Essentials of Pediatric Nursing 4th Edition Kyle Carman Test Bank, Exams of Health sciences

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Essentials of Pediatric Nursing 4th Edition Kyle Carman Test Bank CHAPTER 1 Introduction to Child Health and Pediatric Nursing MULTIPLE CHOICE

1. A nurse is planning a teaching session for parents of preschool children. Which statement explains why the nurse should include information about morbidity and mortality? a. Life-span statistics are included in the data. b. It explains effectiveness of treatment. c. Cost-effective treatment is detailed for the general population. d. High-risk age groups for certain disorders or hazards are identified. ANS: D Analysis of morbidity and mortality data provides the parents with information about which groups of individuals are at risk for which health problems. Life-span statistics is a part of the mortality data. Treatment modalities and cost are not included in morbidity and mortality data. PTS: 1 DIF: Cognitive Level: Apply REF: 6- TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance
2. A clinic nurse is planning a teaching session about childhood obesity prevention for parents of school-age children. The nurse should include which associated risk of obesity in the teaching plan? a. Type I diabetes b. Respiratory disease c. Celiac disease d. Type II diabetes ANS: D Childhood obesity has been associated with the rise of type II diabetes in children. Type I diabetes is not associated with obesity and has a genetic component. Respiratory disease is not associated with obesity, and celiac disease is the inability to metabolize gluten in foods and is not associated with obesity. PTS: 1 DIF: Cognitive Level: Apply REF: 3 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance
3. Which is the leading cause of death in infants younger than 1 year? a. Congenital anomalies b. Sudden infant death syndrome c. Respiratory distress syndrome d. Bacterial sepsis of the newborn ANS: A Congenital anomalies account for 20.1% of deaths in infants younger than 1 year. Sudden infant death syndrome accounts for 8.2% of deaths in this age group. Respiratory distress syndrome accounts for 3.4% of deaths in this age group. Infections specific to the perinatal period account for 2.7% of deaths in this age group.

PTS: 1 DIF: Cognitive Level: Remember REF: 7 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

4. Which leading cause of death topic should the nurse emphasize to a group of African- American boys ranging in ages 15 to 19 years? a. Suicide b. Cancer c. Firearm homicide d. Occupational injuries ANS: C Firearm homicide is the second overall cause of death in this age group and the leading cause of death in African-American males. Suicide is the third-leading cause of death in this population. Cancer, although a major health problem, is the fourth-leading cause of death in this age group. Occupational injuries do not contribute to a significant death rate for this age group. PTS: 1 DIF: Cognitive Level: Understand REF: 5 | 8 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance
5. Which is the major cause of death for children older than 1 year? a. Cancer b. Heart disease c. Unintentional injuries d. Congenital anomalies ANS: C Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. Congenital anomalies are the leading cause of death in those younger than 1 year. Cancer ranks either second or fourth, depending on the age group, and heart disease ranks fifth in the majority of the age groups. PTS: 1 DIF: Cognitive Level: Remember REF: 8 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance
6. Which is the leading cause of death from unintentional injuries for females ranging in age from 1 to 14? a. Mechanical suffocation b. Drowning c. Motorvehicle-related fatalities d. Fire- and burn-related fatalities ANS: C Motorvehicle-related fatalities are the leading cause of death for females ranging in age from 1 to 14, either as passengers or as pedestrians. Mechanical suffocation is fourth or fifth, depending on the age. Drowning is the second- or third-leading cause of death, depending on the age. Fire- and burn-related fatalities are the second-leading cause of death. PTS: 1 DIF: Cognitive Level: Remember REF: 4 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

7. Which factor most impacts the type of injury a child is susceptible to, according to the childs age? a. Physical health of the child b. Developmental level of the child c. Educational level of the child d. Number of responsible adults in the home ANS: B The childs developmental stage determines the type of injury that is likely to occur. The childs physical health may facilitate the childs recovery from an injury but does not impact the type of injury. Educational level is related to developmental level, but it is not as important as the childs developmental level in determining the type of injury. The number of responsible adults in the home may affect the number of unintentional injuries, but the type of injury is related to the childs developmental stage. PTS: 1 DIF: Cognitive Level: Understand REF: 3- TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance
8. Which is now referred to as the new morbidity? a. Limitations in the major activities of daily living b. Unintentional injuries that cause chronic health problems c. Discoveries of new therapies to treat health problems d. Behavioral, social, and educational problems that alter health ANS: D The new morbidity reflects the behavioral, social, and educational problems that interfere with the childs social and academic development. It is currently estimated that the incidence of these issues is from 5% to 30%. Limitations in major activities of daily living and unintentional injuries that result in chronic health problems are included in morbidity data. Discovery of new therapies would be reflected in changes in morbidity data over time. PTS: 1 DIF: Cognitive Level: Remember REF: 3 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance
9. A nurse on a pediatric unit is practicing family-centered care. Which is most descriptive of the care the nurse is delivering? a. Taking over total care of the child to reduce stress on the family b. Encouraging family dependence on health care systems c. Recognizing that the family is the constant in a childs life d. Excluding families from the decision-making process ANS: C The three key components of family-centered care are respect, collaboration, and support. Family-centered care recognizes the family as the constant in the childs life. Taking over total care does not include the family in the process and may increase stress instead of reducing stress. The family should be enabled and empowered to work with the health care system. The family is expected to be part of the decision-making process. PTS: 1 DIF: Cognitive Level: Remember REF: 8 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance

10. The nurse is preparing an in-service education to staff about atraumatic care for pediatric patients. Which intervention should the nurse include? a. Prepare the child for separation from parents during hospitalization by reviewing a video. b. Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal. c. Help the child accept the loss of control associated with hospitalization. d. Help the child accept pain that is connected with a treatment or procedure. ANS: B Preparing the child for any unfamiliar treatments, controlling pain, allowing privacy, providing play activities for expression of fear and aggression, providing choices, and respecting cultural differences are components of atraumatic care. In the provision of atraumatic care, the separation of child from parents during hospitalization is minimized. The nurse should promote a sense of control for the child. Preventing and minimizing bodily injury and pain are major components of atraumatic care. PTS: 1 DIF: Cognitive Level: Understand REF: 9 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Psychosocial Integrity
11. Which is most suggestive that a nurse has a nontherapeutic relationship with a patient and family? a. Staff is concerned about the nurses actions with the patient and family. b. Staff assignments allow the nurse to care for same patient and family over an extended time. c. Nurse is able to withdraw emotionally when emotional overload occurs but still remains committed. d. Nurse uses teaching skills to instruct patient and family rather than doing everything for them. ANS: A An important clue to a nontherapeutic staff-patient relationship is concern of other staff members. Allowing the nurse to care for the same patient over time would be therapeutic for the patient and family. Nurses who are able to somewhat withdraw emotionally can protect themselves while providing therapeutic care. Nurses using teaching skills to instruct patient and family will assist in transitioning the child and family to self-care. PTS: 1 DIF: Cognitive Level: Analyze REF: 9 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity
12. Which is most descriptive of clinical reasoning? a. A simple developmental process b. Purposeful and goal-directed c. Based on deliberate and irrational thought d. Assists individuals in guessing what is most appropriate ANS: B Clinical reasoning is a complex, developmental process based on rational and deliberate thought. Clinical reasoning is not a developmental process. Clinical reasoning is based on rational and deliberate thought. Clinical reasoning is not a guessing process. PTS: 1 DIF: Cognitive Level: Understand REF: 12

TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care

13. A nurse makes the decision to apply a topical anesthetic to a childs skin before drawing blood. Which ethical principle is the nurse demonstrating? a. Autonomy b. Beneficence c. Justice d. Truthfulness ANS: B Beneficence is the obligation to promote the patients well-being. Applying a topical anesthetic before drawing blood promotes reducing the discomfort of the venipuncture. Autonomy is the patients right to be self-governing. Justice is the concept of fairness. Truthfulness is the concept of honesty. PTS: 1 DIF: Cognitive Level: Understand REF: 11 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiological Integrity
14. Which action by the nurse demonstrates use of evidence-based practice (EBP)? a. Gathering equipment for a procedure b. Documenting changes in a patients status c. Questioning the use of daily central line dressing changes d. Clarifying a physicians prescription for morphine ANS: C The nurse who questions the daily central line dressing change is ascertaining whether clinical interventions result in positive outcomes for patients. This demonstrates evidence-based practice (EBP), which implies questioning why something is effective and whether a better approach exists. Gathering equipment for a procedure and documenting changes in a patients status are practices that follow established guidelines. Clarifying a physicians prescription for morphine constitutes safe nursing care. PTS: 1 DIF: Cognitive Level: Apply REF: 11 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care
15. A nurse is admitting a toddler to the hospital. The toddler is with both parents and is currently sitting comfortably on a parents lap. The parents state they will need to leave for a brief period. Which type of nursing diagnosis should the nurse formulate for this child? a. Risk for anxiety b. Anxiety c. Readiness for enhanced coping d. Ineffective coping ANS: A A potential problem is categorized as a risk. The toddler has a risk to become anxious when the parents leave. Nursing interventions will be geared toward reducing the risk. The child is not showing current anxiety or ineffective coping. The child is not at a point for readiness for enhanced coping, especially because the parents will be leaving. PTS: 1 DIF: Cognitive Level: Remember REF: 12 TOP: Integrated Process: Nursing Process: Diagnosis

MSC: Area of Client Needs: Health Promotion and Maintenance

16. A child has a postoperative appendectomy incision covered by a dressing. The nurse has just completed a prescribed dressing change for this child. Which description is an accurate documentation of this procedure? a. Dressing change to appendectomy incision completed, child tolerated procedure well, parent present b. No complications noted during dressing change to appendectomy incision c. Appendectomy incision non-reddened, sutures intact, no drainage noted on old dressing, new dressing applied, procedure tolerated well by child d. No changes to appendectomy incisional area, dressing changed, child complained of pain during procedure, new dressing clean, dry and intact ANS: C The nurse should document assessments and reassessments. Appearance of the incision described in objective terms should be included during a dressing change. The nurse should document patients response and the outcomes of the care provided. In this example, these include drainage on the old dressing, the application of the new dressing, and the childs response. The other statements partially fulfill the requirements of documenting assessments and reassessments, patients response, and outcome, but do not include all three. PTS: 1 DIF: Cognitive Level: Analyze REF: 14 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care
17. A nurse is planning a class on accident prevention for parents of toddlers. Which safety topic is the priority for this class? a. Appropriate use of car seat restraints b. Safety crossing the street c. Helmet use when riding a bicycle d. Poison control numbers ANS: A Motor vehicle accidents (MVAs) continue to be the most common cause of death in children older than 1 year, therefore the priority topic is appropriate use of car seat restraints. Safety crossing the street and bicycle helmet use are topics that should be included for preschool parents but are not priorities for parents of toddlers. Information about poison control is important for parents of toddlers and would be a safety topic to include but is not the priority over appropriate use of car seat restraints. PTS: 1 DIF: Cognitive Level: Apply REF: 3- TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE
18. Which behaviors by the nurse indicate a therapeutic relationship with children and families? (Select all that apply.) a. Spending off-duty time with children and families b. Asking questions if families are not participating in the care c. Clarifying information for families d. Buying toys for a hospitalized child e. Learning about the familys religious preferences

ANS: B, C, E

Asking questions if families are not participating in the care, clarifying information for families, and learning about the familys religious preferences are positive actions and foster therapeutic relationships with children and families. Spending off-duty time with children and families and buying toys for a hospitalized child are negative actions and indicate overinvolvement with children and families, which is nontherapeutic. PTS: 1 DIF: Cognitive Level: Understand REF: 9- TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Psychosocial Integrity ESSAY

1. A nurse is formulating a clinical question for evidence-based practice. Place in order the steps the nurse should use to clarify the scope of the problem and clinical topic of interest. Begin with the first step of the process and proceed ordering the steps ending with the final step of the process. Provide answer as lowercase letters separated by commas (e.g., a, b, c, d, e). a. Intervention b. Outcome c. Population d. Time e. Control ANS: c, a, e, b, d When formulating a clinical question for evidence-based practice, the nurse should follow a concise, organized way that allows for clear answers. Good clinical questions should be asked in the PICOT (population, intervention, control, outcome, time) format to assist with clarity and literature searching. PICOT questions assist with clarifying the scope of the problem and clinical topic of interest. CHAPTER 2 Factors Influencing Child Health MULTIPLE CHOICE
2. A nurse is selecting a family theory to assess a patients family dynamics. Which family theory best describes a series of tasks for the family throughout its life span? a. Interactional theory b. Developmental systems theory c. Structural-functional theory d. Duvalls developmental theory ANS: D Duvalls developmental theory describes eight developmental tasks of the family throughout its life span. Interactional theory and structural-functional theory are not family theories. Developmental systems theory is an outgrowth of Duvalls theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. PTS: 1 DIF: Cognitive Level: Understand REF: 24- TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

2. Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Interactional theory b. Developmental systems theory c. Family stress theory d. Duvalls developmental theory ANS: C Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction. Interactional theory is not a family theory. Interactions are the basis of general systems theory. Developmental systems theory is an outgrowth of Duvalls theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. Duvalls developmental theory describes eight developmental tasks of the family throughout its life span. PTS: 1 DIF: Cognitive Level: Understand REF: 24 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance
3. Which is the term for a family in which the paternal grandmother, the parents, and two minor children live together? a. Blended b. Nuclear c. Binuclear d. Extended ANS: D An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one step-parent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. PTS: 1 DIF: Cognitive Level: Remember REF: 24- TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance
4. A nurse is assessing a familys structure. Which describes a family in which a mother, her children, and a stepfather live together? a. Blended b. Nuclear c. Binuclear d. Extended ANS: A A blended family contains at least one step-parent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the

parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. PTS: 1 DIF: Cognitive Level: Understand REF: 24- TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

5. Which is considered characteristic of children who are the youngest in their family? a. More dependent than firstborn children b. More outgoing than firstborn children c. Identify more with parents than with peers d. Are subject to greater parental expectations ANS: B Later-born children are obliged to interact with older siblings from birth and seem to be more outgoing and make friends more easily than firstborns. Being more dependent, identifying more with parents than peers, and being subject to greater parental expectations are characteristics of firstborn children and only children. PTS: 1 DIF: Cognitive Level: Understand REF: 29- TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance
6. Parents of a firstborn child are asking whether it is normal for their child to be extremely competitive. The nurse should respond to the parents that studies about the ordinal position of children suggest that firstborn children tend to: a. be praised less often. b. be more achievement oriented. c. be more popular with the peer group. d. identify with peer group more than parents. ANS: B Firstborn children, like only children, tend to be more achievement-oriented. Being praised less often, being more popular with the peer group, and identifying with peer groups more than parents are characteristics of later-born children. PTS: 1 DIF: Cognitive Level: Apply REF: 29 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance
7. A 35-year-old client is currently on fertility treatments. When responding to a question from the client about multiple births, which statement by the nurse is accurate? a. Use of fertility treatments has been associated with an increase in multiple births. b. Your chance of having multiple births is at the same rate as all women of childbearing age. c. There is not enough evidence about the use of fertility treatments increasing the rate of multiple births. d. Because of your age and the fertility treatments, you have almost a 100% chance of a multiple birth. ANS: A Because women in their thirties are almost 2.5 times as likely as women in their twenties to have higher-order plural births, increased childbearing among older women and the

expanded use of fertility drugs have been associated with an increase in the multiple-birth ratio. The rate of having a multiple birth for this client is not the same for all women of childbearing age. There are data indicating that fertility treatments increase the rate of multiple births, but fertility treatments do not have a 100% rate of multiple births. PTS: 1 DIF: Cognitive Level: Understand REF: 30 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems

8. Nicole and Kelly, age 5 years, are identical twins. Their parents tell the nurse that the girls always want to be together. The nurses suggestions should be based on which statement? a. Some twins thrive best when they are constantly together. b. Individuation cannot occur if twins are together too much. c. Separating twins at an early age helps them develop mentally. d. When twins are constantly together, pathologic bonding occurs. ANS: A Twins work out a relationship that is reasonably satisfactory to both. They develop a remarkable capacity for cooperative play and considerable loyalty and generosity toward each other. Parents should foster individual differences and allow the children to follow their natural inclinations. Individuation does occur. In twinship, one member of the pair is more dominant, outgoing, and assertive than the other. Early separation may produce unnecessary stresses for the children. There is no evidence that pathologic bonding occurs when twins are constantly together. PTS: 1 DIF: Cognitive Level: Understand REF: 30- TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance
9. The nurse is teaching a group of new parents about the experience of role transition. Which statement by a parent would indicate a correct understanding of the teaching? a. My marital relationship can have a positive or negative effect on the role transition. b. If an infant has special care needs, the parents sense of confidence in their new role is strengthened. c. Young parents can adjust to the new role easier than older parents. d. A parents previous experience with children makes the role transition more difficult. ANS: A If parents are supportive of each other, they can serve as positive influences on establishing satisfying parental roles. When marital tensions alter caregiving routines and interfere with the enjoyment of the infant, then the marital relationship has a negative effect. Infants with special care needs can be a significant source of added stress. Older parents are usually more able to cope with the greater financial responsibilities, changes in sleeping habits, and reduced time for each other and other children. Parents who have previous experience with parenting appear more relaxed, have less conflict in disciplinary relationships, and are more aware of normal growth and development. PTS: 1 DIF: Cognitive Level: Understand REF: 31- TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance
10. When assessing a family, the nurse determines that the parents exert little or no control over their children. This style of parenting is called:

a. permissive. b. dictatorial. c. democratic. d. authoritarian. ANS: A Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their childrens actions. Dictatorial or authoritarian parents attempt to control their childrens behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their childrens behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect the childs individual nature. PTS: 1 DIF: Cognitive Level: Remember REF: 33 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance

11. When discussing discipline with the mother of a 4-year-old child, the nurse should include which instruction? a. Children as young as 4 years old rarely need to be punished. b. Parental control should be consistent. c. Withdrawal of love and approval is effective at this age. d. One should expect rules to be followed rigidly and unquestioningly. ANS: B For effective discipline, parents must be consistent and must follow through with agreed- on actions. Realistic goals should be set for this age group. Parents should structure the environment to prevent unnecessary difficulties. Requests for behavior change should be phrased in a positive manner to provide direction for the child. Withdrawal of love and approval is never appropriate or effective. Discipline strategies should be appropriate to the childs age, temperament, and severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old. PTS: 1 DIF: Cognitive Level: Apply REF: 33 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance
12. Which is most characteristic of the physical punishment of children, such as spanking? a. Psychological impact is usually minimal. b. Children rarely become accustomed to spanking. c. Childrens development of reasoning increases. d. Misbehavior is likely to occur when parents are not present. ANS: D Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake, but rather out of fear of punishment. Spanking can cause severe physical and psychological injury and interfere with effective parent-child interaction. Children do become accustomed to spanking, requiring more

severe corporal punishment each time. The use of corporal punishment may interfere with the childs development of moral reasoning. PTS: 1 DIF: Cognitive Level: Understand REF: 35 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

13. A 3-year-old girl was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guidelines concerning adoption should the nurse use in planning a response? a. Telling the child is an important aspect of their parental responsibilities. b. The best time to tell the child is between ages 7 and 10 years. c. It is not necessary to tell the child who was adopted so young. d. It is best to wait until the child asks about it. ANS: A It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the childs identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to keep third parties from telling the children before the parents have had the opportunity. PTS: 1 DIF: Cognitive Level: Understand REF: 36 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance
14. A parent of a school-age child is going through a divorce. The parent tells the school nurse the child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as which implication? a. Indication of maladjustment b. Common reaction to divorce c. Lack of adequate parenting d. Unusual response that indicates need for referral ANS: B Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. This is not an indication of maladjustment, suggestive of lack of adequate parent, or an unusual response that indicates need for referral in school-age children after parental divorce. PTS: 1 DIF: Cognitive Level: Apply REF: 37 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Psychosocial Integrity
15. A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, I want to go back to work, but I dont want Eric to suffer because Ill have less time with him. The nurses most appropriate answer would be which statement? a. Im sure hell be fine if you get a good babysitter. b. You will need to stay home until Eric starts school. c. You should go back to work so Eric will get used to being with others. d. Lets talk about the child-care options that will be best for Eric. ANS: D

Lets talk about the child-care options that will be best for Eric is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. Im sure hell be fine if you get a good babysitter, You will need to stay home until Eric starts school, and You should go back to work so Eric will get used to being with others are directive statements. They do not address the effect of her working on Eric. PTS: 1 DIF: Cognitive Level: Apply REF: 40 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity MULTIPLE RESPONSE

1. Dunst, Trivette, and Deal identified the qualities of strong families that help them function effectively. Which qualities are included? (Select all that apply.) a. Ability to stay connected without spending time together b. Clear set of family values, rules, and beliefs c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events d. Sense of commitment toward growth of individual family members as opposed to that of the family unit e. Ability to engage in problem-solving activities f. Sense of balance between the use of internal and external family resources ANS: B, E, F A clear set of family rules, values, and beliefs that establishes expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families also are able to engage in problem-solving activities and to find a balance between internal and external forces. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Strong families also use varied coping strategies. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit. PTS: 1 DIF: Cognitive Level: Understand REF: 28 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance
2. A nurse is conducting a teaching session on the use of time-out as a discipline measure to parents of toddlers. Which are correct strategies the nurse should include in the teaching session? (Select all that apply.) a. Time-out as a discipline measure cannot be used when in a public place. b. A rule for the length of time-out is 1 minute per year. c. When the child misbehaves, one warning should be given. d. The area for time-out can be in the family room where the child can see the television. e. When the child is quiet for the specified time, he or she can leave the room. ANS: B, C, E A rule for the length of time-out is 1 minute per year of age; use a kitchen timer with an audible bell to record the time rather than a watch. When the child misbehaves, one warning should be given. When the child is quiet for the duration of the time, he or she can then leave the room. Time-out can be used in public places and the parents should be consistent on the use of time-out. Implement time-out in a public place by selecting a suitable area or explain to children that time-out will be spent immediately on returning

home. The time-out should not be spent in an area from which the child can view the television. Select an area for time-out that is safe, convenient, and unstimulating but where the child can be monitored, such as the bathroom, hallway, or laundry room. PTS: 1 DIF: Cognitive Level: Apply REF: 35 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

3. Divorced parents of a preschool child are asking whether their child will display any feelings or behaviors related to the effect of the divorce. The nurse is correct when explaining that the parents should be prepared for which type of behaviors? (Select all that apply.) a. Displaying fears of abandonment b. Verbalizing that he or she is the reason for the divorce c. Displaying fear regarding the future d. Ability to disengage from the divorce proceedings e. Engaging in fantasy to understand the divorce ANS: A, B, E A child 3 to 5 years of age (preschool) may display fears of abandonment, verbalize feelings that he or she is the reason for the divorce, and engage in fantasy to understand the divorce. They would not be displaying fear regarding the future until school age, and the ability to disengage from the divorce proceedings would be characteristic of an adolescent. PTS: 1 DIF: Cognitive Level: Apply REF: 38 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Teaching and Learning COMPLETION
4. A nurse is admitting a child, in foster care, to the hospital. The nurse recognizes that foster parents care for the child hours a day. (Record your answer as a whole number.) ANS: 24 The term foster care is defined as 24-hour substitute care for children outside of their own homes. PTS: 1 DIF: Cognitive Level: Understand REF: 41 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance
5. A parent of a newborn is expressing concern about returning to work after taking time off under the Family and Medical Leave Act (FMLA). The nurse understands that the Act allows a new parent to take off from work for weeks. (Record your answer as a whole number.) ANS: 12 The passage of the Family and Medical Leave Act (FMLA) in 1993 set the stage for a greater focus on the issues of contemporary families. FMLA allows eligible employees to take up to 12 weeks of unpaid leave each year to care for newborn or newly adopted children, parents, or spouses who have serious health conditions or to recover from their own serious health condition.

CHAPTER 3 Growth and Development of the Newborn and Infant MULTIPLE CHOICE

1. Which is defined as a vaguely outlined area of edematous tissue situated over the portion of the scalp that presents in a vertex delivery? a. Caput succedaneum b. Hydrocephalus c. Cephalhematoma d. Subdural hematoma ANS: A A vaguely outlined area of edematous tissue situated over the portion of the scalp that presents in a vertex delivery is the definition of a caput succedaneum. The swelling consists of serum and/or blood accumulated in the tissues above the bone, and it may extend beyond the bone margin. Hydrocephalus is caused by an imbalance in production and absorption of cerebrospinal fluid. When production exceeds absorption, fluid accumulates within the ventricular system, causing dilation of the ventricles. A cephalhematoma has sharply demarcated boundaries that do not extend beyond the limits of the (bone) suture line. A subdural hematoma is located between the dura and the cerebrum. It would not be visible on the scalp. PTS: 1 DIF: Cognitive Level: Remember REF: 229 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance
2. Which finding on a newborn assessment should the nurse recognize as suggestive of a clavicle fracture? a. Negative scarf sign b. Asymmetric Moro reflex c. Swelling of fingers on affected side d. Paralysis of affected extremity and muscles ANS: B A newborn with a broken clavicle may have no symptoms. The Moro reflex, which results in sudden extension and abduction of the extremities followed by flexion and adduction of the extremities, will most likely be asymmetric. The scarf sign that is used to determine gestational age should not be performed if a broken clavicle is suspected. Swelling of fingers on affected side and paralysis of affected extremity and muscles are not indicative of a fractured clavicle. PTS: 1 DIF: Cognitive Level: Analyze REF: 230 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance
3. The parents of a newborn ask the nurse what caused the babys facial nerve paralysis. The nurses response is based on knowledge that this is caused by a(n): a. genetic defect. b. birth injury. c. spinal cord injury. d. inborn error of metabolism. ANS: B

Pressure on the facial nerve during delivery may result in injury to cranial nerve VII, which can occur with birth injury. A genetic defect, spinal cord injury, or inborn error of metabolism would not cause facial paralysis. PTS: 1 DIF: Cognitive Level: Understand REF: 231 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

4. A mother is upset because her newborn has erythema toxicum neonatorum. The nurse should reassure her that this is: a. easily treated. b. benign and transient. c. usually not contagious. d. usually not disfiguring. ANS: B Erythema toxicum neonatorum, or newborn rash, is a benign, self-limiting eruption of unknown cause that usually appears within the first 2 days of life. The rash usually lasts about 5 to 7 days. No treatment is indicated. Erythema toxicum neonatorum is not contagious. Successive crops of lesions heal without pigmentation. PTS: 1 DIF: Cognitive Level: Apply REF: 232 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance
5. What is oral candidiasis (thrush) in the newborn? a. Bacterial infection that is life threatening in the neonatal period b. Bacterial infection of mucous membranes that responds readily to treatment c. Yeastlike fungal infection of mucous membranes that is relatively common d. Benign disorder that is transmitted from mother to newborn during the birth process only ANS: C Oral candidiasis, characterized by white adherent patches on the tongue, palate, and inner aspects of the cheeks, is not uncommon in newborns. Candida albicans is the usual causative organism. Oral candidiasis is usually a benign disorder in the newborn, often confined to the oral and diaper regions. It is caused by a yeastlike organism and is treated with good hygiene, application of a fungicide, and correction of any underlying disorder. Thrush can be transmitted in several ways, including by maternal transmission during delivery; person-to-person transmission; and contaminated bottles, hands, or other objects. PTS: 1 DIF: Cognitive Level: Understand REF: 232 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance
6. Nursing care of the newborn with oral candidiasis (thrush) includes: a. avoiding use of pacifier. b. removing characteristic white patches with a soft cloth. c. continuing medication for a prescribed number of days. d. applying medication to oral mucosa, being careful that none is ingested. ANS: C The medication must be continued for the prescribed number of days. To prevent relapse, therapy should continue for at least 2 days after the lesions disappear. Pacifiers can be

used. The pacifier should be replaced with a new one or boiled for 20 minutes once daily. One of the characteristics of thrush is that the white patches cannot be removed. The medication is applied to the oral mucosa and then swallowed to treat Candida organisms in the gastrointestinal tract. PTS: 1 DIF: Cognitive Level: Apply REF: 233 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity

7. Which is a bright red, rubbery nodule with a rough surface and a well-defined margin that may be present at birth? a. Port-wine stain b. Juvenile melanoma c. Cavernous hemangioma d. Strawberry hemangioma ANS: D Strawberry hemangiomas or capillary hemangiomas are benign cutaneous tumors that involve capillaries only. They are bright red, rubbery nodules with rough surfaces and well-defined margin. They may or may not be apparent at birth but enlarge during the first year of life and tend to resolve spontaneously by age 2 to 3 years. Port-wine stain is a vascular stain that is a permanent lesion and is present at birth. Initially it is a pink, red, or, rarely, purple stain of the skin that is flat at birth and thickens, darkens, and proportionately enlarges as the child grows. Melanoma is not differentiated into juvenile and adult forms. A cavernous hemangioma involves deeper vessels in the dermis and has a bluish red color and poorly defined margins. PTS: 1 DIF: Cognitive Level: Understand REF: 234 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance
8. The parents of a newborn with a strawberry hemangioma ask the nurse what the treatment will be. The nurses response should be based on knowledge that: a. excision of the lesion will be necessary. b. injections of prednisone into the lesion will reduce it. c. no treatment is usually necessary because of the high rate of spontaneous involution. d. pulsed dye laser treatments will be necessary immediately to prevent permanent disability. ANS: C There is a high rate of spontaneous resolution, so treatment is usually not indicated for hemangiomas. Surgical removal would not be indicated. If steroids are indicated, then systemic prednisone is administered for 2 to 3 weeks. The pulse dye laser is used in the uncommon situation of potential visual or respiratory impairment. PTS: 1 DIF: Cognitive Level: Apply REF: 234 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance
9. Which term refers to a newborn born before completion of week 37 of gestation, regardless of birth weight? a. Postterm b. Premature c. Low birth weight

d. Small for gestational age ANS: B A premature newborn is any child born before 37 weeks of gestation, regardless of birth weight. A postterm or postmature newborn is any child born after 42 weeks of gestational age, regardless of birth weight. A lowbirth-weight newborn is a child whose birth weight is less than 2500 g, regardless of gestational age. A small-for-gestational- age (or small- for-date) newborn is any child whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on intrauterine growth curves. PTS: 1 DIF: Cognitive Level: Remember REF: 236 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

10. Which refers to a newborn whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on intrauterine growth charts? a. Postterm b. Postmature c. Low birth weight d. Small for gestational age ANS: D A small-for-gestational-age (or small-for-date) newborn is any child whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on intrauterine growth curves. A postterm or postmature newborn is any child born after 42 weeks of gestational age, regardless of birth weight. A lowbirth-weight newborn is a child whose birth weight is less than 2500 g, regardless of gestational age. PTS: 1 DIF: Cognitive Level: Remember REF: 236 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance
11. The nurse is caring for a very lowbirth-weight (VLBW) newborn with a peripheral intravenous infusion. Which statement describes nursing considerations regarding infiltration? a. Infiltration occurs infrequently because VLBW newborns are inactive. b. Continuous infusion pumps stop automatically when infiltration occurs. c. Hypertonic solutions can cause severe tissue damage if infiltration occurs. d. Infusion site should be checked for infiltration at least once per 8-hour shift. ANS: C Hypertonic fluids can damage cells if the fluid leaks from the vein. Careful monitoring is required to prevent severe tissue damage. Infiltrations occur for many reasons, not only activity. The vein, catheter, and fluid used all contribute to the possibility of infiltration. The continuous infusion pump may alarm when the pressure increases, but this does not alert the nurse to all infiltrations. Infusion rates and sites should be checked hourly to prevent tissue damage from extravasations, fluid overload, and dehydration. PTS: 1 DIF: Cognitive Level: Understand REF: 240 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Physiologic Integrity
12. The nurse is caring for a high-risk newborn with an umbilical catheter in a radiant warmer. The nurse notes blanching of the feet. Which is the most appropriate nursing action?

a. Elevate feet 15 degrees. b. Place socks on newborn. c. Wrap feet loosely in prewarmed blanket. d. Report findings immediately to the practitioner. ANS: D Blanching of the feet, in a newborn with an umbilical catheter, is an indication of vasospasm. Vasoconstriction of the peripheral vessels, triggered by the vasospasm, can seriously impair circulation. It is an emergency situation and must be reported immediately. PTS: 1 DIF: Cognitive Level: Apply REF: 240 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity

13. The mother of a preterm newborn asks the nurse when she can start breastfeeding. The nurse should explain that breastfeeding can be initiated when her newborn: a. achieves a weight of at least 3 pounds. b. indicates an interest in breastfeeding. c. does not require supplemental oxygen. d. has adequate sucking and swallowing reflexes. ANS: D Research supports that human milk is the best source of nutrition for term and preterm newborns. Preterm newborns should be breastfed as soon as they have adequate sucking and swallowing reflexes and no other complications such as respiratory complications or concurrent illnesses. Weight is not an issue. Interest in breastfeeding can be evaluated by having nonnutritive sucking at the breast during skin-to-skin kangaroo care so the mother and child may become accustomed to each other. Supplemental oxygen can be provided during breastfeeding by using a nasal cannula. PTS: 1 DIF: Cognitive Level: Analyze REF: 240 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance
14. Which is the most appropriate nursing action when intermittently gavage-feeding a preterm newborn? a. Allow formula to flow by gravity. b. Insert tube through nares rather than mouth. c. Avoid letting newborn suck on tube. d. Apply steady pressure to syringe to deliver formula to stomach in a timely manner. ANS: A The formula is allowed to flow by gravity. The length of time to complete the feeding will vary. Preferably, the tube is inserted through the mouth. Newborns are obligatory nose breathers, and the presence of the tube in the nose irritates the nasal mucosa. Passage of the tube through the mouth allows the nurse to observe and evaluate the sucking response. The feeding should not be done under pressure. This procedure is not used as a timesaver for the nurse. PTS: 1 DIF: Cognitive Level: Apply REF: 242 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity

15. A healthy, stable, preterm newborn will soon be discharged. The nurse should recommend which position for sleep? a. Prone b. Supine c. Side lying d. Position of comfort ANS: B The American Academy of Pediatrics recommends that healthy newborns be placed to sleep in a supine position. Other positions are associated with sudden infant death syndrome. The prone position can be used for supervised play. PTS: 1 DIF: Cognitive Level: Apply REF: 244 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance
16. Which intervention should the nurse implement to maintain the skin integrity of the premature newborn? a. Cleanse skin with a gentle alkaline-based soap and water. b. Cleanse skin with a neutral pH solution only when necessary. c. Thoroughly rinse skin with plain water after bathing in a mild hexachlorophene solution. d. Avoid cleaning skin. ANS: B The premature newborn should be given baths no more than two or three times per week with a neutral pH solution. The eyes, oral and diaper areas, and pressure points should be cleansed daily. Alkaline-based soaps might destroy the acid mantle of the skin. They should not be used. The increased permeability of the skin facilitates absorption of the chemical ingredients. The newborns skin must be cleaned to remove stool and urine, which are irritating to the skin. PTS: 1 DIF: Cognitive Level: Apply REF: 244 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity
17. Which is an important nursing action related to the use of tape and/or adhesives on premature newborns? a. Avoid using tape and adhesives until skin is more mature. b. Use solvents to remove tape and adhesives instead of pulling on skin. c. Remove adhesives with warm water or mineral oil. d. Use scissors carefully to remove tape instead of pulling tape off. ANS: C Warm water, mineral oil, or petrolatum can be used to facilitate the removal of adhesive. In the premature newborn, often it is impossible to avoid using adhesives and tape. The smallest amount of adhesive necessary should be used. Solvents should be avoided because they tend to dry and burn the delicate skin. Scissors should not be used to remove dressings or tape from the extremities of very small and immature newborns because it is easy to snip off tiny extremities or nick loosely attached skin. PTS: 1 DIF: Cognitive Level: Analyze REF: 244 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity

18. The nurse is caring for a 3-week-old preterm newborn born at 29 weeks of gestation. While taking vital signs and changing the newborns diaper, the nurse observes the newborns color is pink but slightly mottled, arms and legs are limp and extended, hiccups are present, and heart rate is regular and rapid. The nurse should recognize these behaviors as manifestations of: a. stress. b. subtle seizures. c. preterm behavior. d. onset of respiratory distress. ANS: A Color pink but slightly mottled, arms and legs limp and extended, hiccups, respiratory pauses and gasping, and an irregular, rapid heart rate are signs of stress or fatigue in a newborn. Neonatal seizures usually have some type of repetitive movement from twitching to rhythmic jerking movements. The behavior of a preterm newborn may be inactive and listless. Respiratory distress is exhibited by retractions and nasal flaring. PTS: 1 DIF: Cognitive Level: Understand REF: 247 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity
19. When is the best time for the neonatal intensive care unit (NICU) nurse to initiate an individualized stimulation program for the preterm newborn? a. As soon as possible after newborn is born b. As soon as parent is available to provide stimulation c. When newborn is over 38 weeks of gestation d. When developmental organization and stability are sufficient ANS: D Newborn stimulation is essential for growth and development. The appropriate time for the introduction of an individualized program is when developmental organization and stability are achieved at approximately 34 and 36 weeks of gestation. The newborn needs to be developmentally ready for a stimulation program. The newborn must be assessed to determine the readiness and appropriateness of the stimulation program. The program should be designed and implemented by the nursing staff. The family can be involved, as the nurses help teach the parents to be responsive to the childs cues, but the stimulation should not depend on the familys availability. An individualized stimulation program should be started when the child is developmentally ready. PTS: 1 DIF: Cognitive Level: Analyze REF: 248 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance
20. A preterm newborn, after spending 8 weeks in the NICU, is being discharged. The parents of the newborn express apprehension and worry that the newborn may still be in danger. The nurse should recognize that this is: a. normal. b. a reason to postpone discharge. c. suggestive of maladaptation. d. suggestive of inadequate bonding. ANS: A

Parents become apprehensive and excited as the time for discharge approaches. They have many concerns and insecurities regarding the care of their newborn. A major concern is that they may be unable to recognize signs of illness or distress in their newborn. Preparation for discharge should begin early and include helping the parent acquire the skills necessary for care. Apprehension and worry are normal adaptive responses. The NICU nurses should facilitate discharge by involving parents in care as soon as possible.

21. Recent studies indicate that a deficiency of which vitamin correlates with increased morbidity and mortality in children with measles? a. A b. C c. Niacin d. Folic acid ANS: A Vitamin A deficiency is correlated with increased morbidity and mortality in children with measles. This vitamin deficiency also is associated with complications from diarrhea, and infections are often increased in infants and children with vitamin A deficiency. No correlation exists between vitamins C, niacin, or folic acid and measles. PTS: 1 DIF: Cognitive Level: Remember REF: 355 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity
22. Which vitamin is recommended for all women of childbearing age to reduce the risk of neural tube defects such as spina bifida? a. A b. C c. Niacin d. Folic acid ANS: D The vitamin supplement that is recommended for all women of childbearing age is a daily dose of 0.4 mg of folic acid. Folic acid taken before conception and during pregnancy can reduce the risk of neural tube defects by 70%. No correlation exists between vitamins A, C, or folic acid and neural tube defects. PTS: 1 DIF: Cognitive Level: Remember REF: 355 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity
23. A nurse is assessing a child with kwashiorkor disease. Which assessment findings should the nurse expect? a. Thin wasted extremities with a prominent abdomen b. Constipation c. Elevated hemoglobin d. High levels of protein ANS: A The child with kwashiorkor has thin, wasted extremities and a prominent abdomen from edema (ascites). Diarrhea (persistent diarrhea malnutrition syndrome) not constipation commonly occurs from a lowered resistance to infection and further complicates the

electrolyte imbalance. Anemia and protein deficiency is a common finding in malnourished children with kwashiorkor. PTS: 1 DIF: Cognitive Level: Understand REF: 357 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity

24. A nurse is preparing to accompany a medical missions team to a third world country. Marasmus is seen frequently in children 6 months to 2 years in this country. Which symptoms should the nurse expect for this condition? a. Loose, wrinkled skin b. Edematous skin c. Depigmentation of the skin d. Dermatoses ANS: A Marasmus is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears to be very old, with loose and wrinkled skin, unlike the child with kwashiorkor, who appears more rounded from the edema. Fat metabolism is less impaired than in kwashiorkor; thus, deficiency of fat-soluble vitamins is usually minimal or absent. In general, the clinical manifestations of marasmus are similar to those seen in kwashiorkor with the following exceptions: With marasmus, there is no edema from hypoalbuminemia or sodium retention, which contributes to a severely emaciated appearance; no dermatoses caused by vitamin deficiencies; little or no depigmentation of hair or skin; moderately normal fat metabolism and lipid absorption; and a smaller head size and slower recovery after treatment. PTS: 1 DIF: Cognitive Level: Understand REF: 357 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity
25. Rickets is caused by a deficiency in: a. vitamin A. b. vitamin C. c. vitamin D and calcium. d. folic acid and iron. ANS: C Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent the development of rickets. No correlation exists between vitamins A, C, folic acid, or iron and rickets. PTS: 1 DIF: Cognitive Level: Remember REF: 355 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity
26. A nurse is preparing to administer an oral iron supplement to a hospitalized infant. Which should not be given simultaneously with the iron supplement? a. Milk b. Multivitamin c. Fruit juice d. Meat, fish, poultry ANS: A

Many foods interfere with iron absorption and should be avoided when the iron is consumed. These foods include phosphates found in milk, phytates found in cereals, and oxalates found in many vegetables. Multivitamins may contain iron; no contraindication exists to taking the two together. Vitamin Ccontaining juices enhance the absorption of iron. Meat, fish, and poultry do not have an effect on absorption. PTS: 1 DIF: Cognitive Level: Understand REF: 356 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity

27. Parents report that they have been giving a multivitamin to their 1-year-old infant. The nurse counsels the parents that which vitamin can cause a toxic reaction at a low dose? a. Niacin b. B6 c. D d. C ANS: C Hypervitaminosis of vitamin D presents the greatest problem because this fat-soluble vitamin is stored in the body. Vitamin D is the most likely of all vitamins to cause toxic reactions in relatively small overdoses. The water-soluble vitamins, primarily niacin, B6, and C, can also cause toxicity but not at the low dose that occurs with vitamin D. PTS: 1 DIF: Cognitive Level: Understand REF: 355 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity
28. The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their child. Which is most likely lacking in their particular diet? a. Fat b. Protein c. Vitamins C and A d. Complete protein ANS: D The vegetarian diet can be extremely healthy, meeting the overall nutrition objectives for Healthy People. Parents should be taught about food preparation to ensure that complete proteins are available for growth. When parents use a strict vegetarian diet, likelihood exists of inadequate protein for growth and calories for energy. Fat and vitamins C and A are readily available from vegetable sources. Plant proteins are available. Foods must be combined to provide complete proteins for growth. PTS: 1 DIF: Cognitive Level: Understand REF: 356 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity
29. Which describes marasmus? a. Deficiency of protein with an adequate supply of calories b. Not confined to geographic areas where food supplies are inadequate c. Syndrome that results solely from vitamin deficiencies d. Characterized by thin, wasted extremities and a prominent abdomen resulting from edema (ascites) ANS: B

Marasmus is a syndrome of emotional and physical deprivation. It is not confined to geographic areas were food supplies are inadequate. Marasmus is a deficiency of both protein and calories. It is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears very old, with flabby and wrinkled skin. PTS: 1 DIF: Cognitive Level: Remember REF: 357 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity

30. Although infants may be allergic to a variety of foods, the most common allergens are: a. fruit and eggs. b. fruit, vegetables, and wheat. c. cows milk and green vegetables. d. eggs, cows milk, and wheat. ANS: D Milk products, eggs, and wheat are three of the most common food allergens. Ingestion of these products can cause sensitization and, with subsequent exposure, an allergic reaction. Eggs are a common allergen, but fruit is not. Wheat is a common allergen, but fruit and vegetables are not. Cows milk is a common allergen, but green vegetables are not. CHAPTER 4 Growth and Development of the Toddler MULTIPLE CHOICE
31. Which factor is most important in predisposing toddlers to frequent infections? a. Respirations are abdominal. b. Pulse and respiratory rates are slower than those in infancy. c. Defense mechanisms are less efficient than those during infancy. d. Toddlers have a short, straight internal ear canal and large lymph tissue. ANS: D Toddlers continue to have the short, straight internal ear canal of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose the toddler to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy. PTS: 1 DIF: Cognitive Level: Analyze REF: 379 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity
32. The psychosocial developmental tasks of toddlerhood include which characteristic? a. Development of a conscience b. Recognition of sex differences c. Ability to get along with age-mates d. Ability to delay gratification ANS: D If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that the toddler is concerned with is the ability to delay gratification. Development of a conscience occurs during the preschool years. The recognition of sex differences occurs during the preschool years.