a child progresses in the following ways, EXCEPT:
A. From peripheral to center (Correct Answer)
B. From head to toe
C. From the body to the tip of extremities
D. From the general of the specific
Rationale: Development progresses in a proximo-distal direction (from the center of the body outward to the extremities), not peripheral to center.
Question 2: When developing a teaching plan about growth and development for a group of new parents, which of the following would the nurse use as a basis for the teaching plan?
A. Control of the upper body, torso, and legs occurs before control over mouth and eye movements.
B. Symmetrical development occurs with each side developing at the same time and in the same direction (Correct Answer)
C. Fine motor finger ability occurs before the child develops the ability to control arm movement.
D. The child will demonstrate playing with others before the child engages in solitary play.
Rationale: Development follows a symmetrical pattern where both lateral halves of the body mature simultaneously and in parallel direction.
Question 3: When sharing the purpose of the Denver Developmental Screening Test (Denver II) with parents of an 18-month-old, the nurse explains that:
A. The Denver II is a test that will predict future intellectual ability (Correct Answer)
B. The Denver II is screening test used to detect children who may be slow in development.
C. The Denver II is used for early detection of speech disorders.
D. The Denver II measures psychological, cognitive, and social development.
Rationale: Marked choice per key: highlights screening assessment baseline utility.
Question 4: While preparing to teach a class on child development, you review the works of a theorist who postulated that the personality is a structure with three parts, called the id, the ego, and the superego. This theorist is:
A. Sigmund Freud (Correct Answer)
B. Jean Piaget
C. Erik Erikson
D. Lawrence Kohlberg
Rationale: Sigmund Freud formulated the psychoanalytic model dividing personality into id, ego, and superego.
Question 5: You’re caring for children in a day-care center. According to the theorist Jean Piaget, an infant who learns about objects by placing them in his mouth is in which stage of development?
A. Preoperational
B. Concrete operational
C. Sensorimotor (Correct Answer)
D. Formal
Rationale: During the sensorimotor stage (), infants explore and learn about the environment through primary senses and motor reflexes, notably oral exploration.
Question 6: Based on Kohlberg’s theory, what is the stage of moral development of John Christian; an 11 year old male who avoids doing bad things because the police will put him in jail:
A. Punishment-obedience
B. Law conformity (Correct Answer)
C. “Good boy-Nice girl”
D. Social contract
Rationale: School-age children () in Kohlberg's conventional level obey laws and rules specifically to maintain social order and avoid legal consequences.
Question 7: Which developmental concept is most applicable to a 4 year old child?
A. Separation anxiety
B. Stranger anxiety
C. Egocentricity (Correct Answer)
D. Systematic
Rationale: Preschool-aged children () characteristically demonstrate egocentricity, perceiving the world exclusively from their personal viewpoint.
Question 8: Which of the following stage is not included in Lawrence Kolberg Moral Developmental theory?
A. Pre conventional
B. Conventional
C. Intra conventional (Correct Answer)
D. Post conventional
Rationale: Kohlberg's framework includes Pre-conventional, Conventional, and Post-conventional levels; "Intra conventional" is not a recognized stage.
Question 9: A nurse is assessing the growth and development of a 10 year old. What is the expected behavior of this child?
A. Selfish and insensitive to the welfare of others (Correct Answer)
B. Strong sense of justice and fair play
C. Uncooperative in play and school
D. Enjoys physical demonstration of affection
Rationale: Selected answer per text key.
Question 10: Based on Kohlberg’s theory, what is the stage of moral development of John Christian; a 4 year old male who keeps on doing good because if he does his mother will buy him doctor’s and nurse kit so he can play with his friend Mekaela?
A. Punishment-obedience
B. Individualism (Correct Answer)
C. “good boy-Nice girl”
D. Social contract
Rationale: Instrumental individualism in pre-conventional morality dictates that right actions are defined by what satisfies one's personal desires or yields rewards.
Question 11: Which of the following stages identified by Piaget would be evidenced by the child’s ability to hypothesize and use scientific reasoning?
A. Formal operational thought (Correct Answer)
B. Primary circular reaction
C. Preoperational thought
D. Tertiary circular reaction
Rationale: Formal operational thought () enables abstract thinking, hypothesis testing, and deductive scientific reasoning.
Question 12: Boom, a 15 month old male, is admitted through the emergency department with a suspected diagnosis of dehydration. The pediatrician ordered NPO and infuses IV fluids to prevent fluid volume deficit that may lead to hypovolemic shock. The nurse who understands the developmental milestone of Boom should correctly intervene by:
A. Placing Boom in modified trendelenburg position
B. Providing Boom with a pacifier (Correct Answer)
C. Offer Boom a coloring book
D. Let Boom verbalize his feelings
Rationale: An NPO infant/toddler experiences oral frustration; providing a pacifier satisfies oral sucking needs safely without enteral fluid intake.
Question 13: The nurse notes that an infant stares at an object placed in her hand and take it to her mouth, coos and gurgle when talked to, and sustains part of her own weight when held in a standing position. The nurse correctly interprets these findings as characteristics of an infant at which of the following ages?
A. 2 months
B. 4 months (Correct Answer)
C. 6 months
D. 8 months
Rationale: Cooing, gurgling, disappearance of head lag, partial weight-bearing when held standing, and mouthing objects are classic milestones.
Question 14: Which achievement best characterizes the physical development of a 6-month-old infant?
A. The ability to creep on bed
B. The ability to crawl
C. The ability to lift the head and chest form a prone position
D. The ability to roll over intentionally (Correct Answer)
Rationale: Intentional rolling from back to abdomen (supine to prone) is achieved at .
Question 15: Andrea asks the nurse when her child can sit securely without support. The nurse tells the mother that her child can sit securely without support at age:
A. 5 months
B. 6 months
C. 7 months
D. 8 months (Correct Answer)
Rationale: Independent sitting without external support is achieved at (sitting with support occurs around ).
Question 16: The mother discusses with the nurse that her 10 month old infant seems to look for things that’s been hidden. The mother asks why the child does this. The nurse would explain that these behaviors demonstrate?
A. Object permanence (Correct Answer)
B. Dependency
C. Ritualism
D. Conservation
Rationale: Searching for hidden items demonstrates object permanence, which matures around .
Question 17: Freddy boy, a 12 month old infant is in his normal pacing of growth and development. Which of the following can Freddy boy accomplish?
I. Walks by himself
II. Walks while holding the furniture
III. Sits down from a standing position without help
IV. Attempts his first independent step
Options:
A. II, III, IV (Correct Answer)
B. I, III, IV
C. I, II, III
D. I, II, IV
Rationale: At , an infant cruises along furniture, lowers to a sit from standing, and takes first independent steps; walking fluently with ease occurs later ().
Question 18: A 15 month-old infant is playing in the playpen. The nurse evaluates that the child’s ability to perform physical tasks is at the age-related norm when the child is able to:
A. Build a tower of blocks
B. Walk across the playpen with ease (Correct Answer)
C. Throw all the toys out of the playpen
D. Stand in the playpen holding onto the slides
Rationale: Walking independently with complete ease is expected between .
Question 19: The nurse is teaching parents about the nutritional needs of their full term infant, age 2 months, whose breast feeding. Which response that’s that the parents understand their infant’s dietary needs?
A. “We won’t start any new foods now.” (Correct Answer)
B. “We’ll start the baby on skim milk.”
C. “We’ll introduce cereal into the diet now.”
D. “We should add new fruits to the diet one at a time.”
Rationale: Exclusive breastfeeding is maintained for the first ; solid foods or milk substitutes should not be introduced at .
Question 20: The mother of an infant is concerned that the infant’s anterior fontanel is still open. The nurse would inform the mother that further evaluation is needed if the anterior fontanel is still open after:
A. 6 months
B. 15 months
C. 12 months
D. 18 months (Correct Answer)
Rationale: The normal closure period for the anterior fontanel is between . Closure remaining open past warrants diagnostic evaluation.
Question 21: A mother tells the nurse that each morning she offers her 24-month old son juice and he always shakes his head and says, “No.” She asks the nurse what to do, because she knows the child needs fluids. The nurse suggests that the mother:
A. Distract him with some food
B. Be firm and hand him the glass
C. Let him see that he is making her angry
D. Offer him a choice of between a fruit juice and a chocolate drink (Correct Answer)
Rationale: Toddler negativism is managed by offering limited choices, fostering autonomy while ensuring necessary fluid compliance.
Question 22: When developing a teaching plan for a group of parents about toddlers' negativism, which of the following the nurse keeps in mind?
A. The toddler is exhibiting indications of behavior that will occur later
B. The toddler is questioning the parents authority by saying no
C. The behavior indicates the toddler’s first feelings of independence (Correct Answer)
D. The toddler is using the behavior to demonstrate vindictiveness
Rationale: Saying "No" represents Erikson's stage of Autonomy, marking the child's initial assertions of independence.
Question 23: The mother discusses with the nurse that her toddler asks every night for a bed time story. The mother asks why the child does this. The nurse would explain that these behaviors demonstrate:
A. Ritualism (Correct Answer)
B. Dependency
C. Object permanence
D. Conservation
Rationale: Toddlers require ritualism (consistent bedtime routines) to provide security and master anxiety.
Question 24: All of the following statement about toilet training are true except:
A. Toilet- training session should last no longer than 10 minutes
B. Using negative control may hinder toilet training
C. The readiness of the child is not a good factor to consider (Correct Answer)
D. Placing a stool below the toilet serves as a footrest and provides greater stability for the child
Rationale: Readiness (sphincter control, psychological willingness) is the single most essential factor in toilet training success.
Question 25: The mother of a 20-month old baby asks the nurse why her child has temper tantrums. Which of the following would be the nurse’s best response?
A. Your child is expressing his need for identity
B. Your child cannot express his feelings or frustrations verbally (Correct Answer)
C. Your child is probably spoiled and needs discipline
D. It is the only way that the child can get attention from his mother
Rationale: Toddlers experience severe frustration because their drive for independence exceeds their verbal communication skills.
Question 26: The mother asks the nurse for advice about disciplining her 18 month old child. Which of the following should the nurse suggest that the mother uses first?
A. Time out (Correct Answer)
B. Reasoning
C. Spanking
D. Annihilation
Rationale: Time-out is an effective, non-violent discipline strategy for toddlers ( per year of age).
Question 27: While assessing Kyle’s temper tantrums, the nurse learns from Mrs. James that she sometimes hold her breath until she momentarily faints when she does not get his way. The nurse can differentiate tantrums from seizures based on knowledge that:
A. Kyle’s episodes usually are provoked by anger (Correct Answer)
B. Kyle is alert after regaining consciousness
C. Kyle’s fainting is triggered by aura
D. None of the above
Rationale: Breath-holding spells during tantrums are invariably triggered by clear emotional provocations (anger, frustration), whereas epileptic seizures occur unprovoked.
Question 28: The nurse is planning to teach a group of parents about typical preschooler growth and development. Which of the following characteristics about a preschooler would the nurse include in the teaching plan?
A. Need to ask “why” questions (Correct Answer)
B. Indulge in ritualism
C. Participate in competitive play
D. Seeks for identity
Rationale: Preschoolers () are intensely curious, continually asking "why" questions to explore the environment.
Question 29: A recently hospitalized 2-year-old client screams and shouts that he wants a “bottle”. His parents are puzzled, and state that he has drank from a cup for the past year. The nurse explains that:
A. Irritability is exhibited in all age groups
B. Temper tantrums often represent the child’s need for parental attention
C. Various forms of punishment are necessary when such behaviors occur
D. Regression to an earlier behavior often helps the child cope with stress and anxiety (Correct Answer)
Rationale: Regression to earlier coping behaviors (e.g., demanding a bottle) is a universal defense mechanism in toddlers undergoing hospitalization stress.
Question 30: During a nap, a 4-year-old hospitalized boy wets the bed. The best approach by the nurse would be to:
A. Tell him to help with remaking the bed
B. Change his bed, putting a rubber sheet on it
C. Change his clothes and make no issue of it (Correct Answer)
D. Explain that big boys should try to call the nurse
Rationale: Stress-induced enuresis during hospitalization should be managed calmly without causing shame or guilt.
Question 31: A 6-year old child begins thumb-sucking after surgery. This was not the child’s behavior preoperatively. The nurse should:
A. Accept the thumb-sucking as normal (Correct Answer)
B. Distract her by playing checkers
C. Report this behavior to the physician
D. Tell her that the thumb-sucking causes buck teeth
Rationale: Temporary stress-induced regression following surgical trauma is normal and should be accepted supportively.
Question 32: Which of the following describes the sexual identification of a preschooler as stated by Freud?
A. Attachment to the same-sex parent
B. Attachment to the teacher
C. Attachment to the opposite-sex parent (Correct Answer)
D. Attachment to the peers
Rationale: In Freud's Phallic stage (), the child forms primary attachment toward the opposite-sex parent (Oedipus/Electra complex).
Question 33: By 9 years of age, the school nurse should educate the parents of John Christian that this is the optimum time for their child to engage in:
A. Deals with past present and future
B. Collection and classifying (Correct Answer)
C. Solve hypothetical problems
D. Creates probable solution to a problem
Rationale: At (Concrete Operational stage), children excel at sorting, collecting, and classifying objects.
Question 34: The mother asks the nurse about her 9-year old child’s apparent need for between meal snacks, especially after school. When developing a sound nutritional plan for the child with the mother, which of the following should the nurse need to keep in mind?
A. The child does not need to eat between meal snacks
B. The child should eat the snacks the mother thinks are appropriate
C. The child should help with preparing his or her own snacks (Correct Answer)
D. The child will instructively select nutritional snacks
Rationale: Involving school-age children in food preparation fosters Erikson's sense of Industry and teaches dietary independence.
Question 35: Aubrey at her age of five should be able to use all of the following skills except:
A. Finger painting
B. Molding clay
C. Adding numbers (Correct Answer)
D. Riding a tricycle
Rationale: Mathematical addition is a cognitive skill developed in school-age children, beyond the capability of a 5-year-old preschooler.
Question 36: When providing health teaching for an 12 year old, the nurse knows that the child is capable of:
A. Don’t understands other’s point of view
B. Making simple classifications
C. Exhibiting intuitive thought
D. Seeing relationship in reverse (Correct Answer)
Rationale: Concrete operational cognition () includes reversibility (seeing relationships in reverse).
Question 37: The school nurse is invited to attend a meeting with several parents who express frustration with the amount of time their adolescents spend in front of the mirror and the length of time it takes them to get dressed. The nurse explains that this behavior indicates:
A. An abnormal narcissism
B. A method of procrastination
C. A way of testing the parents limit-setting
D. A result of developing self concept (Correct Answer)
Rationale: Preoccupation with appearance is normal in adolescents developing body image and self-concept during Identity vs. Role Confusion.
Question 38: A 16 year-old is taken to the emergency room with right lower quadrant pain and vomiting. When preparing the child for an emergency appendectomy, what must the nurse expect to be the child's greatest fear?
A. Change in body image (Correct Answer)
B. Perceived loss of control
C. An unfamiliar environment
D. Guilt over being hospitalized
Rationale: Adolescents prioritize peer perception and physical appearance; fear of surgical scars or altered body image is paramount.
Question 39: Therapeutic communication with an adolescent is best accomplished by:
A. Using teen language
B. Relating on a peer level
C. Dealing in concrete terms
D. Establishing a relationship over time (Correct Answer)
Rationale: Adolescents value genuine professional trust built continuously over time, rather than false peer imitation or slang usage.
Question 40: A 15-year old male arrives with his mother at the diabetic outpatient clinic. He has type 1 diabetes. The adolescent sits back in his chair with his arms folded and a frown on his face. He displays an “I don’t care” attitude toward his diabetes and argues with his mother in front of the nurse. The approach that would be best for the nurse to use in dealing with this adolescent and his mother is to:
A. Encourage them to work out their differences together and return to the room afterwards
B. Ask the mother to wait in the waiting room while her son meets with the physicians and other staff
C. Encourage the adolescent to take more responsibility for treatment of his diabetes because he is almost an adult
D. Speak separately with the adolescent and mother, encourage them to ventilate and recognize their anger (Correct Answer)
Rationale: Individual interviews allow both the adolescent and parent to express hidden anger and emotions without peer/parental pressure.
Question 41: Play during infancy is:
A. Initiated by the child
B. A way of teaching how to share
C. More important than in later years
D. Mostly used for physical development (Correct Answer)
Rationale: In infants, play serves primarily as a vehicle for physical and sensorimotor development.
Question 42: In choosing toys for an infant, what criteria should be considered a priority?
A. Educational purpose
B. Development function
C. Safety (Correct Answer)
D. Recreation use
Rationale: Safety (preventing choking, aspiration, injury) is always the absolute priority when selecting infant toys.
Question 43: The mother of a 2 year old child asks the nurse which is the most appropriate toy for her child. The nurse’s best response is:
A. Coloring book
B. Doll
C. Play house
D. Rocking horse (Correct Answer)
Rationale: A rocking horse supports gross motor movement and balance required during toddlerhood.
Question 44: The mother of a 5-year-old child asks the nurse which is the most appropriate toy for her child. The nurse’s best response is:
A. Coloring book (Correct Answer)
B. Push and pull toy
C. Colorful rattle
D. PSP
Rationale: A coloring book enhances fine motor control, hand-eye coordination, and creative focus appropriate for a 5-year-old.
Question 45: When assessing gross motor development in a 3 year old, which of the following activities would the nurse expect to find?
A. Riding a tricycle (Correct Answer)
B. Hopping on one foot
C. Catching a ball
D. Skipping on alternate foot
Rationale: Riding a tricycle is a hallmark gross motor milestone expected at of age.
Question 46: At 2 years of age, a child is readmitted to the hospital for additional surgery. The most important factor in preparing the child for this experience is:
A. Gratification of the child’s wishes
B. The child’s previous hospital visits
C. Assurance of affection and security (Correct Answer)
D. Avoiding leaving the child with strangers
Rationale: Toddlers suffer separation anxiety; reassuring physical affection and security minimizes emotional trauma.
Question 47: As a preschooler, a 4-year old’s response to hospitalization is influenced by:
A. Fear of separation
B. Belief in death’s finality
C. Fear of bodily harm (Correct Answer)
D. Perceive as universal
Rationale: Preschoolers () have intrusive fears of bodily harm, pain, and mutilation.
Question 48: Accidents are the leading cause of death in children from 1 month to 2 years of age. The two most frequent types of accidents in infants are:
A. Burns and poisoning
B. Aspiration and falls (Correct Answer)
C. Falls and suffocation
D. Drowning and aspiration
Rationale: Foreign body aspiration (due to oral exploration) and falls (due to developing mobility) are the leading infant accidents.
Question 49: To comply with the law, the nurse instructs the parents that for the automobile trip home, the newborn should be in an approved car seat in the:
A. Back seat facing the front
B. Back seat facing the back (Correct Answer)
C. Front seat facing the back
D. Front seat facing the front
Rationale: Federal safety regulations require infants to ride rear-facing in the back seat to protect their fragile neck and cervical spine.
Question 50: A child with a myelomeningocele is started on a bowel management plan. The child's mother questions why this is being done. The nurse's response will be based on the understanding that:
A. Lack of innervation to the colon predisposes the child to diarrhea.
B. Lack of innervation to the anal sphincter predisposes the child to being incontinent. (Correct Answer)
C. Lack of mobility increases the gastric-colic reflex.
D. Lack of mobility decreases the need for regular bowel movements.
Rationale: Myelomeningocele disrupts spinal nerve innervation to the anal sphincter, abolishing voluntary bowel control and predisposing the child to fecal incontinence.