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45 Cards in this Set

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Which of the following statements isn’t true regarding health promotion and maintenance?

a. Disease prevention strategies focus mainly on health promotion
b. Screening is a procedure used to detect the possible presence of a health condition before symptoms are present
c. General observations of infants and their families begin as they are called in from the waiting area
d. Participation in physical activity declines as youth get older
A. Disease prevention strategies focus mainly on health promotion

Disease prevention strategies focus mainly on health maintenance, or prevention of disease. Some health disruptions can be detected early and treatment for the condition can begin. (ch. 6, p 173)
A nurse is discussing health promotion topics w/ the parents of a 6-month old infant. Which of the following should the nurse include in the discussion? [select all that apply]

a. Immunization against communicable disease
b. Developmental screening or surveillance
c. Teaching about car safety seats
d. Teach the family about anticipated developmental milestones
e. Integrate physical activity into the child’s daily events
D. Teach the family about anticipated developmental milestones

E. Integrate physical activity into the child’s daily events

Health promotion refers to activities that increase well-being and enhance wellness or health. Discussing about immunizations, developmental screenings and safety are health maintenance activities, which focus on preventing disease or injury occurrence. (ch. 6, p 164-165)
The first contact between the newborn infant’s primary healthcare provider and the parents should occur ____

a. 1 month after birth
b. 6 months after birth
c. Prior to birth
d. 1 year after birth
C. Prior to birth

Most obstetrical care providers encourage the expectant mother to choose her newborn’s care provider prior to the baby’s birth. Pediatric care providers usually welcome a short office visit to allow the expectant mother and care provider to assess their “fit” prior to committing to this important relationship. (ch. 7, p 179)
A nurse is ordered to administer sterile ophthalmic ointment (eye prophylaxis) on a newborn. Which of the following is a correct administration procedure?

a. Hold the newborn in a supine position before administration
b. Administer w/in 6 hours after birth
c. Administer soon after giving IM vitamin K
d. Swaddle or contain the newborn’s limbs and hold semi-upright before administration
D. Swaddle or contain the newborn’s limbs and hold semi-upright before administration

Before administration, dim the room, swaddle or contain the newborn’s limbs, and hold semi-upright. Don’t attempt to pry the newborn’s eyes, or when the infant is supine or facing bright overhead lights.

Eye prophylaxis should be administered w/in 1 hour of birth and before or a different time than the vitamin K injection. (ch. 7, p 180)
A 10-day-old newborn is weighed at the physician's office. The baby is breastfed and weighed 7 pounds, 8 ounces at birth. How much would the nurse expect the baby to weigh now?

a. 7 lbs, 8 oz
b. 7 lbs, 1 oz
c. 10 lbs
d. 8 lbs
a. 7 lbs, 8 oz

In the first week of life, most babies lose about 1/10 of their birth weight. By day 10, most babies are back to their original birth weight and gaining about 2/3 of an ounce per day. (ch. 7, p 182)
A nurse is doing a health promotion teaching for a family of a newborn. All of the following are included in the teaching except:

a. Encourage switching positions when bottle-feeding
b. Position baby on his/her stomach for supervised play periods
c. Avoid alternating the head position from left to right during sleep
d. Encourage toys such as a mobile w/ contrasting colors and patterns
C. Avoid alternating the head position from left to right during sleep

Beginning at birth, nightly alternating the head position from left to right during sleep helps prevent flat spots on the newborn’s head from supine positioning. (ch. 7, p 183)
A nurse is providing nutrition teaching for the parents of a 6-month old infant. Which of the following foods should the nurse advise the parents to not give the infant?

a. Juice
b. Bananas
c. Honey
d. Rice cereal
C. Honey

Parents should be warned against feeding honey in the first year of life.

At 6 months, reinforce proper introduction of new foods to include rice cereal, fruits and vegetables. Serve juice only in a cup and limit to no more than 6 oz daily. (ch. 7, p 192)
A parent of an 8-month-old infant complains to the nurse during a routine checkup that the baby always cries and screams whenever she leaves the baby at the child care center before work. The nurse’s response should be based on which of the following?

a. Separation anxiety is common for infants of this age
b. Further assessment for possible child abuse or neglect
c. Separation anxiety should have disappeared before 8 months of age
d. The infant doesn’t respond well enough w/ the child care personnel
A. Separation anxiety is common for infants of this age

Infants in the second half of the first year of life may exhibit separation anxiety by inconsolable crying and other signs of distress when parents aren’t present. (ch. 7, p 193)
Health promotion interventions for a young toddler include all of the following except:

a. Supporting breastfeeding
b. “five a day” servings of fruit and vegetables
c. “three a day” servings of dairy products
d. Limiting daily fruit juice intake
D. Limiting daily fruit juice intake

Health maintenance activities focus primarily on disease and injury prevention, w/ examples of feeding practices that avoid common choking foods and limiting daily fruit juice intake to prevent dental caries and excessive caloric intake. (ch. 8, p 205)
Which developmental milestone should the nurse expect to see on a 5-month-old infant?

a. Stranger anxiety
b. “pincer grasp”
c. Rolls over, sits w/ support
d. Transfers object hand to hand
C. Rolls over, sits w/ support

(see notes: summary of developmental milestones during infancy)
During a well-child visit, the parents complained to the nurse that their 3-year-old child sometimes “won’t sit still” during meal times and eats only 1 or 2 foods. Which of the following is the appropriate response by the nurse?

a. Encourage to increase the number of snacks for the child
b. Recognize and inform that the behavior is common for children of this age
c. Assess and inquire about any developmental delays
d. Encourage to feed the child while watching the child’s favorite TV show
B. Recognize and inform that the behavior is common for children of this age

Food jags (periods when only 1 or 2 foods are eaten) are common. Meals and snacks should not be eaten while watching TV. (ch. 8, p 206)
The nurse is planning educational interventions to reduce the incidence of the number one cause of mortality in children ages 1-4. Recognizing the developmental needs of this age group, the nurse would focus the session on which topic?

a. Injury prevention
b. SIDS prevention
c. Child abuse prevention
d. Malnutrition awareness
A. Injury prevention

The most common cause of death for children between 1 – 19 years of age is unintentional injury. The major causes of unintentional injury mortality in childhood include motor vehicle, drowning, fires and burns, and suffocation. (ch. 1, p 7)
The nurse is planning an educational session for adolescents, specifically children ages 15 – 19 years, about the leading cause of morbidity among the target age group. Which of the following topics would the nurse focus on teaching?

a. Traumatic injuries
b. Asthma
c. Sexually transmitted infections
d. Depression
D. Depression

Morbidity is an illness or injury that limits activity, requires medical attention or hospitalization, or results in a chronic condition. Mental disorders (such as depression) are a leading cause of hospitalization in adolescents between 15 – 21 years. (ch. 1, p 8 – 9)
An 8-month-old infant is being admitted to the pediatric hospital. The mom has a full-time job and can’t afford to stay at the hospital overnight. As she was leaving, the infant started crying and screaming and resists any attempts of comfort. The mom became worried and asked the nurse about the child’s behavior. Which of the following should be the nurse’s response?

a. “The child’s behavior is normal for his age”
b. “The child may have attachment issues and needs to be evaluated further”
c. “Separation anxiety should’ve disappeared by the time the child is 6-months-old”
d. “The child is in pain and should receive a pain medication shortly”
A. “The child’s behavior is normal for his age”

The most common stressor for the infant is separation from the parents (separation anxiety). Parents often feel guilty for leaving their child, especially if the child protests adamantly. Reassure the parents that it is a normal behavior and it represents healthy parents-infant attachment. (ch. 11, p 264)
A 4-year-old is admitted to the pediatric hospital. The dad has a full time job and can’t afford to stay at the hospital overnight. He knows that the child would start crying and screaming as soon as she finds out he’s leaving. The dad became worried and asked the nurse when would be the best time to leave. Which of the following should be the nurse’s response?

a. “You can leave while the child is asleep”
b. “You can’t leave unless you can calm the child down”
c. “You have to tell the child you have the leave before you go”
d. “You can leave while she’s watching TV or in the bathroom”
C. “You have to tell the child you have to leave before you go”

Parents often believe it’s better to leave the hospital room while the child is asleep so their departure won’t stress the child. In fact, the opposite is true. If a child awakens to find the parent gone unexpectedly, he/she may become anxious and develop a lack of trust. (ch. 11, p 265)
A pediatric nursing instructor is preparing lecture notes about physiologic and anatomic characteristics of infants and children. Which of the following statements should the nursing instructor include in her lecture notes? [select all that apply]

a. Children have a larger surface area to volume ratio
b. All brain cells are present at birth
c. Spinal ligaments and muscles are more elastic
d. Cardiac output is stroke dependent, thus making HR more rapid
e. Hypotension is an early sign of decreased cardiac output
f. Sinus arrhythmia is common
A. Children have a larger surface area to volume ratio

B. All brain cells are present at birth

C. Spinal ligaments and muscles are more elastic

F. Sinus arrhythmia is common

Infants have a larger surface area for weight, making them susceptible to hypothermia. Spinal ligaments and muscles are more elastic in children under 8 years. Cardiac output is rate dependent – not stroke volume dependent.

Hypotension is a late sign of decreased cardiac output. (ch. 5, p 111; see also notes: Anatomical & physiological differences between children & adults)
A nurse is giving a medication to her 6-year-old patient who has a history of regularly refusing to take her medications. Which of the following is the most appropriate statement by the nurse when giving the medication?

a. “Do you want to take your medication now or do you want it later?”
b. “You should take your medication now or else…”
c. “Do you want orange juice or water w/ your medicine?”
d. “If you take your medicine now, I will let you watch Spongebob after”
C. “Do you want orange juice or water w/ your medicine?”

Although children may sometimes not want to take their medicine, have the expectation that the medication will be taken. Let children choose the type of fluid to drink after, but don’t ask if they want to take their medicine now. (ch. 11, p 273)
The nurse instructs the parents of a 3-year-old child that the most representative type of play usually seen in toddlers would be:

a. Two children sitting side by side, each playing with a toy truck
b. The child who sits on the floor by himself playing with blocks
c. The child who dresses up like a fireman
d. Two children putting a puzzle together
A. Two children sitting side by side, each playing w/ a toy truck

Two children sitting side by side playing with similar toys is an example of parallel play, which dominates in toddlers. (ch. 4, p 94)
The nurse instructs the parents of a 5-year-old child that the most representative type of play usually seen in preschool children would be:

a. Two children sitting side by side, each playing with a toy truck
b. The child who sits on the floor by himself playing with blocks
c. The child who dresses up like a fireman
d. Two children putting a puzzle together
C. The child who dresses up like a fireman

Because fantasy life is so powerful at this age, the preschooler readily uses props to engage in dramatic play, that is, living out the drama of human life. (ch. 4, p 99)
The nurse is preparing a 4-year-old for surgery. Which technique is most appropriate?

a. Use an anatomically correct doll to explain the procedure
b. Allow the child to handle safe medical equipment
c. Explain to the child that she will be put to sleep for the procedure
d. Limit the teaching to one one-hour session
B. Allow child to handle safe medical equipment

Handling medical equipment such as IV bags and stethoscopes increase interest and helps the child to focus. Teaching may have to be done in several short sessions rather than one long session. (ch. 4, p 100)
A nurse is performing a pediatric assessment on a 5-year-old patient in the PICU. Which of the following assessment findings would need further assessment by the nurse?

a. Apical pulse heard in the 4th intercostal space, left midclavicular line
b. HR = 100 beats/min
c. Diaphragmatic breathing
d. Adventitious breath sounds
D. adventitious breath sounds

Abnormal breath sounds (adventitious breath sounds), generally indicate disease. Examples include crackles, rhonchi, and friction rubs. (ch. 5, p 139)

In children under 7 years of age, the apical pulse is located in the 4th intercostal space just medial to the left midclavicular line. (ch. 5, p 140)

The diaphragm is the primary breathing muscle in infants and children less than 6 years of age (ch. 5, p 137)
During an assessment of the neck of a 2-year-old child, the nurse notes firm, non-tender, moveable lymph nodes 1 cm in diameter in the cervical chain. The nurse would note the finding as:

a. Indicative of local infection
b. A normal finding
c. Indicates a tumor around the neck area
d. A possible congenital defect
B. A normal finding

Firm, clearly defined, nontender, movable lymph nodes up to 1 cm in diameter are common in young children.

Enlarged, firm, warm, tender lymph nodes indicate a local infection. (ch. 5, p 134)
The nurse is tasked to do a physical assessment on a 2-year-old child. The child is sitting calmly on the parent’s lap holding a chew toy. How should the nurse start her assessment?

a. Start from the child’s head and gradually move toward the body and then the feet
b. Start from the child’s feet and gradually move toward the body and then the head
c. Assess the eyes, ears, and mouth first
d. Perform neurological or developmental assessment first
B. Start from the child’s feet and gradually move toward the body and then the head

Instruments to examine the ears, eyes, and mouth are usually viewed as most fearful and should be used at the end of examination. Begin by touching the feet and then moving gradually toward the body and head. (ch. 5, p 117)
During an otoscopic examination on an infant, in which direction is the pinna pulled?

a. Down and back
b. Up and back
c. Up and forward
d. Down and forward
A. Down and back

For children less than 3 years of age, pull the pinna down and back to straighten the auditory canal. (ch. 5, p 128)
A 16-year-old female complaining of abdominal pain is waiting in the exam room with her mother. It is important that the nurse assess whether the girl is sexually active. What action should the nurse take to gather the data?

a. Let the physician ask the question, so the girl does not have to discuss it twice
b. Ask the mother to leave the room when sexual history questions will be asked
c. Suggest to the girl and mother that the mother can join her after the exam to discuss any findings with the physician
d. Ask the girl if she is sexually active, as the mother needs to know and be involved
C. Suggest to the girl and mother that the mother can join her after the exam to discuss any findings with the physician

When adolescents are seen for health care visits, assess relationship w/ others. Provide time alone w/ both the adolescent and the parents so that everyone has time to talk freely and to ask questions. (ch. 9, p 237)
Which of the following is true regarding pain in infants and children?

a. Children run the risk of becoming addicted to pain medication when used for pain management
b. Children use distraction to cope w/ pain
c. Children tolerate discomfort well
d. Children tell you if they are in pain
B. Children use distraction to cope w/ pain

Children use distraction to cope w/ pain, but they soon become exhausted w/ coping w/pain and fall asleep. Children don’t tolerate pain any better than adults, & may have less tolerance after prior experiences. Addiction is extremely rare when the child is treated for an acute condition. (ch. 15, p 372)
Which developmental considerations about pain should the nurse anticipate in a 4-year-old preschool child?

a. Uses common words for pain such as “owie” and “boo-boo”
b. Denies pain in desire to be brave
c. Fear of death and bodily injury
d. Often believes pain is punishment
D. Often believes pain is punishment

A pre-school child often believes pain is punishment, someone is accountable, and has the language skills to express pain on a sensory level. (ch. 15, p 373; also see notes: Pain – developmental considerations)
The nurse is teaching her 16-year-old post-op patient receiving morphine via PCA about using the pump. Which of the following patient statement would require additional teaching?

a. “The PCA will not relieve all my pain”
b. “I will have to use the PCA until I can take pain pills”
c. “Feeling sleepy is one of the side effects of the drug”
d. “Constipation is one of the side effects of the drug”
C. “Feeling sleepy is one of the side effects of the drug”

Many children sleep after receiving an analgesic. This sleep is not a side effect of the medication or a sign of an overdose, but the result of pain relief. Dramatic reductions in pain should occur, but not all pain may disappear. (ch. 15, p 381-385)
The nurse is providing care for an 8-year-old child with a history of juvenile rheumatoid arthritis (JRA). The child takes non-steroidal anti-inflammatory drugs (NSAIDs) on a regular basis to help control discomfort. The most appropriate nursing diagnosis for the patient is:

a. Chronic pain r/t JRA
b. Acute pain r/t JRA
c. Coping Deficit related to discomfort associated with JRA
d. Knowledge Deficit: Pain Management, related to lack of previous teaching
A. Chronic pain r/t JRA

Some children have medical conditions that cause chronic pain such as rheumatoid arthritis. Children w/ chronic conditions often need long-term pain management. Analgesic medications are prescribed including NSAIDs, acetaminophen, and opioids, often in combination. (ch. 15, p 387-388)
Which of the following statements are true regarding physiologic indicators of pain? [select all that apply]

a. Acute pain stimulates the somatic nervous system and cause physiologic changes
b. Physiologic indicators are not specific to pain
c. Pain indicators include restlessness or agitation, sleep disturbances
d. Physiologic changes demonstrate a complex stress response
e. Physiologic signs of pain are the most reliable method for monitoring pain
B. Physiologic indicators are not specific to pain

D. Physiologic changes demonstrate a complex stress response

Acute pain stimulates the autonomic NS and cause physiologic changes. They aren’t specific to pain, so they can’t be used as the only method for monitoring pain.

Restlessness, agitation, and sleep disturbances are behavioral indicators of pain, not physiologic. (ch. 15, p 377-378)
A nurse is performing patient-parent teaching at the local community center about immunizations. Which of the following statements by the parents indicates that the teaching has been effective?

a. “Even though my child got the vaccine, his immunity to the disease will lessen over time”
b. “vaccine-preventable disease have been eliminated due to developments in modern medicine”
c. “It would be better if I let my child get the disease so she can produce her own immunity”
d. “If my child gets multiple vaccines, it will overload the immune system and cause more severe effects”
A. “Even though my child got the vaccine, his immunity to the disease will lessen over time”

No vaccine is 100% effective, and immunity does wane over time, leading to the need for a second immunization. (ch. 16, p 405)
An 18-year-old patient who is 3 months pregnant is in the local health center for her routine immunizations. Which of the following vaccines is contraindicated for the patient?

a. Measles, mumps, rubella (MMR)
b. Meningococcal
c. Influenza
d. Hepatitis B
A. Measles, mumps, rubella (MMR)

MMR and varicella vaccines are contraindicated in patients who are pregnant or have a possibility of pregnancy w/in 4 weeks. (ch. 16, p 399-400)
A 14-year-old patient is in the pediatric hospital for his chemotherapy. The patient’s parent informed the nurse that there was an outbreak of chickenpox in the patient’s school and is concerned about possible exposure to the disease. Which of the following should the nurse recommend to the patient’s parent?

a. Varicella-zoster immune globulin
b. Varicella vaccine
c. Strict isolation until diagnostic tests confirm absence of disease
d. No precautions necessary
A. Varicella-zoster immune globulin

Varicella-zoster immune globulin is given to immunocompromised children w/in 96 hours of exposure to the disease. The vaccine may be given to healthy children w/in 72 hours of exposure to prevent or significantly modify the disease. (ch. 16, p 410)
A 6-year-old child is to receive regularly scheduled immunizations. The parent states the child is not feeling well, and asks the nurse to defer the immunizations until next week. The nurse's best response is to:

a. Check the child’s temperature
b. Ask if the child has ever had a reaction to immunizations
c. Give the parent an immunization appointment for next week
d. Ask if the child has missed school
A. Check the child’s temperature

The child's temperature will help the nurse decide if the child has a mild or severe illness. Immunizations may be given if the child has a mild illness, with or without fever. Postponing the immunization might result in a missed opportunity if the parent does not keep the appointment. The nurse should ask about previous reactions to immunizations, but this is not related to withholding the immunization because the child is not feeling well. (ch. 16, p 396-400)
A nurse is providing patient care teaching to the parent of a child w/ chickenpox. Which of the following statements by the parent indicates accurate understanding of the teaching?

a. “I will give my child Tylenol 3 times a day for the duration of the illness”
b. “I will take my child to our primary doctor when she feels very sick”
c. “I can apply calamine lotion on open lesions to help prevent itching”
d. “I can send her back to school when she has dry, crusted lesions”
D. “I can send her back to school when she has dry, crusted lesions”

Chicken pox is no longer contagious if the lesions have already dried and crusted over. Tylenol should only be given when the child has fever, not 3x a day, every day, during the illness. (ch. 16, p 410)
A 6-year-old child is admitted to the pediatric hospital for sore throat and high fever. Further assessment shows red “sandpaper-like” rash in the neck, groin, and axillary area. Lab results show presence of group A streptococci bacteria. Which of the following would be the expected diagnosis for the patient?

a. Varicella (chicken pox)
b. Rubeola (measles)
c. Scarlet fever
d. Hand-foot-mouth disease
C. Scarlet fever

Scarlet fever is caused by group A beta-hemolytic streptococci bacteria and characterized by erythematous, confluent, sandpaper rash concentrated in the axilla, groin, and neck. (ch. 16, p 418; see also notes: Rubeola, Scarlet Fever, Varicella, Coxsackie Virus)
A 17-year-old well child is in the community clinic to receive a series of hepatitis B vaccine. Before administering the vaccine, it is important to assess the patient if he had a history of a severe allergic reaction to:

a. Yeast
b. Penicillin
c. Eggs or chicken protein
d. Gelatin
A. Yeast

Contraindications for receiving a hepatitis B vaccine include prior anaphylaxis and serious hypersensitivity reactions due to a vaccine component (e.g., yeast) (ch. 16, p 396-400)
A nurse is ordered to administer medications to a patient diagnosed w/ mononucleosis. Which of the following medication orders for the patient should the nurse question?

a. Tylenol
b. Ibuprofen
c. Prednisone
d. Amoxicillin
D. Amoxicillin

Ampicillin and amoxicillin are contraindicated for patients w/ mononucleosis because they may cause a non-allergic rash. Corticosteroids may be used to control severe pharyngeal swelling and impending airway obstruction. (ch. 16, p 414)
A pediatric nurse is ordered to administer scheduled immunizations for a 4-month-old well child. Which of the following should the nurse prepare to administer? [select all that apply]

a. Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine
b. Rotavirus (RV) vaccine
c. Pneumococcal vaccine
d. Inactivated poliovirus (IPV) vaccine
e. Measles, mumps, rubella (MMR) vaccine
f. Influenza vaccine
a. Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine
b. Rotavirus (RV) vaccine
c. Pneumococcal vaccine
d. Inactivated poliovirus (IPV) vaccine

Immunizations administered at 4 months of age include DTaP, RV, pneumococcal, and IPV vaccines. The minimum age for administration of an MMR vaccine is 12 months and the required minimum age of administration for an influenza vaccine is at 6 months. (see handout: Recommended Immunization Schedule for Persons Aged 0 Through 6 Years – United States 2011)
A pediatric nurse is ordered to administer a combination MMR/Varicella vaccine (a live attenuated virus vaccine) to her patients. Which of the following patients should not receive the live virus vaccine? [select all that apply]

a. Patient experiencing cold symptoms
b. Patient who has a severe allergic reaction to neomycin
c. Patient recently exposed to an infectious disease
d. Patient experiencing mild fever
e. Patient receiving chemotherapy
B. Patient who has a severe allergic reaction to neomycin

E. Patient receiving chemotherapy

Contraindications for receiving an MMR or Varicella vaccine include a history of anaphylactic reaction to the vaccine and hypersensitivity to neomycin or gelatin, and immunocompromised patients. Immunizations may be given if the child has a mild illness, with or without fever. (ch. 16, p 399-400)
The nurse is doing an assessment of a patient presented w/ signs and symptoms of rubeola (measles). Which of the following assessment findings would help confirm the patient’s diagnosis?

a. Beefy red tongue
b. Small bluish-white spots in the buccal area
c. “slapped face” rash
d. Small red lesions on the soft palate
B. Small bluish-white spots in the buccal area

Koplik spots are small, bluish-white spots found on the buccal area and one of the clinical manifestations of Rubeola (measles). (Ch. 16, p 410-421)
A nurse is doing an assessment of a 5-month-old child. The parent asked the nurse which teeth would erupt first. The nurse would answer:

a. Canines
b. Molars
c. Incisors
d. Cuspid
C. Incisors

The bottom incisors are the first teeth to erupt at about 6 – 10 months. (ch. 5, p 133)
A pediatric nurse is performing developmental assessment on a 6-month old well-child. Inability to perform which developmental task by the child would indicate a need for further evaluation of a possible developmental delay?

a. Holds object in both hands
b. Plays interactive games (peek-a-boo, etc.)
c. Crawls or pulls body along floor using arms
d. Stands w/ help
A. Holds object in both hands

Holding object in both hands is an example of a developmental milestone for a 6-month-old infant. All the other choices are milestones relevant to infants ages 8 – 10 months. (ch. 4, p 90-91; see also handout: Summary of developmental milestones during infancy)
A nurse is performing a health and development teaching to parents of adolescent children. One of the parents asked the nurse at what age will her teenage girl get her first period. How should the nurse respond?

a. Before the breasts develop
b. Before pubic hair appears
c. At the start of the prepubertal growth spurt
d. At the end of the prepubertal growth spurt
D. At the end of the prepubertal growth spurt

Growth spurt in girls is accompanied by an increase in breast size and pubic hair growth. Menstruation occurs last and signals achievement of puberty. (ch. 4, p 104)
A nurse is ordered to administer an IM medication for a 2-year-old child. Which of the following is the most appropriate way of explaining the procedure to the patient?

a. Use drawings, pictures, books and contact w/ equipment
b. Explain throughout the procedure what is happening
c. Give explanation just before administering the medication
d. Allow child to play out the procedure by “giving an injection” to a doll
C. Give explanation just before administering the medication

The toddler’s concept of time is limited. Give explanation just before the procedure. (ch. 11, p 274)