Download Essentials of Pediatric Nursing 4th Edition Kyle Carman Test Bank and more Exams Health sciences in PDF only on Docsity! Pediatric TB 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: 6-8 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. Pediatric TB 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 Pediatric TB 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 Pediatric TB 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: 3-4 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. 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 Pediatric TB 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: 9-10 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 1. 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: 24-26 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance Pediatric TB 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: 30-31 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: 31-32 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: Pediatric TB 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 Pediatric TB 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 Pediatric TB 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 Pediatric TB 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 Pediatric TB 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 Pediatric TB 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 Pediatric TB 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 Pediatric TB 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 Pediatric TB 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 1. 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 2. 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. Pediatric TB The ability to get along with age-mates develops during the preschool and school-age years. PTS: 1 DIF: Cognitive Level: Understand REF: 380 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 3. The child of 15 to 30 months is likely to be struggling with which developmental task? a. Trust b. Initiative c. Autonomy d. Intimacy ANS: C Autonomy vs shame and doubt is the developmental task of toddlers. Trust vs mistrust is the developmental stage of infancy. Initiative vs guilt is the developmental stage of early childhood. Intimacy and solidarity vs isolation is the developmental stage of early adulthood. PTS: 1 DIF: Cognitive Level: Remember REF: 380 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 4. A parent of an 18-month-old boy tells the nurse that he says no to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. The nurses best interpretation of this behavior is included in which statement? a. This is normal behavior for his age. b. This is unusual behavior for his age. c. He is not effectively coping with stress. d. He is showing he needs more attention. ANS: A Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and the use of the word no. Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old. Having a rapid mood swing is an expected behavior for a toddler. PTS: 1 DIF: Cognitive Level: Understand REF: 379 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 5. A nurse is planning care for a 17-month-old child. According to Piaget, which stage should the nurse expect the child to be in cognitively? a. Trust b. Preoperational c. Secondary circular reaction d. Tertiary circular reaction ANS: D The 17-month-old child is in the fifth stage of the sensorimotor phase, tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Trust is Eriksons first stage. Preoperational is the stage of cognitive development usually present in older toddlers and preschoolers. Secondary circular reactions last from about ages 4 to 8 months. Pediatric TB PTS: 1 DIF: Cognitive Level: Remember REF: 380 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 6. Which is descriptive of a toddlers cognitive development at age 20 months? a. Searches for an object only if he or she sees it being hidden b. Realizes that out of sight is not out of reach c. Puts objects into a container but cannot take them out d. Understands the passage of time, such as just a minute and in an hour ANS: B At this age, the child is in the final sensorimotor stage. Children will now search for an object in several potential places, even though they saw only the original hiding place. Children have a more developed sense of objective permanence. They will search for objects even if they have not seen them hidden. When a child puts objects into a container but cannot take them out, this is indicative of tertiary circular reactions. An embryonic sense of time exists, although the children may behave appropriately to time-oriented phrases; their sense of timing is exaggerated. PTS: 1 DIF: Cognitive Level: Understand REF: 381 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 7. Although a 14-month-old girl received a shock from an electric outlet recently, her parent finds her about to place a paper clip in another outlet. Which is the best interpretation of this behavior? a. Her cognitive development is delayed. b. This is typical behavior because toddlers are not very developed. c. This is typical behavior because of the inability to transfer knowledge to new situations. d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain. ANS: C During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. Her cognitive development is appropriate for her age. Trying to put things into an outlet is typical behavior for a toddler. Only some awareness exists of a causal relation between events. PTS: 1 DIF: Cognitive Level: Understand REF: 381 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 8. Two toddlers are playing in a sandbox when one child suddenly grabs a toy from the other child. Which is the best interpretation of this behavior? a. This is typical behavior because toddlers are aggressive. b. This is typical behavior because toddlers are egocentric. c. Toddlers should know that sharing toys is expected of them. d. Toddlers should have the cognitive ability to know right from wrong. ANS: B Play develops from the solitary play of infancy to the parallel play of toddlers. The toddler plays alongside other children, not with them. This typical behavior of the toddler Pediatric TB MSC: Area of Client Needs: Health Promotion and Maintenance 15. The parents of a newborn say that their toddler hates the baby; he suggested that we put him in the trash can so the trash truck could take him away. Which is the nurses best reply? a. Lets see if we can figure out why he hates the new baby. b. Thats a strong statement to come from such a small boy. c. Lets refer him to counseling to work this hatred out. Its not a normal response. d. That is a normal response to the birth of a sibling. Lets look at ways to deal with this. ANS: D The arrival of a new infant represents a crisis for even the best-prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. The nurse should work with parents on ways to involve the toddler in the newborns care and to help focus attention on the toddler. The toddler does not hate the infant. This is an expected response to the changes in routines and attention that affect the toddler. The toddler can be provided with a doll to tend to the dolls needs at the same time the parent is performing similar care for the newborn. PTS: 1 DIF: Cognitive Level: Apply REF: 389 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 16. A toddlers parent asks the nurse for suggestions on dealing with temper tantrums. Which is the most appropriate recommendation? a. Punish the child. b. Leave the child alone until the tantrum is over. c. Remain close by the child but without eye contact. d. Explain to child that this is wrong. ANS: C The parent should be told that the best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common in toddlers as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The parents presence is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over. PTS: 1 DIF: Cognitive Level: Apply REF: 389- 390 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 17. A parent asks the nurse about negativism in toddlers. Which is the most appropriate recommendation? a. Punish the child. b. Provide more attention. c. Ask child not always to say no. d. Reduce the opportunities for a no answer. ANS: D The nurse should suggest to the parent that questions be phrased with realistic choices rather than yes or no answers. This provides the toddler with a sense of control and reduces the opportunity for negativism. Negativism is not an indication of stubbornness Pediatric TB or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young to be asked to not always say no. PTS: 1 DIF: Cognitive Level: Apply REF: 390 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 18. Which technique is best for dealing with the negativism of the toddler? a. Offer the child choices. b. Remain serious and intent. c. Provide few or no choices for child. d. Quietly and calmly ask the child to comply. ANS: A The child should have few opportunities to respond in a negative manner. Questions and requests should provide choices. This allows the child to be in control and reduces opportunities for negativism. The child will continue trying to assert control. The toddler is too young for verbal explanations. The negativism is the child testing limits. These should be clearly defined by structured choices. PTS: 1 DIF: Cognitive Level: Understand REF: 390 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance 19. The parents of a 2-year-old tell the nurse that they are concerned because the toddler has started to use baby talk since the arrival of their new baby. The nurse should recommend which intervention? a. Ignore the baby talk. b. Explain to the toddler that baby talk is for babies. c. Tell the toddler frequently, You are a big kid now. d. Encourage the toddler to practice more advanced patterns of speech. ANS: A The baby talk is a sign of regression in the toddler. It should be ignored, while praising the child for developmentally appropriate behaviors. Regression is childrens way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism. PTS: 1 DIF: Cognitive Level: Apply REF: 389- 390 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 20. Parents tell the nurse that their toddler daughter eats little at mealtime, only sits at the table with the family briefly, and wants snacks all the time. Which intervention should the nurse recommend? a. Give her nutritious snacks. b. Offer rewards for eating at mealtimes. c. Avoid snacks so she is hungry at mealtimes. d. Explain to her in a firm manner what is expected of her. ANS: A Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirement associated with the slower growth rate. Parents should help the child develop healthy eating habits. The toddler is often unable to sit through a meal. Frequent Pediatric TB nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should be not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat nonnutritious foods in response. PTS: 1 DIF: Cognitive Level: Apply REF: 390 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 21. A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is: a. a sign the child is spoiled. b. a way to exert unhealthy control. c. regression, common at this age. d. ritualism, common at this age. ANS: D The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain sameness and reliability. It provides a sense of comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. Ritualism is not indicative of a child who has unreasonable expectations, but rather normal development. Toddlers use ritualistic behaviors to maintain necessary structure in their lives. This is not regression, which is a retreat from a present pattern of functioning. PTS: 1 DIF: Cognitive Level: Apply REF: 391 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 22. Developmentally, most children at age 12 months: a. use a spoon adeptly. b. relinquish the bottle voluntarily. c. eat the same food as the rest of the family. d. reject all solid food in preference to the bottle. ANS: C By age 12 months, most children are eating the same food that is prepared for the rest of the family. Using a spoon usually is not mastered until age 18 months. The parents should be engaged in weaning a child from a bottle if that is the source of liquid. Toddlers should be encouraged to drink from a cup at the first birthday and be weaned from the bottle totally by 14 months. The child should be weaned from a milk- or formula-based diet to a balanced diet that includes iron-rich sources of food. PTS: 1 DIF: Cognitive Level: Understand REF: 391 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 23. The most effective way to clean a toddlers teeth is for the: a. child to brush regularly with a toothpaste of his or her choice. b. parent to stabilize the chin with one hand and brush with the other. c. parent to brush the mandibular occlusive surfaces, leaving the rest for the child. d. parent to brush the front labial surfaces, leaving the rest for the child. ANS: B Pediatric TB d. electric burn from electric outlets. ANS: A Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age group. High-temperature tap water, hot objects, and electrical outlets are all significant causes of burn injury. The child should be protected from these causes by reducing the temperature on the hot water in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electric outlets when not in use. PTS: 1 DIF: Cognitive Level: Understand REF: 401 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Safe and Effective Care Environment 30. Which play item should the nurse bring from the playroom to a hospitalized toddler in isolation? a. Small plastic Lego b. Set of large plastic building blocks c. Brightly colored balloon d. Coloring book and crayons ANS: B Play objects for toddlers must still be chosen with an awareness of danger from small parts. Large, sturdy toys without sharp edges or removable parts are safest. Large plastic blocks are appropriate for a toddler in isolation. Small plastic toys such as Lego can cause choking or can be aspirated. Balloons can cause significant harm if swallowed or aspirated. Coloring book and crayons would be too advanced for a toddler. PTS: 1 DIF: Cognitive Level: Apply REF: 403 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Safe and Effective Care Environment 31. A nurse places some x-ray contrast the toddler is to drink in a small cup instead of a large cup. Which concept of a toddlers preoperational thinking is the nurse using? a. Inability to conserve b. Magical thinking c. Centration d. Irreversibility ANS: A The nurse is using the toddlers inability to conserve. This is when the toddler is unable to understand the idea that a mass can be changed in size, shape, volume, or length without losing or adding to the original mass. Instead, toddlers judge what they see by the immediate perceptual clues given to them. A small glass means less amount of contrast. Magical thinking is believing that thoughts are all-powerful and can cause events. Centration is focusing on one aspect rather than considering all possible alternatives. Irreversibility is the inability to undo or reverse the actions initiated, such as being unable to stop doing an action when told. PTS: 1 DIF: Cognitive Level: Apply REF: 382 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance 32. Parents need further teaching about the use of car safety seats if they make which statement? Pediatric TB a. Even if our toddler helps buckle the straps, we will double-check the fastenings. b. We wont start the car until everyone is properly restrained. c. We wont need to use the car seat on short trips to the store. d. We will anchor the car seat to the cars anchoring system. ANS: C Parents need to be taught to always use the restraint even for short trips. Further teaching is needed if they make this statement. Parents have understood the teaching if they encourage the child to help attach buckles, straps, and shields but always double-check fastenings; do not start the car until everyone is properly restrained; and anchor the car safety seat securely to the cars anchoring system and apply the harness snugly to the child. PTS: 1 DIF: Cognitive Level: Apply REF: 400 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. Which are characteristic of physical development of a 30-month-old child? (Select all that apply.) a. Birth weight has doubled. b. Primary dentition is complete. c. Sphincter control is achieved. d. Anterior fontanel is open. e. Length from birth is doubled. f. Left or right handedness is established. ANS: B, C Usually by age 30 months, the primary dentition of 20 teeth is completed, and the child has sphincter control in preparation for bowel and bladder control. Birth weight doubles at approximately ages 5 to 6 months. The anterior fontanel closes at age 12 to 18 months. Birth length is doubled around age 4. Left or right handedness is not established until about age 5. PTS: 1 DIF: Cognitive Level: Understand REF: 387 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 2. Which should the nurse teach to parents of toddlers about accidental poison prevention? (Select all that apply.) a. Keep toxic substances in the garage. b. Discard empty poison containers. c. Know the number of the nearest poison control center. d. Remove colorful labels from containers of toxic substances. e. Caution child against eating nonedible items, such as plants. ANS: B, C, E To prevent accidental poisoning, parents should be taught to promptly discard empty poison containers, know the number of the nearest poison control center and to caution the child against eating nonedible items, such as plants. Parents should place all potentially toxic agents, including cosmetics, personal care items, cleaning products, pesticides, and medications in a locked cabinet, not in the garage. Parents should be taught to never remove labels from containers of toxic substances. Pediatric TB PTS: 1 DIF: Cognitive Level: Apply REF: 397 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 3. Which gross motor milestones should the nurse assess in an 18-month-old child? (Select all that apply.) a. Jumps in place with both feet b. Takes a few steps on tiptoe c. Throws ball overhand without falling d. Pulls and pushes toys e. Stands on one foot momentarily ANS: A, C, D An 18-month-old child can jump in place with both feet, throw a ball overhand without falling, and pull and push toys. Taking a few steps on tiptoe and standing on one foot momentarily is not acquired until 30 months of age. CHAPTER 5 Growth and Development of the Preschooler MULTIPLE CHOICE 1. Which should the nurse expect of a healthy 3-year-old child? a. Jump rope. b. Ride a two-wheel bicycle. c. Skip on alternate feet. d. Balance on one foot for a few seconds. ANS: D Three-year-olds are able to accomplish this gross motor skill. Jumping rope, riding a two- wheel bicycle, and skipping on alternate feet are gross motor skills of 5-year-olds. PTS: 1 DIF: Cognitive Level: Understand REF: 408 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 2. In terms of fine motor development, which should the 3-year-old child be expected to do? a. Lace shoes and tie shoelaces with a bow. b. Use scissors to cut pictures, and print a few numbers. c. Draw a person with seven parts and correctly identify the parts. d. Draw a circle and name what has been drawn. ANS: D Three-year-olds are able to accomplish this fine motor skill. Being able to lace shoes and tie shoelaces with a bow, use scissors to cut pictures, and print a few numbers, or draw a person with seven parts and correctly identify the parts are fine motor skills of 4- or 5- year-olds. PTS: 1 DIF: Cognitive Level: Understand REF: 408 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 3. A nurse is assessing a preschool-age child and notes the child exhibits magical thinking. According to Piaget, which describes magical thinking? a. Events have cause and effect. b. God is like an imaginary friend. c. Thoughts are all-powerful. Pediatric TB Imaginary friends do not take the place of pets or toys. Imaginary friends accomplish what the child is still attempting. PTS: 1 DIF: Cognitive Level: Understand REF: 412 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 10. Which characteristic best describes the language of a 3-year-old child? a. Asks meanings of words b. Follows directional commands c. Describes an object according to its composition d. Talks incessantly regardless of whether anyone is listening ANS: D Because of the dramatic vocabulary increase at this age, 3-year-olds are known to talk incessantly regardless of whether anyone is listening. A 4- to 5-year-old asks lots of questions and can follow simple directional commands. A 6-year-old can describe an object according to its composition. PTS: 1 DIF: Cognitive Level: Understand REF: 410 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 11. By which age should the nurse expect that most children could obey prepositional phrases such as under, on top of, beside, and behind? a. 18 months b. 24 months c. 3 years d. 4 years ANS: D At 4 years, children can understand directional phrases. Children at 18 months, 24 months, and 3 years are too young. PTS: 1 DIF: Cognitive Level: Understand REF: 410 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 12. Which is a useful skill that the nurse should expect a 5-year-old child to be able to master? a. Tie shoelaces. b. Use knife to cut meat. c. Hammer a nail. d. Make change out of a quarter. ANS: A Tying shoelaces is a fine motor task of 5-year-olds. Using a knife to cut meat is a fine motor task of a 7-year-old. Hammering a nail and making change out of a quarter are fine motor and cognitive tasks of an 8- to 9-year-old. PTS: 1 DIF: Cognitive Level: Understand REF: 414 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 13. The nurse is guiding parents in selecting a daycare facility for their child. Which is especially important to consider when making the selection? a. Structured learning environment Pediatric TB b. Socioeconomic status of children c. Cultural similarities of children d. Teachers knowledgeable about development ANS: D A teacher knowledgeable about development will structure activities for learning. A structured learning environment is not necessary at this age. Socioeconomic status is not the most important factor in selecting a preschool. Preschool is about expanding experiences with others, so cultural similarities are not necessary. PTS: 1 DIF: Cognitive Level: Apply REF: 412 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 14. Parents tell the nurse that they found their 3-year-old daughter and a male cousin of the same age inspecting each other closely as they used the bathroom. Which is the most appropriate recommendation the nurse should make? a. Punish children so this behavior stops. b. Neither condone nor condemn the curiosity. c. Allow children unrestricted permission to satisfy this curiosity. d. Get counseling for this unusual and dangerous behavior. ANS: B Three-year-olds become aware of anatomic differences and are concerned about how the other works. Such exploration should not be condoned or condemned. Children should not be punished for this normal exploration. Encouraging the children to ask questions of the parents and redirecting their activity are more appropriate than giving permission. Exploration is age-appropriate and not dangerous behavior. PTS: 1 DIF: Cognitive Level: Apply REF: 410 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 15. The parent of a 4-year-old boy tells the nurse that the child believes that monsters and boogeymen are in his bedroom at night. The nurses best suggestion for coping with this problem is to: a. let the child sleep with his parents. b. keep a night-light on in the childs bedroom. c. help the child understand that these fears are illogical. d. tell the child frequently that monsters and boogeymen do not exist. ANS: B A night-light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with parents will not get rid of the fears. A 4-year-old child is in the preconceptual age and cannot understand logical thought. PTS: 1 DIF: Cognitive Level: Apply REF: 418 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 16. Preschoolers fears can best be dealt with by which intervention? a. Actively involving them in finding practical methods to deal with the frightening experience b. Forcing them to confront the frightening object or experience in the presence of their parents Pediatric TB c. Using logical persuasion to explain away their fears and help them recognize how unrealistic the fears are d. Ridiculing their fears so that they understand that there is no need to be afraid ANS: A Actively involving them in finding practical methods to deal with the frightening experience is the best way to deal with fears. Forcing a child to confront fears may make the child more afraid. Preconceptual thought prevents logical understanding. Ridiculing fears does not make them go away. PTS: 1 DIF: Cognitive Level: Apply REF: 416 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance 17. Which accurately describes the speech of the preschool child? a. Dysfluency in speech patterns is normal. b. Sentence structure and grammatic usage are limited. c. By age 5 years, child can be expected to have a vocabulary of about 1000 words. d. Rate of vocabulary acquisition keeps pace with the degree of comprehension of speech. ANS: A Dysfluency includes stuttering and stammering, a normal characteristic of language development. Children speak in sentences of three or four words at age 3 to 4 years and eight words by age 5 years. At 5 years, children have a vocabulary of 2100 words. Children often gain vocabulary beyond degree of comprehension. PTS: 1 DIF: Cognitive Level: Understand REF: 417 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 18. A nurse is teaching parents about language development for preschool children. Which dysfunctional speech pattern is a normal characteristic the parents might expect? a. Lisp b. Stammering c. Echolalia d. Repetition without meaning ANS: B Stammering and stuttering are normal dysfluency patterns in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers language. PTS: 1 DIF: Cognitive Level: Apply REF: 417 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 19. During the preschool period, injury prevention efforts should emphasize: a. constant vigilance and protection. b. punishment for unsafe behaviors. c. education for safety and potential hazards. d. limitation of physical activities. ANS: C Education for safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Constant vigilance and protection is not practical at this Pediatric TB c. There are not that many physical differences among school-age children. d. I will have a gradual increase in fat, which may contribute to a heavier appearance. ANS: B In middle childhood, growth in height and weight occurs at a slower pace. Between the ages of 6 and 12 years, children grow 2 inches per year. In middle childhood, childrens weight will almost double; they gain 3 kg/year. At the end of middle childhood, girls grow taller and gain more weight than boys. Children take on a slimmer look with longer legs in middle childhood. PTS: 1 DIF: Cognitive Level: Apply REF: 458 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 2. Generally, the earliest age at which puberty begins is years in girls, in boys. a. 13; 13 b. 11; 11 c. 10; 12 d. 12; 10 ANS: C Puberty signals the beginning of the development of secondary sex characteristics. This begins earlier in girls than in boys. Usually a 2-year difference occurs in the age of onset. Girls and boys do not usually begin puberty at the same age. Girls generally begin puberty 2 years earlier than boys. PTS: 1 DIF: Cognitive Level: Understand REF: 459 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 3. Which describes the cognitive abilities of school-age children? a. Have developed the ability to reason abstractly b. Are capable of scientific reasoning and formal logic c. Progress from making judgments based on what they reason to making judgments based on what they see d. Are able to classify, to group and sort, and to hold a concept in their minds while making decisions based on that concept ANS: D In Piagets stage of concrete operations, children have the ability to group and sort and make conceptual decisions. Children cannot reason abstractly and logically until late adolescence. Making judgments based on what they reason to making judgments based on what they see is not a developmental skill. PTS: 1 DIF: Cognitive Level: Understand REF: 460 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 4. Which describes moral development in younger school-age children? a. The standards of behavior now come from within themselves. b. They do not yet experience a sense of guilt when they misbehave. c. They know the rules and behaviors expected of them but do not understand the reasons behind them. d. They no longer interpret accidents and misfortunes as punishment for misdeeds. Pediatric TB ANS: C Children who are ages 6 and 7 years know the rules and behaviors expected of them but do not understand the reasons for these rules and behaviors. Young children do not believe that standards of behavior come from within themselves, but that rules are established and set down by others. Younger school-age children learn standards for acceptable behavior, act according to these standards, and feel guilty when they violate them. Misfortunes and accidents are viewed as punishment for bad acts. PTS: 1 DIF: Cognitive Level: Understand REF: 460 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 5. Which statement characterizes moral development in the older school-age child? a. They are able to judge an act by the intentions that prompted it rather than just by the consequences. b. Rules and judgments become more absolute and authoritarian. c. They view rule violations in an isolated context. d. They know the rules but cannot understand the reasons behind them. ANS: A Older school-age children are able to judge an act by the intentions that prompted the behavior rather than just by the consequences. Rules and judgments become less absolute and authoritarian. Rule violation is likely to be viewed in relation to the total context in which it appears. The situation and the morality of the rule itself influence reactions. PTS: 1 DIF: Cognitive Level: Understand REF: 460 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 6. An 8-year-old girl tells the nurse that she has cancer because God is punishing her for being bad. She shares her concern that if she dies, she will go to hell. The nurse should interpret this as: a. a belief common at this age. b. a belief that forms the basis for most religions. c. suggestive of excessive family pressure. d. suggestive of a failure to develop a conscience. ANS: A Children at this age may view illness or injury as a punishment for a real or imagined misdeed. The belief in divine punishment is common for an 8-year-old child. PTS: 1 DIF: Cognitive Level: Analyze REF: 460 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance 7. Parents ask the nurse whether it is common for their school-age child to spend a lot of time with peers. The nurse should respond, explaining that the role of the peer group in the life of school-age children provides: a. opportunity to become defiant. b. time to remain dependent on their parents for a longer time. c. time to establish a one-on-one relationship with the opposite sex. d. security as they gain independence from their parents. ANS: D Pediatric TB Peer-group identification is an important factor in gaining independence from parents. Children learn how to relate to people in positions of leadership and authority and how to explore ideas and the physical environment. Becoming defiant in a peer-group relationship may lead to bullying. Peer-group identification helps in gaining independence rather than remaining dependent. One-on-one opposite sex relationships do not occur until adolescence. School-age children form peer groups of the same sex. PTS: 1 DIF: Cognitive Level: Understand REF: 462 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 8. A group of boys ages 9 and 10 years have formed a boys-only club that is open to neighborhood and school friends who have skateboards. This should be interpreted as: a. behavior that encourages bullying and sexism. b. behavior that reinforces poor peer relationships. c. characteristic of social development at this age. d. characteristic of children who later are at risk for membership in gangs. ANS: C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer-group identification and association are essential to a childs socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. A boys-only club does not have a direct correlation with later gang activity. PTS: 1 DIF: Cognitive Level: Analyze REF: 462 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 9. A school nurse observes school-age children playing at recess. Which is descriptive of the play the nurse expects to observe? a. Individuality in play is better tolerated than at earlier ages. b. Knowing the rules of a game gives an important sense of belonging. c. They like to invent games, making up the rules as they go. d. Team play helps children learn the universal importance of competition and winning. ANS: B Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age, children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play, children learn about competition and the importance of winning, an attribute highly valued in the United States. PTS: 1 DIF: Cognitive Level: Understand REF: 463 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 10. Teasing can be common during the school-age years. The nurse should recognize that which applies to teasing? a. Can have a lasting effect on children b. Is not a significant threat to self-concept c. Is rarely based on anything that is concrete d. Is usually ignored by the child who is being teased Pediatric TB When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development. Fifth-graders are usually 10 or 11 years old. This age is not too young to speak about physiologic changes in their bodies. They should be encouraged to ask questions. Preadolescents need precise and concrete information. PTS: 1 DIF: Cognitive Level: Apply REF: 471 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 17. The school nurse is conducting a class on bicycle safety. Which statement made by a participant indicates a need for further teaching? a. Most bicycle injuries occur from a fall off the bicycle. b. Head injuries are the major causes of bicycle-related fatalities. c. I should replace my helmet every 5 years. d. I can ride double with a friend if the bicycle has an extra large seat. ANS: D Children should not ride double. Most injuries result from falls. The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission and should replace the helmet at least every 5 years. PTS: 1 DIF: Cognitive Level: Apply REF: 472 | 474 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Safe and Effective Care Environment: Safety and Infection Control 18. When teaching injury prevention during the school-age years, what should the nurse include? a. Teach children to fear strangers. b. Teach basic rules of water safety. c. Avoid letting child cook in microwave ovens. d. Caution child against engaging in competitive sports. ANS: B Water safety instruction is an important source of injury prevention at this age. The child should be taught to swim, select safe and supervised places to swim, swim with a companion, check for sufficient water depth before diving, and use an approved flotation device. Teach stranger safety, not fear of strangers. This includes instructing children to not go with strangers, not wear personalized clothing in public places, tell parents if anyone makes child feel uncomfortable, and say no in uncomfortable situations. Teach child safe cooking. Caution against engaging in hazardous sports such as those involving trampolines. PTS: 1 DIF: Cognitive Level: Apply REF: 473 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Safe and Effective Care Environment: Safety and Infection Control 19. A nurse is teaching parents of kindergarten children general guidelines to assist their children in school. Which statement by the parents indicates they understand the teaching? a. We will only meet with the teacher if problems occur. Pediatric TB b. We will discourage hobbies so our child focuses on school work. c. We will plan a trip to the library as often as possible. d. We will expect our child to make all As in school. ANS: C General guidelines for parents to help their child in school include sharing an interest in reading. The library should be used frequently and books the child is reading should be discussed. Hobbies should be encouraged. The parents should not expect all As. They should focus on growth more than grades. PTS: 1 DIF: Cognitive Level: Apply REF: 467 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 20. A school nurse is teaching dental health practices to a group of sixth-grade children. How often should the nurse recommend the children brush their teeth? a. Twice a day b. Three times a day c. After meals d. After meals, snacks, and bedtime ANS: D Teeth should be brushed after meals, after snacks, and at bedtime. Children who brush their teeth frequently and become accustomed to the feel of a clean mouth at an early age usually maintain the habit throughout life. Twice a day, three times a day or after meals would not be often enough. PTS: 1 DIF: Cognitive Level: Apply REF: 470 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 21. Parents of a twelve-year-old child ask the clinic nurse, How many hours of sleep should our child get? The nurse should respond that 12-year-old children need how many hours of sleep at night? a. 8 b. 9 c. 10 d. 11 ANS: B School-age children usually do not require naps, but they do need to sleep approximately 11 hours at age 5 years and 9 hours at age 12 years each night. PTS: 1 DIF: Cognitive Level: Apply REF: 468 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 22. A nurse planning care for a school-age child should take into account that which thought process is seen at this age? a. Animism b. Magical thinking c. Ability to conserve d. Thoughts are all-powerful ANS: C Pediatric TB One cognitive task of school-age children is mastering the concept of conservation. At an early age (5 to 7 years), children grasp the concept of reversibility of numbers as a basis for simple mathematics problems (e.g., 2 + 4 = 6 and 6 4 = 2). They learn that simply altering their arrangement in space does not change certain properties of the environment, and they are able to resist perceptual cues that suggest alterations in the physical state of an object. Animism, magical thinking, and believing that thoughts are all powerful are thought processes seen in preschool children. PTS: 1 DIF: Cognitive Level: Apply REF: 460 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse is planning care for a 7-year-old child hospitalized with osteomyelitis. Which activities should the nurse plan to bring from the playroom for the child? (Select all that apply.) a. Paper and some paints b. Board games c. Jack-in-the-box d. Stuffed animals e. Computer games ANS: A, B, E School-age children become fascinated with complex board, card, or computer games that they can play alone, with a best friend, or with a group. They also enjoy sewing, cooking, carpentry, gardening, and creative activities such as painting. Jack-in-the-box and stuffed animals would be appropriate for a toddler or preschool child. PTS: 1 DIF: Cognitive Level: Apply REF: 463 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 2. A nurse teaches parents that team play is important for school-age children. Which can children develop by experiencing team play? (Select all that apply.) a. Achieve personal goals over group goals. b. Learn complex rules. c. Experience competition. d. Learn about division of labor. ANS: B, C, D Team play helps stimulate cognitive growth because children are called on to learn many complex rules, make judgments about those rules, plan strategies, and assess the strengths and weaknesses of members of their own team and members of the opposing team. Team play can also contribute to childrens social, intellectual, and skill growth. Children work hard to develop the skills needed to become team members, to improve their contribution to the group, and to anticipate the consequences of their behavior for the group. Team play teaches children to modify or exchange personal goals for goals of the group; it also teaches them that division of labor is an effective strategy for attaining a goal. CHAPTER 7 Growth and Development of the Adolescent MULTIPLE CHOICE 1. In girls, the initial indication of puberty is: a. menarche. Pediatric TB Adolescents are no longer restricted to the real and actual. They also are concerned with the possible; they think beyond the present. During concrete operations (between ages 7 and 11 years), children exhibit these characteristic thought processes. PTS: 1 DIF: Cognitive Level: Remember REF: 482 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 8. Parents are concerned about the number of hours their teenage daughter spends with peers. The nurse explains that peer relationships are important during adolescence for which reason? a. Adolescents dislike their parents. b. Adolescents no longer need parental control. c. They provide adolescents with a feeling of belonging. d. They promote a sense of individuality in adolescents. ANS: C The peer group serves as a strong support to teenagers, providing them with a sense of belonging and a sense of strength and power. During adolescence, the parent-child relationship changes from one of protection-dependency to one of mutual affection and quality. Parents continue to play an important role in the personal and health- related decisions. The peer group forms the transitional world between dependence and autonomy. PTS: 1 DIF: Cognitive Level: Apply REF: 483 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 9. An adolescent boy tells the nurse that he has recently had homosexual feelings. The nurses response should be based on knowledge that: a. this indicates the adolescent is homosexual. b. this indicates the adolescent will become homosexual as an adult. c. the adolescent should be referred for psychotherapy. d. the adolescent should be encouraged to share his feelings and experiences. ANS: D These adolescents are at increased risk for health-damaging behaviors, not because of the sexual behavior itself, but because of societys reaction to the behavior. The nurses first priority is to give the young man permission to discuss his feelings about this topic, knowing that the nurse will maintain confidentiality, appreciate his feelings, and remain sensitive to his need to talk about the topic. In recent studies among self-identified gay, lesbian, and bisexual adolescents, many of the adolescents report changing self-labels one or more times during their adolescence. An assessment must be made about any risks to himself or others. If these do not exist, the adolescent needs a supportive person to talk with. PTS: 1 DIF: Cognitive Level: Apply REF: 486 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Health Promotion and Maintenance 10. The school nurse tells adolescents in the clinic that confidentiality and privacy will be maintained unless a life-threatening situation arises. This practice is: a. not appropriate in a school setting. b. never appropriate because adolescents are minors. Pediatric TB c. important in establishing trusting relationships. d. suggestive that the nurse is meeting his or her own needs. ANS: C Health professionals who work with adolescents should consider adolescents increasing independence and responsibility while maintaining privacy and ensuring confidentiality. However, in some circumstances, such as self-destructive behavior or maltreatment by others, they are not able to maintain confidentiality. Confidentiality and privacy are necessary to build trust with this age group. The nurse must be aware of the limits placed on confidentiality by local jurisdiction. PTS: 1 DIF: Cognitive Level: Understand REF: 487 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Management of Care 11. A 14-year-old boy seems to be always eating, although his weight is appropriate for his height. What is the best explanation for this? a. This is normal because of increase in body mass. b. This is abnormal and suggestive of future obesity. c. His caloric intake would have to be excessive. d. He is substituting food for unfilled needs. ANS: A In adolescence, nutritional needs are closely related to the increase in body mass. The peak requirements occur in the years of maximal growth. The caloric and protein requirements are higher than at almost any other time of life. Seemingly always eating describes the expected eating pattern for young adolescents; as long as weight and height are appropriate, obesity is not a concern. PTS: 1 DIF: Cognitive Level: Understand REF: 478-479 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 12. Which predisposes the adolescent to feel an increased need for sleep? a. An inadequate diet b. Rapid physical growth c. Decreased activity that contributes to a feeling of fatigue d. The lack of ambition typical of this age group ANS: B During growth spurts, the need for sleep increases. Rapid physical growth, the tendency toward overexertion, and the overall increased activity of this age contribute to fatigue. PTS: 1 DIF: Cognitive Level: Understand REF: 490 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 13. The most common cause of death in the adolescent age group involves: a. drownings. b. firearms. c. drug overdoses. d. motor vehicles. ANS: D Pediatric TB Forty percent of all adolescent deaths in the United States are the result of motor vehicle accidents. Drownings, firearms, and drug overdoses are major concerns in adolescence but are not the most common cause of death. PTS: 1 DIF: Cognitive Level: Understand REF: 487 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Safe and Effective Care Environment: Safety and Infection Control 14. A young adolescent boy tells the nurse he feels gawky. The nurse should explain that this occurs in adolescents because of: a. growth of the extremities and neck precedes growth in other areas. b. growth is in the trunk and chest. c. the hip and chest breadth increases. d. the growth spurt occurs earlier in boys than it does in girls. ANS: A Growth in length of the extremities and neck precedes growth in other areas, and, because these parts are the first to reach adult length, the hands and feet appear larger than normal during adolescence. Increases in hip and chest breadth take place in a few months followed several months later by an increase in shoulder width. These changes are followed by increases in length of the trunk and depth of the chest. This sequence of changes is responsible for the characteristic long-legged, gawky appearance of early adolescent children. The growth spurt occurs earlier in girls than in boys. PTS: 1 DIF: Cognitive Level: Apply REF: 478 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 15. A nurse is reviewing hormone changes that occur during adolescence. The hormone that is responsible for the growth of beard, mustache, and body hair in the male is: a. estrogen. b. pituitary. c. androgen. d. progesterone. ANS: C Beard, mustache, and body hair on the chest, upward along the linea alba, and sometimes on other areas (e.g., back and shoulders) appears in males and is androgen dependent. Estrogen and progesterone are produced by the ovaries in the female and do not contribute to body hair appearance in the male. The pituitary hormone does not have any relationship to body hair appearance in the male. PTS: 1 DIF: Cognitive Level: Analyze REF: 481 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance 16. A nurse is caring for an adolescent hospitalized for cellulitis. The nurse notes that the adolescent experiences many mood swings throughout the day. The nurse interprets this behavior as: a. requiring a referral to a mental health counselor. b. requiring some further lab testing. c. normal behavior. d. related to feelings of depression. Pediatric TB PTS: 1 DIF: Cognitive Level: Apply REF: 491 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance COMPLETION 1. The estimated average requirement of calcium for an adolescent is milligrams. (Record your answer in a whole number.) ANS: 1100 The EAR (estimated average requirement) for calcium in adolescents 14 to 18 years of age is 1100 mg. PTS: 1 DIF: Cognitive Level: Understand REF: 489 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance ESSAY 1. Place in order the sequence of maturational changes for girls. Begin with the first change seen, sequencing to the last change. Provide answer in using lowercase letters, separated by commas (e.g., a, b, c, d, e). a. Growth of pubic hair b. Rapid increase in height and weight c. Breast changes d. Menstruation e. Appearance of axillary hair ANS: c, b, a, e, d The usual sequence of maturational changes for girls is breast changes, rapid increase in height and weight, growth of public hair, appearance of axillary hair, and then menstruation, which usually begins 2 years after the first signs. CHAPTER 8 Atraumatic Care of Children and Families MULTIPLE CHOICE 1. The best site for the nurse to use when assessing the pulse rate on a 12-month-old infant is: a . Brachial pulse b . Apical pulse c . Radial pulse d . Femoral pulse ANS: B Pediatric TB Apical pulses are advised for children under age 5 years. DIF: Cognitive Level: Application REF: 486 OBJ: 11 TOP: Physical Assessment KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. When the nurse starts to administer a medication to a 2-month-old child, the nurse discovers there is no ID bracelet on the child. The nurse should: a . Give the medication after confirming the childs name from the foot of the crib. b . Ask the charge nurse to give the medicine. c . Confirm the identity with the charge nurse, make a new bracelet, and give the medicine. d . Delay the medication until the admissions office can supply a new ID bracelet. ANS: C After confirmation of the childs identity with the charge nurse and making a new bracelet, the medication can be safely given. All patients should be identified before treatment. DIF: Cognitive Level: Analysis REF: 481 OBJ: 2 TOP: ID Bracelets KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 3. The nurse instructed an adolescent female about collecting a clean-catch urine specimen. The nurse determined the adolescent understood the instructions when she stated: a . I should wash my perineum with soap and water, then begin to urinate. b . I clean the perineum from front to back with an antiseptic wipe before I urinate. c . Ill collect the first stream of urine in a sterile container. d . I will discard the first void and collect a freshly voided specimen 30 minutes later. ANS: B Pediatric TB To obtain a clean-catch specimen, the perineum is cleansed with an antiseptic wipe from front to back. DIF: Cognitive Level: Analysis REF: 493 OBJ: N/A TOP: Collecting Specimens KEY: Nursing Process Step: Evaluation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 4. The strategy the nurse might use when administering oral medications to a young child who is reluctant to take it is: a . Mix the medication with chocolate milk. b . Tell the child that the medication is candy. c . Give the medication quickly if the child is crying. d . Offer the child fruit juice after the medication is swallowed. ANS: D The nurse can offer a chaser of water, fruit juice, or a carbonated beverage after the medication has been swallowed. Medications should not be mixed with important nutrients such as milk since the child may develop a distaste for the food. DIF: Cognitive Level: Application REF: 498 OBJ: 5 TOP: Administering Oral Medications KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 5. A parent tells the nurse, Im not sure how to give this medicine to my infant. The nurse would teach the parent to best administer an oral suspension by: a . Pouring the medication into a small cup and allowing the infant to drink it b . Placing the medication in a nipple and having the infant suck the nipple c . Using an oral syringe and placing the medication in the side of the infants mouth d . Administering the medication with a dropper onto the back of the infants tongue ANS: C Pediatric TB DIF: Cognitive Level: Comprehension REF: 483 OBJ: 2 TOP: Restraining the Infant KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 10. A child who has a continuous intravenous infusion should be assessed every: a . Hour b . Two hours c . Three hours d . Four hours ANS: A The nurse must assess hourly an intravenous infusion for complications, such as inflammation and infiltration. DIF: Cognitive Level: Knowledge REF: 503 OBJ: 6 TOP: Administering Parenteral Medications KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Risk Reduction 11. The prescription for a 4-month-old is: penicillin G 150,000 units IM bid. The drug is supplied as a unit dose of 600,000 units in a 5-ml vial. The nurse should give the dose as: a . 1 ml b . 1.4 ml c . 1.6 ml d . 1.8 ml ANS: B This dose would have to be given in divided doses as only 1 ml should be injected in one site on an infant. Pediatric TB DIF: Cognitive Level: Application REF: 498 OBJ: 6 TOP: Administering Injections KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 12. When suctioning a tracheostomy, the nurse will: a . Suction for a period of 2 to 3 breaths. b . Clear the catheter with water after suctioning for reuse. c . Apply suction for no more than 15 seconds. d . Establish a regular schedule for suctioning. ANS: C Suctioning should be limited to 15 seconds. DIF: Cognitive Level: Knowledge REF: 510 OBJ: 7 TOP: Respiration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 13. The emergency action for airway obstruction in the infant is to give: a . 6 to 10 midsternal thrusts b . 5 back blows followed by 5 chest thrusts c . 5 chest thrusts followed by 5 back blows d . Abdominal thrusts until the object is expelled ANS: B Five back blows followed by 5 chest thrusts is the appropriate intervention for airway obstruction in the infant. DIF: Cognitive Level: Knowledge REF: 514 OBJ: N/A TOP: Management of Airway Obstruction KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Pediatric TB 14. When the 4-year-old asks tearfully if the IM injection will hurt, the nurses most effective response is: a . No. It is over before you know it b . Yes. It will sting a little. c . No. Would you like to see the syringe? d . Yes. Your mom and I are going to hold you to help you be still. ANS: B Truthful answers will give a child a realistic expectation and help establish trust in the nurse. DIF: Cognitive Level: Implementation REF: 503 OBJ: 6 TOP: Preparation for an IM Injection KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 15. The nurse selects the best site for giving an intramuscular injection to a 15-month-old child, which is the: a . Ventrogluteal muscle b . Dorsogluteal muscle c . Deltoid muscle d . Vastus lateralis muscle ANS: D The vastus lateralis muscle is free of major blood vessels and nerves and can be used in children of any age. DIF: Cognitive Level: Application REF: 502 OBJ: 14 TOP: Administering Injections KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Basic Care and Comfort Pediatric TB MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 20. The nurse is caring for a 4-year-old child. When reviewing yesterdays intake and output record, the nurse would expect the childs daily urinary output to be approximately: a . 400 to 500 ml b . 500 to 600 ml c . 600 to 700 ml d . 700 to 1000 ml ANS: C The average daily excretion of urine for a 4-year-old child is 600 to 700 ml. DIF: Cognitive Level: Knowledge REF: 506 OBJ: 12 TOP: Collecting Specimens-Urine Output KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 21. An infants dry diaper weighs 2.5 grams. The wet diaper weighs 47 grams. The nurse would record the infants urine output as: a . 47 ml b . 44.5 ml c . 43.5 ml d . 40.5 ml ANS: B Urine output is determined by calculating the difference in weight between the wet diaper and a dry diaper. Key Point: One gram is equivalent to one milliliter of output. 47 2.5 = 44.5 grams = 44.5 ml of urine. DIF: Cognitive Level: Application REF: 507 OBJ: 12 TOP: Collecting Specimens-Urine Output Pediatric TB KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort MULTIPLE RESPONSE 1. The nurse clarifies that the informed consent for a minor guarantees that the parent or legal guardian understands: Select all that apply. a . Purpose of the procedure b . Associated risks c . No suit can be brought for damages d . The document must be signed and witnessed e . Information given ANS: A, B, D, E The informed consent establishes that the patient, parent, or legal guardian understands the purpose and risks of the procedure. It also establishes that the patient, parent, or legal guardian understands what they have been told; the document should be signed and witnessed. CHAPTER 9 Health Supervision MULTIPLE CHOICE 1. Which child would have the most difficulty in coping with separation from parents because of hospitalization? a . The 3-month-old child b . The 16-month-old child c . The 4-year-old child d . The 7-year-old child ANS: B Pediatric TB Separation anxiety occurs after age 6 months and is most pronounced in the toddler. DIF: Cognitive Level: Comprehension REF: 466-467 OBJ: 2 TOP: Separation Anxiety KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 2. A 2-year-old child has been crying constantly for his mother since he was hospitalized 3 days ago. The nurse understands that this behavior suggests: a . The toddler feels abandoned by his mother. b . The child still has not adjusted to his hospitalization. c . The child is not separated from his mother often. d . A poor mother-child bond exists. ANS: A Unless toddlers are extremely ill, their grief and sense of abandonment during hospitalization are obvious. DIF: Cognitive Level: Analysis REF: 465-466 OBJ: 2 TOP: Separation Anxiety KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 3. The statement that best corresponds to a preschoolers understanding of hospitalization is: a . A germ made me get sick. b . I got sick because I was mad at my brother. c . My tonsils are sick and they have to come out. d . I have a cast because I broke my leg. ANS: B The preschooler may feel guilty, particularly if an accident happens as a result of mischief on his or her part. Pediatric TB d . Exhibiting normal behavior for his age, as children often stop new behaviors after they feel they have mastered them ANS: A Hospitalization is frustrating for toddlers. They show their displeasure when illness restricts satisfaction of their desires. It is not unusual for a toddler who was drinking from a cup to refuse it in the hospital. DIF: Cognitive Level: Comprehension REF: 468 OBJ: 4 TOP: Regression KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 8. A nurse encourages a school-age child to draw a picture after a painful procedure. The best rationale for this intervention is that the nurse is: a . Attempting to reestablish rapport b . Providing a way for the child to express his feelings c . Encouraging quiet play d . Distracting the child from thinking about the pain ANS: B Following treatments, the nurse should encourage children to draw and talk about their drawings or to act out their feelings through puppet play. DIF: Cognitive Level: Comprehension REF: 490 OBJ: 7 TOP: The Hospitalized School-Age Child KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 9. The nurse suggests that the best time for parents to begin to prepare a 5-year-old for surgery and hospitalization is: a . As soon as the surgery is scheduled b . About 2 weeks before surgery Pediatric TB c . About 4 days before surgery d . On the night before admission to the hospital ANS: C Parents should prepare children for procedures and hospitalization a few days in advance. DIF: Cognitive Level: Application REF: 471 OBJ: 4, 6 TOP: The Nurses Role in Hospital Admission-Preparing the Child KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 10. The mother of a 3-year-old tells the nurse that she will be in to visit tomorrow around 12:00 PM. The next morning, the child asks the nurse, When is my mommy coming? The best response for the nurse to make is: a . Your mommy will be here around noon. b . Your mommy will be here when you have lunch. c . Mommy will be here very soon. d . Your mommy is coming in 4 hours. ANS: B The toddler and preschooler do not understand time yet. They understand time relationships through activities in their experience, such as naptime and mealtimes. DIF: Cognitive Level: Application REF: 476 OBJ: 6 TOP: The Hospitalized Toddler/Preschooler KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 11. A 13-year-old girl has been hospitalized for the past week. When discussing the girls feelings about her illness, the nurse would expect the girl to express the most concern about: a . Invasive procedures Pediatric TB b . Loss of control c . Appearance d . Separation from her boyfriend ANS: C Illness during early adolescence (12 to 15 years) is seen mainly as a threat to body image. DIF: Cognitive Level: Comprehension REF: 477 OBJ: 8 TOP: The Hospitalized Adolescent KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 12. The nurse notices that the mother of a child with cerebral palsy corrects and redoes many of the things the nurse does for her child. The most appropriate response to this mother would be: a . Would you like to do all of your childs care? b . Im doing the very best job that I can with your child. c . Why dont you go have a cup of coffee. You are going to be exhausted if you dont take a break. d . Id be happy if you would share with me some of the special things you do for your child. ANS: D The person who cares daily for the child with a chronic illness can provide information that will best guarantee continuity of care between the home and the hospital. DIF: Cognitive Level: Application REF: 472 OBJ: 4 TOP: The Parents Reaction KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 13. The mother of a hospitalized toddler states, He cries when I visit. Maybe I should just stay away. The nurses best response would be: a . Perhaps you are right. He only gets upset when you have to leave. Pediatric TB 17. A 4-year-old begins to cry when his mother tells him it is time for his operation. The nurse understands this is an expected reaction because the preschooler is particularly fearful of: a . Loss of control b . Restricted mobility c . Unfamiliar routines d . Invasive procedures ANS: D The preschool-age child is afraid of bodily harm, particularly invasive procedures. DIF: Cognitive Level: Knowledge REF: 476 OBJ: 6 TOP: The Hospitalized Preschooler KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 18. The nurse determines a parent understands a hospitalized toddlers need for transitional objects when the parent states: a . This stuffed animal makes him feel secure. b . He insisted on bringing this dirty old blanket with him. c . Im going to buy him a big stuffed animal from the gift shop. d . Id like to get him some toys from the playroom. ANS: A The use of a transitional object such as a blanket or a favorite toy promotes security. DIF: Cognitive Level: Comprehension REF: 475 OBJ: 10 TOP: The Hospitalized Toddler KEY: Nursing Process Step: Evaluation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation Pediatric TB 19. An 8-year-old child will be hospitalized for several weeks in skeletal traction to treat a fractured femur. In planning care for the child, the nurse realizes immobilization in this age group can generate feelings of: a . Loss of control b . Altered body image c . Shame and guilt d . Fear of bodily harm ANS: A Forced dependency in the hospital, such as immobilization, can result in a feeling of loss of control and loss of security. DIF: Cognitive Level: Analysis REF: 477 OBJ: 10 TOP: The Hospitalized School-Age Child KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 20. The nurse explains the use of fentanyl has the advantages of: a . Being specifically designed for children b . Rapid onset c . Nonaddicting d . Long duration ANS: B Fentanyl is a drug useful for all ages because of its rapid onset and brief duration. DIF: Cognitive Level: Application REF: 467 OBJ: 5 TOP: Fentanyl KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies MULTIPLE RESPONSE Pediatric TB 1. The nurse suggests to parents that they avail themselves of the outpatient surgical center for their childs upcoming surgery because the surgical center has the advantages of: Select all that apply. a . Lower cost b . Less incidence of nosocomial infections c . Reduction of parent-child separation d . Recuperation at home e . Decreased emotional impact of illness ANS: A, B, C, D, E All options listed are advantages of outpatient services. DIF: Cognitive Level: Application REF: 463 OBJ: 4 TOP: Use of Outpatient Facilities KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation 2. The nurse understands that no matter the reason for the young child being hospitalized, the basic fears are: Select all that apply. a . Separation b . Permanent scarring c . Pain d . Cost e . Body intrusion Pediatric TB c. Directing the focus d. Defining the problem ANS: B Using stereotyped comments or clichs can block effective communication, and this technique should be avoided. After use of such trite phrases, parents will often not respond. Silence can be an effective interviewing tool. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. To be effective, the nurse must be able to direct the focus of the interview while allowing maximal freedom of expression. By using open-ended questions, along with guiding questions, the nurse can obtain the necessary information and maintain the relationship with the family. The nurse and parent must collaborate and define the problem that will be the focus of the nursing intervention. PTS: 1 DIF: Cognitive Level: Understand REF: 90 TOP:Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 4. What is the single most important factor to consider when communicating with children? a. The childs physical condition b. Presence or absence of the childs parent c. The childs developmental level d. The childs nonverbal behaviors ANS: C The nurse must be aware of the childs developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Although the childs physical condition is a consideration, developmental level is much more important. The parents presence is important when communicating with young children but may be detrimental when speaking with adolescents. Nonverbal behaviors will vary in importance, based on the childs developmental level. PTS: 1 DIF: Cognitive Level: Understand REF: 91 TOP:Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 5. Which approach would be best to use to ensure a positive response from a toddler? a . Assume an eye-level position and talk quietly. b . Call the toddlers name while picking him or her up. Pediatric TB c . Call the toddlers name and say, Im your nurse. d . Stand by the toddler, addressing him or her by name. ANS: A It is important that the nurse assume a position at the childs level when communicating with the child. By speaking quietly and focusing on the child, the nurse should be able to obtain a positive response. The nurse should engage the child and inform the toddler what is going to occur. If the nurse picks up the child without explanation, the child is most likely going to become upset. The toddler may not understand the meaning of the phrase, Im your nurse. If a positive response is desired, the nurse should assume the childs level when speaking if possible. PTS: 1 DIF: Cognitive Level: Apply REF: 91 TOP:Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 6. What is an important consideration for the nurse who is communicating with a very young child? a . Speak loudly, clearly, and directly. b . Use transition objects, such as a doll. c . Disguise own feelings, attitudes, and anxiety. d . Initiate contact with child when parent is not present. ANS: B Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This will facilitate communication with a child this age. Speaking in this manner will tend to increase anxiety in very young children. The nurse must be honest with the child. Attempts at deception will lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children. PTS: 1 DIF: Cognitive Level: Understand REF: 90-91 TOP:Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Psychosocial Integrity 7. A nurse is preparing to assess a 3-year-old child. What communication technique should the nurse use for this child? a. Focus communication on child. Pediatric TB b. Explain experiences of others to child. c. Use easy analogies when possible. d. Assure child that communication is private. ANS: A Because children of this age are able to see things only in terms of themselves, the best approach is to focus communication directly on them. Children should be provided with information about what they can do and how they will feel. With children who are egocentric, experiences of others, analogies, and assurances that the communication is private will not be effective because the child is not capable of understanding. PTS: 1 DIF: Cognitive Level: Apply REF: 91 TOP:Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 8. The nurses approach when introducing hospital equipment to a preschooler should be based on which principle? a . The child may think the equipment is alive. b . The child is too young to understand what the equipment does. c . Explaining the equipment will only increase the childs fear. d . One brief explanation will be enough to reduce the childs fear. ANS: A Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. The child should be given simple concrete explanations about what the equipment does and how it will feel to the child. Simple, concrete explanations will help alleviate the childs fear. The preschooler will need repeated explanations as reassurance. PTS: 1 DIF: Cognitive Level: Analyze REF: 91 TOP:Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Psychosocial Integrity 9. A nurse is assigned to four children of different ages. In which age group should the nurse understand that body integrity is a concern? a. Toddler b. Preschooler Pediatric TB b. a way to establish rapport. c. too distracting, when cooperation is important. d. acceptable, if there is adequate time. ANS: B A magic trick or other simple game may help alleviate anxiety for a 5-year-old. It is an excellent method to build rapport and facilitate cooperation during a procedure. Magic tricks appeal to the natural curiosity of young children. The nurse should establish rapport with the child. Failure to do so may cause the procedure to take longer and be more traumatic. PTS: 1 DIF: Cognitive Level: Analyze REF: 92 TOP:Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 14. The nurse must assess 10-month-old infant. The infant is sitting on the fathers lap and appears to be afraid of the nurse and of what might happen next. Which initial action by the nurse would be most appropriate? a . Initiate a game of peek-a-boo. b . Ask father to place the infant on the examination table. c . Undress the infant while he is still sitting on his fathers lap. d . Talk softly to the infant while taking him from his father. ANS: A Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done on the fathers lap. The nurse should have the father undress the child as needed for the examination. PTS: 1 DIF: Cognitive Level: Apply REF: 94 TOP:Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 15. The nurse is taking a health history on an adolescent. Which best describes how the chief complaint should be determined? a . Ask for detailed listing of symptoms. Pediatric TB b . Ask adolescent, Why did you come here today? c . Use what adolescent says to determine, in correct medical terminology, what the problem is. d . Interview parent away from adolescent to determine chief complaint. ANS: B The chief complaint is the specific reason for the childs visit to the clinic, office, or hospital. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. A detailed listing of symptoms will make it difficult to determine the chief complaint. The adolescent should be prompted to tell which symptom caused him to seek help at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention at this time. PTS: 1 DIF: Cognitive Level: Apply REF: 92 TOP:Integrated Process: Nursing Process: Assessment MSC:Area of Client Needs: Health Promotion and Maintenance 16. Where in the health history should the nurse describe all details related to the chief complaint? a. Past history b. Chief complaint c. Present illness d. Review of systems ANS: C The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. The focus of the present illness is on all factors relevant to the main problem, even if they have disappeared or changed during the onset, interval, and present. Past history refers to information that relates to previous aspects of the childs health, not to the current problem. The chief complaint is the specific reason for the childs visit to the clinic, office, or hospital. It does not contain the narrative portion describing the onset and progression. The review of systems is a specific review of each body system. PTS: 1 DIF: Cognitive Level: Understand REF: 96 TOP:Integrated Process: Communication and Documentation MSC:Area of Client Needs: Health Promotion and Maintenance 17. The nurse is interviewing the mother of an infant. She reports, I had a difficult delivery, and my baby was born prematurely. This information should be recorded under which of the following headings? Pediatric TB a. Past history b. Present illness c. Chief complaint d. Review of systems ANS: A The past history refers to information that relates to previous aspects of the childs health, not to the current problem. The mothers difficult delivery and prematurity are important parts of the past history of an infant. The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. Unless the chief complaint is directly related to the prematurity, this information is not included in the history of present illness. The chief complaint is the specific reason for the childs visit to the clinic, office, or hospital. It would not include the birth information. The review of systems is a specific review of each body system. It does not include the premature birth. Sequelae such as pulmonary dysfunction would be included. PTS: 1 DIF: Cognitive Level: Understand REF: 96 TOP:Integrated Process: Communication and Documentation MSC:Area of Client Needs: Health Promotion and Maintenance 18. Which is most important to document about immunizations in the childs health history? a. Dosage of immunizations received b. Occurrence of any reaction after an immunization c. The exact date the immunizations were received d. Practitioner who administered the immunizations ANS: B The occurrence of any reaction after an immunization was given is the most important to document in a history because of possible future reactions, especially allergic reactions. Exact dosage of the immunization received may not be recorded on the immunization record. Exact dates are important to obtain but not as important as a history of reaction to an immunization. The practitioner who administered the immunization does not need to be recorded in the health history. A potentially severe physiologic response is the most threatening and most important information to document for safety reasons. PTS: 1 DIF: Cognitive Level: Analyze REF: 97 TOP:Integrated Process: Communication and Documentation MSC:Area of Client Needs: Health Promotion and Maintenance 19. When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. This should be considered: Pediatric TB d. Demonstrate use of equipment. ANS: C Parents can remove clothing, and the child can remain on the parents lap. The nurse should use minimal physical contact initially to gain the childs cooperation. The head-to- toe assessment can be done in older children but usually must be adapted in younger children. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for toddlers. PTS: 1 DIF: Cognitive Level: Apply REF: 106 TOP:Integrated Process: Nursing Process: Planning MSC:Area of Client Needs: Health Promotion and Maintenance 24. The nurse is preparing to perform a physical assessment on a 10-year-old girl. The nurse gives her the option of her mother either staying in the room or leaving. This action should be considered: a . appropriate because of childs age. b . appropriate because mother would be uncomfortable making decisions for child. c . inappropriate because of childs age. d . inappropriate because child is same sex as mother. ANS: A The older school-age child should be given the option of having the parent present or not. During the examination, the nurse should respect the childs need for privacy. Although the question was appropriate for the childs age, the mother is responsible for making decisions for the child. It is appropriate because of the childs age. During the examination, the nurse must respect the childs privacy. The child should help determine who is present during the examination. PTS: 1 DIF: Cognitive Level: Apply REF: 107 TOP:Integrated Process: Nursing Process: Assessment MSC:Area of Client Needs: Health Promotion and Maintenance 25. A nurse is counseling parents of a child beginning to show signs of being overweight. The nurse accurately relates which body mass index (BMI)-for-age percentile indicates a risk for being overweight? a. 10th percentile b. 9th percentile Pediatric TB c. 85th percentile d. 95th percentile ANS: C Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children in the 9th and 10th percentiles are within normal limits. Children who are greater than or equal to the 95th percentile are considered overweight. PTS: 1 DIF: Cognitive Level: Apply REF: 108-109 TOP:Integrated Process: Nursing Process: Implementation MSC:Area of Client Needs: Health Promotion and Maintenance 26. The nurse is using the NCHS growth chart for an African-American child. Which statement should the nurse consider? a . This growth chart should not be used. b . Growth patterns of African-American children are the same as for all other ethnic groups. c . A correction factor is necessary when the NCHS growth chart is used for non-Caucasian ethnic groups. d . The NCHS charts are accurate for U.S. African- American children. ANS: D The NCHS growth charts can serve as reference guides for all racial or ethnic groups. U.S. African-American children were included in the sample population. The growth chart can be used with the perspective that different groups of children have varying normal distributions on the growth curves. No correction factor exists. PTS: 1 DIF: Cognitive Level: Understand REF: 107 TOP:Integrated Process: Nursing Process: Assessment MSC:Area of Client Needs: Health Promotion and Maintenance 27. Which tool measures body fat most accurately? a. Stadiometer b. Calipers c. Cloth tape measure d. Paper or metal tape measure ANS: B Calipers are used to measure skin-fold thickness, which is an indicator of body fat content. Stadiometers are used to measure height. Cloth tape measures should not be used Pediatric TB because they can stretch. Paper or metal tape measures can be used for recumbent lengths and other body measurements that must be made. PTS: 1 DIF: Cognitive Level: Understand REF: 111 TOP:Integrated Process: Nursing Process: Assessment MSC:Area of Client Needs: Health Promotion and Maintenance 28. The nurse is using calipers to measure skin-fold thickness over the triceps muscle in a school-age child. What is the purpose of doing this? a. To measure body fat b. To measure muscle mass c. To determine arm circumference d. To determine accuracy of weight measurement ANS: A Measurement of skin-fold thickness is an indicator of body fat. Arm circumference is an indirect measure of muscle mass. The accuracy of weight measurement should be verified with a properly balanced scale. Body fat is just one indicator of weight. PTS: 1 DIF: Cognitive Level: Remember REF: 111 TOP:Integrated Process: Nursing Process: Assessment MSC:Area of Client Needs: Health Promotion and Maintenance 29. A nurse notes that a 10-month-old infant has a larger head circumference than chest. The nurse interprets this as a normal finding because the head and chest circumference become equal at which age? a. 1 month b. 6 to 9 months c. 1 to 2 years d. 2 1/2 to 3 years ANS: C Head circumference begins larger than chest circumference. Between ages 1 and 2 years, they become approximately equal. Head circumference is larger than chest circumference before age 1. Chest circumference is larger than head circumference at 2 1/2 to 3 years. PTS: 1 DIF: Cognitive Level: Remember REF: 111 TOP:Integrated Process: Nursing Process: Assessment MSC:Area of Client Needs: Health Promotion and Maintenance 30. Which would be best for the nurse to use when determining the temperature of a preterm infant under a radiant heater? a. Axillary sensor b. Tympanic membrane sensor c. Rectal mercury glass thermometer