Pediatric Primary Care 4th Edition, Richardson Test Bank, Exams of Pediatrics

Download Pediatric Primary Care 4th Edition, Richardson Test Bank and more Exams Pediatrics in PDF only on Docsity! Pediatric Primary Care 4th Edition, Richardson Test Bank Table of Content Section 1 Child Health Care Chapter 1 Obtaining an Initial History Chapter 2 Obtaining an Interval History Chapter 3 Performing a Physical Examination Chapter 4 Making Newborn Rounds Chapter 5 Guidelines for Breastfeeding Chapter 6 Common Genetic Disorders Chapter 7 Two-Week Visit Chapter 8 One-Month Visit Chapter 9 Two-Month Visit Chapter 10 Four-Month Visit Chapter 11 Six-Month Visit Chapter 12 Nine-Month Visit Chapter 13 Twelve-Month Visit Chapter 14 Fifteen- to Eighteen-Month Visit Chapter 15 Two-Year Visit Chapter 16 Three-Year Visit (Preschool) Chapter 17 Six-Year Visit (School Readiness) Chapter 18 Seven- to Ten-Year Visit (School Age) Chapter 19 Eleven- to Thirteen-Year Visit (Preadolescent) Chapter 20 Fourteen- to Eighteen-Year Visit (Adolescent) Section 2 Common Childhood Disorders Chapter 21 Dermatological Problems Chapter 22 Eye Disorders Chapter 23 Ear Disorders Chapter 24 Sinus, Mouth, Throat, and Neck Disorders Chapter 25 Respiratory Disorders Chapter 26 Cardiovascular Disorders Chapter 27 Gastrointestinal Disorders Chapter 28 Genitourinary Disorders Chapter 29 Gynecologic Disorders Chapter 30 Endocrine Disorders Chapter 31 Musculoskeletal Disorders Chapter 32 Neurologic Disorders Chapter 33 Hematologic Disorders Chapter 34 Pediatric Obesity Chapter 35 Behavioral Disorders Chapter 36 Mental Health Disorders Pediatric Primary Care 4th Edition Richardson Testbank/StudyGuide Chapter 1 Obtaining an Initial History MULTIPLE CHOICE 1. The nurse is seeing an adolescent and the parents in the clinic for the first time. Which should the nurse do first? a. Introduce him- or herself. b. Make the family comfortable. c. Give assurance of privacy. d. Explain the purpose of the interview. ANS: A The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. Clarification of the purpose of the interview and the nurses role is the second thing that should be done. During the initial part of the interview, the nurse should include general conversation to help make the family feel at ease. The interview also should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality. 2. Which is considered a block to effective communication? a. Using silence b. Using clichs c. Directing the focus d. Defining the problem ANS: B Using stereotyped comments or clichs can block effective communication. After the nurse uses such trite phrases, parents often do 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 maximum freedom of expression. By using open-ended questions and guiding questions, the nurse can obtain the necessary information and maintain a relationship with the family. The nurse and parent must collaborate and define the problem that will be the focus of the nursing intervention. 3. Which is the single most important factor to consider when communicating with children? a. Presence of the childs parent b. Childs physical condition c. Childs developmental level communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not always uncommunicative. 10. Which data should be included in a health history? a. Review of systems b. Physical assessment c. Growth measurements d. Record of vital signs ANS: A A review of systems is done to elicit information concerning any potential health problems. This further guides the interview process. Physical assessment, growth measurements, and a record of vital signs are components of the physical examination. 11. The nurse is taking a health history of an adolescent. Which best describes how the chief complaint should be determined? a. Request a detailed listing of symptoms. b. Ask the adolescent, Why did you come here today? c. Interview the parent away from the adolescent to determine the chief complaint. d. Use what the adolescent says to determine, in correct medical terminology, what the problem is. 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. Requesting a detailed list of symptoms makes it difficult to determine the chief complaint. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention 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. 12. The nurse is interviewing the mother of an infant. The mother reports, I had a difficult delivery, and my baby was born prematurely. This information should be recorded under which heading? a. History b. Present illness c. Chief complaint d. Review of systems ANS: A The history refers to information that relates to previous aspects of the childs health, not to the current problem. The difficult delivery and prematurity are important parts of the infants history. 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 the present illness. The chief complaint is the specific reason for the childs visit to the clinic, office, or hospital. It should not include the birth information. The review of systems is a specific review of each body system. It does not include the premature birth but might include sequelae such as pulmonary dysfunction. 13. Where in the health history does a record of immunizations belong? a. History b. Present illness c. Review of systems d. Physical assessment ANS: A The history contains information relating to all previous aspects of the childs health status. The immunizations are appropriately included in the history. The present illness, review of systems, and physical assessment are not appropriate places to record the immunization status. 14. The nurse is taking a sexual history on an adolescent girl. Which is the best way to determine whether she is sexually active? a. Ask her, Are you sexually active? b. Ask her, Are you having sex with anyone? c. Ask her, Are you having sex with a boyfriend? d. Ask both the girl and her parent if she is sexually active. ANS: B Asking the adolescent girl if she is having sex with anyone is a direct question that is well understood. The phrase sexually active is broadly defined and may not provide specific information for the nurse to provide necessary care. The word anyone is preferred to using gender-specific terms such as boyfriend or girlfriend. Using gender-neutral terms is inclusive and conveys acceptance to the adolescent. Questioning about sexual activity should occur when the adolescent is alone. 15. When doing a nutritional assessment on a Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. The nurse should recognize that this diet is which? a. Lacking in protein b. Indicating they live in poverty c. Providing sufficient amino acids d. Needing enrichment with meat and milk ANS: C A diet that contains vegetables, legumes, and starches may provide sufficient essential amino acids even though the actual amount of meat or dairy protein is low. Combinations of foods contain the essential amino acids necessary for growth. Many cultures use diets that contain this combination of foods. It is not indicative of poverty. A dietary assessment should be done, but many vegetarian diets are sufficient for growth. 16. Which parameter correlates best with measurements of total muscle mass? a. Height b. Weight c. Skinfold thickness d. Upper arm circumference ANS: D Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves as the bodys major protein reserve and is considered an index of the bodys protein stores. Height is reflective of past nutritional status. Weight is indicative of current nutritional status. Skinfold thickness is a measurement of the bodys fat content. 17. The nurse is preparing to perform a physical assessment on a 10-year-old girl. The nurse gives her the option of her mother staying in the room or leaving. This action should be considered which? a. Appropriate because of childs age b. Appropriate, but the mother may be uncomfortable c. Inappropriate because of childs age d. Inappropriate because child is same sex as mother ANS: A It is appropriate to give older school-age children the option of having the parent present or not. During the examination, the nurse should respect the childs need for privacy. Children who are 10 years old are minors, and parents are responsible for health care decisions. The mother of a 10-year-old child would not be uncomfortable. The child should help determine who is present during the examination. 18. With the National Center for Health Statistics criteria, which body mass index (BMI)for-age percentiles should indicate the patient is at risk for being overweight? a. 10th percentile b. 75th percentile 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 who are greater than or equal to the 95th percentile are considered overweight. Children whose BMI is between the 10th and 75th percentiles are within normal limits. 19. Rectal temperatures are indicated in which situation? a. In the newborn period b. Whenever accuracy is essential c. Rectal temperatures are never indicated d. When rapid temperature changes are occurring ANS: B Rectal temperatures are recommended when definitive measurements are necessary in infants older than age 1 month. Rectal temperatures are not done in the newborn period to avoid trauma to the rectal mucosa. Rectal temperature is an intrusive procedure that should be avoided whenever possible. 20. What is the earliest age at which a satisfactory radial pulse can be taken in children? a. 1 year b. 2 years b. 1 to 2 months c. 3 to 4 months d. 6 months ANS: C Visual fixation and ability to follow a target should be present by ages 3 to 4 months. One to 2 months is too young for this developmental milestone. If an infant is not able to fix and follow by 6 months, further ophthalmologic evaluation is needed. 29. During an otoscopic examination on an infant, in which direction is the pinna pulled? a. Up and back b. Up and forward c. Down and back d. Down and forward ANS: C In infants and toddlers, the ear canal is curved upward. To visualize the ear canal, it is necessary to pull the pinna down and back to the 6 to 9 oclock range to straighten the canal. In children older than age 3 years and adults, the canal curves downward and forward. The pinna is pulled up and back to the 10 oclock position. Up and forward and down and forward are positions that do not facilitate visualization of the ear canal. Chapter 2 Obtaining an Interval History 1. What is an appropriate screening test for hearing that the nurse can administer to a 5-year-old child? a. Rinne test b. Weber test c. Pure tone audiometry d. Eliciting the startle reflex ANS: C Pure tone audiometry uses an audiometer that produces sounds at different volumes and pitches in the childs ears. The child is asked to respond in some way when the tone is heard in the earphone. The Rinne and Weber tests measure bone conduction of sound. Eliciting the startle reflex may be useful in infants. 2. What is the appropriate placement of a tongue blade for assessment of the mouth and throat? a. On the lower jaw b. Side of the tongue c. Against the soft palate d. Center back area of the tongue ANS: B The side of the tongue is the correct position. It avoids the gag reflex yet allows visualization. On the lower jaw and against the soft palate are not appropriate places for the tongue blade. Placement in the center back area of the tongue elicits the gag reflex. 3. When assessing a preschoolers chest, what should the nurse expect? a. Respiratory movements to be chiefly thoracic b. Anteroposterior diameter to be equal to the transverse diameter c. Retraction of the muscles between the ribs on respiratory movement d. Movement of the chest wall to be symmetric bilaterally and coordinated with breathing ANS: D Movement of the chest wall should be symmetric bilaterally and coordinated with breathing. In children younger than 6 or 7 years, respiratory movement is principally abdominal or diaphragmatic. The anteroposterior diameter is equal to the transverse diameter during infancy. As the child grows, the chest increases in the transverse direction, so that the anteroposterior diameter is less than the lateral diameter. Retractions of the muscles between the ribs on respiratory movement are indicative of respiratory distress. 4. When auscultating an infants lungs, the nurse detects diminished breath sounds. What should the nurse interpret this as? a. Suggestive of chronic pulmonary disease b. Suggestive of impending respiratory failure c. An abnormal finding warranting investigation d. A normal finding in infants younger than 1 year of age ANS: C Absent or diminished breath sounds are always an abnormal finding. Fluid, air, or solid masses in the pleural space all interfere with the conduction of breath sounds. Further data are necessary for diagnosis of chronic pulmonary disease or impending respiratory failure. Diminished breath sounds in certain segments of the lungs can alert the nurse to pulmonary areas that may benefit from chest physiotherapy. Further evaluation is needed in all age groups. 5. Which type of breath sound is normally heard over the entire surface of the lungs except for the upper intrascapular area and the area beneath the manubrium? a. Vesicular b. Bronchial c. Adventitious d. Bronchovesicular ANS: A This is the definition of vesicular breath sounds. They are heard over the entire surface of the lungs, with the exception of the upper intrascapular area and the area beneath the manubrium. Bronchial breath sounds are heard only over the trachea near the suprasternal notch. Adventitious breath sounds are not usually heard over the chest. These sounds occur in addition to normal or abnormal breath sounds. Bronchovesicular breath sounds are heard over the manubrium and in the upper intrascapular regions, where the trachea and bronchi bifurcate. 6. The nurse is assessing a childs capillary refill time. This can be accomplished by doing what? a. Inspect the chest. b. Auscultate the heart. c. Palpate the apical pulse. d. Palpate the nail bed with pressure to produce a slight blanching. ANS: D Capillary refill time is assessed by pressing lightly on the skin to produce blanching and then noting the amount of time it takes for the blanched area to refill. Inspecting the chest, auscultating the heart, and palpating the apical pulse will not provide an assessment of capillary refill time. 7. Which heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? a. S1 and S2 b. S3 and S4 c. Murmur d. Physiologic splitting ANS: C Murmurs are the sounds that are produced in the heart chambers or major arteries from the back- and-forth flow of blood. S1 and S2 are normal heart sounds. S1 is the closure of the tricuspid and mitral valves, and S2 is the closure of the pulmonic and aortic valves. S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If it is heard, medical evaluation is required. Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding. 8. Examination of the abdomen is performed correctly by the nurse in which order? a. Inspection, palpation, percussion, and auscultation d. The tympanic membrane is a nontransparent grayish color e. A whitish line extending from the umbo upward to the margin of the membrane ANS: B, C, E Normal findings include the light reflex and bony landmarks. The light reflex is a fairly well- defined, cone-shaped reflection that normally points away from the face. The bony landmarks of the eardrum are formed by the umbo, or tip of the malleus. It appears as a small, round, opaque, concave spot near the center of the eardrum. The manubrium (long process or handle) of the malleus appears to be a whitish line extending from the umbo upward to the margin of the membrane. The tympanic membrane should be light pearly pink or gray and translucent, not nontransparent. Ashen gray areas indicate signs of scarring from a previous perforation. 16. The nurse is assessing breath sounds on a child. Which are expected auscultated breath sounds? (Select all that apply.) a. Wheezes b. Crackles c. Vesicular d. Bronchial e. Bronchovesicular ANS: C, D, E Normal breath sounds are classified as vesicular, bronchovesicular, or bronchial. Wheezes or crackles are abnormal or adventitious sounds. 17. The nurse is performing an oral examination on a preschool child. Which strategies should the nurse use to encourage the child to open the mouth for the examination? (Select all that apply.) a. Lightly brush the palate with a cotton swab. b. Perform the examination in front of a mirror. c. Let the child examine someone elses mouth first. d. Have the child breathe deeply and hold his or her breath. e. Use a tongue blade to help the child open his or her mouth. ANS: A, B, C, D To encourage a child to open the mouth for examination, the nurse can lightly brush the palate with a cotton swab, perform the examination in front of a mirror, let the child examine someone elses mouth first, and have the child breathe deeply and hold his or her breath. A tongue blade may elicit the gag reflex and should not be used. 18. Which are effective auscultation techniques? (Select all that apply.) a. Ask the child to breathe shallowly. b. Apply light pressure on the chest piece. c. Use a symmetric and orderly approach. d. Place the stethoscope over one layer of clothing. e. Warm the stethoscope before placing it on the skin. ANS: C, E Effective auscultation techniques include using a symmetric approach and warming the stethoscope before placing it on the skin. Breath sounds are best heard if the child inspires deeply, not shallowly. Firm, not light, pressure should be used on the chest piece. The stethoscope should be placed on the skin, not over clothing. 19. The nurse is assessing heart sounds on a school-age child. Which should the nurse document as abnormal findings if found on the assessment? (Select all that apply.) a. S4 heart sound b. S3 heart sound c. Grade II murmur d. S1 louder at the apex of the heart e. S2 louder than S1 in the aortic area ANS: A, C, E S4 is rarely heard as a normal heart sound; it usually indicates the need for further cardiac evaluation. A grade II murmur is not normal; it is slightly louder than grade I and is audible in all positions. S3 is normally heard in some children. Normally, S1 is louder at the apex of the heart in the mitral and tricuspid area, and S2 is louder near the base of the heart in the pulmonic and aortic area. 20. The nurse understands that blocks to therapeutic communication include what? (Select all that apply.) a. Socializing b. Use of silence c. Using clichs d. Defending a situation e. Using open-ended questions ANS: A, C, D Blocks to communication include socializing, using clichs, and defending a situation. Use of silence and using open-ended questions are therapeutic communication techniques. Chapter 3 Performing a Physical Examination Question 1 Type: MCSA The nurse is taking a health history from a family of a 3-year-old child. Which statement by the nurse would most likely establish rapport and elicit an accurate response from the family? 1. Does any member of your family have a history of asthma, heart disease, or diabetes? 2. Hello, I would like to talk with you and get some information on you and your child. 3. Tell me about the concerns that brought you to the clinic today. 4. You will need to fill out these forms; make sure that the information is as complete as possible. Correct Answer: 3 Global Rationale: Asking the parents to talk about their concerns is an open-ended question and one which is more likely to establish rapport and an understanding of the parents perceptions. Giving the family a list of items to answer at once may be confusing to the parents. Giving an introduction before asking the parents for information is likely to establish rapport, but giving an explanation of why the information would be needed would be even more effective at establishing rapport and also for getting more accurate, pertinent information. Simply asking the parents to fill out forms is very impersonal, and more information is likely to be obtained and clarified if the nurse is directing the interview. Question 2 Type: MCSA When assessing the cognitive development, which technique would be appropriate to test the remote memory of a 5-year-old? 1. Say the name of an object and after 5 minutes ask the child to tell you what you said the object was. 2. Ask the child to repeat his address. 3. Ask the child to say a poem and listen to the childs speech articulation. 4. Have the child point to various parts of the body as you name them. Correct Answer: 2 Global Rationale: Repeating the name of an object after 510 minutes is assessing recent memory. Asking the child to repeat his address is assessing remote memory. Listening to speech articulation and pointing to body parts both assess communication skills. Question 3 Type: SEQ Place the nursing assessments of a toddler in the best order. Standard Text: Click and drag the options below to move them up or down. Choice 1. Examination of eyes, ears, and throat Choice 2. Auscultation of chest Choice 3. Palpation of abdomen Choice 4. Developmental assessment Correct Answer: 4,2,3,1 Global Rationale: In examining a toddler, it is usually best to go from least invasive to most invasive examination in order to build her trust and cooperation. Developmental assessment involves visual inspection and activities that the toddler may view as games and will likely cooperate with. Auscultation is usually less threatening to the toddler than palpation, especially if 3. Coarctation of the aorta 4. Ventricular septal defect Correct Answer: 3 Rationale 1: Normally, blood pressures in the lower extremities are the same as or higher Global Rationale: Normally, blood pressures in the lower extremities are the same as or higher than upper-extremity blood pressures. But in coarctation of the aorta, the narrowing of the aorta causes decreased blood flow to the lower extremities and thus lower-extremity blood-pressure readings are significantly lower than upper-extremity readings. There are minimal differences between upper and lower blood-pressure readings in tetralogy of Fallot, pulmonary atresia, and ventricular septal defect. Question 10 Type: MCSA During an examination, a nurse asks a 5-year-old child to repeat his address. What is the nurse evaluating with this action? 1. Recent memory 2. Language development 3. Remote memory 4. Social-skill development Correct Answer: 3 Global Rationale: Asking children to remember addresses, phone numbers, and dates assesses remote-memory development. To evaluate recent memory the nurse would have the child name something and then ask him to name it again in 10 to 15 minutes. Listening to how the child talks and his sentence structure evaluates the childs language development, and assessing how he interacts with others evaluates social-skill development. Question 11 Type: MCSA During the newborn examination, the nurse assesses the infant for signs of developmental dysplasia of the hip. A finding that would strongly indicate this disorder would be: 1. soles are flat with prominent fat pads. 2. positive Babinski reflex. 3. metatarsus varus. 4. asymmetric thigh and gluteal folds. Correct Answer: 4 Rationale 1: A positive Babinski reflex and flat soles are normal newborn findings. Metatarsus varus is an in-toeing of the feet that usually occurs secondary to intra-uterine positioning and frequently resolves on its own, but approximately 10 percent of infants with metatarsus varus also have developmental dysplasia of the hip. Asymmetric thigh and gluteal folds are a positive finding for developmental dysplasia of the hip requiring follow-up with ultrasound. Rationale 2: A positive Babinski reflex and flat soles are normal newborn findings. Metatarsus varus is an in-toeing of the feet that usually occurs secondary to intra-uterine positioning and frequently resolves on its own, but approximately 10 percent of infants with metatarsus varus also have developmental dysplasia of the hip. Asymmetric thigh and gluteal folds are a positive finding for developmental dysplasia of the hip requiring follow-up with ultrasound. Rationale 3: A positive Babinski reflex and flat soles are normal newborn findings. Metatarsus varus is an in-toeing of the feet that usually occurs secondary to intra-uterine positioning and frequently resolves on its own, but approximately 10 percent of infants with metatarsus varus also have developmental dysplasia of the hip. Asymmetric thigh and gluteal folds are a positive finding for developmental dysplasia of the hip requiring follow-up with ultrasound. Rationale 4: A positive Babinski reflex and flat soles are normal newborn findings. Metatarsus varus is an in-toeing of the feet that usually occurs secondary to intra-uterine positioning and frequently resolves on its own, but approximately 10 percent of infants with metatarsus varus also have developmental dysplasia of the hip. Asymmetric thigh and gluteal folds are a positive finding for developmental dysplasia of the hip requiring follow-up with ultrasound. Question 12 Type: MCSA The nurse must assess each of the 2-year-olds listed below. Which one should be evaluated first? 1. A child with a temperature of 101 degrees F 2. A child who has stridor 3. A child who has absent Babinski sign 4. A child who has a pot belly appearance Correct Answer: 2 Global Rationale: A child with stridor is at risk for airway compromise; a child with a temperature of 101 degrees F, while sick, is not as ill as the child with stridor; and the child with an absent Babinski sign and the pot-bellied child are normal. Question 13 Type: MCSA The nurse notes a history of a grade III heart murmur in a small infant. When assessing the heart, the nurse would expect to: 1. hear a quiet but easily heard murmur. 2. hear a moderately loud murmur without a palpable thrill. 3. hear a very loud murmur with easily palpable thrill. 4. listen without a stethoscope and hear a murmur at chest wall. Correct Answer: 2 Global Rationale: A quiet but easily heard murmur is a grade II. A moderately loud murmur without palpable thrill is a grade III. A very loud murmur with easily palpable thrill is a grade V. A murmur heard at the chest wall without the aid of a stethoscope is a grade VI. Question 14 Type: MCSA The nurse is measuring an abdominal girth on a child with abdominal distension. Identify the area on the childs abdomen where the tape measure should be placed for an accurate abdominal girth. 1. Just above the umbilicus, around the largest circumference of the abdomen 2. Below the umbilicus 3. Just below the sternum 4. Just above the pubic bone Correct Answer: 1 Global Rationale: An abdominal girth should be taken around the largest circumference of the abdomen, in this case, just above the umbilicus. The circumference below the umbilicus or just below the sternum would not be an accurate abdominal girth. Question 15 Type: MCMA The nurse is preparing to assessment a toddler client. Which activities would gain cooperation from the toddler? Standard Text: Select all that apply. 1. Asking the parents to wait outside 2. Allowing the client to sit in the parents lap 3. Administering vaccinations prior to the assessment 4. Handing the client a stethoscope while taking the health history 5. Making a game out of the assessment process Correct Answer: 2,4 Global Rationale: Allowing the client to stay on the parents lap and allowing the client to play with instruments that will be used in the assessment process are activities the nurse can implement to gain the toddlers cooperation during the assessment process. Asking the parents to wait outside may cause the toddler to become fearful. Vaccinations should be administered at the end of the visit. While making a game out of the assessment process may be appropriate for older children, this is not an appropriate strategy for a toddler client. Question 16 Type: MCMA The nurse is assessing an infant client during a health supervision visit. Which assessment findings are considered normal variations for this client? Standard Text: Select all that apply. 1. Sucking pads in the mouth 2. A rounded chest 3. Hearing breath sounds over the entire chest 4. Pubertal development 5. Knock-knees Correct Answer: 1,2,3 Global Rationale: Normal variations for the infant client include sucking pads in the mouth, a rounded chest, and hearing breath sounds over the entire chest. Pubertal development and knock- knees are not normal variations for the infant client. Question 17 Type: MCMA The nurse is conducting a health surveillance visit with a 6-month-old infant. Which methods are appropriate to monitor the infants growth pattern since birth? Standard Text: Select all that apply. 1. Weight the infant twice and average together 2. Measure the infants height ANS: A Brown fat is a unique source of heat for newborns. It has a larger content of mitochondrial cytochromes and a greater capacity for heat production through intensified metabolic activity than does ordinary adipose tissue. Heat generated in brown fat is distributed to other parts of the body by the blood. It is effective only in heat production. Brown fat is located in superficial areas such as between the scapulae, around the neck, in the axillae, and behind the sternum. These areas should not protect the newborn from injury during the birth process. The newborn has a thin layer of subcutaneous fat, which does not provide for conservation of heat. 2. Which characteristic is representative of a full-term newborns gastrointestinal tract? a. Transit time is diminished. b. Peristaltic waves are relatively slow. c. Pancreatic amylase is overproduced. d. Stomach capacity is very limited. ANS: D Newborns require frequent small feedings because their stomach capacity is very limited. A newborns colon has a relatively small volume and resulting increased bowel movements. Peristaltic waves are rapid. A deficiency of pancreatic lipase limits the absorption of fats. 3. Which term is used to describe a newborns first stool? a. Milia b. Milk stool c. Meconium d. Transitional ANS: C Meconium is composed of amniotic fluid and its constituents, intestinal secretions, shed mucosal cells, and possibly blood. It is a newborns first stool. Milia involves distended sweat glands that appear as minute vesicles, primarily on the face. Milk stool usually occurs by the fourth day. The appearance varies depending on whether the newborn is breast or formula fed. Transitional stools usually appear by the third day after the beginning of feeding. They are usually greenish brown to yellowish brown, thin, and less sticky than meconium. 4. In term newborns, the first meconium stool should occur no later than within how many hours after birth? a. 6 b. 8 c. 12 d. 24 ANS: D The first meconium stool should occur within the first 24 hours. It may be delayed up to 7 days in very lowbirth-weight newborns. 5. Which is true regarding an infants kidney function? a. Conservation of fluid and electrolytes occurs. b. Urine has color and odor similar to the urine of adults. c. The ability to concentrate urine is less than that of adults. d. Normally, urination does not occur until 24 hours after delivery. ANS: C At birth, all structural components are present in the renal system, but there is a functional deficiency in the kidneys ability to concentrate urine and to cope with conditions of fluid and electrolyte stress such as dehydration or a concentrated solute load. Infants urine is colorless and odorless. The first voiding usually occurs within 24 hours of delivery. Newborns void when the bladder is stretched to 15 ml, resulting in about 20 voidings per day. 6. The Apgar score of an infant 5 minutes after birth is 8. Which is the nurses best interpretation of this? a. Resuscitation is likely to be needed. b. Adjustment to extrauterine life is adequate. c. Additional scoring in 5 more minutes is needed. d. Maternal sedation or analgesia contributed to the low score. ANS: B The Apgar reflects an infants status in five areas: heart rate, respiratory effort, muscle tone, reflex irritability, and color. A score of 8 to 10 indicates an absence of difficulty adjusting to extrauterine life. Scores of 0 to 3 indicate severe distress, and scores of 4 to 7 indicate moderate difficulty. All infants are rescored at 5 minutes of life, and a score of 8 is not indicative of distress; the newborn does not have a low score. The Apgar score is not used to determine the infants need for resuscitation at birth. 7. Which statement best represents the first stage or the first period of reactivity in the infant? a. Begins when the newborn awakes from a deep sleep b. Is an excellent time to acquaint the parents with the newborn c. Ends when the amounts of respiratory mucus have decreased d. Provides time for the mother to recover from the childbirth process ANS: B During the first period of reactivity, the infant is alert, cries vigorously, may suck his or her fist greedily, and appears interested in the environment. The infants eyes are usually wide open, suggesting that this is an excellent opportunity for mother, father, and infant to see each other. The second period of reactivity begins when the infant awakes from a deep sleep and ends when the amounts of respiratory mucus have decreased. The mother should sleep and recover during the second stage, when the infant is sleeping. 8. Which statement reflects accurate information about patterns of sleep and wakefulness in the newborn? a. States of sleep are independent of environmental stimuli. b. The quiet alert stage is the best stage for newborn stimulation. c. Cycles of sleep states are uniform in newborns of the same age. d. Muscle twitches and irregular breathing are common during deep sleep. ANS: B During the quiet alert stage, the newborns eyes are wide open and bright. The newborn responds to the environment by active body movement and staring at close-range objects. Newborns ability to control their own cycles depend on their neurobehavioral development. Each newborn has an individual cycle. Muscle twitches and irregular breathing are common during light sleep. 9. The nurse observes that a new mother avoids making eye contact with her infant. What should the nurse do? a. Ask the mother why she wont look at the infant. b. Examine the infants eyes for the ability to focus. c. Assess the mother for other attachment behaviors. d. Recognize this as a common reaction in new mothers. ANS: C Attachment behaviors are thought to indicate the formation of emotional bonds between the newborn and mother. A mothers failure to make eye contact with her infant may indicate difficulties with the formation of emotional bonds. The nurse should perform a more thorough assessment. Asking the mother why she will not look at the infant is a confrontational response that might put the mother in a defensive position. Infants do not have binocularity and cannot focus. Avoiding eye contact is an uncommon reaction in new mothers. 10. Which should the nurse use when assessing the physical maturity of a newborn? a. Length b. Apgar score c. Posture at rest d. Chest circumference ANS: C With the newborn quiet and in a supine position, the degree of flexion in the arms and legs can be used for determination of gestational age. Length and chest circumference reflect the newborns size and weight, which vary according to race and gender. Birth weight alone is a poor indicator of gestational age and fetal maturity. The Apgar score is an indication of the newborns adjustment to extrauterine life. 11. What is the grayish white, cheeselike substance that covers the newborns skin? a. Milia b. Meconium c. Amniotic fluid d. Vernix caseosa ANS: D The vernix caseosa is the grayish white, cheeselike substance that covers a newborns skin. 12. What is most descriptive of the shape of the anterior fontanel in a newborn? a. Circle b. Square c. Triangle d. Diamond a. Grasp b. Perez c. Babinski d. Dance or step ANS: C This is a description of the Babinski reflex. Stroking the outer sole of the foot upward from the heel across the ball of the foot causes the big toes to dorsiflex and the other toes to hyperextend. This reflex persists until approximately age 1 year or when the newborn begins to walk. The grasp reflex is elicited by touching the palms or soles at the base of the digits. The digits will flex or grasp. The Perez reflex involves stroking the newborns back when prone; the child flexes the extremities, elevating the head and pelvis. This disappears at ages 4 to 6 months. When the newborn is held so that the sole of the foot touches a hard surface, there is a reciprocal flexion and extension of the leg, simulating walking. This reflex disappears by ages 3 to 4 weeks. 21. Which is most important in the immediate care of the newborn? a. Maintain a patent airway. b. Administer prophylactic eye care. c. Maintain a stable body temperature. d. Establish identification of the mother and baby. ANS: A Maintaining a patent airway is the primary objective in the care of the newborn. First, the pharynx is cleared with a bulb syringe followed by the nasal passages. Administering prophylactic eye care and establishing identification of the mother and baby are important functions, but physiologic stability is the first priority in the immediate care of the newborn. Conserving the newborns body heat and maintaining a stable body temperature are important, but a patent airway must be established first. 22. What should nursing interventions to maintain a patent airway in a newborn include? a. Positioning the newborn supine after feedings. b. Wrapping the newborn as snugly as possible. c. Placing the newborn to sleep in the prone (on abdomen) position. d. Using a bulb syringe to suction as needed, suctioning the nose first and then the pharynx. ANS: A Positioning the newborn supine after feedings is recommended by the American Academy of Pediatrics to prevent sudden newborn death syndrome. The child can be wrapped snugly but should be placed on the side or back. Placing a newborn to sleep in the prone (on abdomen) position is not advised because of the possible link between sleeping in the prone position and sudden newborn death syndrome. A bulb syringe should be kept by the bedside if necessary, but the pharynx should be suctioned before the nose. 23. The nurse quickly dries the newborn after delivery. This is to conserve the newborns body heat by preventing heat loss through which method? a. Radiation b. Conduction c. Convection d. Evaporation ANS: D Evaporation is the loss of heat through moisture. The newborn should be quickly dried of the amniotic fluid. Radiation is the loss of heat to a cooler solid object. The cold air from either the window or the air conditioner will cool the walls of the incubator and subsequently the body of the newborn. Conduction involves the loss of heat from the body because of direct contact of the skin with a cooler object. Convection is similar to conduction but is the loss of heat aided by air currents. 24. An infant is being discharged at 48 hours of age. The parents ask how the infant should be bathed this first week home. Which is the best recommendation by the nurse? a. Bathe the infant daily with mild soap. b. Bathe the infant daily with an alkaline soap. c. Bathe the infant two or three times this week with mild soap. d. Bathe the infant two or three times this week with plain water. ANS: D A newborn infants skin has a pH of approximately 5. This acidic pH has a bacteriostatic effect. The parents should be taught to use only plain warm water for the bath and to bathe the infant no more than two or three times the first 2 weeks. Soaps are alkaline. They will alter the acid mantle of the infants skin, providing a medium for bacterial growth. 25. The stump of the umbilical cord usually drops off in how many days? a. 3 to 6 b. 10 to 14 c. 16 to 21 d. 24 to 28 ANS: B The average umbilical cord separates in 10 to 14 days. Three to 6 days is too soon, and 16 to 28 days is too late. 26. The parents of an infant plan to have him circumcised. They ask the nurse about pain associated with this procedure. The nurses response should be based on which? a. That infants experience pain with circumcision b. That infants are too young for anesthesia or analgesia c. That infants do not experience pain with circumcision d. That infants quickly forget about the pain of circumcision ANS: A Circumcision is a surgical procedure. The American Academy of Pediatrics has recommended that procedural analgesia be provided when circumcision is performed. The pain infants experience with surgical procedures can be alleviated with analgesia. Infants who undergo circumcision without anesthetic agents react more intensely to immunization injections at 4 to 6 months of age compared with infants who had an anesthetic. 27. The nurse is teaching a class on breastfeeding to expectant parents. Which is a contraindication for breastfeeding? a. Mastitis b. Twin births c. Inverted nipples d. Maternal cancer therapy ANS: D Mothers receiving chemotherapy with antimetabolites and certain antineoplastic drugs should not breastfeed. The drugs are passed to the newborn through the breast milk. Mastitis, twin births, and inverted nipples are not contraindications. 28. Successful breastfeeding is most dependent on which? a. Birth weight of newborn b. Size of mothers breasts c. Mothers desire to breastfeed d. Familys socioeconomic level ANS: C The factors that contribute to successful breastfeeding are the mothers desire to breastfeed, satisfaction with breastfeeding, and available support systems. Very lowbirth-weight infants may be unable to breastfeed. The mother can express milk, and it can be used for the infant. The size of mothers breasts does not affect the success of breastfeeding. The familys socioeconomic level may affect the mothers need to return to work and available support systems, but with support, the mother can be successful. 29. A mother who breastfeeds her 6-week-old infant every 4 hours tells the nurse that he seems hungry all the time. The nurse should recommend which? a. Newborn cereal b. Supplemental formula c. More frequent feedings d. No change in feedings ANS: C Infants who are breastfed tend to be hungry every 2 to 3 hours. They should be fed frequently. Six weeks is too early to introduce newborn cereal. Supplemental formula is not indicated. Giving additional formula or water to a breastfed infant may satiate the infant and create problems with breastfeeding. The infant requires additional feedings. Four hours is too long between feedings for a breastfed infant. 30. What should a nursing intervention to promote parentinfant attachment include? a. Encouraging parents to hold the infant frequently unless the infant is fussy b. Explaining individual differences among infants to the parents c. Delaying parentinfant interactions until the second period of reactivity d. Alleviating stress for parents by decreasing their participation in the infants care ANS: B The Apgar score is based on observation of heart rate, respiratory effort, muscle tone, reflex irritability, and color. Blood pressure and blood glucose are not part of the Apgar scoring system. 4. The nurse is completing a respiratory assessment on a newborn. What are normal findings of the assessment the nurse should document? (Select all that apply.) a. Periodic breathing b. Respiratory rate of 40 breaths/min c. Wheezes on auscultation d. Apnea lasting 25 seconds e. Slight intercostal retractions ANS: A, B, E Periodic breathing is common in full-term newborns and consists of rapid, nonlabored respirations followed by pauses of less than 20 seconds. The newborns respiratory rate is between 30 and 60 breaths/min. The ribs are flexible, and slight intercostal retractions are normal on inspiration. Periods of apnea lasting more than 20 seconds are abnormal, and wheezes should be reported. 5. The nurse is instructing a new mother on safety measures for newborn abduction. Which should the nurse include in the instructions? (Select all that apply.) a. Publish the birth announcement in your local newspaper. b. Dont relinquish the newborn to anyone without identification. c. Keep your door open if the newborn is in the room while you shower. d. Use a password system with the staff when the newborn is taken from the room. e. When you use the restroom, ring for a nurse to stay in the room with your newborn. ANS: B, D, E Safety measures to be taught to new mothers should include (1) not leaving the newborn alone in the crib while taking a shower or using the bathroom; rather, they should ask to have the newborn observed by a health care worker if a family member is not present in the room; (2) not relinquishing the newborn to anyone without identification; and (3) using a password system with the staff when the newborn is taken from the room as a routine security measure. The newborn should not be left alone while the mother is showering, even if the door is left open. It is recommended to not publish the birth announcement in the newspaper. 6. The nurse is conducting discharge teaching to parents regarding care of the umbilical cord. Which should the nurse include in the instructions? (Select all that apply.) a. Cover the umbilical cord with the diaper. b. The cord will fall off in 5 to 15 days. c. Clean around the umbilical cord stump with water. d. Watch for redness and drainage around the umbilical cord stump. e. A tub bath can be done every other day. ANS: B, C, D The umbilical cord is cleansed initially with sterile water or a neutral pH cleanser and then subsequently with water. The stump deteriorates through the process of dry gangrene, with an average separation time of 5 to 15 days. The umbilical cord area should be watched for redness or drainage, which could indicate infection. The diaper is placed below the cord to avoid irritation and wetness on the site, and tub bathing is not allowed until the umbilical cord falls off. COMPLETION 1. A health care provider prescribes vitamin K intramuscular 1 mg one time within 1 hour of birth. The medication label states: Vitamin K 2 mg/1 ml. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer to one decimal place. ANS: 0.5 Follow the formula for dosage calculation. Desired Volume = ml per dose Available 1 mg 1 ml = 0.5 ml 2 mg Chapter 5 Guidelines for Breastfeeding MULTIPLE CHOICE 1. The breastfeeding client should be taught a safe method to remove her breast from the babys mouth. Which suggestion by the nurse is most appropriate? a. Break the suction by inserting your finger into the corner of the infants mouth. b. A popping sound occurs when the breast is correctly removed from the infants mouth. c. Slowly remove the breast from the babys mouth when the infant has fallen asleep and the jaws are relaxed. d. Elicit the Moro reflex in the baby to wake the baby up, and remove the breast when the baby cries. ANS: A Inserting a finger into the corner of the babys mouth between the gums to break the suction avoids trauma to the breast. A popping sound indicates improper removal of the breast from the babys mouth and may cause cracks or fissures in the breast. The infant who is sleeping may lose grasp on the nipple and areola, resulting in chewing on the nipple, making it sore. Most mothers prefer the infant to continue to sleep after the feeding. Gentle wake-up techniques are recommended. 2. Which woman is most likely to continue breastfeeding beyond 6 months? a. A woman who avoids using bottles b. A woman who uses formula for every other feeding c. A woman who offers water or formula after breastfeeding d. A woman whose infant is satisfied for 4 hours after the feeding ANS: A Women who avoid using bottles and formula are more likely to continue breastfeeding. Use of formula decreases breastfeeding time and decreases the production of prolactin and, ultimately, the milk supply. Overfeeding after breastfeeding causes a sense of fullness in the infant, so the infant will not be hungry in 2 to 3 hours. Formula takes longer to digest. The new breastfeeding mother needs to nurse often to stimulate milk production. 3. In which condition is breastfeeding contraindicated? a. Triplet birth b. Flat or inverted nipples c. Human immunodeficiency virus infection d. Inactive, previously treated tuberculosis ANS: C Human immunodeficiency virus is a serious illness that can be transmitted to the infant via body fluids. Because the amount of milk being produced depends on the amount of suckling of the breasts, providing enough milk should not be a problem. Nipple abnormality can begin to be treated during pregnancy but may begin after birth. Many methods help flat or inverted nipples to become more erect. Only active tuberculosis patients would be cautioned not to breastfeed. 4. Which type of formula should not be diluted before being administered to an infant? a. Powdered b. Concentrated c. Ready to use d. Modified cows milk ANS: C Ready to use formula can be poured directly from the can into the babys bottle and is good (but expensive) when a proper water supply is not available. Formula should be well mixed to dissolve the powder and make it uniform. Improper dilution of concentrated formula may cause malnutrition or sodium imbalances. Cows milk is more difficult for the infant to digest and is not recommended, even if it is diluted. 5. How many kilocalories per kilogram (kcal/kg) of body weight does a full-term formula-fed infant need each day? establish lactation. Fluid intake should not be limited with a breastfeeding mother; that would decrease the amount of breast milk produced. Warm packs should be applied to the breast before feedings. 13. What is the difference between the aseptic and terminal methods of sterilization? a. The aseptic method requires a longer preparation time. b. The aseptic method does not require boiling of the bottles. c. The terminal method requires boiling water to be added to the formula. d. The terminal method sterilizes the prepared formula at the same time it sterilizes the equipment. ANS: D In the terminal sterilization method, the formula is prepared in the bottles, which are loosely capped, and then the bottles are placed in the sterilizer, where they are boiled for 25 minutes. The terminal method takes 25 minutes to boil; the aseptic method takes 5 minutes to boil. With the aseptic method, the bottles are boiled separate from the formula. With the terminal method, the formula is prepared, placed in bottles, and everything is boiled at one time. 14. How many ounces will an infant who is on a 4-hour feeding schedule need to consume at each feeding to meet daily caloric needs? a. 1 b. 1.5 c. 3.5 d. 5 ANS: C The newborn requires approximately 12 to 24 oz of formula each day (6 feedings/24-hour period). 1 and 1.5 ounces are too small to meet calorie needs; 5 ounces with every feeding would be overfeeding the infant. 15. A new mother is concerned because her 1-day-old newborn is taking only 1 oz at each feeding. What should the nurse explain? a. The infant is probably having difficulty adjusting to the formula. b. An infant does not require as much formula in the first few days of life. c. The infants stomach capacity is small at birth but will expand within a few days. d. The infant tires easily during the first few days but will gradually take more formula. ANS: C The infants stomach capacity at birth is 10 to 20 mL and increases to 30 to 90 mL by the end of the first week. There are other symptoms if there is a formula intolerance. The infants requirements are the same, but the stomach capacity needs to increase before taking in adequate amounts. The infants sleep patterns do change, but the infant should be awake enough to feed. 16. As the nurse assists a new mother with breastfeeding, the mother asks, If formula is prepared to meet the nutritional needs of the newborn, what is in breast milk that makes it better? The nurses best response is that it contains: a. more calcium. b. more calories. c. essential amino acids. d. important immunoglobulins. ANS: D Breast milk contains immunoglobulins that protect the newborn against infection. Calcium levels are higher in formula than breast milk. This higher level can cause an excessively high renal solute load if the formula is not diluted properly. The calorie counts of formula and breast milk are about the same. All the essential amino acids are in formula and breast milk. The concentrations may differ. 17. What should the nurse explain when responding to the question, Will I produce enough milk for my baby as she grows and needs more milk at each feeding? a. Early addition of baby food will meet the infants needs. b. The breast milk will gradually become richer to supply additional calories. c. As the infant requires more milk, feedings can be supplemented with cows milk. d. The mothers milk supply will increase as the infant demands more at each feeding. ANS: D The amount of milk produced depends on the amount of stimulation of the breast. Increased demand with more frequent and longer breastfeeding sessions results in more milk available for the infant. Solids should not be added until about 4 to 6 months, when the infants immune system is more mature. This will decrease the chance of allergy formations. Mature breast milk will stay the same. The amounts will increase as the infant feeds for longer times. Supplementation will decrease the amount of stimulation of the breast and decrease the milk production. 18. Which should the nurse recommend to the postpartum client to prevent nipple trauma? a. Assess the nipples before each feeding. b. Limit the feeding time to less than 5 minutes. c. Wash the nipples daily with mild soap and water. d. Position the infant so the nipple is far back in the mouth. ANS: D If the infants mouth does not cover as much of the areola as possible, the pressure during sucking will be applied to the nipple, causing trauma to the area. Assessing the nipples for trauma is important, but it will not prevent sore nipples. Stimulating the breast for less than 5 minutes will not produce the extra milk the infant may need. Soap can be drying to the nipples and should be avoided during breastfeeding. 19. A breastfeeding client who was discharged yesterday calls to ask about a tender hard area on her right breast. What should be the nurses first response? a. This is a normal response in breastfeeding mothers. b. Notify your doctor so he can start you on antibiotics. c. Stop breastfeeding because you probably have an infection. d. Try massaging the area and apply heat; it is probably a plugged duct. ANS: D A plugged lactiferous duct results in localized edema, tenderness, and a palpable hard area. Massage of the area followed by heat will cause the duct to open. This is a normal deviation but requires intervention to prevent further complications. Tender hard areas are not the signs of an infection, so antibiotics are not indicated. Fatigue, aching muscles, fever, chills, malaise, and headache are signs of mastitis. She may have a localized area of redness and inflammation. 20. Which is an important consideration about the storage of breast milk? a. Can be thawed and refrozen b. Can be frozen for up to 2 months c. Should be stored only in glass bottles d. Can be kept refrigerated for 48 hours ANS: D If used within 48 hours after being refrigerated, breast milk will maintain its full nutritional value. It should not be refrozen. Frozen milk should be kept for 1 month only. Antibodies in the milk will adhere to glass bottles. Only rigid polypropylene plastic containers should be used. 21. What is the most serious consequence of propping an infants bottle? a. Colic b. Aspiration c. Dental caries d. Ear infections ANS: B Propping the bottle increases the likelihood of choking and aspiration if regurgitation occurs. Colic can occur but is not the most serious consequence. Dental caries becomes a problem when milk stays on the gums for a long period of time. This may cause a buildup of bacteria that will alter the growing teeth buds. However, this is not the most serious consequence. Ear infections can occur when the warm formula runs into the ear and bacterial growth occurs. However, this is not the most serious consequence. 22. A new mother asks why she has to open a new bottle of formula for each feeding. What is the nurses best response? a. Formula may turn sour after it is opened. b. Bacteria can grow rapidly in warm milk. c. Formula loses some nutritional value once it is opened. d. This makes it easier to keep track of how much the baby is taking. ANS: B Formula should not be saved from one feeding to the next because of the danger of rapid growth of bacteria in warm milk. Formula will have bacterial growth before turning sour. This will cause problems in a newborn with an immature immune system. The loss of some nutritional value after the formula is opened is not the reason for using fresh bottles with each feeding. The danger of bacterial growth is the main concern. 23. A new mother asks whether she should feed her newborn colostrum because it is not real milk. The nurses best answer includes which information? life. Breastfeeding infants who are not exposed to the sun and those with dark skin are particularly at risk for insufficient vitamin D. Formula-fed infants who drink less than 1 quart of vitamin Dfortified milk per day should also be supplemented. Although the fatty acid content of breast milk is influenced by the mothers diet, malnourished mothers milk has about the same proportions of total fat, protein, carbohydrates, and most minerals as milk from those who are well nourished. Levels of water-soluble vitamins in breast milk are affected by the mothers intake and stores. It is important for breastfeeding women to eat a well-balanced diet to maintain their own health and energy levels. 29. A new mother is preparing for discharge. She plans on bottle feeding her baby. Which statement indicates to the nurse that the mom needs more information about bottle feeding? a. I should encourage my baby to consume the entire amount of formula prepared for each feeding. b. I can make up a 24-hour supply of formula and refrigerate the bottles so I am ready to feed my baby. c. I will hold my baby in a cradle hold and alternate sides from left to right when I feed my baby. d. I will generally feed my baby every 3 to 4 hours or more as signs of hunger are displayed. ANS: A Infants will stop suckling when they are full. Encouraging them to overeat may lead to problems with regurgitation and possible aspiration. The mother can prepare a single bottle or a 24-hour supply if adequate refrigeration is available. Show the parents how to position the infant in a semiupright position, such as the cradle hold. This allows them to hold the infant close in a faceto-face position. The bottle is held with the nipple kept full of formula to prevent excessive swallowing of air. Placing the infant in the opposite arm for each feeding provides varied visual stimulation during feedings. Feed the infant every 3 to 4 hours but avoid rigid scheduling and take cues from the infant. 30. A client who is receiving a pitocin (Oxytocin) infusion for the augmentation of labor is experiencing a contraction pattern of more than eight contractions in a 10-minute period. Which intervention would be a priority? a. Increase the rate of pitocin infusion to help spread out the contraction pattern. b. Place oxygen on the client at 8 to 10 L/min via face mask and turn the client to her left side. c. Stop the pitocin infusion. d. Call the physician to obtain an order for the initiation of magnesium sulfate. ANS: C The client is exhibiting uterine tachysystole (uterine tetany). The priority intervention is to stop the infusion. The next course of action is to place oxygen on the client and reposition and increase the flow rate of the primary infusion. If the condition does not improve, the physician may be contacted for additional orders. 31. The nurse is teaching a postpartum client different holds for breastfeeding. Which of the following figures depicts the football hold frequently used for clients who have had a cesarean birth? a. b. c. d. ANS: C For the football or clutch hold, the mother supports the infants head and neck in her hand, with the infants body resting on pillows next to her hip. This method allows the mother to see the position of the infants mouth on the breast, helps her control the infants head, and is especially helpful for mothers with heavy breasts. This hold also avoids pressure against an abdominal incision. For the cradle hold, the mother positions the infants head at or near the antecubital space and level with her nipple, with her arm supporting the infants body. Her other hand is free to hold the breast. The cross-cradle or modified cradle hold is helpful for infants who are preterm or have a fractured clavicle. The mother holds the infants head with the hand opposite the side on which the infant will feed and supports the infants body across her lap with her arm. The other hand holds the breast. The side-lying position avoids pressure on the episiotomy or abdominal incision and allows the mother to rest while feeding. MULTIPLE RESPONSE 32. Late in pregnancy, the clients breasts should be assessed by the nurse to identify any potential concerns related to breastfeeding. Which of the following nipple conditions make it necessary to intervene before birth. (Select all that apply.) a. Flat nipples b. Cracked nipples c. Everted nipples d. Inverted nipples e. Nipples that contract when compressed ANS: A, D, E Flat nipples appear soft, like the areola, and do not stand erect unless stimulated by rolling them between the fingers. Inverted nipples are retracted into the breast tissue. These nipples appear normal; however, they will draw inward when the areola is compressed by the infants mouth. Dome-shaped devices known as breast shells can be worn during the last weeks of pregnancy and between feedings after birth. The shells are placed inside the bra, with the opening over the nipple. The shells exert slight pressure against the areola to help the nipples protrude. The helpfulness of breast shells has been debated. A breast pump can be used to draw the nipples out before feedings after birth. Everted nipples protrude and are normal. No intervention will be required. Cracked, blistered, and bleeding nipples occur after breastfeeding has been initiated and are the result of improper latching on. The infant should be repositioned during feeding. The application of colostrum and breast milk after feedings will aid in healing. 33. Which interventions may relieve symptoms of colic in the infant? (Select all that apply.) a. Increased stimulation of infant to provide distraction b. Burping infant frequently during feedings c. Feeding infant placed in an upright position d. Providing chamomile tea to infant e. Feeding infant on an on demand schedule ANS: B, C, D The presence of colic is a self-limiting temporary condition seen in infants during the first few months of life. Although there are many theories about its cause, none has been determined to show direct causation. Providing a quiet environment and a consistent feeding schedule, positioning the infant in an upright position during feeding, burping the infant frequently, and using supplements or medications that have antispasmodic properties may be recommended. Chamomile tea is reported to have antispasmodic effects. Feeding the infant on an on demand schedule may exacerbate the condition as a result of overfeeding. 34. For which infant should the nurse anticipate the use of soy formula? (Select all that apply.) a. Preterm infant b. Infant with galactosemia c. Infant with phenylketonuria d. Infant with lactase deficiency e. Infant with a malabsorption disorder ANS: B, D, E Soy formula may be given to infants with galactosemia or lactase deficiency or those whose families are vegetarians. Soy milk is derived from the protein of soybeans and supplemented with amino acids. The formulas are also used for infants with malabsorption disorders. The preterm infant may require a more concentrated formula, with more calories in less liquid. Modifications of other nutrients are also made. Human milk fortifiers can be added to breast milk to adapt it for preterm infants. Low-phenylalanine formulas are needed for infants with phenylketonuria, a deficiency in the enzyme to digest phenylalanine found in standard formulas. 35. A new mother asks the nurse, How will I know early signs of hunger in my baby? The nurses best response is which of the following? (Select all that apply.) a. Crying b. Rooting c. Lip smacking d. Decrease in activity e. Sucking on the hands ANS: B, C, E Early signs of hunger in a baby are rooting, lip smacking, and sucking on the hands. Crying is a late sign, and the babys activity will increase, not decrease. 36. The mother of a 7-month-old states, The baby is eating food now. Should I give him regular milk, too? What is the nurses best response? a. You should give the baby low-fat milk. b. Try the milk. See if he has any digestive problems. c. Continue breast milk or iron-fortified formula until 1 year of age. d. At this age, infants can tolerate lactose-free or soy-based milk. ANS: C a. Align the limbs b. Support the head c. Keep the head lower than the hips d. Check intake and output ANS: B The child with hydrocephalus has a heavy head on a small body with poor muscle tone; the head must be supported when feeding and moving the child to prevent injury to the neck. 3. The nurse observes that the infants anterior fontanelle is bulging after placement of a ventriculoperitoneal shunt. The nurse positions this infant: a. Prone, with the head of the bed elevated b. Supine, with the head flat c. Side-lying on the operative side d. In the semi-Fowlers position ANS: D If the fontanels are bulging, the child would be positioned in a semi-Fowlers position to promote drainage from the ventricles through the shunt. 4. After feeding a baby with hydrocephalus, the nurse will take special care to: a. Sit the baby upright in an infant seat b. Place the baby over the shoulder to burp c. Leave the baby in a side-lying position d. Stimulate the baby by rubbing its feet ANS: C Because children with hydrocephalus are prone to vomiting, the child is fed and then positioned in the side-lying position in a quiet atmosphere to reduce the incidence of vomiting. 5. A newborn was just admitted to the NICU with a meningomyelocele. The priority for preoperative nursing care of this newborn is to protect the sac by: a. Keeping the sac dry b. Diapering snugly c. Positioning prone in an incubator d. Moving from side to side every hour ANS: C The infant is placed prone in a humidified incubator, and the sac is covered with dressings of sterile saline. The babys hips are kept lower than the lesion, and the baby is usually not in diapers. 6. The nurse caring for the child who has had a ventriculoperitoneal shunt for hydrocephalus observes an increasing abdominal girth. The most appropriate response would be to: a. Elevate the childs head b. Check bowel sounds c. Record retention of feeding d. Notify charge nurse of possible malabsorption ANS: D An increasing abdominal girth in a child with a VP shunt may be indicative of malabsorption of the CSF that is being shunted to the peritoneum. 7. The nurse counsels the parents of a child with a cleft palate that they should be alert for signs of: a. Facial paralysis b. Ear infections c. Increasing ICP d. Drooling ANS: B Children with cleft palate are at risk of ear infections and dental disorders. 8. Postoperative nursing care of the infant following surgical repair of a cleft lip would include: a. Feeding the infant with a spoon to avoid sucking b. Positioning the infant on the abdomen to facilitate drainage c. Applying elbow restraints to protect the surgical area d. Providing minimal stimulation to prevent injury to the incision ANS: C Elbow restraints are used postoperatively to prevent the infant from damaging the operative area. 9. The statement that indicates parents understand how to feed their infant who had surgical repair of a cleft lip is: a. We are feeding the baby with a dropper for two weeks. b. We resumed bottle feeding after discharge. c. We started the baby on solid food yesterday. d. The baby is drinking well from a straw. ANS: A The infant is fed with a dropper until the incision is completely healed, about 1 to 2 weeks after surgery. 10. An 18-month-old child who has had a surgical repair of a cleft palate is now allowed to eat a regular diet. The adjustment the nurse would make in feeding is: a. Feed solid foods with the spoon at the side of the mouth. b. Puree foods and offer them through a straw. c. Place small bites of food in the mouth with a tongue blade. d. Offer small, frequent meals of finger foods. ANS: A The primary concern with feeding is to protect the operative site. The child can be fed with a spoon, but only the side of the spoon is placed into the mouth at the side of the mouth. The spoon must not touch the roof of the mouth. 11. The nurse bathing an infant would recognize a sign of developmental hip dysplasia, which is: a. Hypotonicity of the leg muscles b. One leg is shorter than the other c. Broadening and flattening of the buttocks d. Two skin folds on the back of each thigh ANS: B When developmental hip dysplasia is present, the leg on the affected side will appear shorter than the leg on the unaffected side. 12. A 3-month-old infant is diagnosed with developmental hip dysplasia. The nurse explains that the usual treatment for this infant would be: a. A Pavlik harness b. A body spica cast c. Traction d. Triple-diapering ANS: A In infants more than 2 months of age, longer-term immobilization with a Pavlik harness is required. 13. Following delivery, a mother asks the nurse about newborn screening tests. The nurse explains that the optimal time for testing for phenylketonuria is: a. In the first 24 hours of life b. After 2 to 3 days c. At 4 to 6 weeks of age d. At 2 months of age ANS: B Blood tests for phenylketonuria should be obtained 48 to 72 hours after birth. The newborn will have had enough time to ingest protein through feedings and the chance of false-negative results will be reduced. 14. The nurse advising parents about feeding their infant who has phenylketonuria, would include the information to: a. Provide a life-long high-protein diet. b. Use a formula that is low in the amino acid leucine. c. Feed the baby a soy-based formula. d. Substitute Lofenalac for some protein foods. ANS: D A synthetic food providing enough protein for growth and tissue repair, but little phenylalanine, is substituted for natural protein foods. 16. The nurse instructing parents about positioning their toddler who has just had a body spica cast applied would include to: a. Prop the child upright with pillows for meals. ANS: meningomyelocele NOT: Rationale: A spina bifida that includes a portion of the cord in the sac in addition to the meninges is classified as a meningomyelocele. 3. The nurse demonstrates how to flush the ventriculoperitoneal shunt by the use of the that is in place behind the babys ear. ANS: pump NOT: Rationale: A small pump is part of the VP shunt. The pump is in place behind the childs ear. The shunt can be pumped according to the physicians instructions in order to maintain flow from the ventricles to the peritoneum. Chapter 7 Two-Week Visit 1. A 2-week-old infant can fixate on an object but cannot follow a light or bright toy. The nurse would: a. Consider this a normal finding. b. Assess the pupillary light reflex for possible blindness. c. Continue with the examination, and assess visual fields. d. Expect that a 2-week-old infant should be able to fixate and follow an object. ANS: A By 2 to 4 weeks an infant can fixate on an object. By the age of 1 month, the infant should fixate and follow a bright light or toy. 2. A nurse is providing discharge teaching to parents of a newborn. The baby had no medical problems and is healthy other than having failed an automated auditory brainstem response (AABR) hearing test conducted in the nursery. What information does the nurse provide? A. AABR tests are conclusive and the baby is deaf. B. Background noise may have interfered with the test. C. The babys hearing should be retested within 1 month. D. The baby should have another hearing test next week. ANS: C Babies who fail a hearing screening test at birth should have a follow-up test within a month. The AARB test can be conducted in the presence of background noise. The results are not conclusive (it is a screening device), which is why the babys hearing needs to be retested. 3. The perinatal nurse teaches new parents that the best sleeping position for infants is which of the following? A. Prone B. Side-lying C. Side-lying with a blanket roll behind the infants back D. Supine ANS: D The nurse should teach the parents that all newborns should be placed on their backs (supine) for sleep by every caregiver for the first year of life. 4. The nursery nurse notes the presence of diffuse edema on a newborn babys head. Review of the birth record indicates that her mother experienced a prolonged labor and difficult childbirth. What action by the nurse is best? A. Document the findings in the infants chart. B. Measure head circumference every 12 hours. C. Prepare to administer IV osmotic diuretics. D. Transfer the baby to the NICU for monitoring . ANS: A Caput succedaneum is diffuse edema that crosses the cranial suture lines and disappears without treatment during the first few days of life. It often is the result of a traumatic or difficult birth. The nurse should document the findings. No other action is needed. 5. The nurse completes an initial newborn examination. The nurses findings include the following: heart rate, 136 beats/minute; respiratory rate, 64 breaths/minute; temperature, 98.2F (36.8C). The nurse also documents a heart murmur, absence of bowel sounds, symmetry of ears and eyes, no grunting or nasal flaring, and full range of movement of all extremities. Which finding requires immediate consultation with the health-care provider? A. Absent bowel sounds B. Heart murmur C. Respiratory rate D. Temperature ANS: A Bowel obstruction in the neonate is often first identified by an absence of bowel sounds in a small, distinct section of the intestines; therefore, this finding should be reported. The other findings are normal (it is not uncommon to hear murmurs in infants less than 24 hours old). 6. The nurse is assessing the neonates skin and notes the presence of small irregular red patches on the cheeks that turn into single yellow pimples on the babys chest. What treatment and care does the nurse recommend to the parents to help resolve this rash? A. Apply aloe vera lotion to lesions and skin. B. Apply hormonal skin cream twice a day. C. None; it will disappear within about a month. D. Vigorously wash and cleanse the babys skin. ANS: C Erythema toxicum is a newborn rash that consists of small, irregular flat red patches on the cheeks that develop into singular, small yellow pimples appearing on the chest, abdomen, and extremities. The etiology is unknown and it may persist for up to a month before resolving on its own. 7. The mother of an infant born prematurely at 32 weeks expresses the desire to breastfeed her child. The nurse correctly responds with which statement when the mother asks how long she should breastfeed her baby? 1. Until the child begins solid foods. 2. Many breastfeed for 2 years. 3. It is recommended that mothers of preterm infants breastfeed at least a month. 4. Breast milk should be the only food for the first 6 months. Correct Answer: 4 Rationale 1: Breast milk should be the only food for the first 6 months, and should continue until 12 months even after solid foods are introduced. Rationale 2: Breast milk should be the only food for the first 6 months, and should continue until 12 months even after solid foods are introduced. Rationale 3: Breast milk should be the only food for the first 6 months, and should continue until 12 months even after solid foods are introduced. Rationale 4: Breast milk should be the only food for the first 6 months, and should continue until 12 months even after solid foods are introduced. Global Rationale: Breast milk should be the only food for the first 6 months, and should continue until 12 months even after solid foods are introduced. 8. The nurse is instructing a parent of a newborn on the foods that are to be started based on age. The nurse instructs the parent that the first food given to a newborn is rice cereal. What statement by the parent suggests appropriate understanding of the next food that can be introduced? 1. Chicken can be given next. 2. Eggs can be given next. 3. Fruits should be given next. 4. Whole milk should be started. Correct Answer: 3 B. Ensure the tub water is not too hot. C. Obtain all of the needed supplies. D. Take the babys blood pressure. ANS: A Preventing temperature instability is a critical nursing action when bathing an infant in the hospital. If the infants temperature is within normal limits, the baby can be given a sponge bath. After the umbilical cord stump falls off, the infant can be bathed in a tub of water. Obtaining needed supplies is always important prior to performing any procedure, but this is not as important as maintaining safety. Taking the blood pressure is not needed. 3. A nurse notes that an infant has a drooping tongue, which causes difficulty with feeding. What cranial nerve should the nurse assess further? A. Facial B. Olfactory C. Trigeminal D. Vagus ANS: A Birth-related damage to the 7th cranial nerve (facial) can lead to drooping tongue or mouth, unequal movement of the cheek muscles, or inappropriate eyelid movement. 4. A nursing student is measuring a newborn babys head circumference. Which action by the student demonstrates good understanding of this procedure? A. Measures three times, records the average B. Places tape measure at the hair line C. Records the largest of three measurements D. Uses two finger-breadths to estimate size ANS: C The student should measure the infants head three times and record the largest of the three measurements. The other actions are incorrect; the student should not use the average, the tape measure is placed above the eyebrows and pinna of the ear, and a tape measure is used, not the fingers. 5.A nurse takes a newborns initial set of vital signs and records the following: Temperature: 97.9F (36.6C), pulse: 198 beats/minute, respirations: 78 breaths/minute, blood pressure: 64/44 mm Hg. What does the nurse conclude about this infant? A. Hypotensive: needs IV fluid administration B. Hypothermic: needs to be put in an incubator C. Tachycardic: take pulse again when baby is not crying D. Tachypneic: suction if needed, administer oxygen per protocol ANS: D A normal respiratory rate for an infant is 3060 breaths/minute. This respiratory rate is too rapid, and the nurse needs to suction the infant if needed and provide oxygen per protocol. The blood pressure and temperature are normal. The heart rate is too fast, even for a crying baby. 6. A nurse is beginning a newborns physical assessment and notes that the infant is jumpy and seems irritable when being handled and when the nurse or parents speak. What action by the nurse is best? A. Ask the mother to attempt to breastfeed the infant. B. Conduct the assessment quickly then swaddle the baby. C. Increase the heat in the room so the baby wont get chilled. D. Postpone the assessment until the infant has calmed. ANS: D An infant who seems irritable and overreacts to voices, touch, or movement is displaying disorganized behavior. The nurse should postpone the physical examination until the infant has been calmed. To continue the assessment would risk increasing the babys behavioral disorganization and would be disruptive for the infant. The other actions are not appropriate in this situation, although swaddling can help calm the baby, as can cuddling, rocking, and gentle holding. 7.A student nurse is verbalizing disappointment in a new mothers seeming lack of interest in her newborn baby. The student complains to the registered nurse that the mother just wants to sleep and have someone else care for the infant. What response by the registered nurse is best? A. Assess closely; we may need to call social work. B. Dont judge other people until you have had a baby. C. The mother may be completely exhausted from the childbirth experience. D. We have to accept that everyones experience is different. ANS: C Each option has an element of an appropriate response to the student. A definitive lack of bonding may call for a social work consult. Nurses should not judge other peoples responses. Every mothers experience is different. However, the best response is the one that gives the student definitive information that can clarify the situation. After a long and possibly difficult birth, the mother may be too exhausted and too overwhelmed to assume an active role in parenting at this point. The student should show acceptance, reinforce previously taught information, allow the mother rest, and assist with bonding as opportunities present themselves, praising the mother for her efforts. 8.While teaching the parents of a newborn about infant care and feeding, which instruction by the nurse is the most appropriate? 1. Delay supplemental foods until the infant is 4 to 6 months old. 2. Delay supplemental foods until the infant reaches 15 pounds or greater. 3. Begin diluted fruit juice at 2 months of age, but wait three to five days before trying a new food. 4. Add rice cereal to the nighttime feeding if the infant is having difficulty sleeping after 2 months of age. Correct Answer: 1 Global Rationale: Four to six months is the optimal age to begin supplemental feedings because earlier feeding of nonformula foods is not needed by the infant and does not promote sleep. Earlier feeding of nonformula foods, regardless of the infants weight, is more likely to cause the development of food allergies. Also, early feeding is not well tolerated by infants because the necessary tongue control is not well developed and they lack the digestive enzymes to take in and metabolize many food products. Chapter 9 Two-Month Visit 1. At a 2-month well-child visit, parents ask the nurse about the red area on the babys neck. They tell the nurse that the mark appeared a few weeks after birth. The nurse recognizes this skin lesion as a(n): a. Port wine nevus b. Strawberry nevus c. Exanthum d. Intertrigo ANS: B The strawberry nevus is a common hemangioma consisting of dilated capillaries in the dermal space, which may not become apparent for a few weeks after birth. 2. Parents of a 2-month-old Down syndrome infant should be instructed, because of the generalized hypotonicity of the child, that special attention should be given to: 2.During a 4-month-olds well-child check, the nurse discusses introduction of solid foods into the infants diet and concerns for foods commonly associated with food allergies. Due to allergies, which foods will the nurse instruction the parents to avoid until after 1 year of age? 1. Strawberries, eggs, and wheat 2. Peas, tomatoes, and spinach 3. Carrots, beets, and spinach 4. Squash, pork, and tomatoes Correct Answer: 1 Global Rationale: Strawberries, eggs, and wheat, along with corn, fish, and nut products, are all foods that have commonly been associated with food allergies. Carrots, beets, and spinach contain nitrates and should not be given before the age of 4 months. Squash, peas, and tomatoes are acceptable to try after an infant is 4 to 6 months old but should be given one at a time and three to five days after starting a new food. Pork can be tried after the infant is 8 to 10 months old, as meats are harder to digest and have a high protein load. 3. A nurse asks the mother of a 4-month-old infant to undress the infant. The nurse observes the mother taking off several layers of clothing and knows that the outdoor temperature is 70 degrees Fahrenheit. Which statement by the nurse is most appropriate in this situation? 1. My, you are dressing your infant warmly today. 2. Did you think it was cold when you left your home this morning? 3. I see that you have many layers of clothing on your baby. This may cause your babys temperature to rise. 4. When you leave the office, only put one layer of clothing on your baby. Correct Answer: 3 Rationale 1: In this scenario, the mother has overdressed the infant. The nurse needs to \ Global Rationale: In this scenario, the mother has overdressed the infant. The nurse needs to gently inform the mother of this problem and to provide information to the mother on why it is a problem. Just making a statement on how warmly the child is dressed will not accomplish this goal or just telling the mother to only put one layer of clothing on the child does not provide a rationale for the mother to make a better decision the next time, so this statement also is not helpful to the mother. Chapter 11 Six-Month Visit 1. A mother asks which developmental milestones she can expect when her baby is 6 months old. Which response by the nurse is the most appropriate? 1. Lifts head momentarily when prone 2. Has well-developed pincer grasp 3. Transfers objects from one hand to the other 4. Rolls from front to back Correct Answer: 3 Global Rationale: Lifting head when prone is a milestone at 1 month. A well-developed pincer grasp is a milestone at 12 months. Transferring objects from one hand to the other is a milestone at 6 months. Rolling from front to back is a milestone at 4 months. 2. The nurse is counseling the parents of a 6-1/2-month-old infant. Which age-appropriate toy is most appropriate for the nurse to suggest to these parents? 1. Soft, fluid-filled ring that can be chilled in the refrigerator 2. Colorful rattle 3. Jack-in-the-box toy 4. Push-and-pull toy Correct Answer: 1 Global Rationale: Teething toys would be appropriate for this age. The rattle might be better enjoyed by a 3- to 6-month-old infant, and the jack-in-the-box and push-and-pull toys are better suited for a 9- to 12-month-old child. Chapter 12 Nine-Month Visit 1. While assessing the development of a 9-month-old infant, the nurse asks the mother if the child actively looks for toys when they are placed out of sight. Which developmental task is the nurse assessing this infant for? 1. Object permanence 2. Centration 3. Transductive reasoning 4. Conservation Correct Answer: 1 Global Rationale: A child who has developed object permanence has the ability to understand that even though something is out of sight, it still exists. In centration, a child focuses only on a particular aspect of a situation. Transductive reasoning happens when a child connects two events in a cause-effect relationship because they have occurred at the same time. Conservation describes when a child knows that matter is not changed when its form is altered. 2. A nurse is assessing an 11-month-old infant and notes that the infants height and weight are at the 5th percentile on the growth chart. Family history reveals that the infants two siblings are at the 50th percentile for height and at the 75th percentile for weight. Psychosocial history reveals that the parents are separated and are planning to divorce. Which of these nursing diagnoses takes priority? b. 9 months c. 1 year d. 2 years ANS: A The infant can usually drink from a cup when it is offered at about 5 months. 8. The nurse would expect a 4-month-old to be able to: a. Hold a cup b. Stand with assistance c. Lift head and shoulders d. Sit with back straight ANS: C Because development is cephalocaudal, of these choices, sitting is the one that the infant learns to do first. The infant can usually sit with support at about 5 months of age and can sit alone at about 8 months. 9. The abnormal finding in an evaluation of growth and development for a 6-month-old infant would be: a. Weight gain of 4-7 ounces per week b. Length increase of 1 inch in 2 months c. Head lag present d. Can sit alone for a few seconds ANS: C The infant should be holding the head up well by 5 months of age. If head lag is present at 6 months, the child should undergo further evaluation. 10. A parent brings a 6-month-old infant to the pediatric clinic for her well-child examination. Her birthweight was 8 pounds, 2 ounces. The nurse weighing the infant today would expect her weight to be at least: a. 12 pounds b. 16 pounds c. 20 pounds d. 24 pounds ANS: B Birth weight is usually doubled by 6 months of age. 11. The nurse would advise a parent when introducing solid foods to: a. Begin with one tablespoon of the food. b. Mix foods together. c. Eliminate a refused food from the diet. d. Introduce each new food 4 to 7 days apart. ANS: D Only one new food is offered in a 4- to 7-day period to determine tolerance. 12. When talking with a parent about tooth eruption, the nurse explains that the first deciduous teeth to erupt are the: a. Lower central incisors b. Upper central incisors c. Lower lateral incisors d. Upper lateral incisors ANS: A The first teeth to erupt, usually at about 7 months, are the lower central incisors. 13. When assessing development in a 9-month-old infant, the nurse would expect to observe the infant: a. Sitting if supported b. Grasping objects with the palm c. Imitating sounds such as da-da d. Beginning to use a spoon rather sloppily ANS: C The 9-month-old tries to imitate sounds such as da-da or ba-ba. 14. The statement made by a parent that indicates correct understanding of infant feeding is: a. Ive been mixing rice cereal and formula in the babys bottle. b. I switched the baby to low-fat milk at 9 months. c. The baby really likes little pieces of chocolate. d. I give the baby any new foods before he takes his bottle. ANS: D New solid foods should be introduced before formula or breast milk to encourage the infant to try new foods. 15. The nurse would advise a mother who is concerned because her 10-month-old is lethargic, to: a. Keep the babys room well-lit. b. Rub the babys soles vigorously. c. Offer the baby a pacifier. d. Handle the infant slowly and gently. ANS: D Some infants respond to stimulating environments by shutting down. Move and handle infants slowly and gently. 16. The nurse discusses safety-proofing the home with the mother of a 9-month-old. The statement made by the mother that indicates an unsafe behavior is: a. I put covers on all of the electrical outlets. b. In the car, she rides in a front-facing car seat. c. There are locks on all of the cabinets in the house. d. I have a gate at the top and bottom of the stairs. ANS: B A rear-facing infant car seat should be used for infants under 1 year of age. 17. The nurse observes a 10-month-old infant using her index finger and thumb to pick up Cheerios. This behavior is evidence that the infant has developed the: a. Pincer grasp b. Grasp reflex c. Prehension ability d. Parachute reflex ANS: A By 1 year, the pincer-grasp coordination of index finger and thumb is well established. 18. A parent is concerned because her infant has a diaper rash. The nurse would advise the parent to: a. Use commercial diaper wipes to clean the area. b. Apply a protective ointment on the area. c. Change the babys diaper less frequently. d. Keep the diaper area covered all of the time. ANS: B A protective ointment can be applied when the skin in the diaper area appears pink and irritated. 19. The mother of an infant born prematurely tells the nurse, The baby is irritable. He cries during diaper changes and feedings. Can you make some suggestions about what I should do to soothe him? The most appropriate recommendation to help this parent would be: a. Play the radio or TV while you feed the baby. b. Put the baby in a room with sunlight. c. Cover the baby snugly when you hold him. d. Change the babys position quickly. ANS: C A strategy that may be helpful is to swaddle the infant snugly in a light blanket with extremities flexed and hands near the face. 20. The most appropriate activity to recommend to parents to promote sensorimotor stimulation for a 1-year-old would be: a. Ride a tricycle. b. Spend time in an infant swing. c. Play with push-pull toys. d. Read large picture books. ANS: C Push-pull toys are appropriate to promote sensorimotor stimulation for a 1-year-old child. 21. The statement that indicates the mother of an 8-month-old understands infant sleep patterns is: a. I put the baby in my bed until she falls asleep, then I put her in her crib. 3. 3 years 4. 4 years Correct Answer: 1 Global Rationale: Health promotion for the toddler includes whole milk until age 2. Age 1 is too early for low-fat milk, and it can safely be introduced before ages 3 and 4. 3.A nurse is preparing to perform a physical assessment on a toddler. Which action is most appropriate for the nurse to take? 1. Perform the assessment from head to toe. 2. Leave intrusive procedures such as ear and eye examinations until the end. 3. Explain each part of the examination to the child before performing it. 4. Ask the mother to tell the child not to be afraid. Correct Answer: 2 Global Rationale: Intrusive procedures such as examination of the ears, throat, eye, and genital areas should be done last to decrease the anxiety of the child during the initial phases of the examination, which includes the heart and lungs. Chapter 15 Two-Year Visit 1. A 27-month-old toddler who is in the pediatric office for a well-child visit begins to cry the moment he is placed on the examination table. The parent attempts to comfort the toddler; however, nothing is effective. Which of these actions by the nurse takes priority? 1. Instruct the father to hold the toddler down tightly to complete the examination. 2. Allow the toddler to sit on the parents lap and begin the assessment. 3. Allow the toddler to stand on the floor until he stops crying. 4. Ask another nurse in the office to hold the toddler, since the parent is not able to control the toddlers behavior. Correct Answer: 2 Global Rationale: Toddlers are most comfortable when sitting with the parents. Much of the examination can be completed in this way. Allowing the toddler to stand on the floor is inappropriate. A nurse can assist if the parent is unable to hold the child during the examination of the throat and ears to prevent injury from movement. 2. Which statement by the nurse is most appropriate prior to giving an intramuscular injection to a 2-1/2-year-old child? 1. We will give you your shot when your mommy comes back. 2. This is medicine that will make you better. First we will hold your leg, then I will wipe it off with this magic cloth that kills the germs on your leg right here, then I will hold the needle like this and say one, two, three . . . go and give you your shot. Are you ready? 3. It is all right to cry, I know that this hurts. After we are done you can go to the box and pick out your favorite sticker. 4. This is a magic sword that will give you your medicine and make you all better. Correct Answer: 3 Global Rationale: The most appropriate response would be to acknowledge the childs feelings and give her something to look forward to (picking out a sticker). Waiting for the mother to come back would be inappropriate because toddlers do not have an understanding of time. Giving elaborate descriptions and using colorful language are inappropriate. The instructions should not end with a are you ready statement because the toddler will say no. You also dont want to frighten and/or confuse the child by using statements such as use of a magic sword. Chapter 16 Three-Year Visit (Preschool) MULTIPLE CHOICE 1. Which of the following statements best describes the 3-year-old child? a. Boisterous, tattles on others b. Aggressive, shows off c. Helpful, wants to assist with chores d. Talkative, inquisitive about the environment ANS: C Three-year-old children are helpful and can assist in simple household chores. 2. The parents of a 4-year-old boy are concerned because they have noticed him frequently touching his penis. The nurse would base a response on the knowledge that: a. This behavior indicates a normal curiosity about sexuality. b. Masturbation suggests the boy has an excessive fear of castration. c. It is usually a result of discomfort from a penile rash or irritation. d. The behavior is abnormal and the child should be referred for counseling. ANS: A Masturbation at this age is common and indicates that the preschooler has a normal curiosity about sexuality. 3. A preschool-age child is asked, Why do trees have leaves? Which of the following responses would be an example of animism? a. So I can have shade over my sandbox. b. Because God made them that way. c. To hide behind when they are scared. d. For the squirrels to play in. ANS: C Animism describes the tendency of preschool children to attribute human characteristics to nonhuman objects. 4. The tasks that would be appropriate to expect of a 5-year-old would be: a. Setting the table with paper plates b. Washing the dirty knives c. Carrying glasses from the table to the sink d. Scrubbing out the sink with cleanser ANS: A Parents must consider developmental level and safety when asking the 5-year-old child to help with chores. 5. A 3-year-old child, while playing with her favorite toy in the playroom of the pediatric unit, is approached by another child who also wants to play with the same toy. The nurse anticipates that the 3-year-old will: a. Play well with the other child b. Give the toy up and then not play any more c. Become angry and a physical response might ensue d. Ignore the toy and go on to something else ANS: C The 3-year-old child is egocentric and likely will become angry when others attempt to take his or her possessions. 6. A parent is concerned about her childrens reaction should their grandmother die. In planning a response, the nurse is guided by the understanding that: a. Children are unlikely to notice their grandmothers absence if no one reminds them. b. Young children often understand that other people die, but do not equate it with themselves. c. The childrens response will depend entirely on whether they have been acquainted with death before th d. Children can understand the concept of a higher being much like adults can. ANS: B Between 3 and 4 years of age, the child becomes curious about death and dying. They may realize that others die, but they do not relate death to themselves. 7. The intervention that is most effective in dealing with occasional aggression in a 4-year-old child is: b. Let the child read in his room until he falls asleep. c. Establish a bedtime routine and use it consistently. d. Tire him out with physical activity before bedtime. ANS: C Parents should engage the child in quiet activities before bedtime and establish a ritual that signals readiness for bedtime. 17. The nurse understands that a fear unique to the preschool period is: a. Fear of water b. Fear of animals c. Fear of bodily harm d. Fear of death ANS: C The fear of bodily harm, particularly the loss of body parts, is unique to this stage. 18. A 4-year-old child tells the nurse that he will not eat peas because they are green. This is an example of: a. Egocentrism b. Artificialism c. Animism d. Centering ANS: D The tendency to concentrate on a single outstanding characteristic of an object while excluding other features is known as centering. 19. A 4-year-old child insists that he has more money with a nickel than his father has with a dime. The nurse is aware that this perception is described in Piagets theory as: a. Egocentrism b. Artificialism c. Animism d. Centering ANS: D The intuitive stage, as described by Piaget, is prelogical thinking that is based on the outside appearance of objects. A nickel is larger than a dime, and therefore more valuable MULTIPLE RESPONSE 1. The nurse suggests that bedtime preparation be preceded by rituals, such as: Select all that apply. a. Telling a story b. Placing a favorite toy in bed c. Placing a glass of water at the bedside d. Turning on a night light e. Playing energetically ANS: A, B, C, D All options are soothing and bedtime suggestive rituals except energetic playing, which would be stimulating and counterproductive to sleep. 2. The nurse planning a seminar on safety for the preschooler will focus on: Select all that apply. a. Poison b. Burns c. Falls d. Abduction e. Car-pedestrian ANS: A, B, C, D, E All of the options are significant safety threats to the preschooler because of their developmental characteristics of playing boisterously, imitating their parents using matches, and drinking from bottles or taking pills. Their egocentrism does not make them suspicious of strangers. 3. The nurse points out that among the advantages of a nursery school experience are: Select all that apply. a. Increasing self-confidence b. Fostering group cooperation c. Detecting adjustment problems d. Enhancing social skills e. Playing experiences with other children ANS: A, B, C, D, E Nursery school increases self-confidence, group cooperation, social skills, and cooperative play. Objective observations by a nursery school instructor can detect early adjustment problems. 1. When planning an activity for a 3-year-old, the nurse bases the plan on the average attention span of minutes. ANS: 15 Chapter 17 Six-Year Visit (School Readiness) 1.The school nurse performs screenings on all students in the middle school. In addition, the nurse will perform selected screenings on individual school-age children. When planning the screenings for the year, which screenings will the nurse include for all school-age children? Standard Text: Select all that apply. 1. Hearing 2. Height and weight 3. Blood-pressure measurement 4. Hepatitis B profile serology 5. Chest x-ray Correct Answer: 1,2,3 Global Rationale: Routine screening for school-age children include hearing, checking for height and weight, and blood-pressure measurements. The hepatitis B profile is only needed once, prior to administration of hepatitis B vaccine; however, this is not a required screening for all school- age children. A chest x-ray is not a routine screening test for school-age children. 2.An school-age client who recently moved to a new school in a different town presents to an ambulatory care center and describes the following: I have no friends in my new school, and I no d. Plays about 1 to 3 hours each evening ANS: A The 9-year-old child requires about 10 hours of sleep per night. 11. A parent asked the nurse, At what age are children capable of assuming more responsibility for personal belongings? Based on a knowledge of growth and development, the nurse would respond: a. 6 years b. 7 years c. 9 years d. 12 years ANS: C The 9-year-old is dependable and assumes more responsibility for personal belongings. 12. The school nurse who is preserving a tooth that was knocked out on the school yard will be especially careful to: a. Wrap the tooth loosely in a clean cloth. b. Rinse the tooth with alcohol. c. Handle the tooth only by the crown. d. Place the tooth in a warm environment. ANS: C When a permanent tooth is avulsed, the tooth should be picked up by the crown to prevent any further damage to the root and placed in milk until the child can be examined by a dentist. 13. A parent states, My 7-year-old really wants a dog. His 10-year-old brother has allergies to animal dander. I dont know what to do. The nurse could advise this parent to: a. Choose a small breed of dog because the large dogs produce more allergens. b. An older unneutered dog produces fewer allergens than a younger one. c. A cat may be a good choice since it requires less care and is less allergenic. d. Poodles do not shed, making this dog a good choice for people with allergies. ANS: D The poodle breed of dog does not have a shed cycle and so it may be the least offensive pet for the allergic child. 14. When asked about her activities, a 10-year-old girl responded, I like school. I play the flute in the school band and I take tennis lessons. The nurse knows these activities will help this child develop a sense of: a. Initiative b. Industry c. Identity d. Intimacy ANS: B The school-age period is referred to by Erikson as the stage of industry. Successful participation in activities facilitates the childs sense of industry. 15. A mother reports that she has a new job and her 12-year-old child is home alone for a time after school. The statement made by the parent, indicating a potentially unsafe situation for this child, is: a. I told him that he could invite a few friends after school. b. I put a list of emergency numbers next to the telephone. c. Last week we made a first aid kit together. d. There is a neighbor available in case of an emergency. ANS: A Latchkey children are subject to a higher rate of accidents. Permitting school-age children and their friends to be home alone in an unsupervised environment is an unsafe situation. 16. A mother is concerned because her 9-year-old has developed the habit of twitching his eyes and flipping his hair while communicating with anyone. The best nursing response to this parent is: a. This may indicate that he needs eyeglasses. b. Children sometimes do these things for attention. c. This behavior suggests low self-esteem. d. Tics appear when a child is under stress. ANS: D The child cannot help such actions and should not be scolded for them because they are mainly a result of tension. 17. A seventh-grade girl tells the school nurse that her art teacher, also a female, is her hero. The most appropriate interpretation of the girls comment is: a. The student may be exploring her career options. b. The comment is cause for concern about sexual abuse. c. The child may have difficulty interacting with her peers. d. Hero worship is a normal phenomenon. ANS: D School-age children tend to admire their teachers and adult companions. For the 11- to 12-year- old, hero worship is a normal phenomenon. 18. According to Piaget, a 9-year-old child is in which stage of cognitive development? a. Formal operations b. Preoperational c. Concrete operations d. Sensorimotor ANS: C School-age children are in the concrete operations stage of cognitive development. 19. The nurse assesses that the 11-year-old has moved from the mind set of egocentrism when he says: a. I am a member of the best Cub Scout group in the world. b. I must do my homework before I can play. c. My dad can do anything! d. Im sorry. I bet that hurt your feelings. ANS: D The ability to see anothers point of view indicates moving away from egocentrism into a more altruistic mind set. 20. When the school-age child becomes frustrated with a school assignment and says, I cant do this!, the parent should: a. Ask, What is it that is so difficult? b. Allow the child to quit the effort. c. Call in older siblings to help. d. Finish the project for him. ANS: A Helping the child focus on the problem that is keeping him from mastery can limit frustration. Quitting or having someone else finish is detrimental to the development of industry. MULTIPLE RESPONSE 21. The nurse, in attempting to help a 7-year-old girl express her feelings about being in a new school, would prompt the child with basic feeling words, such as: Select all that apply. a. Mad b. Glad c. Sad d. Scared e. Jealous ANS: A, B, C, D The words mad, glad, sad, and scared are basic feeling words that can prompt a young child to better express his or her feelings. 22. The nurse advises the parents of a 6-year-old to try and ensure at least hours of sleep daily. ANS: 11 NOT: Rationale: The 6-year-old school-age child needs at least 11 hours of sleep. 23. The nurse reminds the parents who are trying to select a dog for their allergic child that the best selection would be a female dog that is and . ANS: young, neutered NOT: Rationale: Young, neutered female dogs produced less allergens. 24. When the fifth-grade class collected geckos in a special aquarium in the classroom, the school nurse cautioned the teacher to be alert for symptoms of that can be carried by the reptiles. ANS: Salmonella of Disease NOT: Rationale: Geckos can infect humans with Salmonella. 2. An adolescent female presents at a nurse practitioners office and requests a signature for working papers. The nurse reviews her chart and notes that the last physical examination was two years ago. In addition to providing the signature for the working papers, what else should the nurse use this visit? 1. An opportunity to discuss birth-control measures 2. A time to discuss exercise and sports participation 3. A health-supervision opportunity 4. A chance to discuss the importance of pursuing post secondary education Correct Answer: 3 Global Rationale: All visits should be used as health-promotion and health-supervision visits. While discussing birth control, exercise, and future plans is important, these can be included in the overall health-supervision protocols. 3. The preadolescent child reports issues during assessment. While the mother is in the room, the nurse should avoid which questions? Standard Text: Select all that apply. 1. Sexual activity 2. Cigarette smoking 3. School performance 4. Use of alcohol 5. Car seatbelt use Correct Answer: 1,2,4 Global Rationale: The nurse must maintain the nurseclient relationship, which is between the nurse and the adolescent, and the nurse must maintain confidentiality. Therefore, the nurse cannot ask any personal questions while the mother is in the room, such as those related to sexual activity, drug and alcohol use, and smoking cigarettes. The nurse can ask general questions about seatbelt use and academic performance without breaching confidentiality. 4. The school nurse performs screenings on all students in the middle school. In addition, the nurse will perform selected screenings on individual school-age children. When planning the screenings for the year, which screenings will the nurse include for all school-age children? Standard Text: Select all that apply. 1. Hearing 2. Height and weight 3. Blood-pressure measurement 4. Hepatitis B profile serology 5. Chest x-ray Correct Answer: 1,2,3 Global Rationale: Routine screening for school-age children include hearing, checking for height and weight, and blood-pressure measurements. The hepatitis B profile is only needed once, prior to administration of hepatitis B vaccine; however, this is not a required screening for all school- age children. A chest x-ray is not a routine screening test for school-age children. 5. A school nurse is performing annual height and weight screening. The nurse notes that three females who are close friends each lost 15 pounds over the past year. What is the priority nursing action in this situation? 1. Call the respective parents to discuss the eating patterns of each adolescent. 2. Speak with the girls in a group to discuss the problems associated with anorexia nervosa. 3. Refer these adolescents to the school psychologist. 4. Obtain a nutritional history for each of these adolescents. Correct Answer: 4 Global Rationale: The school nurse must evaluate why these three friends have all lost 15 pounds in one year. The best way to begin this assessment is to obtain a nutritional history for each client. Speaking with the parents would not be appropriate at this time. Discussing anorexia nervosa is too extreme, as is referring the adolescents to a school psychologist without performing a complete nursing assessment. Chapter 20 Fourteen- to Eighteen-Year Visit (Adolescent) MULTIPLE CHOICE 1. When assessing a 13-year-old boy, the nurse would keep in mind physical changes in the pubertal male, beginning with: a. Development of axillary and facial hair b. Enlargement of pectoral muscles c. Enlargement of testicles d. Voice changes ANS: C In boys, pubertal changes begin with enlargement of the testicles and internal structures. 2. A 13-year-old boy states, The girls in my class tower over me. The nurses most informative response would be: a. It may seem that way because girls have a growth spurt 2 years earlier than boys. b. Perhaps your parents are not exceptionally tall. c. Boys usually experience a growth spurt 1 year earlier than girls. d. You may feel short, but you are actually average height for your age. ANS: A Although the age for growth spurts during puberty varies, growth spurts occur 2 years earlier for girls than for boys. 3. A parent comments that her adolescent daughter seems to be daydreaming a lot these days. The nurse understands that this behavior indicates she is: a. Bored b. Not getting enough rest c. Trying to block out stress and anxiety d. Mentally preparing for real situations ANS: D Daydreaming allows adolescents to act out in their imaginations what will be said or done in certain situations. This helps them to prepare for and cope with interactions with others. 4. The nurse planning a safety program for high school students should understand that most accidental deaths in adolescence are related to: a. Firearms b. Automobiles c. Drowning d. Diving injuries ANS: B The chief safety hazard for the adolescent is automobiles. 5. A 16-year-old excitedly tells his parents that he was offered a part-time job. Which response represents an effective problem-solving approach for his parents? a. Your studies are too important for you to have a part-time job. b. When we went to high school, academics were the teenagers priority. c. We want you to put your earnings in a savings account. d. How do you think you will manage your school work and a job? ANS: D An effective approach to help adolescents learn to solve problems is for parents to guide them in exploring alternatives. 6. One psychosocial task of adolescence on which the nurse must focus when planning care, is the development of a sense of: a. Initiative b. Industry c. Identity d. Involvement ANS: C Psychosocial milestones that must be accomplished during adolescence include the five Isimage of self, identity, independence, interpersonal relationships, and intellectual maturity. 7. A 13-year-old female tells the school nurse that she is getting fat, especially in her hips and legs. The understanding by the nurse that would best guide the response is: ANS: A Parents may need help understanding that the teenagers exaggerated conformity is necessary for moving away from dependence and obtaining approval from persons outside the nuclear family. 16. The nurse points out to a group of parents that the most positive developmental significance of a peer group to the adolescent is that the group serves as: a. A social outlet b. An association to blur personal identity c. A platform for group think d. An initial separation from family ANS: D Being a member of a peer group and communicating with and seeking approval from this group are the first separation from the family. 17. The nurse understands that the adolescents avid sexual orientation to be based on Freuds theory, which describes adolescence as the stage. a. Conceptual b. Genital c. Glandular d. Pubertal ANS: B Freud describes the adolescent period as genital. 18. The nurse using the PACE interview guide for persons at risk for substance abuse arrives at a score of 2 for an adolescent patient. The nurse should assess this score as: a. Nonindicative of potential substance abuse b. Normal experimentation of the adolescent c. Need to schedule another PACE interview in 3 months d. Indication for referral for counseling ANS: D The PACE guide recommends that a score of 2 or higher would suggest the need for a referral for counseling about substance abuse. MULTIPLE RESPONSE 1. The nurse explains that the restlessness seen in the adolescent is, in part, attributable to: Select all that apply. a. Drive to be accepted by society as an individual b. Surge for independence c. Establishment of a personal identity d. Intense libido e. Rapid body changes ANS: A, B, C, D, E All the options listed are sources of stress to the adolescent and are stimulants to restlessness. 2. The nurse teaching a seminar on teen pregnancy tells the parents that they should be alert for indications of a child concealing a pregnancy with such behaviors as: Select all that apply. a. Wearing baggy clothes b. Wearing excessive makeup c. Dieting to lose weight d. Seeking privacy e. Ostentatiously purchasing tampons ANS: A, C, E Wearing of concealing clothing, dieting to lose weight, and conspicuous advertising of a menstrual period are indicators of a hidden pregnancy. Wearing of excessive makeup and seeking privacy are normal adolescent behaviors. 3. The nurse considers the rites of passage that are valued by the adolescent in American society, which are: Select all that apply. a. Attaining legal drinking age b. Selection of a career c. Religious affiliation d. Obtaining a drivers license e. High school graduation ANS: A, D, E Rites of passage are socially recognized milestones that signify adulthood. Legal drinking age, drivers license, and matriculation through high school are such signals. Religious affiliation and selection of a career path do not necessarily signal adulthood. Chapter 21 Dermatological Problems MULTIPLE CHOICE 1. The nurse is amused, but understands that as adolescents strive for individuality, the strongest need of any adolescent in society is that of . ANS: conformity 2. The nurse takes into consideration that children who have been diagnosed with infantile eczema have an increased risk of: a. Pneumonia b. Acne c. Sun sensitivity d. Asthma ANS: D Some children with eczema also develop asthma and hay fevertype allergies. 3. The appropriate technique for the application of a topical treatment for a child with eczema is: a. Apply skin lotions in a circular motion. b. Apply prescribed ointments with a gloved hand. c. Apply as much and as frequently as relieves the symptoms. d. Choose lanolin-based ointments. ANS: B The prescribed amount of ointment is usually applied to the skin by a gloved hand in long, smooth strokes. Lanolin-based preparations should be avoided because of a possible allergy to wool. 4. When the 2-day-old infant is noted to have small pustules on her skin, the nurse should: a. Report it immediately because it may be a staphylococcus infection. b. Keep the affected area dry and clean. c. Teach the parents how to care for seborrheic dermatitis. d. Chart the finding as it may be the beginning of a strawberry nevus. ANS: A A staphylococcal infection can spread readily from one infant to another. Small pustules on the newborn must be reported immediately. 5. The home health nurse discovers a family infected with pediculosis and helps the mother understand ways to start eradication of the lice, such as: a. Covering the hair with Vaseline b. Applying a soda-vinegar solution to the hair c. Combing through the hair with a vinegar-water solution d. Shampooing the hair with dish detergent ANS: C Combing a vinegar/water solution through the hair with a fine-tooth comb and then shampooing is an initial step toward eradication. 6. A group of football players is taking oral griseofulvin for tinea pedis. The school nurse cautions that while they are taking this medication they should avoid: a. Changing socks often b. Eating shellfish c. Alcohol consumption d. Taking corticosteroids ANS: C Consumption of alcohol while taking griseofulvin will cause severe tachycardia. 7. Before the 17-year-old boy starts a protocol of Accutane for his acne, the nurse should instruct him to: a. Get a prescription for oral contraceptives. b. Increase the dose if his acne worsens. c. Limit intake of chocolate, cola, and peanuts. d. Increase exposure to sunlight. ANS: A Oral contraceptives are prescribed to young males to reduce androgens, which make the skin greasy. 8. The nurse assesses a major burn as: