PRACTICE NCLEX QUESTIONS BASED ON GROWTH, DEVELOPMENT, AND STAGES OF LIFE (PART:10)

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PRIORITY CONCEPTS ARE DEVELOPMENT, FAMILY DYNAMICS

KEY POINTS: MUST READ

  1. THE HOSPITALIZED INFANT AND TODDLER:
    1. SEPARATION ANXIETY
      1. PROTEST: crying, screaming, searching for parent, avoidance and rejection of contact with strangers; verbal attacks on others; physical fighting including kicking, biting, hitting, pinching.
      2. DESPAIR: withdrawn, depressed, uninterested in the environment, loss of newly learned skills.
      3. DETACHMENT: uncommon and only occurs after lengthy separations from the parents; the toddler copes by forming shallow relationships with others, primary importance to material objects; most serious phase because reversal of the potential adverse effects is less likely to occur once detachment is established.
    2. FEAR OF INJURY AND PAIN: affected by previous experiences, separation from the parents, preparation for the experience
    3. LOSS OF CONTROL: often exhibited in behavior related to feeding, toileting, playing, and bedtime.
    4. INTERVENTIONS: softly talk, provide stimulation, approach via positive attitude, encouragement, accept regressive behavior, utilize play therapy, maintain safe environment, employ pain reduction techniques.
  2. THE HOSPITALIZED PRESCHOOLER
    1. SEPARATION ANXIETY: generally, less obvious and less serious than in the toddler, as stress increases, the preschooler’s ability to separate from the parents decreases.
      1. PROTEST: less direct and aggressive than in the toddler
      2. DESPAIR: reacts in a manner similar to that of the toddlers; repeatedly asks when the parents will be visiting.
      3. DETACHMENT: similar to toddler.
    2. FEAR OF INJURY AND PAIN: lack of understanding of the body integrity, fears invasive procedures and mutilation, imagines things to be worse than they are.
    3. LOSS OF CONTROL: Likes familiar situations, may show regression, preschooler’s egocentric and magical thinking limits their ability to understand events because they view all experiences from their own self-referenced (egocentric) perspective.
    4. INTERVENTIONS: safe environment, communication. express anger, acknowledge fears and anxiety, accept regressive behavior, encourage rooming in or leaving a favorite toy, allow mobility and provide play and diversional activities, encourage to be independent, explain procedure simply, avoid intrusive procedure.
  3. THE HOSPITALIZED SCHOOL-AGE CHILD
    1. SEPARATION ANXIETY: as stressors are, the separation becomes more difficult, more concerned with missing school.
      1. PROTEST: do not occur
      2. DESPAIR: do not occur
      3. DETACHMENT: do not occur
    2. FEAR OF INJURY AND PAIN: fears bodily injury, pain, fears illness itself, disability, death, intrusive procedure in the genital areas; uncomfortable with any type of sexual examinations.
    3. LOSS OF CONTROL: usually highly social, independent, and involved with activities, seeks information and asks relevant questions about tests, procedures, and the illness.
    4. INTERVENTIONS: encourage rooming-in, focus on the needs and abilities; accept regression, allow express feelings verbally and non-verbally, acknowledge fears and concerns and allow for discussion, provide privacy, encourage to contact with the friends, provide for educational needs, use appropriate interventions to relieve pain.
  4. THE HOSPITALIZED ADOLESCENT
    1. SEPARATION ANXIETY: separation from the friends is a source of anxiety
      1. PROTEST: not occur
      2. DESPAIR: not occur
      3. DETACHMENT: not occur
    2. FEAR OF INJURY AND PAIN: fear being different from others and their peers, become guarded when any areas related to sexual development are examined.
    3. LOSS OF CONTROL: behaviors exhibited include anger, withdrawal, and uncooperativeness; seek help and then reject it.
    4. INTERVENTIONS: Encourage questions regarding the illness effects and appearance, explore feelings about the hospital, encourage to wear their own clothes and carry out normal grooming activities, provide privacy, maintaining contact with peer groups, develop positive coping mechanism.
  5. COMMUNICATION APPROACHES:
    1. GENERAL GUILDELINES FOR COMMUNICATIONS:
      1. Allow child to feel comfort with nurse
      2. Communicate through the use of the object
      3. Allow to express feelings
      4. Speak clearly and quietly,
      5. Offer choices if possible
      6. Be honest with the child
      7. Set limits with the child as appropriate.
  6. CAR SAFETY SEATS AND GUIDELINES:
    1. The safest place for all children to ride is in the back seat of the car (regardless of age).
    2. For more detail, click on this link: Car Seats: Information for Families – HealthyChildren.org
  7. PREVENTIVE PEDIATRIC HEALTH CARE:
    1. For detailed information, click on this link: periodicity_schedule.pdf (aap.org)
  8. IMMUNIZATIONS:
    1. Immunizations are important aspect of health promotion during childhood
    2. In the United States, the recommended age for beginning primary immunizations of infants is at birth.
    3. Children who began primary immunizations at the recommended age but failed to receive all required doses do not need to begin the series again, they need to receive only the missed doses.
    4. ADMINISTERING A PARENTAL VACCINE:
      1. Verification of the prescription for the vaccine
      2. Obtain an immunization history from the parents and assess for allergies.
      3. Provide information regarding vaccine
      4. Obtain parental consent
      5. Check the lot number and expiration date and prepare the injection.
      6. Select appropriate site for administration
      7. Administer the vaccine
      8. Documentation
      9. Provide a vaccination record to the parents.
    5. GENERAL CONTRAINDICATIONS AND PRECAUTIONS:
      1. Contraindicated if the child experienced an anaphylactic reaction to a previously administered vaccine or a component in the care
      2. LIVE VIRUS VACCINES generally are not administered to individuals with severely deficient immune systems, individuals with a severe sensitivity to gelatin, or pregnant women.
    6. GUIDELINES FOR ADMINISTRATION OF VACCINE:
      1. follow manufacturer’s recommendation for route of administration, storage, and reconstitution of the vaccine.
      2. If registration is necessary, store on a central shelf to maintain the vaccine’s potency
      3. Provide vaccine information to parent
      4. Check expiration date
      5. Parenteral vaccines are given in separate syringes in different injection sites
      6. Vaccines administered INTRAMUSCULARLY are given in the VASTUS LATERALIS MUSCLE (best site), or VENTROGLUTEAL MUSCLE (the DELTOID muscle can be used for children 36 months of age and older)
      7. Vaccines administered subcutaneously are given in the fatty areas in the lateral upper arms and anterior thighs
      8. Adequate needle length and gauge are as follow: intramuscular, 1 inch, 23-25 gauge; subcutaneous, {5/8} inch, 25 gauge (needle length may vary depending on the child’s size.
      9. Mild side effects are fever, soreness, swelling, or redness at injection site.
      10. A topical anesthetic may be applied to injection site before the injection
      11. For painful or red injection sites, advise the parent to apply cool compresses for the first 24 hours, and then use warm and cold compresses as long as needed.
      12. Maintain an immunization record
      13. Document day, month, year of administration, manufacturer and lot number of vaccine; name, address, and title of the person administering the vaccine; and site and route of administration.
      14. A vaccine adverse event report needs to be filled
  9. RECOMMENDED CHILDHOOD AND ADOLESCENT IMMUNIZATIONS:
    1. CLICK BELOW to know more in details:
      1. Birth-18 Years Immunization Schedule | CDC
      2. Adult Immunization Schedule by Vaccine and Age Group | CDC
      3. COVID-19 Vaccine Interim COVID-19 Immunization Schedule for 6 Months of Age and Older (cdc.gov)
  10. REACTIONS TO A VACCINE:
    1. Local reactions: tenderness, erythema, swelling at injection site; Low grade fever; behavioral changes such as drowsiness, unusual crying, decreased appetite
    2. Minimizing the local reactions: Select adequate length of needle, adequate site.
  11. DEVELOPMENTAL CHARACTERISTICS:
    1. INFANT: Never shake an infant because of the risk of causing a closed head injury known as shaken baby syndrome, which is a life-threatening injury.
    2. TODDLER: Toddlers are eager to explore the world around them; they need to be supervised at play to ensure safety
    3. PRESCHOOLER: Teach a preschooler and school-age child to leave an area immediately if a gun is visible and to tell an adult. The preschooler should be taught never to point a toy gun at another person.
    4. SCHOOL-AGE CHILD: Teach the preschooler and school-age child that if another person touches his or her body in an inappropriate way, an adult should be told. Also teach the child to avoid speaking to strangers and never to accept a ride, toys, or gifts from a stranger.
    5. ADOLESCENT: Discuss issues such as acquaintance rape, sexual relationships, and transmission of sexually transmitted infections with the adolescent. Also discuss the dangers of the internet and social media related to communicating and setting up meetings (dates) with unknown persons.
    6. EARLY ADULTHOOD
    7. MIDDLE ADULTHOOD
    8. LATER ADULHOOD
  12. GENDER DYSPHORIA ACROSS THE LIFE SPAN:
    1. CHILDREN: An incongruence between one’s experienced and expressed gender and assigned gender of a duration of at least 6 months and at least two of the following assessment findings: results in clinically significant distress in school or other important areas of functioning.
    2. ASSESSMENT:
      1. A strong desire or insistence that one is the other gender
      2. A strong preference for cross-dressing in female attire for boys; a strong preference for wearing masculine attire for girls.
      3. A strong preference for cross- gender roles in make-believe play.
      4. A strong preference for toys, games or activities used for stereotypically by the other gender.
      5. A strong preference for playmates of the other gender
      6. Avoidance of rough play and masculine toys for boys, and avoidance of feminine toys for girls.
    3. ADOLESSCENTS AND ADULTS: An incongruence between one’s experienced and expressed gender and assigned gender of a duration of at least 6 months and at least two of the following assessment findings: results in clinically significant distress in social, occupational, or other important areas of the functioning.
    4. ASSESSMENT:
      1. Incongruence between expressed gender and sex characteristics
      2. A strong desire to be rid of one’s sex characteristics because of incongruence with expressed gender
      3. A strong desire for sex characteristics of the other gender
      4. A strong desire to be of the other gender
      5. A strong desire to be treated as the other gender
      6. A strong conviction that one has the typical feelings and reactions of the other gender.
    5. POSTTRANSITION: The individual has transitioned to full-time living in the desired gender.
  13. END-OF-LIFE CARE relates to death and dying
    1. Legal and ethical issues: based on the client’s wishes
    2. Cultural and religious considerations
    3. Palliative and hospice care

PRACTICAL QUESTIONS:

  1. A-4-YEAR-old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention should be implemented to alleviate the child’s fear?
    1. Encourage the child’s parents to stay with the child
    2. Encourage play with other children of the same age.
    3. Advise the family to visit only during the scheduled visiting hours
    4. Provide a private room, allowing the child to bring the favorite toys from home
  2. A 16-year-old client is admitted to the hospital for acute appendicitis and an appendectomy is performed. Which nursing interventions is most appropriate to facilitate normal growth and development postoperatively?
    1. Encourage the client to rest and read
    2. Encourage the parents to room in with the client
    3. Allow the family to bring in the client’s favorite computer games
    4. Allow the client to interact with others in his or her same age group
  3. Which car safety device should be used for a client who is 8 years old and 4 feet tall?
    1. Seat belt
    2. Booster seat
    3. Rear-facing convertible seat
    4. Front-facing convertible seat
  4. The nurse assesses the vital signs of a 12-month-old infant with a respiratory infection and notes that the respiratory rate is 35 breaths per minute. On the basis of this finding, which action is most appropriate?
    1. Administer oxygen
    2. Document the findings
    3. Notify the pediatrician
    4. Reassess the respiratory rate in 15 minutes
  5. The nurse is monitoring a 3-month-old infant for signs of increased intracranial pressure. On palpation of the fontanels, the nurse notes that the anterior fontanel is soft and flat. On the basis of this finding, which nursing action is most appropriate?
    1. Increased oral fluids
    2. Document the findings
    3. Notify the pediatrician
    4. Elevate the head of the bed to 90 degrees.
  6. The nurse is evaluating the development level of a 2-year-old. Which does the nurse expect to observe in this child?
    1. Uses a fork to eat
    2. Uses a cup to drink
    3. Pour own milk into the cup
    4. Uses a knife for cutting food
  7. A-2year-old child is treated in the emergency department for a burn to the chest and abdomen. The child sustained the burn by grabbing a cup of hot coffee that was left on the kitchen counter. The nurse reviews safety principles with the parents before discharge. Which statement by the parents indicates an understanding of measures to provide safety in the home?
    1. We’ll be sure not to leave the hot liquids unattended
    2. I guess our children need to understand what the word hot means
    3. We will be sure that the children stay in their rooms when we work in the kitchen
    4. We will install a safety gate as soon as we get home so the children cannot get into the kitchen.
  8. A mother arrives at a clinic with her toddler and tells the nurse that she has a difficult time getting the child to go to bed at night. What measures is most appropriate for the nurse to suggest to the mother?
    1. Allow the child to set bedtime limits
    2. Allow the child to have temper tantrums
    3. Avoid letting the child nap during the day
    4. Inform the child of bedtime a few minutes before it is time for bed
  9. The mother of a 3-year-old is concerned because her child still is insisting on a bottle at nap time and at bedtime. Which is the most appropriate suggestion to the mother?
    1. Allow the bottle if it contains juice
    2. Allow the bottle if it contains water
    3. Do not allow the child to have the bottle.
    4. Allow the bottle during naps but not at bedtime.
  10. The nurse is preparing to care for a 5-year-old who has been placed in traction following a fracture of the femur. The nurse plans care, knowing that which is the most appropriate activity for this child?
    1. A radio
    2. Sports video
    3. Large picture books
    4. Crayons and a coloring book
  11. The mother of a 3-year-old asks a clinic nurse about appropriate and safe toys for the child. The nurse should tell the mother that the most appropriate toy for a 3-year-old is which?
    1. A wagon
    2. A golf set
    3. A farm set
    4. A jack set with marbles.
  12. Which interventions are appropriate for the care of an infant? Select All That Apply.
    1. Provide swaddling
    2. Talk in a loud voice
    3. Provide the infant with a bottle of juice at nap time.
    4. Hang mobiles with black and white contrast designs
    5. Caress the infant while bathing or during diaper changes
    6. Allow the infant to cry for at least 10 minutes before responding.
  13. The nurse is preparing to care for a dying client, and several family members are at the client’s bedside. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply.
    1. Discourage reminiscing
    2. Make the decisions for the family
    3. Encourage expression of feelings, concerns, and fears
    4. Explain everything that is happening to all family members.
    5. Touch and hold the client’s or family member’s hand if appropriate
    6. Be honest and let the client and family know they will not be abandoned by the nurse
  14. An infant receives a diphtheria, tetanus, and acellular pertussis DTaP immunization at a well-baby clinic. The parent returns home and calls the clinic to report that the infant has developed swelling and redness at the site of injection. Which interventions should the nurse suggest to the parent?
    1. Monitor the infant for a fever
    2. Bring the infant back to the clinic
    3. Apply a hot pack to the injection site.
    4. Apply a cold pack to the injection site
  15. A child is receiving a series of the hepatitis B vaccine and arrives at the clinic with his parent for the second dose. Before administering the vaccine, the nurse should ask the child and parent about a history of a severe allergy to which substance?
    1. Eggs
    2. Penicillin
    3. Sulfonamides
    4. A previous dose of hepatitis B vaccine or component
  16. A parent brings her 4- month-old infant to a well-baby clinic for immunizations. The child is up to date with the immunization schedule. The nurse should prepare to administer which immunizations to this infant?
    1. Varicella, hepatitis B vaccine (HepB)
    2. Diphtheria, tetanus, acellular pertussis (DTaP); measles, mumps, rubella (MMR); Inactivated poliovirus vaccine (IPV)
    3. MMR, Hemophilus influenzae type b (Hib), DTaP
    4. DTaP, Hib, IPV, pneumococcal vaccine (PCV), Rota-virus vaccine (RV)
  17. The clinic nurse is assessing a child who is scheduled to receive a live virus vaccine(immunization). What are the general contraindications associated with the receiving a live virus vaccine? Select All that Apply.
    1. The child has symptoms of a cold
    2. The child had a previous anaphylactic reaction to the vaccine
    3. The mother reports that the child is having intermittent episodes of diarrhea
    4. The mother reports that the child has not had an appetite and has been fussy
    5. The child has a disorder that caused a severely deficient immune system
    6. The mother reports that the child has recently been exposed to an infectious disease.

ANSWERS:

  1. 1
  2. 4
  3. 2
  4. 2
  5. 2
  6. 2
  7. 1
  8. 4
  9. 2
  10. 4
  11. 1
  12. 1,4,5
  13. 3,5,6
  14. 4
  15. 4
  16. 4
  17. 2,5

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