2. 50%.

Because the disorder is an autosomal dominant genetic crown-heel length measurement is the most accurate measurement
disorder, children of a heterozygous parent have a 50% chance of in infants.
possessing the defective gene. Children of 2 heterozygous parents
have a 25% of being affected in autosomal recessive disorders. In D) locate the proper size cuff before taking the blood
X-linked dominant disorders, daughters of an affected father will pressure.
probably be affected; sons will not. Half the daughters and half Rationale:
the sons of affected mothers will be affected. In X-linked To obtain an accurate blood pressure reading, it is preferable to
recessive inheritance, males are usually affected. use the proper-size cuff. Thus, locating one before taking the
blood pressure is the best nursing action.

2. Understand her own beliefs. D) The child has poor skin turgor.
Rationale:
1. Chest auscultation. It is least intrusive
In normal elasticity the skin would return immediately to its
4. Intrafamily communication patterns original position. If the child is properly hydrated, skin turgor
would be elastic. This is the correct way to assess turgor.
4. Oblique palpebral fissures, small nose, and high palate. "Tenting" is the term for poor skin turgor.
Microcephaly, wide spaced eyes and cat cry are in cri du chat. Low
set ears, small jaw, and wide spaced eyes are in Edward's B) Amblyopia, a type of blindness, may result.
syndrome. Maladaptive behaviors with a long face and prominent Rationale:
jaw are in fragile X-syndrome. Amblyopia may develop if the eyes do not work together. The brain
may ignore the visual cues from one eye, resulting in blindness.

Answer: B. The child is acting out personal experiences

A) Down and back
Preschoolers should be developmentally incapable of demonstrating Rationale:
explicit sexual behavior. If a child does so, the child has been Correct position for an infant's ear examination is to pull the
exposed to such behavior, and sexual abuse should be suspected. pinna down and back.

A) Ask child to open mouth wide and say "aah."

A. “We’ll keep him at home until phobia subsides.” Rationale:
If the child is cooperative, the child can open his or her mouth and
C) "How is Adam doing in school?"
move the tongue around for the examiner.

Rationale:
D) bilaterally and coordinated with breathing.
This is an open-ended question without any descriptive terms that
Rationale:
may limit the mother's responses.
The preschool-age child should have symmetric chest movement
bilaterally and a coordinated breathing pattern.
A) explaining to the interpreter what information is necessary
to obtain from the patient and family. D) Having the child "help" with palpation by placing his or her
Rationale: hand over the palpating hand
The interpreter should be given guidance about what information is Rationale:
necessary to obtain during the interview. One question should be This allows the nurse to perform the assessment while including
asked at a time, leaving sufficient time for the family to answer. the child in the care.
The interpreter should not have to guess what to ask and what
information to obtain during the interview. The interpreter should D) explain with concrete terms, such as putting medicine under
gain as much information from the family as they are willing to the skin.
share based on the questions posed. Limits should not be placed on Rationale:
the interview. Children at this age are very literal. By using concrete terms the
nurse helps the child understand what the nurse is going to do.

D) Recall of children's food consumption is frequently A) sexual history.

unreliable. B) review of systems.
Rationale: E) family medical history.
It is difficult for parents to recall exactly what their child has
eaten. Concurrent food diaries are somewhat more reliable. Rationale:
Sexual history is a component of the health history. Review of
systems is a component of the health history.
D) recumbent length measured in the supine position.
Review of family medical history is a component of the health
Rationale:
history.
Infants are generally unable to stand to obtain a height
measurement. Measurement should not be estimated since an
accurate measurement is required to determine growth. The infant
should be measured in the supine, not the prone, position. The
A) obtain a rectal thermometer probe for a child with give up dependence for control, independence, and autonomy. One
diarrhea. of the tasks that the toddler is concerned with is the ability to
B) attempt to take an oral temperature on a child who is delay gratification. Development of a conscience and recognition of
receiving oxygen. sex differences occur during the preschool years.
D) documenting an axillary temperature for a 3-year-old child
ANS:C
Rationale: During the tertiary circular reactions stage, children have only a
IN EVOLVE IT LISTS D AS AN ANSWER, BUT IN THE rudimentary sense of the classification of objects. The appearance
RATIONALE IT STATES: of an object denotes its function for these children. The slot of an
An oral temperature is appropriate for a 12-year-old child who has outlet is for putting things into. This is typical behavior for a
not had anything hot or cold to eat or drink recently. toddler, who is only somewhat aware of a causal relation between
An axillary temperature is appropriate for a 3-year-old child. BUT events. Her cognitive development is appropriate for her age.
THEN IT ALSO STATES: Axillary temperatures are inconsistent
and insensitive in infants and children over 1 month old. ANS:A
Animism is the attribution of lifelike qualities to inanimate objects.
By scolding the stairs, the toddler is attributing human
3 characteristics to them.
The parents may be confused or anxious about the treatment
procedure that is prescribed for their child. Therefore, it is ANS:C
important for the nurse to explain the procedure at the family's During the second year of life the comprehension and
level of understanding to alleviate their fears.  understanding of speech increase to a level far greater than the
child's vocabulary. This is also true for bilingual children, who are
ANS:A able to achieve this linguistic milestone in both languages. The 18-
Metabolic acidosis results from the increased absorption of short- month-old has a vocabulary of approximately 10 words.
chain fatty acids produced in the colon. There is an increase in
lactic acid from tissue hypoxia secondary to hypovolemia. ANS:D
The 24-month-old child can go up and down stairs alone with two
ANS:C feet on each step. Skipping and broad jumping are skills acquired at
G. lamblia is a parasite that represents 10% of nondysenteric age 3. Tricycle riding is achieved at age 4.
illness in the United States. Shigella, Salmonella, and E. coli are
bacterial pathogens. ANS:C
Usually by age 30 months the primary dentition of 20 teeth is
ANS:D complete. Birth weight doubles at approximately ages 5 to 6
Easily digested foods such as cereals, cooked vegetables, and months. The anterior fontanel closes at ages 12 to 18 months.
meats should be provided for the child. Early reintroduction of Binocularity is established by age 15 months.
nutrients is desirable. Continued feeding or reintroduction of a
regular diet has no adverse effects and actually lessens the Ans:C
severity and duration of the illness. Clear fluids (such as fruit A 2-year-old child usually can kick a ball forward. Riding a tricycle
juices and gelatin) and carbonated drinks have high carbohydrate is characteristic of a 3-year-old child. Tying shoelaces is a
content and few electrolytes. Caffeinated beverages should be behavior to be expected of a 5-year-old child. Using blunt scissors
avoided because caffeine is a mild diuretic. In some children, is characteristic of a 3-year-old child.
lactose intolerance will develop with diarrhea, and cow's milk
should be avoided in the recovery stage. Ans:B.
Parents can be asked to assist when their child becomes
ANS:C uncooperative during a procedure. Most commonly, the child's
Children who are vomiting should be given ORS at frequent difficulty in cooperating is caused by fear. In most situations, the
intervals and in small amounts. Intravenous fluids are not indicated child will feel more secure with a parent present. 
for mild dehydration. Carbonated beverages are high in
carbohydrates and are not recommended for the treatment of ANS:B
diarrhea and vomiting. The child is not kept NPO, since this would Voluntary control of the anal and urethral sphincters is achieved
cause additional fluid losses. sometime after the child is walking. The child must be able to
recognize the urge to let go and to hold on. The child must want to
ANS:A please parent by holding on rather than pleasing self by letting go. 
It is appropriate to advance to a regular diet after ORS has been
used to rehydrate the child. Clear liquids are not appropriate for ANS:D
hydration or afterward. A high carbohydrate diet may contribute The best way to deal with temper tantrums is to ignore the
to loose stools because of the low electrolyte content and high behaviors, provided that the actions are not dangerous to the
osmolality. The BRAT diet has little nutritional value and is high in child. 
carbohydrates.

ANS:D
ANS:D The nurse should suggest to the parent that questions should be
If the need for basic trust has been satisfied, then toddlers can phrased with realistic choices rather than yes or no answers. This
provides a sense of control for the toddler and reduces the scissors or a pencil very well, and to draw a person with seven to
opportunity for negativism.  nine parts are fine motor skills of 5-year-olds.

ANS:A ANS:A
The baby talk is a sign of regression in the toddler. Often toddlers Because of their egocentrism and transductive reasoning,
attempt to cope with a stressful situation by reverting to patterns preschoolers believe that thoughts are all-powerful. Believing God
of behavior that were successful in earlier stages of development. is an imaginary friend is an example of concrete thinking in a
It should be ignored, while praising the child for developmentally preschooler's spiritual development. Cause-and-effect implies
appropriate behaviors. Regression is children's way of expressing logical thought, not magical thinking. 
stress. 
ANS:B
ANS:A Magical thinking is believing that thoughts can cause events. An
Most toddlers exhibit a physiologic anorexia in response to the example would be that thinking of the death of a parent might
decreased nutritional requirement associated with the slower cause it to happen. Abstract thought does not develop until school-
growth rate. Parents should assist the child in developing healthy age years. The concept of conservation is the cognitive task of
eating habits.  school-age children, ages 5 to 7 years. 

ANS:D ANS:B
The child is exhibiting the ritualism that is characteristic at this A 4-year-old understands time in relation to events such as meals.
age. Ritualism is the need to maintain the sameness and reliability. Children perceive "soon" as a very short time. The nurse may lose
It provides a sense of structure and comfort to the toddler. It will the child's trust if his parents do not return in the time he
dictate certain principles in feeding practices, including rejecting a perceives as "soon." 
favorite food because it is served in a different container.
ANS:B
ANS:B Preschoolers cannot understand the cause and effect of illness.
Although the transition point for switching to the forward-facing Their egocentrism makes them think they are directly responsible
position is defined by the manufacturer, it is generally at 9 kg (20 for events, making them feel guilt for things outside of their
lb); 4.5 kg (10 lb) is too small to be safe. Because of the relatively control. 
large head, this size child should be in the rear-facing position. It
is usually safe to put children who weigh more than 20 lb in ANS:C
forward-facing convertible safety seats. Preschoolers have little understanding of body boundaries, which
leads to fears of mutilation. 
ANS:D
Scald burns are the most common type of thermal injury in ANS:D
children, especially 1- and 2-year-olds. Temperature should be Because of the dramatic vocabulary increase at this age, 3-year-
reduced on the hot water in the house and hot liquids placed out of olds are known to talk incessantly regardless of whether anyone is
the child's reach. listening. A 4- to 5-year-old asks lots of questions and can follow
simple directional commands. A 6-year-old can describe an object
ANS:D according to its composition.
One cause of early childhood caries is allowing the child to go to
sleep with a bottle of milk or juice; as the sweet liquid pools in the ANS:C
mouth, the teeth are bathed for several hours in this cariogenic A developmental assessment with a screening tool that addresses
environment. Eating citrus fruit at bedtime and poor fluoride cognitive, social, and physical milestones can help identify children
supply in drinking water do not cause early childhood caries. who may need further assessment. A readiness assessment involves
an evaluation of skill acquisition.
ANS:A
A 24-month-old toddler starts to show readiness for toilet ANS:B
training; it is important for the parent to be aware of this and be Three-year-olds become aware of anatomic differences and are
ready to start the process. At 18 months of age, a child needs concerned about how the other sex "works." Such exploration
consistent but gentle discipline, since the child cannot yet should not be condoned or condemned. Children should not be
understand firmness and structure with discipline. punished for this normal exploration. This is age appropriate and
not dangerous behavior.
ANS: A, B, C, D
Tasks accomplished by an 18-month-old toddler include eating well ANS:C
with a spoon and cup, running clumsily, walking up stairs, pointing to Stammering and stuttering are normal dysfluency in preschool-age
common objects such as shoes, and building a tower with three or children. Lisps are not a normal characteristic of language
four blocks.  development. Echolalia and repetition are traits of toddlers'
language.
ANS:B
Three-year-olds are able to accomplish this fine motor skill of ANS:B
copying (drawing) a circle. The ability to tie shoelaces, to use Involve the child in problem solving. A night light shows a child that
imaginary creatures do not lurk in the darkness. Letting the child
sleep with parents will not get rid of the fears. A 4-year-old is in
the preconceptual stage and cannot understand logical thought. ANS:C
Boys and girls double both strength and physical capabilities. Their
ANS:A consistent refinement in coordination increases their poise and
Parents need to be reassured that the quality of food eaten is skill. In middle childhood, growth in height and weight occurs at a
more important than the quantity. Children are able to self- slower pace. Between the ages of 6 and 12 years, children grow 5
regulate their intake when offered foods high in nutritional value. cm/yr and gain 3 kg/yr. Their weight will almost double. Although
The average daily caloric intake should be approximately 1800 the strength increases, muscles are still functionally immature
calories. when compared with those of adolescents. This age-group is more
easily injured by overuse. Children take on a slimmer look with
ANS:B longer legs in middle childhood.
This is a description of a sleep terror. The child is observed during
the episode and not disturbed unless there is a possibility of ANS:C
injury. A child who awakes from a nightmare is distressed. She is Classification skills involve the ability to group objects according to
aware of and reassured by the parent's presence. This is not the the attributes they have in common. School-age children can place
case with sleep apnea. This behavior is not indicative of seizure things in a sensible and logical order, group and sort, and hold a
activity. concept in their mind while they make decisions based on that
concept. Individuals who are not twins engage in classification at
ANS:D this age.
Education about safety and potential hazards is appropriate for
preschoolers because they can begin to understand dangers. ANS:D
Limitation of physical activities is not appropriate. Punishment may Older school-age children are able to judge an act by the
make children scared of trying new things. Constant vigilance and intentions that prompted the behavior rather than just by the
protection is not practical at this age, since preschoolers are consequences. Rule violation is likely to be viewed in relation to the
becoming more independent. total context in which it appears. Rules and judgments become less
absolute and authoritarian. The situation and the morality of the
ANS:C rule itself influence reactions.
An appropriate intervention for a child who resists going to bed is
to establish limited rituals such as a bath or story that signal ANS:A
readiness for bed and consistently follow through with the ritual. Children at this age may view illness or injury as a punishment for a
Punishing the child will not alleviate the resistance problem and real or imagined misbehavior. School-age children expect to be
may only add to the frustration. Allowing the child to fall asleep in punished and tend to choose a punishment that they think "fits the
a different room or to watch television to fall asleep is not a crime." This is a common belief and not related to excessive family
recommended approach to sleep resistance. pressure. Many faiths do not include a God that causes cancer in
response for "bad" behavior. 
ANS:D
A 3-year-old exhibits a more stable appetite than during the ANS:D
toddler years and is more willing to try different foods. A 4-year- Peer-group identification is an important factor in gaining
old child is imaginative and indulges in telling "tall tales" and may independence from parents. Through peer relationships, children
have an imaginary playmate; these are normal findings, not signs of learn ways to deal with dominance and hostility. They also learn
stress. Also a 4-year-old has an increasing curiosity in sexuality, how to relate to people in positions of leadership and authority and
which is not a sign of child abuse. A 5-year-old child is usually how to explore ideas and the physical environment. A child's
tranquil, not aggressive like the 4-year-old child. concept of appropriate sex roles is influenced by relationship with
peers.
ANS: B, C, E, F
Developmental achievements for a 4-year-old include throwing a ANS:B
ball overhead, having a vocabulary of 1500 words, tending to be Identification with peers is a strong influence in children's gaining
selfish and impatient, and perhaps having an imaginary playmate. independence from parents. Interaction among peers leads to the
Caring for self totally and skipping and hopping on alternate feet formation of close friendships with same-sex peers—"best
are achievements normally seen in the 5-year-old age-group. friends." Daily relationships with age-mates in the school setting
provide important social interaction for school-age children. During
AnswerD. later school years, groups are composed predominantly of children
of the same sex.
Preschoolers commonly have fears of the dark,being left alone
especially at bedtime, and ghosts,which may affect the child's ANS:C
going to bed at night. Quiet play and time with parents is a positive School-age children need and want restrictions placed on their
bedtime routine that provides security and also readies the child behavior, and they are not prepared to cope with all the problems
for sleep. The child should sleep in his own bed. Telling the child of their expanding environment. Although increased independence
about locking him in his room will viewed by the child as a threat. is the goal of middle childhood, they feel more secure knowing that
Additionally, a locked door is frightening and potentially hazardous. an authority figure can implement controls and restriction. In the
Vigorous activity at bedtime stirs up the child and makes more middle-school years, children prefer peer-group activities to family
difficult to fall asleep.
activities and want to spend more time in the company of peers. ANS:B
Family values usually take precedence over peer value systems. Water safety instruction is an important component of injury
prevention at this age. The child should be taught to swim, select
ANS:C safe and supervised places to swim, swim with a companion, check
Pets have been observed to influence a child's self-esteem. They sufficient water depth for diving, and use an approved flotation
can have a positive effect on physical and emotional health and can device. Teach stranger safety, not fear of strangers. This includes
teach children the importance of nurturing and nonverbal telling the child not to go with strangers, not to wear personalized
communication. Most 7-year-olds are capable of caring for a pet clothing in public places, to tell parents if anyone makes child feel
with supervision. Caring for a pet should be a positive experience. uncomfortable, and to say no in uncomfortable situations. Teach
It should not be used to identify weaknesses. The pet chosen does the child safe cooking.
not matter as much as the child's being responsible for a pet.

ANS:C
Play involves increased physical skill, intellectual ability, and
fantasy. Children form groups and cliques and develop a sense of
belonging to a team or club. At this age, children begin to see the
need for rules. Conformity and ritual permeate their play. Their
games have fixed and unvarying rules, which may be bizarre and
extraordinarily rigid. With team play, children learn about
competition and the importance of winning, an attribute highly
valued in the United States but not in all cultures.

ANS:C
Older school-age children may lie to meet expectations set by
others to which they have been unable to measure up. Cheating
usually becomes less frequent as the child matures. Young children
may lack a sense of property rights; older children may steal to
supplement an inadequate allowance, or it may be an indication of
serious problems. In this age-group, children are able to distinguish
between fact and fantasy.

ANS:A
Signs of stress include stomach pains or headache, sleep problems,
bed-wetting, changes in eating habits, aggressive or stubborn
behavior, reluctance to participate, or regression to earlier
behaviors. The child is completing school work satisfactorily; any
developmental delay would have been diagnosed earlier. The
teacher reports that this is a departure from the child's normal
behavior. Adjustment issues would most likely be evident soon
after a change. Medical intervention is not immediately required.
Recognizing that this constellation of symptoms can indicate
stress, the nurse should help the child identify sources of stress
and how to use stress reduction techniques. The parents are
involved in the evaluation process.

ANS:C
During the school-age years, children experience a wide variety of
fears, but new fears related predominantly to school and family
bother children during this time. Parents and other persons
involved with children should discuss children's fear with them
individually or as a group activity. Sometimes school-age children
hide their fears to avoid being teased. Hiding the fears does not
end them and may lead to phobias.

ANS:A
School-age children often participate in dangerous activities in an
attempt to prove themselves worthy of acceptance. The incidence
of injury during middle childhood is significantly higher in boys
compared with girls. Motor vehicle collisions are the most common
cause of severe injuries in children.