Pediatric Answers

1. (Answer: D) Rationale: Children have 20 deciduous teeth that erupt between 6 months and 24 months of age. The deciduous teeth are lost beginning at age 6 through age 12, and they are replaced by permanent teeth. The other choices are incorrect.

2. (Answer: C) Rationale: Fontanels are inspected and palpated for size, tenseness, and pulsation. The anterior fontanel should be soft, flat, and pulsatile with the child in the sitting position. The anterior fontanel should be completely closed by age 12 to 18 months. If the fontanel is found to be open after 18 months, the child is referred for further evaluation.

3. (Answer: C) Rationale: By age 8 months, infants can sit well while unsupported. Infants can now explore their environment. Avoid walkers near stairs and fence stairways. At age 4 months, the infant rolls over; by age 6 months, the baby sits with support and at 12 months stands, cruises around furniture, and walks with one hand held.

4. (Answer: B) Rationale: The NCHS growth charts use the 5th and 95th percentiles as criteria for determining those children who fall outside the normal limits for growth. Children whose height and weight are above the 95th percentile are considered overweight or large for stature. Prepubescent growth spurts are between 10 to 12 years for girls and 12 to 14 years for boys. This is not a normal proportion for height and weight for this 9 year old.

5. (Answer: A) Rationale: Secondary sex characteristics begin at 10 to 12 years for girls and 12 to 14 years for boys. The growth in girls is accompanied by an increase in breast size and develop0ment of pubic hair, and lastly menstruation. In boys, the growth spurt includes growth in size of the penis and testes and pubic hair development.

6. (Answer: D) Rationale: Regression usually occurs in instances of stress when the child attempts to cope by reverting to patterns of behavior from earlier stages of development. Regression is common in toddlers; it lessens the threat of illness, hospitalization, or separation. A need to revert to use of the bottle, refusal to use the potty, or temper tantrums represent forms of behaviors exhibited as regression. It should be explained to parents that regression is a temporary coping mechanism; the best approach is to ignore it and praise appropriate behavior. Any form of punishment is not advisable.

7. (Answer: C) Rationale: Toddlers enjoy physical skills in play, such as push and pull toys that enhance fine and gross motor abilities. Stuffed animals are favorite toys for the 3 to 6 month old, but be cautious of buttons and pieces that can easily be aspirated. A large ball is pleasurable for the infant to develop grasp and manipulation. Preschoolers enjoy tricycles and climbing toys, which develop muscles and coordination.

8. (Answer: A) Rationale: Visual aids such as dolls, puppets, and outlines of the body can be used to illustrate the cause and treatment of the child's illness. Use of such equipment provides information for the school-age child to understand and cope with feelings about the procedure. Written pamphlets should be given to the parents to review prior to the procedure. Children should be allowed to cry or verbalized their feelings without guilt as long as they hold still. Parents should be given a choice to accompany their child during the procedure.

9. (Answer: B) Rationale: all formulas be fortified with iron and continued for the first 12 months. Whole milk should not be introduced to infants until after 1 year of age. Pasteurized cow's milk is deficient in iron, zinc, and vitamin C, and has a high renal solute load. Solid foods are introduced between 4 and 6 months of age.

10. (Answer: C) Rationale: The child in the preoperational stage is egocentric and is unable to see things from another perspective. Logic is not well developed. Magical thinking is common. Centration if focusing on only one particular aspect of a situation. Negativism is a common toddler response of "no" to situations and request. Selfishness is a negative behavior exhibited by the child who refuses to share with another.

11. (Answer: B) Rationale: An infant of 7 months just begins to transfer objects from one hand to the other. Smiling at self begins at about 5 months; imitating sounds and rolling over begin at about 6 months of age.

12. (Answer: A) Rationale: The Snellen eye chart measures visual acuity by assessing from a set distance how well a child can see. An ophthalmoscope looks at the internal parts of the eye, the cover-uncover test measures eye muscle coordination, and the Weber test measures hearing.

13. (Answer: C) Rationale: By age 7, most children are able to clearly and in chronological order describe symptoms. Their vocabulary is extensive enough to have words to describe what they are feeling, time of onset, changes from the norm, etc.

14. (Answer: C) Rationale: It is important for the nurse to know the immunization record and status for any child. If a child is not up to date with immunizations it is up to the nurse to plan with the family a schedule to get necessary immunizations. Hospitalizations, coping mechanisms, and accidents are important for the nurse, but immunizations are uniquely important for pediatric clients.

15. (Answer: B) Rationale: The purpose of a genogram is to have a pictorial representation of a child's family history. It identifies at least three generations by gender, age, health status, cause of death, and family genetic relationships. Past history, treatment, and immunizations are not recorded on a genogram.

16. (Answer: D) Rationale: The normal range for most children falls somewhere between the 5th and 95th percentile. The other ranges do not accommodate as many variations in height and weight that are considered normal.

17. (Answer C) Rationale: Save the painful area for last to avoid abdominal guarding and to gain the child's trust. Always tell the child before touching a tender area.

18. (Answer: B) Rationale: The Denver II is used to screen children for possible developmental delays in the areas of gross-motor skills, language, fine-motor skills, and personal-social development. The Denver II does not measure intelligence, cognitive, or speech difficulties

19. (Answer: B) Rationale: Auscultation is always easiest in a sleeping or quiet baby. Checking the eyes is considered invasive and should be saved for the end of the examination. There is no need to awaken the child because he or she will begin to stir once the examination begins

20. (Answer: B) Rationale: The preschooler may be somewhat anxious so the nurse should give feedback and reassurance about what will be done. children do not need detailed explanations nor do they need to be told to act older than they are. Most children at this age are willing to remove clothing.

21. (Answer: A) Rationale: only the oral route gives Amoxicillin

22. (Answer: C) Rationale: Candida infections are a common side effect of antibiotic therapy because of alteration of the normal bacterial flora by the antibiotic agent

23. (Answer: B) Rationale: The nurse must emphasize the importance of completing the full course of antibiotic therapy, event though symptoms may have resolved before the antibiotic is finished.

24. (Answer: B) Rationale: The nurse must observe the post-tonsillectomy client for signs of excessive bleeding or hemorrhage from the operative site. In the posterior pharynx, the bleeding can be concealed by the child swallowing the blood. Applying heat to the neck, warm liquids, or giving a straw would be contraindicated, as this could cause bleeding.

25. (Answer: C) Rationale: The common cold is a viral infection. It is self-limiting, with symptoms lasting about 4 to 10 days. Antibiotics are not indicated for a viral infection. The other options are incorrect.

26. (Answer: C) Rationale: Turning up the volume loudly is a behavioral indicator suggesting hearing impairment. The other options are incorrect.

27. (Answer: B) Rationale: Development of parent-infant attachment is important in promoting developmental progress. Parents are encouraged to talk, sing, and interact with their baby to learn about their infant's response, and to provide appropriate stimulation at 1 month of age. The other options are incorrect.

28. (Answer: D) Rationale: Purulent exudates and crusting are characteristic of conjunctivitis. Conjunctivitis associated with foreign body can cause severe eye pain. The other options are incorrect.

29. (Answer: D) Rationale: The infected are should be cleansed with a disposable tissue after a single use. Handwashing is important to prevent the spread of infection. Items that come in contact with the infected eye are considered contaminated.

30. (Answer: B) Rationale: The nurse must emphasize the importance of completing the full course of antibiotic therapy, even though symptoms may have resolved before the antibiotic is finished.