Which action would the nurse do first when planning to provide a back massage to a client quizlet?

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  • Which of the following is an appropriate play activity for a 7 month old infant to encourage visual stimulation?
  • Which of the following describes a good way to help children develop language skills?
  • What information could be given to the parents of a 12
  • What age do infants begin to recognize familiar faces and voices?

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Terms in this set (47)

A nurse is in a provider's office and is observing children playing in the waiting room. The nurse should expect to identify parallel behavior in which of the following age groups?

A. Infants
B. Toddlers
C. Preschoolers
D. School-aged children

B. Toddlers

Toddlers demonstrate parallel play. Infants demonstrate solitary play. Preschoolers demonstrate associative play. School-aged children demonstrate cooperative play.

A nurse is caring for a child with a vesicular rash that has been present for 6 days. The nurse should expect the client to have which of the following conditions?

A. Measles
B. Fifth disease
C. Tetanus
D. Varicella

D. Varicella

Children who have varicella may present first with a maculopapular rash that progresses to vesicles on erythematous bases, which eventually rupture and crust over.

A nurse is assessing a 3-year-old preschooler. Which of the following developmental milestone should the nurse expect the preschooler to do?

A. Stacking 10 blocks
B. Printing 1 letter
C. Tying shoelaces
D. Using 7-word sentence

A. Stacking 10 blocks

The nurse should expect a 3-year-old preschooler to have the fine motor ability to stack 10 blocks. They should have the ability to draw a circle but not print letters or tie shoelaces until the age of 5. They should be able to use 3 to 4 word sentences, but 7 word sentences are not expected until the age of 5.

A nurse in the ER is caring for am unaccompanied infant following a MVC. During the assessment, the nurse notes that the infant's anterior fontanel is almost closed. She has 6 teeth, is able to sit unsupported, and can drink from a cup. The child cries whenever anyone new to her enters the room, says a few words, and is asking for "mama" and "dada." The nurse should make which of the following age assessments for the child?

A. 6 months old
B. 12 months old
C. 18 months old
D. 25 months old

B. 12 months old

The nurse should know the infant is less than 18 months old because her anterior fontanel is still open. 12 months old have approximately 6 teeth. Her skills like sitting unsupported (8 months) and ability to say 2 words (12 months) should also help you assess her age.

A nurse is planning to implement relaxation strategies with a young child prior to a painful procedure. Which of the following actions should the nurse take?

A. Ask the child to hold a breath and blow it out slowly
B. Ask the child to describe a pleasurable event.
C. Bounce the child gently while holding him upright
D. Rock the child using long, rhythmic movements

D. Rock the child

Sitting with the child in a well-supported position such as against the chest and rocking and swaying back and forth in long, wide movements.

A nurse is assessing a toddler who has measles (rubeola). Which of the following finding should the nurse expect?

A. Koplik spots
B. Parotitis
C. Strawberry tongue
D. Paroxysmal coughing

A. Koplik spots

A nurse is in an acute pediatric unit caring for a 2 year old who has separation anxiety when her parents leave for work. Which of the following are a manifestation of the stage of despair?

A. Child tries to bite the nurse.
B. Child is withdrawn and refuses to talk
C. The child attempts to run away to find her parents
D. Child screams and cries loudly

B. Child is withdrawn and refuses to talk

A nurse is assessing a 30-month-old toddler during a well child visit. Which of the following findings requires further assessment by the nurse?

A. primary dentition is complete
B. toddler is unable to hop on 1 foot
C. toddlers birth weight has tripled
D. toddler is able to state her first and last name

C. toddlers birth weight has tripled.

Toddler's birth weight should triple by 12 months of age. By 30 months, the birth weight should be quadrupled.

A nurse is caring for a 4-month-old who is hospitalized. Which of the following toys should the nurse provide for the child?

A. a board book with large pictures
B. a toy with movable parts
C. a plastic mirror
D. push-pull toy

C. a plastic mirror

A 4 month old can recognize herself and also attempt to play with the "baby in the mirror". A mirror is a bright object that provides appropriate visual stimulation for this age group.

The guardian of a pre-schooler states they have had an imaginary playmate for about 3 months. Which of the following pieces of information should the nurse give the guardian?

A. Children commonly begin having imaginary friends when they reach school age
B. Notify your provider if the imaginary friend persists longer than 6 months
C. Have your child take responsibility for actions if he tries to blame the imaginary friend
D. Set limits by not allowing your child to have the imaginary friend present during family mealtimes.

C.

A nurse is reviewing the recommended immunizations with the guardian of a 2 month old infant. Which of the following statements should the nurse make?

A. Your baby can receive the varicella vaccine at 6 months of age.
B. Your baby can start the pneumococcal vaccine now
C. Your baby should receive the flu vaccine before 6 months of age.
D. Your baby can start the MMR vaccine now.

B. pneumococcal vaccine

A. Varicella vaccine starts at 12 months old
B. first dose of pneumococcal vaccine at 2 months and then again at 4 months and 12 months
C. the annual flu shot can start after the baby is 6 months old
D. first dose of MMR starts at 12 months of age

A hospice nurse is conducting a support group for parents of toddlers who have a terminal illness. Which of the following pieces of information should the nurse include in the teaching?

A. toddlers will react to the parents anxiety and sadness
B. Toddlers view death as a punishment for bad behavior
C. toddlers view death as permanent and irreversible
D. Toddlers have a realistic conception of death

A. toddlers will react to their parents

The nurse is monitoring a child with burns during treatment. Which assessment provides the most accurate guide to determine the adequacy of fluid resuscitation?

A. skin turgor
B. Level of edema at the burn site
C. Adequacy of capillary filling
D. amount of fluid tolerated within 24 hours

C. Adequacy of capillary

The mother of a 3 year-old child arrives at a clinic and tells the nurse that the child has been scratching the skin continuously and has developed a rash. The nurse assesses the child and suspects the presence of scabies. The nurse bases this suspicion on which finding notes on the assessment of the child's skin?

A. Fine grayish red lines
B. purple colored lesions
C. thick, honey colored crusts
D. cluster of fluid filled vesicles

A. Fine grayish red lines

A nurse is providing teaching about age-appropriate activities to the guardian of a 2 year old. Which of the following statements by the guardian indicates the teaching was successful?

A. I will send my childs favorite stuffed animal with them when napping away from home will occur
B. My child should be able to stand on one foot
C. The soccer team my child will be playing on starts practicing next week
D. I should expect my child to be able to draw circles.

A. transitional objects provide a sense of security for toddlers

A nurse is assessing a 2 and a half year old. Which of the following findings should the nurse report to the provider?

A. height increased by 3 in in the past year
B. Head circumference exceeds chest circumference
C. Anterior and posterior fontanels are closed
D. Current weight equals 4 times the birth weight

B. head and chest circumference should be equal by 1-2 years of age

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

A. Build a tower with 6 blocks
B. Throw a ball overhand
C. Walk up and down the stairs
D. Stand on one foot for a few seconds
E. Use a spoon without rotation

B, E

A nurse is providing anticipatory guidelines to the caregivers of a toddler. Which of the following should the nurse include? (SATA)

A. develop food habits that will prevent dental caries
B. meeting caloric needs results in a increased appetite
C. expression of bedtime fears is common
D. expect behaviors associated with negativism and ritualism
E. annual screenings for PKU are important

A, C, and D

A nurse is caring for a 3 year old child on the pediatric unit. The nurse should identify which of the following as an appropriate toy for the child?

A. Jump rope
B. coloring book and crayons
C. checkers game
D. jack-in-the-box

B

A charge nurse is reviewing the expected growth and development of school-aged children with a group of staff nurses. Which of the following statements should the nurse include??

A. A 7 year old prefers to play with children of a different gender
B. A 6 year old should understand the concept of cause and effect
C. A 6 year old child should be able to count to 13 coins
D. An 8 year old child should be able to wash his/her hair independently

C.

Children at 8 to 9 begin to understand the concept of cause and effect

A nurse is providing teaching to the parents of an infant who is breastfeeding. When should the nurse instruct the parents to introduce solid foods in the infants diet?

A. after the rooting reflex disappears
B. at 2 to 3 months of age
C. After the infants first tooth erupts
D. At 4 to 6 months of age

D

The nurse is assessing the fine motor skills of a 3 year old preschooler. Which of the following findings should the nurse expect?

A. The preschooler can draw a stick figure that has 7 parts
B. The preschooler can print her first name
C. the preschooler can cut out pictures using scissors
D. The preschooler builds a tower of 9 cubes

D

A nurse is caring for a 2 year old child who has cystic fibrosis. The is planning to take the child to the playroom. Which of the following activities would be appropriate for the child?

A. cutting figures from colored paper
B. drawing stick figures using crayons
C. riding a tricycle
D. building towers with blocks

D

A nurse is assessing a 6 year old client at a well child visit. Which of the following findings requires further assessment by the nurse?

A. Presence of sparse, fine pubic hair
B. Decreased head circumference compared to full height
C. increased leg length in relation to height
D. presence of a loose central incisor

A

Development of sexual characteristics before the age of 9 in boys and 8 in girls is an indication of precocious puberty.

A nurse is caring for a 4 year old child who has superficial partial-thickness burns over 50% of his body. To meet the nutritional needs of the child, which of the following actions should the nurse plan to take?

A. Administer pancrelipase to the child prior to each meal
B. Supplement the child's feedings with enteral feedings
C. provide the child with a low-protein meal
D. Perform dressing changes 10 min prior to the child's meals

B

Burns in excess of 25% of total body surface are require enteral supplementation

A nurse enters an exam room to assess an 8 month old infant for the first time. Which of the following reactions by the infant should the nurse expect?

A. the infant gives the nurse a social smile
B. The infant turns away when the nurse approaches
C. the infant reached to the nurse to be held
D. the infant is responsive and alert as the nurse comes closer

B

The nurse should expect an 8 month old to have a heightened fear of strangers

A nurse is assessing a 4 year old child's cognitive development during a well child visit. Which of the following should the nurse expect the child to display?

A. conservation
B. development of the superego
C. concrete operational thought
D. separation anxiety

B.

this is the development of a conscience; they begin understanding right from wrong

A nurse is assessing a 1 week old infant at a well child visit. The nurse should notify the provider about which of the following assessment findings?

A. a flat, dark pink area between the eyes that blanches
B. an area of deep blue pigmentation over the buttocks
C. a blue coloring of the sclera
D. a patchy, red rash

C

A nurse is teaching about home safety to the parent of a 2 month old infant. Which of the following information should the nurse include?

A. remove bibs before the infant goes to sleep
B. Cover the infant with a lightweight blanket at bedtime
C. Place the infant in direct sunlight for at least 10 minutes a day
D. set the hot water heater to 140 degrees

A

A nurse is assessing a 9 month old during a well child visit. Which of the following indicates that the infant has a developmental delay?

A. creeping on hands and knees
B. inability to vocalize vowel sounds
C. using a crude pincher grasp
D. standing by holding onto a support

B

should be vocalized vowel sounds by 7 months old; by 10 months they should be able to say 1 word

A nurse is preparing to administer recommended immunizations to a 2 month old infant. Which of the following immunizations should the nurse plan to administer?

A. HPV and Hep A
B. MMR, tetanus, TDaP, diphtheria
C. Flu B, IPV
D. Varicella, LAIV

C

A nurse is assessing a 6 month old infant at a well child visit. Which of the following findings indicated a need for further assessment?

A. infant is grabbing feet and pulling them to the mouth
B. the infant has a closed posterior fontanel
C. the infant's legs remain crossed and extended when supine
D. the infants birth weight has doubled

C

legs that are crossed and extended when supine is an unexpected finding; this is associated with cerebral palsy

A nurse at a clinic is preparing to administer immunizations to a 5 year old child. Which of the following immunizations should the nurse plan to give?

A. DTaP
B. PCV
C. Haemophilus influenzae type B (Hib)
D. Hep B

A

Children should receive boosters of the DTaP immunizations between the ages of 4 and 6

A nurse is assessing a 4 year old child for growth and developmental milestones during a well child visit. Which of the following findings suggests a possible delay in development?

A. inability to tie shoes
B. adding three parts to a stick figure
C. speaking using 2 or 3 word sentences
D. inability to walk backwards

C

should be speaking in 4 to 5 word sentences; walking backwards is a skill expected of a 5 year old; tying shoelaces is expected of a 5 year old; adding 3 parts to a stick figure is expected for a 4 year old

A nurse is providing teaching to the guardians of a 4 month old on how to play with the infant. Which of the following play activities should the nurse suggest for this infant?

A. Show the infant a board book with large pictures
B. imitate the sounds of different farm animals for the infant
C. give the infant a push-pull toy
D. allow the infant to splash in the bathtub

D

provides tactile stimulation

A nurse is instructing a group of parents and guardians about child development. Which of the following recommendations should the nurse make to promote the developmental task of industry in the school-aged child?

A. have an after school snack ready for the child each day
B. assign the child several small chores
C. talk with the child about what future goals as an adult
D. talk openly about the family's value system

B

A nurse is assessing a 6 month old infant. the guardian reports that the infant does not appear interested in the brightly colored mobile hanging above the crib at home. Which of the following techniques should the nurse use to check the infant's visual acuity?

A. shine a penlight briefly into the left eye and then the right eye
B. move a brightly colored toy from side to side in front of the infants face
C. ask the guardian to sit in front of the infant and nod his head up and down
D. Observe the infants ability to grasp the feet and pull them up to mouth

B

A nurse is providing teaching to a parent of a preschooler who has tinea capitis. Which of the following instructions should the nurse include in the teaching?

A. apply aluminum acetate solution compresses to the lesions
B. apply hydrocortisone cream to the lesions 2 time a day
C. seal non-washable toys in plastic bag for 2 weeks
D. leave the medicated shampoo on the scalp for 5 to 10 minutes

D.

A nurse is planning care for a preschooler who is scheduled for a medical procedure. The nurse identifies that the preschooler is in which of the following of Erikson's psychological stage of development?

A. industry vs. inferiority
B. trust vs. mistrust
C. initiative vs guilt
D. identity vs. role confusion

C. initiative vs guilt

A nurse is caring for a preschooler who has a terminal illness. Which of the following is how a preschooler perceives death?

A. believe that her own thoughts can cause death
B. has an understanding of the finality of death
C. exhibits curiosity about what happens to the body after death
D. views funerals as unnecessary

A

a nurse is providing teaching to the parents of a 4 year old about fine motor development. which of the following tasks should the nurse include as an expected finding for this age group?

A. copying a circle
B. cutting foods using a table knife
C. beginning to write in cursive
D. printing the first and last name clearly

A

A nurse is educating a group of parents about toddler language development. Which of the following findings should the parent expect in a 18 month old toddler?

A. ability to refer to self by name
B. vocabulary of 10 or more words
C. following simple directional commands
D. naming a single color

B

a 2 year old can state his/her name as well has follow simple commands; at 30 months old, they will be able to name a color

A nurse is assessing the gross and fine motor behaviors of a toddler. Which of the following behaviors would the nurse identify as expected form a 3 year old child?

A. walking backward while moving heel to toe
B. standing on one foot for several seconds
C. using scissors to cut out shapes
D. printing letters with a pencil

B

A nurse is assessing a patient who is 18 months old post op. Which of the following pain scales should the nurse use?

A. FACES
B. CRIES
C. FLACC
D. PIPP

C. FLACC

A nurse is assessing a 6 month old. Which of the following motor activities should the nurse expect the infant to have achieved?

A. sitting alone
B. attempting to stack objects
C. picking up small objects with a crude pincher grasp
D. turning from back to stomach

D.

sitting alone occurs around 9 months; a 12 month old will try to attempt to stack objects but normally fails; around 9 months of age, infants usually achieve the crude pincher grasp

A nurse is assessing an 18 month old. which of the following findings should the nurse report to the provider?

A. unable to remove his shoes
B. unable to draw a plus sign
C. unable to jump off of a step
D. unable to turn one page of a book at a time

A.

30 month old can draw a plus sign and jump off of a step; 24 months old can turn a single page in a book

A nurse is assessing a 9 month infant. Which of the following findings should the nurse report to the provider as a developmental delay?

A. grasping small object with thumb and index finger
B. dropping a cube when passing from one hand to the other
C. falling from a standing position to sitting
D. losing balance when leaning sideways

B

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Which of the following is an appropriate play activity for a 7 month old infant to encourage visual stimulation?

What is an appropriate play activity for a 7-month-old infant to encourage visual stimulation? Because object permanence is a new achievement, peek-a-boo is an excellent activity to practice this new skill for visual stimulation.

Which of the following describes a good way to help children develop language skills?

The best way to encourage your child's language development is to do a lot of talking together about things that interest your child. It's all about following your child's lead as they show you what they're interested in by waving, babbling or using words.

What information could be given to the parents of a 12

What information should be given to the parents of a 12-month-old child regarding appropriate play activities for this age? Ans: Give large push-pull toys for kinetic stimulation. The parents of a 2-month-old boy are concerned about spoiling their son by picking him up when he cries.

What age do infants begin to recognize familiar faces and voices?

Studies have shown that even newborns, with their eyesight limited to about 12 inches, prefer to look at familiar faces — especially yours. Months 2 to 4: Your baby will start to recognize her primary caregivers' faces, and by the 4-month mark, she'll recognize familiar faces and objects from a distance.

What is the nurse's most important role in the care of the family when a client's death is imminent?

The nurse's most important role in the care of the family is compassionate communication. The family needs to be informed about the situation so that they are prepared for the client's death and can provide support to one another.

Which action would the nurse perform as the highest priority for a client with trauma in the emergency unit quizlet?

Which action would the nurse perform as the highest priority for a client with trauma in the emergency unit? Providing adequate oxygen (O 2) supply. Providing adequate oxygen (O 2) supply. The nurse would prioritize care while caring for a client with trauma in the emergency department.

Which tasks could the nurse working on a cardiac unit delegate to an unlicensed assistive personnel UAP )?

In general, simple, routine tasks such as making unoccupied beds, supervising patient ambulation, assisting with hygiene, and feeding meals can be delegated.

Which intervention would the nurse add to the plan of care for a client who engages in ritualistic behaviors?

The psychiatric-mental health nurse knows that the most appropriate nursing intervention is to: acknowledge the ritualistic behavior each time and point out that it is inappropriate. allow the patient to carry out the ritualistic behavior, since it is helping him or her.