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During the nursing assessment, which of the following suggests that the mother may be continuing to abuse heroin?
- A. The mother states, 'I am tired all the time and find myself needing to sleep when the baby sleeps.'
- B. The nurse notes a variety of small ecchymotic areas on the arms and legs of the mother.
- C. The mother appears indifferent to the crying of the newborn.
- D. The mother has a body odor and the newborn appears unkempt.
- E. The mother expresses an inability to afford public transportation to the clinic.
- F. The mother states that the father of the child is no longer associated with the family.
Correct Answer: B,C,D
Rationale: Ecchymotic areas suggest injection sites, indifference may indicate substance use, and poor hygiene is a common sign of ongoing abuse.
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The nurse correctly explains that this is normal behavior for toddlers who are developing which psychosocial characteristic?
- A. Integrity
- B. Identity
- C. Autonomy
- D. Generativity
Correct Answer: C
Rationale: The 'no' phase reflects toddlers asserting autonomy, per Erikson's stages.
Which of the following information documented by the nurse provides the most evidence that the mother is bonding with her newborn with Down syndrome?
- A. The mother smiles and talks to the baby.
- B. The mother asks questions about infant care.
- C. The mother wants to see visitors who come.
- D. The mother feeds and burps the baby.
Correct Answer: A
Rationale: Smiling and talking to the baby indicate emotional engagement and attachment, key signs of bonding.
If this child is typical of others the same age with a serious illness, which concept is the most commonly held belief about being ill?
- A. Illness is not life-threatening; recovery is assured.
- B. Significant others can prevent serious consequences.
- C. Illness is a punishment for some wrong-doing.
- D. Failure to comply with treatment results in parental rejection.
Correct Answer: C
Rationale: School-age children often view illness as punishment due to magical thinking.
What is the most appropriate recommendation for eliminating the 2-year-old's tantrums?
- A. Give the child candy before entering the store.
- B. Ask the child to stop kicking and screaming.
- C. Explain to the child that this behavior is childish.
- D. Remind the child of how a big person acts.
Correct Answer: B
Rationale: Calmly addressing the behavior sets boundaries without reinforcing it.
If the mother asks the nurse how to appropriately discipline a child of this age, which response by the nurse is most appropriate?
- A. By identifying the consequences of unacceptable behavior to the nurse.
- B. By showing disapproval immediately after an unacceptable act
- C. By administering some form of moderate physical punishment
- D. By explaining to the toddler why certain behavior is undesirable
Correct Answer: B
Rationale: Immediate disapproval helps toddlers associate behavior with consequences.