Test Bank for Pediatric Physical Examination An Illustrated Handbook 3rd Edition by Karen, Exams of Pediatrics

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Test Bank for Pediatric Physical Examination An Illustrated

Handbook 3rd Edition by Karen G. Duderstadt Latest 2024 100%

Graded

Pediatric Physical Examination 3

rd

Edition Duderstadt TESTBANK

Chapter 1: Approach to Care and Assessment of Children and Adolescents MULTIPLE CHOICE

1. A nurse is reviewing developmental concepts for infants and children. Which statement best describes development in infants and children? a. Development, a predictable and orderly process, occurs at varying rates within normal limits. b. Development is primarily related to the growth in the number and size of cells. c. Development occurs in a proximodistal direction with fine muscle development occurring first. d. Development is more easily and accurately measured than growth. ANS: A Development, a continuous orderly process, provides the basis for increases in the childs function and complexity of behavior. The increases in rate of function and complexity can vary normally within limits for each child. An increase in the number and size of cells is a definition for growth. Development proceeds in a proximodistal direction with fine muscle organization occurring as a result of large muscle organization. Development is a more complex process that is affected by many factors; therefore, it is less easily and accurately measured. Growth is a predictable process with standard measurement methods.
2. Frequent developmental assessments are important for which reason? a. Stable developmental periods during infancy provide an opportunity to identify any delays or deficits. b. Infants need stimulation specific to the stage of development. c. Critical periods of development occur during childhood. d. Child development is unpredictable and needs monitoring.

Stuvia.comStuvia.com - - TheThe MarketplaceMarketplace^ toto^ BuyBuy ANS: C Critical periods are blocks of time during which children are ready to master specific developmental tasks. Children can master these tasks more easily during particular periods of time in their growth and developmental process. Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage. Normal growth and development are orderly and proceed in a predictable pattern on the basis of each individuals abilities and potentials.

3. Which factor has the greatest influence on child growth and development? a. Culture b. Environment c. Genetics d. Nutrition ANS: C Genetic factors (heredity) determine each individuals growth and developmental rate. Although factors such as environment, culture, nutrition, and family can influence genetic traits, they do not eliminate the effect of the genetic endowment, which is permanent. Culture is a significant factor that influences how children grow toward adulthood. Culture influences both growth and development but does not eliminate inborn genetic influences. Environment has a significant role in determining growth and development both before and after birth. The environment can influence how and to which extent genetic traits are manifested, but environmental factors cannot eliminate the effect of genetics. Nutrition is critical for growth and plays a significant role throughout childhood.
4. A nurse is planning a teaching session with a child. According to Piagetian theory, the period of cognitive development in which the child is able to distinguish fact from fantasy is the period of cognitive development. a. sensorimotor

b. formal operations c. concrete operations d. preoperational ANS: C Concrete operations is the period of cognitive development in which childrens thinking is shifted from egocentric to being able to see anothers point of view. They develop the ability to distinguish fact from fantasy. The sensorimotor stage occurs in infancy and is a period of reflexive behavior. During this period, the infants world becomes more permanent and organized. The stage ends with the infant demonstrating some evidence of reasoning. Formal operations is a period in development in which new ideas are created through previous thoughts. Analytic reason and abstract thought emerge in this period. The preoperational stage is a period of egocentrism in which the childs judgments are illogical and dominated by magical thinking and animism.

5. The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is: a. Erikson. b. Freud. c. Kohlberg. d. Piaget. ANS: A Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled. Sigmund Freud proposed a psychosexual theory of development in which certain parts of the body assume psychological significance as foci of sexual energy. The foci shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of development. Lawrence Kohlberg described moral development as having three levels (preconventional, conventional, and postconventional). His

theory closely parallels Piagets. Jean Piagets cognitive theory interprets how children learn and think and how this thinking progresses and differs from adult thinking. Stages of his theory include sensorimotor, preoperations, concrete operations, and formal operations.

6. What does the nurse need to know when observing chronically ill children at play? a. Play is not important to hospitalized children. b. Children need to have structured play periods. c. Childrens play is an indication of a childs response to treatment. d. Play is to be discouraged because it tires hospitalized children. ANS: C Play for all children is an activity woven with meaning and purpose and is a mechanism for mastering their environment. For chronically ill children, play can indicate their state of wellness and response to treatment. Play is important to all children in all environments. Although childrens play activities appear unorganized and at times chaotic, play has purpose and meaning. Imposing structure on play interferes with the tasks being worked on. Children who have fewer energy reserves still require play. For these children, less-active play activities will be important.
7. Which child is most likely to be frightened by hospitalization? a. A 4-month-old infant admitted with a diagnosis of bronchiolitis b. A 2-year-old toddler admitted for cystic fibrosis c. A 9-year-old child hospitalized with a fractured femur d. A 15-year-old adolescent admitted for abdominal pain ANS: B Toddlers are most likely to be frightened by hospitalization because their thought processes are egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange environments. Young infants are not as likely to be frightened as toddlers by hospitalization because they are not as aware of the environment. The 9-year-old childs cognitive ability is

sufficient enough for the child to understand the reason for the hospitalization. The 15-year-old adolescent has the cognitive ability to interpret the reason for the hospitalization.

8. Which statement made by a 15-year-old adolescent with a diagnosis of neurofibromatosis (an autosomal dominant genetic disorder) best demonstrates an understanding of the mechanism of inheritance for the disease? a. My babies will probably not have neurofibromatosis. b. My babies have a 50% chance of having neurofibromatosis. c. Whether my babies have problems depends on the father. d. My babies have a 25% chance of having neurofibromatosis. ANS: B Neurofibromatosis is an autosomal dominant genetic disorder that occurs when the abnormal gene is carried on the affected chromosome with a normal gene. Because the abnormal gene is dominant, an individual with the defective gene has a 50% chance of transmitting the defect to an infant with each pregnancy. Neurofibromatosis is not a sex-linked genetic disease; therefore, either the father or the mother genetically transfers it to the infant. A parent with the defective gene will genetically transfer either a normal or abnormal gene to an infant. Because the defective gene is dominant, there is a 50% probability of the child inheriting the disease.
9. During a routine healthcare visit, a parent asks the nurse why her 9-month-old infant is not walking as her older child did at the same age. Which response by the nurse best demonstrates an understanding of child development? a. Shes a little slow. b. If she is pulling up, you can help her by holding her hand. c. Babies progress at different rates. Your infants development is within normal limits. d. Maybe she needs to see a behavioral specialist. ANS: C

Ninety percent of infants walk by 14 months of age. The infant is within normal developmental limits. It is inappropriate for the nurse to state that the infant is a little slow. Infants will walk when they are developmentally ready. Hurrying an infant does not result in the developmental task being achieved at an earlier time period. Consulting a behavioral specialist for diagnostic evaluation is indicated when a child demonstrates developmental delays. The child has no evidence of a delay.

10. Which expected outcome would be developmentally appropriate for a hospitalized 4-year- old child? a. The child will be dressed and fed by the parents. b. The child will independently ask for play materials or other personal needs. c. The child will be able to verbalize an understanding of the reason for the hospitalization. d. The child will have a parent stay in the room at all times. ANS: B Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrate developmental appropriateness. Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. A 4- year-old child cannot be expected to cognitively understand the reason for his or her hospitalization. Expecting the child to verbalize an understanding for the hospitalization is an inappropriate outcome. Parents staying with the child throughout a hospitalization is an inappropriate outcome. Although children benefit from parental involvement, parents may not have the support structure to stay in the room with the child at all times.
11. A nurse has completed a teaching session with parents of preschool aged children. Which statement made by the parent identifies an appropriate level of language development for a 4- year-old child? a. The child has a vocabulary of 300 words and uses simple sentences. b. The child uses correct grammar in sentences.

c. The child is able to pronounce consonants clearly. d. The child uses language to express abstract thought. ANS: B The 4-year-old child is able to use correct grammar in sentence structure and typically has difficulty in pronouncing consonants. Simple sentences and a 300-word vocabulary are appropriate for a 2-year-old child. The use of language to express abstract thought is developmentally appropriate for the adolescent.

12. Which should the nurse evaluate before administering the Denver Developmental Screening Test II (DDST-II)? a. The childs height and weight b. The parents ability to comprehend the results c. The childs mood d. The parentchild interaction ANS: C The results of the screening test are valid if the child acted in a normal and expected manner. The childs height and weight are not relevant to the DDST-II screening process. The parents ability to understand the results of the screening is not relevant to the validity of the test. The parentchild interaction is not significantly relevant to the test results.
13. Which children are at greater risk for not receiving immunizations? a. Children who attend licensed day care programs b. Children entering school c. Children who are home schooled d. Young adults entering college ANS: C

Home schooled children are at risk for being underimmunized and need to be monitored. All states require immunizations for children in day care programs and entering school. Most colleges require a record of immunizations as part of a health history.

14. Which developmental assessment instrument is appropriate to assess a 5-year-old child? a. Brazelton Behavioral Scale b. Denver Developmental Screening Test II (DDST-II) c. Dubowitz Scale d. New Ballard Scale ANS: B The DDST-II is used for infants and children between birth and 6 years of age. Brazeltons Behavioral Scale is used for newborn assessment. The Dubowitz Scale is used for estimation of gestational age. The New Ballard Scale is used for newborn screening.
15. A 2-month-old child has not received any immunizations. Which immunizations should the nurse give? a. DTaP, Hib, HepB, IPV, varicella b. DTaP, Hib, HepB, MMR, IPV c. DTaP, Hib, HepB, PCV, IPV, rotavirus d. DTaP, Hib, HepB, PCV, IPV, HepA ANS: C DTaP, Hib, HepB, PCV, IPV, and rotavirus are appropriate immunizations for an unimmunized 2-month-old child. The child should not receive varicella until at or after 12 months of age. MMR is not given to children until at or after 12 months of age. HepA is recommended for all children at 1 year of age.
16. You are preparing immunizations for a 12-month-old child who is immunocompromised. Which immunization cannot be given?

a. DTaP b. HepA c. IPV d. Varicella ANS: D Children who are immunologically compromised should not receive live viral vaccines. Varicella is a live vaccine, and should not be given except in special circumstances. DTaP, HepA, and IPV can be safely given.

17. Which immunization can cause fever and rash to occur 1 to 2 weeks after administration? a. HepB b. DTaP c. Hib d. MMR ANS: D MMR is a live virus vaccine and can cause fever and rash 1 to 2 weeks after administration. HepB, DTaP, and Hib do not cause fever or rash.
18. A nurse is teaching an adolescent about Tanner stages. Which statement best describes Tanner staging? a. Predictable stages of puberty that are based on chronological age b. Staging of puberty based on the initiation of menarche and nocturnal emissions c. Predictable stages of puberty that are based on primary and secondary sexual characteristics d. Staging of puberty based on the initiation of primary sexual characteristics ANS: C

Tanner sexual-maturing ratings are based on the development of stages of primary and secondary sexual characteristics. They are not based on chronological age. The age at which an adolescent enters puberty is variable. The puberty stage in girls begins with breast development. The puberty stage in boys begins with genital enlargement. Primary sexual characteristics are not the basis of Tanner staging.

19. Which behavior suggests appropriate psychosocial development in the adolescent? a. The adolescent seeks validation for socially acceptable behavior from older adults. b. The adolescent is self-absorbed and self-centered and has sudden mood swings. c. Adolescents move from peers and enjoy spending time with family members. d. Conformity with the peer group increases in late adolescence. ANS: B During adolescence, energy is focused within. Adolescents concentrate on themselves in an effort to determine who they are or who they will be. Adolescents are likely to be impulsive and impatient. The peer group validates acceptable behavior during adolescence. Adolescents move from family and enjoy spending time with peers. Adolescents also spend time alone; they need this time to think and concentrate on themselves. Conformity becomes less important in late adolescence.
20. The parents of a 14-year-old girl are concerned that their adolescent spends too much time looking in the mirror. Which statement is the most appropriate for the nurse to make? a. Your teenager needs clearer and stricter limits about her behavior. b. Your teenager needs more responsibility at home. c. During adolescence, this behavior is not unusual. d. The behavior is abnormal and needs further investigation. ANS: C

Narcissistic behavior is normal during this period of development. The teenager is seeking a personal identity. Stricter limits are not an appropriate response for a behavior that is part of normal development. More responsibility at home is not an appropriate response for this situation.

21. Which factor contributes to early adolescents engaging in risk-taking behaviors? a. Peer pressure b. A desire to master their environment c. Engagement in the process of separation from their parents d. A belief that they are invulnerable ANS: D During early to middle adolescence, children feel that they are exempt from the consequences of risk-taking behaviors: they believe negative consequences happen only to others. Impressing peers is more typically the factor influencing behavior of older school-age children. Mastering the environment is the task of young school-age children. Emancipation is a major issue for the older adolescent. The process is accomplished as the teenager gains an education or vocational training.
22. Which statement is the most appropriate advice to give parents of a 16-year-old teenager who is rebellious? a. You need to be stricter so that your teenager feels more secure. b. You need to allow your teenager to make realistic choices while using consistent and structured discipline. c. Increasing your teens involvement with his peers will improve his self-esteem. d. Allow your teenager to choose the type of discipline that is used in your home. ANS: B Allowing teenagers to choose between realistic options and offering consistent and structured discipline typically enhances cooperation and decreases rebelliousness. Setting stricter limits

typically does not decrease rebelliousness or increase feelings of security. Increasing peer involvement does not typically increase self-esteem. Allowing teenagers to choose the method of discipline is not realistic and typically does not reduce rebelliousness. MULTIPLE RESPONSE

1. The nurse is preparing immunizations for a healthy 11-year-old boy who has received all his primary immunizations. Which immunizations will the nurse consider? Select all that apply. a. Meningococcal b. DTaP c. OPV d. Smallpox ANS: A, B Meningococcal conjugate vaccine should be given to all children at age 11 to 12 years. The American Academy of Pediatrics recommends one dose of DTaP vaccine for children at age 11 to 12 years, as long as they have received the primary DTaP series. Oral polio vaccine is no longer administered in the U.S. The current smallpox vaccine is not recommended for healthy, low-risk children younger than 18 years of age.
2. Parents of a 4-month-old child ask the nurse what they can do to help relieve the discomfort of teething. The nurse should include which suggestions for the parents? Select all that apply. a. Provide warm liquids. b. Rub the gums with aspirin. c. Over-the-counter topical medications for gum pain relief can be used as directed. d. Administer acetaminophen (Tylenol) as directed. e. Provide a hard food such as a frozen bagel for chewing.

ANS: C, D, E

To help parents cope with teething, nurses can suggest that they provide cool liquids and hard foods (e.g., dry toast, Popsicles, frozen bagels) for chewing. Hard, cold teethers and ice wrapped in cloth may also provide comfort for inflamed gums. Nurses should explain to parents that over- the-counter topical medications for gum pain relief should be used only as directed. Home remedies, such as rubbing the gums with whiskey or aspirin, should be discouraged, but acetaminophen administered as directed for the childs age can relieve discomfort. OTHER

1. Place in order the gross motor developmental milestones a nurse expects to assess in an infant. Begin with the earliest gross motor milestone expected and progress to the last gross motor milestone attained. a. Turns from abdomen to back b. Lifts head off of bed when in a prone position c. Walks holding on to furniture d. Turns from back to abdomen e. Sits unsupported ANS: B, A, D, E, C The infant lifts its head off of the bed when in a prone position at 3 months, turns from abdomen to back at 4 to 5 months, turns from back to abdomen at 6 to 7 months, sits unsupported at 8 to 9 months, and can walk holding on to furniture at 10 to 12 months.

Chapter 2. Physical Assessment Parameters MULTIPLE CHOICE

1. The nurse is performing an abdominal assessment on a child. When percussing over the stomach, the nurse should hear which sound? a. Tympany b. Resonance c. Flatness d. Dullness ANS: A Tympany is a high-pitched, loud-intensity sound heard over air-filled body parts such as the stomach and bowel. Resonance is a low-pitched, low-intensity sound elicited over hollow organs such as the lungs. Flatness is a high-pitched, soft-intensity sound elicited by percussing over solid masses such as bone or muscle. Dullness is a medium-pitched, medium-intensity sound elicited when percussing over high-density structures such as the liver.
2. A nurse is preparing to begin an assessment on a newly admitted child. The nurse should be aware that the single most important component of a pediatric physical examination is: a. assessment of heart and lungs. b. measurement of height and weight. c. documentation of parental concerns. d. obtaining an accurate history. ANS: D An accurate history is most helpful in identifying problems and potential problems. Heart and lung assessment and documentation of parental concerns are not as important as an accurate history. A single measurement of height and weight is not as significant as determining growth over time. The childs growth pattern can be elicited from the history.

3. In which section of the health history should the nurse record that the parent brought the infant to the clinic today because of frequent diarrhea? a. Review of systems b. Chief complaint c. Lifestyle and life patterns d. Health history ANS: B The chief complaint is documented using the childs or parents words for the reason the child was brought to the healthcare center. The review of systems includes past health functions of body systems. Lifestyle and life patterns include the childs interaction with the social, psychological, physical, and cultural environment. Health history includes birth history, growth and development, common childhood illnesses, immunizations, hospitalizations, injuries, and allergies.
4. A nurse is reviewing pediatric physical assessment techniques. Which statement about performing a pediatric physical assessment is correct? a. Physical examinations proceed systematically from head to toe unless developmental considerations dictate otherwise. b. The physical examination should be done with parents in the examining room for children of any age. c. Measurement of head circumference is done until the child is 5 years old. d. The physical examination is done only when the child is cooperative. ANS: A Physical assessment usually proceeds from head to toe; however, developmental considerations with infants and toddlers dictate that the least threatening assessments be done first to obtain accurate data. Having parents in the examining room with adolescents is not appropriate. Head circumference is routinely measured until 36 months of age. Children will not always be

cooperative during the physical examination. The examiner will need to incorporate communication and play techniques to facilitate cooperation.

5. A nurse is conducting an assessment on a child during a well-child visit. Which of the following includes the components of a complete pediatric history? a. Statistical information, client profile, health history, family history, review of systems, and lifestyle and life patterns b. Vital signs, chief complaint, and a list of previous problems c. Chief complaint, including body location, quality, quantity, time frame, and alleviating and aggravating factors d. Pertinent developmental and family information ANS: A Statistical information, client profile, health history, family history, review of systems, and lifestyle and life patterns are included in a complete pediatric history. Vital signs, chief complaint, and list of previous problems do not constitute a complete history. A problem- oriented history includes specific information about the chief complaint. Pertinent developmental and family information are part of the complete history.
6. At what age can the nurse expect a childs head and chest circumference to be almost equal? a. Birth b. 6 months c. 1 year d. 3 years ANS: C Head and chest measurements are almost equal at 1 year of age. Head circumference is larger than chest circumference until approximately 1 year of age. By 3 years of age, the chest circumference exceeds the head circumference.

7. A nurse is teaching unlicensed assistive personnel (UAP) how to take accurate blood pressure on children. The nurse knows the UAPs have understood the teaching if they state that to obtain an accurate measurement of a childs blood pressure, the cuff should cover which portion of the childs upper arm? a. Two-thirds b. Three-fourths c. One-half d. One-third ANS: A The blood pressure cuff should cover two-thirds of the childs upper arm to get an accurate reading. A cuff that covers more than two-thirds of the childs upper arm will result in a false low reading. A cuff that covers less than two-thirds of the childs upper arm will result in a false high reading.
8. Which chart should the nurse use to assess the visual acuity of an 8-year-old child? a. Lea chart b. Snellen chart c. HOTV chart d. Tumbling E chart ANS: B The Snellen chart is used to assess the vision of children older than 6 years of age. The Lea chart tests vision using four different symbols designed for use with preschool children. The HOTV chart tests vision by using graduated letters and is designed for use with children ages 3 to 6 years. The Tumbling E chart uses the letter E in various directions and is designed for use with children ages 3 to 6 years.

9. Which action is appropriate when the nurse is assessing breath sounds of an 18-month- old crying child? a. Ask the parent to quiet the child so the nurse can listen. b. Auscultate breath sounds and chart that the child was crying. c. Encourage the child to play with the stethoscope to distract and to calm down the child before auscultating. d. Document that data are not available because of noncompliance. ANS: C Distracting the child with an interesting activity can assist the child to calm down so an accurate assessment can be made. Asking a parent to quiet the child may or may not work. Auscultating while the child is crying typically results in less than optimal data. Documenting that the child is not compliant is not appropriate. An assessment needs to be completed.
10. Which is the most appropriate site for the nurse to use to measure a pulse rate on a 1-year- old child? a. Apical b. Radial c. Carotid d. Femoral ANS: A Apical pulse rates are taken in children younger than 2 years. Radial pulse rates may be taken in children older than 2 years. It is difficult to palpate the carotid pulse in an infant. The femoral pulse is palpated when comparing peripheral pulses, but it is not used to measure an infants pulse rate.
11. What is the most appropriate action for the nurse to take when a crying toddler has a blood pressure measurement of 120/70 mm Hg?

a. Notify the physician of the measurement. b. Document the blood pressure reading and check it again in 4 hours. c. Quiet the child and retake the blood pressure. d. Ask the parent if the child has a history of hypertension. ANS: C Blood pressure is elevated when a child is upset and crying. Quieting the child before retaking the blood pressure is appropriate. Notifying the physician is not necessary until accurate data are obtained. Documenting the blood pressure and waiting 4 hours before taking another measurement is inappropriate because this reading is not within the normal range. Asking the parent about a history of hypertension is irrelevant when a child is upset and crying as blood pressure is elevated.

12. What term should be used in the nurses documentation to describe auscultation of breath sounds that are short, popping, and discontinuous on inspiration? a. Pleural friction rub b. Bronchovesicular sounds c. Crackles d. Wheeze ANS: C Crackles are short, popping, discontinuous sounds heard on inspiration. A pleural friction rub has a grating, coarse, low-pitched sound. Bronchovesicular sounds are auscultated over mainstem bronchi. They are clear, without any adventitious sounds. Wheezes are musical, high-pitched, predominant sounds heard on expiration.
13. Which strategy should be the best approach when initiating the physical examination of a 9- month-old infant? a. Undress the infant and do a head-to-toe examination.

b. Have the parent hold the child on his or her lap. c. Put the infant on the examination table and begin assessments at the head. d. Ask the parent to leave because the infant will be upset. ANS: B Infants 6 months and older feel stranger anxiety. It is easier to do most of the examination on the parents lap to decrease anxiety. The head-to-toe approach needs to be modified for the infant. Uncomfortable procedures, such as the otoscopic examination, should be left until last. The infant may feel less fearful if placed in the parents lap or with the parent within visual range if placed on the examining table. There is no reason to ask a parent to leave when an infant is being examined. Having the parent with the infant will make the experience less upsetting for the infant.

14. Which strategy is not always appropriate for a pediatric physical examination? a. Take the history in a quiet, private place. b. Examine the child from head to toe. c. Exhibit sensitivity to cultural needs and differences. d. Perform frightening procedures last. ANS: B The classic approach to a physical examination is to begin at the head and proceed through the entire body to the toes. When examining a child, however, the examiner must tailor the physical assessment to the childs age and developmental level. The nurse should collect the childs health history in a quiet, private area and painful or frightening procedures should be left to the end of the examination. The nurse should always be sensitive to cultural needs and differences among children.
15. Which assessment should the nurse perform last when examining a 5-year-old child? a. Heart

b. Lungs c. Abdomen d. Throat ANS: D Examination of the mouth and throat is considered to be more invasive than other parts of a physical examination. For preschool children, invasive procedures should be left to the end of the examination. The nurse may proceed from head to toe with preschool age children. Assessment of the abdomen and lungs is not considered to be frightening.

16. When would be the most appropriate time to inspect the genital area during a well- child examination of a 14-year-old female? a. It is not necessary to inspect the genital area. b. Examine the genital area first. c. After the abdominal assessment. d. Do the genital inspection last. ANS: C It is best to incorporate the genital assessment into the middle of the examination. This allows ample time for questions and discussion. If possible, proceed from the abdominal area to the genital area. A visual inspection of all areas of the body is included in a physical examination. Examination of the genital area can be embarrassing. It would not be appropriate to begin the examination of this area. Assessing the genital area earlier in the examination allows more time for the adolescent to ask questions and engage in discussion.
17. Which measurement is not indicated for a 4-year-old well-child examination? a. Blood pressure b. Weight c. Height

d. Head circumference ANS: D Head circumference is measured on all children from birth to 3 years. Blood pressure measurements are taken on all children at every ambulatory visit. Weight and height are measured at every well-child examination.

18. The nurse inspecting the skin of a dark-skinned child notices an area that is a dusky red or violet color. This skin coloration is associated with which? a. Cyanosis b. Erythema c. Vitiligo d. Nevi ANS: B In dark-skinned children, erythema appears as dusky red or violet skin coloration. Cyanosis in a dark-skinned child would appear as a black coloration of the skin. Vitiligo refers to areas of depigmentation. Nevi are areas of increased pigmentation.
19. The nurse palpated the anterior fontanel of a 14-month-old infant and found that it was closed. What would this finding indicate? a. This is a normal finding. b. This finding indicates premature closure of cranial sutures. c. This is an abnormal finding and the child should have a developmental evaluation. d. This is an abnormal finding and the child should have a neurological evaluation. ANS: A

The anterior fontanel should be completely closed by 12 to 18 months of age. A closed anterior fontanel at 14 months of age does not indicate premature closure of cranial sutures, is not abnormal, and does not indicate the need for a neurological examination.

20. A nurse is conducting vision screening on preschool children. Which of the following corresponds with the normal range for visual acuity of a 4-year-old child? a. 20/50 to 20/80 b. 20/40 to 20/70 c. 20/30 to 20/40 d. 20/20 to 20/30 ANS: C 20/30 to 20/40 is the normal range for visual acuity at 4 years of age. 20/50 to 20/80 is the normal range for visual acuity at 4 months of age. 20/40 to 20/70 is the normal range for visual acuity at 1 year of age. 20/20 to 20/30 is the normal range for visual acuity at 5 years of age.
21. A child begins to squirm and giggle when the nurse begins to palpate the abdomen. What is the best approach for the nurse to use with a child who is ticklish? a. Skip the abdominal palpation. b. Touch the abdomen firmly as the child takes short, quick breaths. c. Press the abdomen with the child bearing down and holding the breath. d. Palpate with the childs hand under the examiners hand. ANS: D Placing the childs hand on the abdomen and the examiners hand on top of the childs hand with fingers touching the abdomen gives the child some control and reduces the sensation of tickling. Abdominal palpation should not be eliminated from the physical assessment. To help the child relax, the nurse would ask the child to take deep breaths. Bearing down and holding the breath would tighten the abdominal muscles.

22. Which cranial nerve is assessed when the child is asked to imitate the examiners wrinkled frown, wrinkled forehead, smile, and raised eyebrow? a. Accessory b. Hypoglossal c. Trigeminal d. Facial ANS: D The facial nerve is assessed as described in the question. To assess the accessory nerve, the examiner palpates and notes the strength of the trapezius and sternocleidomastoid muscles against resistance. To assess the hypoglossal nerve, the examiner asks the child to stick out the tongue. To assess the trigeminal nerve, the child is asked to identify a wisp of cotton on the face. The corneal reflex and temporal and masseter muscle strength are evaluated.
23. Which assessment finding is considered a neurological soft sign in a 7-year-old child? a. Plantar reflex b. Poor muscle coordination c. Stereognostic function d. Graphesthesia ANS: B Poor muscle coordination is a neurological soft sign. The plantar reflex is a normal response. When the lateral aspect of the sole of the foot is stroked in a movement curving medially from the heel to the ball, the response will be plantar flexion of the toes. Stereognostic function refers to the ability to identify familiar objects placed in each hand. Graphesthesia is the ability to identify letters or numbers traced on the palm or back of the hand with a blunt point. MULTIPLE RESPONSE