NR-328 Pediatric Nursing - Set 1 - Part 2

Correct Answer: Imaginary audience and personal fable

The imaginary audience is the conviction that everyone is watching and judging, and the personal fable is a sense of uniqueness and invulnerability. Together they explain both the school refusal and the helmetless ride. Option a is incorrect because those two features belong to the preschool years, when a child cannot take another viewpoint and treats objects as living. A sixteen-year-old reasons abstractly, which is what makes these distortions possible. Option b is incorrect because linking events that merely happened together, and believing wishes cause outcomes, describes preoperational reasoning. Neither explains a teenager who understands the helmet risk perfectly well and still leaves it behind. Option d is incorrect because role confusion is the failure to settle on values or direction, showing up as drifting and inability to commit. This adolescent's behavior turns on how he believes others see him.

Correct Answer: Solitary play with objects and adults

Infants engage in solitary play, exploring objects and interacting with adults rather than with other children. Rattles, unbreakable mirrors and soft blocks suit this stage, provided nothing carries small parts or long strings. Option a is incorrect because parallel play describes toddlers busy with similar toys side by side and not sharing. A six-month-old has no interest in another child's activity and plays alone with objects. Option c is incorrect because associative play is the preschool pattern of playing house or sharing a sandbox without formal rules or a leader. Infants lack the language and social awareness such joint activity requires. Option d is incorrect because organized games with roles and rules belong to school-age children, who care intensely about fairness. Nothing in the first year supports turn taking, so the choice misses this infant entirely.

Correct Answer: Human milk or iron-fortified formula only

Human milk is the preferred food for the first year and iron-fortified formula is the appropriate alternative when it is not used. Other fluids displace the calories a growing infant needs. Option a is incorrect because cow milk stays off the menu until the first birthday. It is low in iron, hard to digest, and can cause slow intestinal blood loss that produces anemia. Option b is incorrect because juice has no place in the first year at all. It offers no nutritional advantage, promotes tooth decay and loose stools, and takes the place of milk feedings. Option d is incorrect because plain water before solids begin can bring on water intoxication and a falling sodium level, seen as irritability, lethargy and seizures. Small amounts wait until spoon feeding starts.

Correct Answer: "Nerve pathways controlling the bladder mature closer to eighteen months."

Voluntary sphincter control depends on myelination of the spinal cord, which occurs around eighteen to twenty-four months. No amount of practice moves that timetable, so training a twelve-month-old only frustrates both the child and the parent. Option b is incorrect because practice cannot substitute for neurologic readiness. Maturation unfolds on a genetic schedule and is observed rather than trained, so repeated drills before the nerves are ready simply produce accidents and power struggles. Option c is incorrect because holding one child against another is exactly what the nurse should avoid. Reassurance belongs to the expected range for the skill, not to a neighbor whose timing carries no meaning here. Option d is incorrect because rewards work only after the child can sense a full bladder and hold urine. Praising dryness in an infant who lacks that awareness teaches nothing and shifts attention away from real readiness signs.

Correct Answer: Carry out the home bedtime sequence unchanged

Ritualism gives the toddler control over an environment that has suddenly become unpredictable, so honoring the home sequence lowers distress more than any new routine can. Rituals are asked about on admission and preserved. Option a is incorrect because substituting a hospital routine strips away the sameness the toddler relies on. A new sequence adds one more unfamiliar demand at the very hour the child is least able to adapt. Option c is incorrect because an overtired toddler melts down faster, not slower. Pushing bedtime later removes the predictable cue that sleep is coming and usually produces a longer, louder struggle for everyone. Option d is incorrect because darkness alone does nothing for a child whose security rests on a familiar order of events. Many toddlers fear the dark, so withdrawing contact can deepen rather than settle the distress.

Correct Answer: Explain that walking normally appears through fifteen months

Independent walking appears anywhere from twelve to fifteen months, and this child has moved through the motor sequence in order. Sequence is universal while rate varies widely, so reassurance with continued surveillance is right. Option a is incorrect because referral is driven by a broken sequence or a lost skill, not by a child who is a few weeks behind the average while progressing normally through every step. Option b is incorrect because drilling a skill does not speed the neurologic maturation underneath it. Such advice implies the parent has been doing too little and adds guilt where simple reassurance was needed. Option c is incorrect because a cousin's timeline is not a standard. Development is judged against an expected range and against the child's own trajectory, so lining the two boys up answers nothing and feeds the parent's anxiety.

Correct Answer: Droplet precautions with a surgical mask

The catarrhal stage followed by paroxysms with post-tussive vomiting describes pertussis, a bacterium carried in large respiratory droplets. Droplet precautions with a surgical mask on entry continue until five days of antibiotics. Option b is incorrect because negative pressure rooms are reserved for organisms that hang in the air, such as measles and tuberculosis. Pertussis particles fall within a few feet and never need a respirator. Option c is incorrect because dedicated gowns and gloves belong with organisms spread by touching skin, linens or shared toys. Impetigo and scabies fit that pattern, while this infant is spraying secretions during every paroxysm. Option d is incorrect because teaching alone leaves an infectious infant sharing air with the rest of the unit. Whooping cough is a reportable illness requiring isolation and prophylaxis for close contacts, not just instruction.

Correct Answer: The illness is resolving as expected

Roseola runs three to five days of high fever in a child who looks well, then the fever breaks and a rose-pink trunk rash appears. The rash signals recovery, not worsening. Option a is incorrect because a drug eruption usually itches, often involves the whole body, and follows a new medication rather than a falling fever. Nothing in this pattern points toward an allergic cause. Option b is incorrect because human herpesvirus six does not seed the skin as the illness advances. Telling a parent the infection is spreading creates alarm about a rash that fades within two days. Option d is incorrect because one febrile course followed by a rash is the classic single sequence of roseola. Suggesting a fresh infection invites unnecessary testing and antibiotics for a self-limited viral illness.

Correct Answer: Airborne precautions plus gown and gloves

Lesions in every stage at once mark varicella, which spreads through the air and by contact with vesicle fluid. Airborne isolation plus gown and gloves covers both routes until all lesions crust. Option a is incorrect because a surgical mask stops large particles only, and varicella virus stays suspended on air currents. Staff entering without a fitted respirator can carry the infection to unprotected children elsewhere. Option c is incorrect because gown and glove barriers handle the vesicle fluid but ignore the respiratory route. A private room without negative pressure still lets virus escape each time the door opens. Option d is incorrect because standard practice alone treats this child like any other admission. Chickenpox infects roughly ninety percent of susceptible household contacts, so dedicated equipment without isolation leaves the unit exposed.

Correct Answer: Phrase requests as statements with two choices

Negativism is the toddler asserting autonomy, so parents should cut down on yes or no questions and state what happens next while offering two acceptable options. Both choices must be ones the parent can honor. Option a is incorrect because ignoring the child is the response reserved for a tantrum, not for ordinary refusals. Everyday negativism still needs guidance, and silence leaves the toddler without the structure the stage requires. Option b is incorrect because every yes or no question hands the toddler a fresh chance to refuse. Increasing them multiplies the standoffs a parent must manage and makes routine care slower and louder. Option c is incorrect because turning food into a bargaining chip invites a power struggle and can seed later feeding problems. Mealtimes should stay outside the discipline arena during a stage built on control.

Correct Answer: Auscultate the heart, lungs and abdomen

Heart, lung and bowel sounds require a quiet child, and a toddler will not stay quiet once upset. Auscultating early captures data that becomes impossible to obtain after crying begins. Option b is incorrect because the otoscope reliably provokes crying and resistance in this age group. Ear inspection belongs at the very end of the examination, after every quiet finding has already been recorded. Option c is incorrect because palpation alters bowel sounds and must follow auscultation, not precede it. Pressing on a toddler's abdomen also triggers guarding and squirming that cost the nurse the remaining quiet minutes. Option d is incorrect because throat examination sits with the ears among the most distressing maneuvers. Opening a toddler's mouth with a blade produces immediate screaming, and the chance to hear breath sounds is gone.

Correct Answer: Cephalocaudal progression from head to toe

Cephalocaudal development proceeds from the head downward, so the infant controls the head, then the trunk for sitting, then the legs for standing and walking. The order never varies, even when timing does. Option a is incorrect because proximodistal refers to control spreading outward from the body's center, shoulder before elbow and wrist before fingers. It describes reaching and grasping rather than the head-to-foot sequence of postural milestones. Option b is incorrect because differentiation names the shift from broad generalized reactions to precise ones, such as a whole-body startle becoming a turn of the head. Nothing in it dictates which body part gains control first. Option d is incorrect because rate variation explains why one healthy toddler walks at ten months and another at fifteen. That answers timing, while the parent asked about the fixed order in which the skills appear.

Correct Answer: Parallel play typical of toddlers

Toddlers play alongside one another with similar toys rather than together, and they do not share. Parallel play is the expected pattern between one and three years and needs no correction from staff. Option a is incorrect because solitary play involves an infant absorbed in objects or an adult, with no other child in the picture at all. Here two children have deliberately settled next to each other. Option b is incorrect because associative play means preschoolers joined in one loose activity, talking and lending toys without rules or a leader. These toddlers share nothing and never engage each other. Option c is incorrect because cooperative play requires assigned roles, a shared goal and rules that the group enforces. Children under three lack the language and turn taking that such structure demands, so the label does not fit.

Correct Answer: Assign the same nurses across consecutive shifts

Trust grows from consistent, predictable responses, so the same faces across shifts let the infant learn that comfort reliably arrives. Continuity of staff is a direct nursing intervention for the trust versus mistrust task. Option a is incorrect because a rotating cast of caregivers is precisely what undermines trust. Broad exposure does not teach an infant that the world responds dependably, and stranger anxiety at this age makes each new face harder. Option c is incorrect because restricting the family removes the very source of security the infant depends on. Rooming in and caregiver participation are encouraged, since the parent's presence anchors the infant through unfamiliar routines and procedures. Option d is incorrect because an infant cannot be spoiled by having needs met promptly. Withholding comfort teaches that signalling brings nothing, which is the mistrust half of the crisis rather than its healthy resolution.

Correct Answer: Smiling at staff and ignoring the returning caregiver

Turning away from the caregiver while charming the staff is detachment, the third and most damaging phase. The child has defensively given up the attachment, and a prolonged version harms the relationship. Option a is incorrect because loud protest is the healthiest of the three phases. The child is still fighting to keep the caregiver close, which means the attachment remains intact and worth supporting. Option b is incorrect because watching the door belongs to protest as well, simply in a quieter form. A child scanning for the caregiver is still oriented toward that person and has not withdrawn. Option c is incorrect because stillness and food refusal signal despair, which does warrant intervention but sits one step short of detachment. Grief is painful, yet the bond has not been abandoned.

Correct Answer: Call Poison Control and keep the bottle in hand

The child is alert and breathing, so the airway needs nothing. Poison Control is called immediately with the container in hand, and the mother reports the substance, the amount, and the time. Option a is incorrect because nothing goes into the mouth unless Poison Control directs it. Milk neither neutralizes iron nor slows absorption, and a full stomach can complicate the treatment that follows. Option c is incorrect because ipecac was withdrawn from practice years ago and families are told to discard any they still own. Vomiting risks aspiration and offers no benefit after an ingestion like this one. Option d is incorrect because driving off without guidance wastes the minutes when advice matters most. Poison Control can say whether this amount is dangerous, where to go, and what to bring along.

Correct Answer: Brief pauses in breathing with color change

Infants under six months often never whoop. They present with apnea, gasping, cyanosis and bradycardia, and mortality is highest under two months, so any breathing pause with color change demands immediate provider notification. Option b is incorrect because pertussis produces little or no fever during the catarrhal stage. A mild temperature with fussiness is worth documenting, yet it will not change the plan of care tonight. Option c is incorrect because runny nose and sneezing are exactly the cold-like features of the first stage. Expected findings guide teaching about contagiousness rather than an urgent call to the provider. Option d is incorrect because a longer sleep after feeding is ordinary infant behavior. Watch instead for the infant who tires during feeds or turns dusky, since those signal serious airway compromise.

Correct Answer: Offer a choice between two clean gowns

A real but bounded choice lets the toddler exercise will while the task still happens, which is exactly how the nurse supports autonomy versus shame and doubt. Never offer a choice you cannot honor. Option a is incorrect because reasoning depends on a grasp of cause and consequence a two-year-old barely has. Long explanations at this age wash past the child, who needs one short direction and a way to say yes. Option b is incorrect because overriding the toddler removes all control and breeds the shame and doubt half of the crisis. Force also teaches the child that resisting harder is the only remaining option. Option d is incorrect because waiting on a parent postpones care and rewards refusal without addressing the underlying need for control. The nurse can hand the child that control immediately, without an audience or a delay.

Correct Answer: Hold his hand and cross the street with him

A preschooler cannot judge how fast a car is moving or how far away it is, however well he recites the rule. He holds an adult's hand and never crosses a street alone. Option a is incorrect because reciting a rule and applying it under pressure are different skills. Praise is fine, yet letting him walk ahead leaves a child at the curb who may step out after a ball. Option b is incorrect because an older child is not a substitute for adult supervision at a road. School-age children misjudge traffic themselves and cannot control what a four-year-old does beside them. Option c is incorrect because quiet streets still carry cars, and drivers backing out of driveways see nobody that short. Independence at crossings comes years later, once speed and distance can be judged reliably.

Correct Answer: Respirations, apical pulse, temperature, then blood pressure

Least invasive comes first because crying raises the first three readings, and cuffs upset small children. Respirations, then pulse, then temperature, then blood pressure preserves accuracy at every step. Option a is incorrect because opening with the cuff guarantees an upset toddler for everything that follows. Once crying starts the pulse and respiratory counts climb, and the recorded numbers describe distress rather than baseline. Option c is incorrect because a rectal or tympanic temperature disturbs the child at the outset, and radial pulses are unreliable under two years. Both choices in this order undermine the data. Option d is incorrect because listening to the apex requires touching the child first, and the cuff then lands before respirations are ever counted. Counting last captures an agitated rate, not a resting one.