Exam (elaborations)
Capstone VATI Nursing care of Children Health Promotion and Maintenance quiz 1 3-26-19
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Capstone VATI Nursing care of Children Health Promotion and Maintenance quiz 1 3-26-19The parent of a two-year-old child reports feeling frustrated with the fact that her son is saying no to
everything. The nurse should teach the parent that this behavior is a normal expression of the child’s
desire to accomplish which of the following?
Select one:
a. Gratify their oral fixation.
b. Develop their sense of trust.
c. Finish a project they set out to do.
d. Increase their independence.
CORRECT. The drive for independence is expressed by the toddler opposing the desires of those in
authority (tantrums) and attempting to do everything for themselves. The Erickson developmental
stage for this age is “Autonomy vs. Shame and Doubt.”
Feedback
The correct answer is: Increase their independence.
At a well-child visit, the parents report that their toddler occasionally touches and fondles her genital
area. The parents ask the nurse if this behavior is something to be concerned about. Which of the
following is a correct response?
Select one:
a. This is a possible infection or irritation in the genital area
b. Your child is probably imitating behaviors that she has observed
c. Awareness of body structures and sensations is normal and expected
CORRECT. Genital self-stimulation by the toddler is normal and expected. It is a new area to
explore, similar to exploring the toes at an earlier age, but it has pleasurable sensations too! It
should be ignored unless the behavior becomes pervasive, and then it should still be ignored and
the child should be distracted to come and do some fun and exciting activity
d. This is an early emergence of sexual expression that should be discouraged
Feedback
The correct answer is: Awareness of body structures and sensations is normal and expected
A nurse is taking the health history of a school-age girl. Which statement by the client’s mother
indicates a need for further teaching regarding the client’s nutritional status?
Select one:
a. “She eats a large breakfast every morning.”
b. "She enjoys helping to prepare her snacks in the kitchen.”
c. “We allow her to pick out a treat at the grocery store for good behavior.”
, CORRECT. This statement indicates a need for further teaching. This client’s mother should be
educated about the importance of praising the client’s abilities and skills rather than using food as a
reward, which may lead to an increased risk for obesity.
d. “We increase her protein intake when she’s playing sports.”
Feedback
The correct answer is: “We allow her to pick out a treat at the grocery store for good behavior.”
A nurse correctly understands which of the following characteristics is a possible developmental
delay for a 3-month-old client?
Select one:
a. The infant demonstrates stranger anxiety
b. The infant is unable to point to objects
c. The infant is unable to sit with support
d. The infant does not raise his head when placed on his abdomen
CORRECT. When placed on the abdomen the 3 month old should attempt to raise his head. Some
sources refer to this as “tummy time” which provides the infant with the stimulation to strengthen
upper body and neck muscles in preparation for good head control when sitting upright and the
some of the muscles required for crawling.
Feedback
The correct answer is: The infant does not raise his head when placed on his abdomen
A nurse has administered the first DTaP (diphtheria toxoid, tetanus and pertussis) immunization to a
two-month-old infant. For which of the following symptoms should the nurse teach the parents to
seek immediate medical attention?
Select one:
a. The baby is crying inconsolably for more than three hours
CORRECT. Inconsolable crying lasting more than three hours and/or seizures within 48 hours of
vaccination is a sign of encephalopathy that must be treated immediately.
b. The baby develops swelling or redness at the injection site
c. The baby has an axillary temperature of 100.4o F. (38o C)
d. The baby develops a localized or generalized rash
Feedback
The correct answer is: The baby is crying inconsolably for more than three hours
A nurse is educating the parents of an infant about symptoms that should be reported to the
provider. What finding should be immediately reported?
Select one:
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