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Which activity should the PN identify as typical for a 2 year old child's cognitive development? a) has a vocabulary of about 1000 words b) uses short sentences to express self c) initiates play with other children d) recognizes right and wrong Answer: B Rationale: Although children develop at different rates, a 2 year old typically uses short sentences to express independence and control (B) and has a vocabulary of up to 300 words, not (A). At the age of 2 years, a toddler is developing negativism without understanding the concepts of right and wrong (D). A 2 year old engages in solitary play and parallel play but does not initiate or cooperative with other children (C) in play, which begins with socialization of the preschool child. The practical nurse (PN) is interviewing a 10 year old girl about school and her extracurricular activities. She responds, "I like school. I play the flute in the school band, and I take tennis lessons." Based on Erikson's psychosocial theory, the PN identifies that this child is in what stage of development? a) identity b) intimacy c) industry d) initiative Answer: C Rationale: Erikson's stage of industry (C) for a school aged child is demonstrated by successful participation in new skills and peer activities, such as sports and band. (A, B, and D) are achieved in other age groups. The practical nurse (PN) identifies an increased frequency of otitis media (OM) is children who are coming to the clinic. Based on this finding, which age group should the PN monitor a child for signs and symptoms of OM? a) toddler b) preschooler c) school ager d) adolescent Answer: A Rationale: Infants and toddlers (A) are most prone to otitis media due to the anatomical structure of the eustachian tube that allows fluid and microbial entry into the middle ear. (B, C, and D) are most susceptible to acute infectious diseases acquired through environmental transmission from daycare or school settings. The practical nurse (PN) collects information about infant growth and development milestones for infants who come to the clinic for a well child visit. Which findings should the PN document as normal infant growth and development? a) maternal iron stores persist during the first 12 months of life b) anterior fontanel closes by 6 to 10 months of age c) binocularity is well established by 8 months of age d) birth weight double by age 5 months and triples by 1 year Answer: D Rationale: Infants gain approximately 1.5 pounds/month until age 5 to 6 months, when the birth weight doubles, and by 1 year of age, the birth weight usually triples (D). The anterior fontanel closes by 12 to 18 months of age, with the average being 14 months, not (B). Binocularity begins to develop by 6 weeks of age and should be well established by age 4 months, not (C). Maternally derived iron stores ares present for the first 5 to 6 months and gradually diminish, which results in an expected lowered hemoglobin levels toward the end of the first 6 months (A). Which nonfood item is the most common cause of respiratory arrest in young children? a) latex balloons b) broken rattles c) buttons d) pacifiers Answer: A Rationale: Nonfood items cause the majority of choking deaths in young children. Latex balloons (A), whether partially inflated, uninflated, or popped, are the leading cause of pediatric choking that leads to aspiration of small objects (A,B, and D) because they experience the environment by placing objects in the mouth, but (A) is the leading cause of death causing respiratory obstruction and arrest. The practical nurse (PN) is talking with a group of elementary students about bicycle safety. Which information should the PN provide? a) wearing protective gear on a bicycle is a voluntary measure b) children should wear a bicycle helmet when riding a bicycle c) bicycle injuries involve a collision with an automobile d) riding double is allowed if the bicycle has an extra large seat Answer: B Rationale: Bicycle accidents that result in head injuries are a common, accidental cause of morbidity and mortality, so bicycle safety and some state laws mandate that children should wear a protective helmet (B). (A, C, and D) do not provide accurate information. An adolescent female who comes to the school clinic is reluctant to confide her concerns to the practical nurse (PN). The PN tells the teen that confidentiality and privacy are maintained unless a life-threatening situation arises. Which principal supports the PN's response? a) disclosures from the adolescent should be kept confidential b) minor adolescents should not be encouraged to disclose private concerns c) the adolescent should be encouraged to seek help outside of the school clinic d) honest information ensures establishing a trusting relationship Answer: D Rationale: Critical elements in establishing trusting relationships include active listening, responding to the adolescent's emotions, and ensuring confidentiality and privacy, but situations that pose a life-threatening situation for the adolescent must be reported. Minor-aged adolescents have the right to confidential communication with providers unless the client is being abused or a life-threatening situation is evident. Honesty (D) is vital in the development of trust between an adolescent and a health professional. (A,B, and C) do not provide immediate intervention for the adolescent's concerns about self integrity and safety. The practical nurse (PN) is caring for a 6 year old girl who had surgery 12 hours ago. The child tells the PN that she does not have pain but a few minutes later, tells her parents that she does. What child development concept is relevant to this situation? a) inconsistency in pain reporting suggests that pain is not present b) truthful reporting of pain should occur by this age c) a child may have pain yet deny its presence to the nurse d) children use pain experiences to manipulate their parents Answer: C Rationale: A child may fear receiving an injection for pain or may believe that pain is a deserved punishment for some misdeed, so the pain is denied (C) when the nurse asks the child, who then readily admits having pain to a parent. This behavior should not be interpreted as (D) but as a valid indication of pain. (A and B) are incorrect interpretations of this behavior.