1.A nurse is assessing a 9 mo old for potential developmental delay. Which observation should the nurse

expect to find to support this condition?

-inability to sit without support. Infant should be able to sit alone with support, roll back and forth,

reach for objects, and may even begin to crawl by 7 months.

2.The nurse is assessing a 4 mo old. Which assessment should prompt the nurse to conduct a further

evaluation?

-head lag when pulled from a lying to sitting position. By 4-6 months, head control is wellestablished.

Only a slight head lag should be evident.

3.Which reflex should the nurse expect to find on a 6 month old infant?

-Babinski (stroking the bottom ofthe foot causing toes to fan and the big toe to dorsiflex) is present

until age 1.

4.Appropriate toy for 4 year old admitted to hospital?

-plastic stethoscope

5.The nurse is caring for a 3 year old newly diagnosed with diabetes mellitus. When writing the care pla,

the nurse includes this goal: the child will be provided with opportunities for therapeutic play. Which

would be the most appropriate toy to help meet this goal?

-doll and syringe with no needle.

6.Appropriate to tell parent?

-Establish a set bedtime and follow a nightly routine. Preschool-aged childrentest limits. Consistency in

approach to the child is very important.

7.Nutrition for 12 month old:

-4-6 oz of juice/day is recommended; apple slivers and cereal are good snacks. Cereal is small and

dissolves with infants’ saliva so it does not cause airway obstruction, and apple slivers are good because

infants need to be offered finger foods; child should be introduced to thesame food as the family is

eating.

8. nurse is caring for a child with bacterial endocarditis. The child with receive long-term antibiotics and

will require a PICC. Which statement is appropriate for the nurse to state to the parents?

-the PICC linewill last several weeks with proper care. They may remain in place for up to 6 months or

longer with proper care.

9.Pain is a subjective experience even for a 3 year old.

-The FACES scale can be used to accuratelydetermine the presence of pain in children as young as 3.

10.A nurse is conducting a yearly health assessment of a 14-yr old girl. The nurse should understand

whichfinding will require further evaluation?

-there is a lateral curvature to her spine (could indicate scoliosis)