Test bank for current diagnosis and treatment pediatrics twenty fourth edition 24th edition william hay (1).pdf

TEST BANK FOR CURRENT Diagnosis & Treatment Pediatrics
26th Edition by Maya Bunik; William W. Hay,
Chapter 1 - 46 Complete

Current Diagnosis and Treatment Pediatrics, 26th Edition Test Bank
Table of Contents:
Chapter 1. The Newborn Infant
Chapter 2. Child Development and Behavior
Chapter 3. Adolescence
Chapter 4. Adolescent Substance Abuse
Chapter 5. Eating Disorders
Chapter 6. Child and Adolescent Psychiatric Disorders
Chapter 7. Child Abuse and Neglect
Chapter 8. Ambulatory / Office Pediatrics
Chapter 9. Immunization
Chapter 10. Travel Medicine
Chapter 11. Normal Childhood Nutrition and Its Disorders
Chapter 12. Emergencies and Injuries
Chapter 13. Poisoning
Chapter 14. Critical Care
Chapter 15. Skin
Chapter 16. Eye
Chapter 17. Oral Medicine and Dentistry
Chapter 18. Ear, Nose, and Throat
Chapter 19. Respiratory Tract and Mediastinum
Chapter 20. Sleep Medicine
Chapter 21. Cardiovascular Diseases
Chapter 22. Gastrointestinal Tract
Chapter 23. Liver and Pancreas
Chapter 24. Kidney and Urinary Tract
Chapter 25. Neurologic and Muscular Disorders
Chapter 26. Orthopedics
Chapter 27. Sports Medicine
Chapter 28. Rehabilitation Medicine
Chapter 29. Rheumatic Diseases
Chapter 30. Hematologic Disorders
Chapter 31. Neoplastic Disease
Chapter 32. Pain Management and Palliative Care
Chapter 33. Immunodeficiency
Chapter 34. Endocrine Disorders
Chapter 35. Diabetes Mellitus
Chapter 36. Inborn Errors of Metabolism
Chapter 37. Genetics and Dysmorphology
Chapter 38. Allergic Disorders
Chapter 39. Antimicrobial Therapy
Chapter 40. Infections: Viral and Rickettsial
Chapter 41. Human Immunodeficiency Virus Infection
Chapter 42. Infections: Bacterial and Spirochetal
Chapter 43. Infections: Parasitic and Mycotic
Chapter 44. Sexually Transmitted Infections
Chapter 45. Fluid, Electrolyte, and Acid-Base Disorders and Therapy
Chapter 46. Pediatric Laboratory Medicine and Reference Ranges

Chapter 1: The Newborn Infant
Multiple Choice
1. Which milestone is developmentally appropriate for a 2-month-old infant when the nurse pulls
the infant to a sitting position?
a. Head lag is present when the infants trunk is lifted.
b. The infant is able to support the head when the trunk is lifted.
c. The infant is briefly able to hold the head erect.
d. The infant is fully able to support and hold the head in a straight line.
ANSWER: C
A 2-month-old infant is able to hold the head erect only briefly and continues to have some head
lag. It is not until 4 months of age that the infant can keep his or her head in a straight line when
pulled to a sitting position.
2. Approximately what should a newborn weigh at 1 year of age if the newborns birth weight
was 7 pounds 6 ounces?
a. 14 3/4 pounds
b. 22 1/8
pounds
c. 29 1/2 pounds
d. Unable to estimate weight at 1 year
ANSWER: B
An infant triples the birth weight by 1 year of age. An infant doubles the birth weight by 6 months
of age. An infant quadruples the birth weight by2 years of age. Weight at 6 months, 1 year, and 2
years of age can be estimated from the birth weight.

3. Which statement made by a parent would be consistent with a developmental delay?
a. I have noticed that my 9-month-old infant responds consistently to the sound of
his name.
b. I have noticed that my12-month-old child does not get herself to a sitting
position or pull to stand.
c. I am so happy when my 1 1/2-month-old infant smiles at me.
d. My 5-month-old infant is not rolling over in both directions yet.
ANSWER: B
Critical developmental milestones for gross motor development in a 12 month old include standing
briefly without support, getting to a sitting position, and pulling to stand. If a 12-month- old child
does not perform these activities, it may be indicative of a developmental delay. An infant who
responds to his name at 9 months of age is demonstrating abilities to both hear and interpret
sound. A social smile is present by 2 months of age. Rolling over in both directions is not a critical
milestone for gross motor development until the child reaches 6 months of age.
4. At a healthy 2-month-old infants well-child clinic visit, the nurse should give which
immunizations?
a. DTaP, IPV, HepB, Hib, PCV, rotavirus
b. MMR, DTaP, PVC, and IPV
c. Hib, DTaP, rotavirus, and OPV
d. Hib and MMR, IPV, and rotavirus
ANSWER: A
DTaP, IPV, HepB, Hib, PCV, and rotavirus are the appropriate sequence of immunizations for a
healthy 2-month-old infant. MMR is given at or after 12 months of age. Oral polio vaccine (OPV)
is no longer administered in the U.S.
5. The nurse advises the mother of a 3-month-old infant, exclusively breast-fed, to:
a. start giving the infant a vitamin D supplement.

b. start using an infant feeder and add rice cereal to the formula.
c. start feeding the infant rice cereal with a spoon at the evening feeding.
d. continue breast-feeding without any supplements.
ANSWER: A
Breast milk does not provide an adequate amount of dietary vitamin D. Infants who are exclusively
breast-fed need vitamin D supplements to prevent rickets. An infant feeder is an inappropriate
method of providing the infant with caloric intake. Solid foods and rice cereal are not recommended
for a 3-month-old infant. Solid feedings do not typically begin before 4 to 6 months of age.
Because breast milk is not an adequate source of fluoride, infants need to be given a fluoride
supplement.
6. At months of age, an infant should first be expected to locate an object hidden from
view.
a. 4
b. 6
c. 9
d. 20
ANSWER: C
By 9 months of age an infant will actively search for an object that is out of sight. Four-month- old
infants are not cognitively capable of searching out objects hidden from their view. Infants at this
developmental level do not pursue hidden objects. Six-month-old infants have not developed the
ability to perceive objects as permanent and do not search out objects hidden fromtheir view.
Twenty-month-old infants actively pursue objects not in their view and are capable of recalling the
location of an object not in their view. They first look for hidden objects around the age of 9
months.
7. The parents of a newborn infant state, We will probably not have our baby immunized because
we are concerned about the risk of our child being injured. Which is the best response for the nurse
to make?

a. It is your decision.
b. Have you talked with your parents about this? They can probably help you think
about this decision.
c. The risks of not immunizing your baby are greater than the risks fromthe
immunizations.
d. You are making a mistake.
ANSWER: C
Although immunizations have been documented to have a negative effect in a small number of
cases, an unimmunized infant is at greater risk for development of complications from childhood
diseases than from the vaccines. It is the parents decision not to immunize the child; however, the
nurse has a responsibility to inform parents about the risks to infants who are not immunized.
Grandparents can be supportive but are not the primary decision makers for the infant. Telling
parents that they are making a mistake is an inappropriate response.
8. The mother of a 9-month-old infant is concerned because the infant cries when she leaves him.
Which is the best response for the nurse to make to the mother?
a. You could consider leaving the infant more often so he can adjust.
b. You might consider taking him to the doctor because he may be ill.
c. Have you noticed whether the baby is teething?
d. This can be a healthy sign of attachment.
ANSWER: D
Healthy attachment is manifested by stranger anxiety in late infancy. An infant who manifests
stranger anxiety can be supported by the mother leaving the infant for only short periods of time.
Assessing developmental needs is appropriate before taking an infant to a physician. Pain from
teething expressed by the infants cries would not occur only when the mother left the room.
9. Which statement concerning physiological factors of infancy is true?
a. The infant has a slower metabolic rate than an adult.

b. An infant is not able to digest protein and lactase.
c. Infants have a slower circulatory response than adults.
d. The kidneys of an infant are less efficient in concentrating urine than an adults
kidneys.
ANSWER: D
The infants kidneys are not as effective at concentrating urine compared with an adults kidneys
because of immaturity of the renal system and a slower glomerular filtration rates. The infants
metabolic rate is faster, not slower, than an adults. Although the newborn infants gastrointestinal
system is immature, it is capable of digesting protein and lactase, but the ability to digest and
absorb fat does not reach adult levels until approximately 6 to 9 months of age.
10. Which is a priority in counseling parents of a 6-month-old infant?
a. Increased appetite from secondary growth spurt
b. Allowing the infant to self-feed
c. Securing a developmentally safe environment for the infant
d. Strategies to teach infants to sit up
ANSWER: C
Safety is a primary concern as an infant becomes increasingly mobile. The infants appetite and
growth velocity decrease in the second half of infancy. Fine motor development, which is refined in
the second half of infancy, is necessary before the infant can self-feed. Unless the infant has a
neuromuscular deficit, strategies for teaching a normally developing infant to sit up are not
necessary.
11. A mother of a 2-month-old infant tells the nurse, My child doesnt sleep as much as his older
brother did at the same age. What is the best response for the nurse?
a. Have you tried to feed the baby more often?
b. Infant sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a
time.

c. It is helpful to keep a record of your babys eating, waking, sleeping, and
elimination patterns and to come back in a week to discuss them.
d. This infant is difficult. It is important for you to identify what is bothering the
baby.
ANSWER: B
Newborn infants may sleep as much as 17 to 20 hours per day. Sleep patterns vary widely, with
some infants sleeping only 2 to 3 hours at a time. Infants typically do not need more caloric intake
to improve sleep behaviors. Keeping intake, output, waking, and sleeping data is not typically
helpful in discussing differences among infants behaviors. Identifying an infant as difficult without
identifying helpful actions is not a therapeutic response for a parent concerned about sleep.
12. The mother of a 10-month-old infant tells the nurse that her infant really likes cows milk.
Which is the best response to this mother?
a. Milk is good for him.
b. It is best to wait until he is a year old before giving him cows milk.
c. Limit cows milk to his bedtime bottle.
d. Mix his cereal with cows milk and give him formula in a bottle.
ANSWER: B
It is best to wait until the infant is at least a year old before giving him cows milk because of the
risk of allergies and intestinal problems. Cows milk protein intolerance is the most common food
allergy during infancy. Although milk is a good source of calcium and protein for children after the
first year of life, it is not the best source of nutrients for children younger than 1 year old.
Bedtime bottles of formula or milk are contraindicated because of their high sugar content, which
leads to dental decay in primary teeth. Cereal can be mixed with formula.
13. The mother of a 10-month-old infant asks the nurse about beginning to wean her child from
the bottle. Which statement by the mother suggests that the child is not ready to be weaned?
a. My son is frequently throwing his bottle down.

b. The baby takes a few ounces of formula from the bottle.
c. He is constantly chewing on the nipple. It concerns me.
d. He consistently is sucking.
ANSWER: D
Consistent sucking is a sign that the child is not ready to be weaned. A decreased interest in the
bottle starts between 6 and 12 months. Throwing the bottle down is a sign of a decreased interest in
the bottle. When the child is taking more fluids from a cup and decreasing amounts from the
bottle, the child is demonstrating a readiness for weaning. Chewing on the nipple is another sign
that the infant is ready to be weaned.
14. Which is appropriate play for a 6-month-old infant?
a. Pat-a-cake, peek-a-boo
b. Ball rolling, hide and seek game
c. Bright rattles and tactile toys
d. Push and pull toys
ANSWER: A
Six-month-old children enjoy playing pat-a-cake and peek-a-boo. Nine-month-old infants enjoy
rolling a ball and playing hide and seek games. Four-month-old infants enjoy bright rattles and
tactile toys. Twelve-month-old infants enjoy playing with push and pull toys.
15. Which statement by a mother indicates that her 5-month-old infant is ready for solid food?
a. When I give my baby solid foods, she has difficulty getting it to the back of her
throat to swallow.
b. She has just started to sit up without anysupport.
c. I am surprised that she only weighs 11 pounds. I expected her to have gained
some weight.
d. I find that she really has to be encouraged to eat.
ANSWER: B

Sitting is a sign that the child is ready to begin with solid foods. Children who are ready to manage
solid foods are able to move food to the back of their throats to swallow. Infants who weigh less
than 13 pounds and demonstrate a lack of interest in eating are not ready to be started on solid
foods. Infants who are difficult feeders and do not demonstrate an interest in solid foods are not
ready to be started on them.
16. A mother asks the nurse, When should I begin to clean my babys teeth? What is the best
response for the nurse?
a. You can begin when all her baby teeth are in.
b. You can easily begin now. Just put some toothpaste on a gauze pad to clean the
teeth.
c. I dont think you have to worry about that until she can handle a toothbrush.
d. You can begin as soon as your child has a tooth. The easiest way is to take cotton
swabs or a face cloth and just wipe the teeth. Toothpaste is not necessary.
ANSWER: D
An infants teeth need to be cleaned as soon as they erupt. Cleaning the teeth with cotton swabs or a
face cloth is appropriate. Waiting until all the baby teeth are in is inappropriate and prolongs
cleaning until 2 years of age. Because toothpaste contains fluoride and infants will swallow the
toothpaste, parents should avoid its use. Even when a child has the ability to hold a toothbrush, the
parent should continue cleaning the childs teeth.
1. An infants length was 20 inches at birth. What should the nurse expect the infants length to be
at 6 months (in inches)?
ANSWER:
26
During the first 6 months, infants increase their birth length by approximately 1 inch (2.54 cm) per
month, slowing to 1/2 inch (1.27 cm) per month over the next 6 months.

Chapter 2. Child Development and Behavior
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 orderlyprocess, 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.
ANSWER: 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.
ANSWER: 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
ANSWER: 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

ANSWER: 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.
ANSWER: 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.
ANSWER: 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
ANSWER: 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.
ANSWER: 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 bythe 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.
ANSWER: 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.
ANSWER: 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.
ANSWER: 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
ANSWER: 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
ANSWER: 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
ANSWER: 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
ANSWER: 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
ANSWER: 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
ANSWER: 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.
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
ANSWER: 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.
ANSWER: 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
ANSWER:

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 3. Adolescence
1. 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
ANSWER: 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.
2. 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.
ANSWER: 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.
3. 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.
ANSWER: 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.
4. 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
ANSWER: 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.
5. 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.
ANSWER: 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.
6. Which statement bythe nurse is most appropriate to a 15-year-old adolescent whose friend has
mentioned suicide?
a. Tell your friend to come to the clinic immediately.
b. You need to gather details about your friends suicide plan.

c. Your friends threat needs to be taken seriously and immediate help for your
friend is important.
d. If your friend mentions suicide a second time, you will want to get your friend
some help.
ANSWER: C
Suicide is the third most common cause of death among American adolescents. A suicide threat
from an adolescent serves as a dramatic message to others and should be taken seriously.
Adolescents at risk should be targeted for supportive guidance and counseling before a crisis
occurs. Instructing a 15-year-old adolescent to tell a friend to come to the clinic immediately
provides the teen with limited information and does not address the concern. It is important to
determine whether a person threatening suicide has a plan of action; however, the best information
for the 15-year-old adolescent to have is that all threats of suicide should be taken seriously and
immediate help is important. It is imperative that help is provided immediately for a teenager who
is talking about suicide. Waiting until the teen discusses it a second time may be too late.
7. When planning care for adolescents, the nurse should:
a. teach parents first, and they, in turn, will teach the teenager.
b. provide information for their long-term health needs because teenagers respond
best to long-range planning.
c. maintain the parents role by providing explanations for treatment and procedures
to the parents only.
d. give information privately to adolescents about how they can manage the specific
problems that they identify.
ANSWER: D
Problems that teenagers identify and are interested in are typically the problems that they are the
most willing to address. Confidentiality is important to adolescents. Adolescents prefer to confer
privately (without parents) with the nurse and healthcare provider. Teenagers are socially and
cognitively at the developmental stage where the healthcare provider can teach them and can

receive explanations about healthcare directly from the nurse. Teenagers are more interested in
immediate healthcare needs than in long-term needs.
8. A 17-year-old adolescent tells the nurse that he is not having sex because it would make his
parents veryangry. This response indicates that the adolescent has a developmental lag in which
area?
a. Cognitive development
b. Moral development
c. Psychosocial development
d. Psychosexual development
ANSWER: B
The appropriate moral development for a 17-year-old adolescent would include evidence that the
teenager has internalized a value system and does not depend on parents to determine right and
wrong behaviors. Cognitive development is related to moral development, but it is not the pivotal
point in determining right and wrong behaviors. Identity formation is the psychosocial
development task. Energy is focused within the adolescent, who exhibits behavior that is self-
absorbed and egocentric. Although a task during adolescence is the development of a sexual
identity, the teenagers dependence on the parents sanctioning of right or wrong behavior is more
appropriately related to moral development.
9. The best response a nurse can make to a 15-year-old girl who has verbalized a desire to have a
baby is:
a. Have you talked with your parents about this?
b. Do you have plans to continue school?
c. Will you be able to support the baby?
d. Can you tell me how your life will change if you have an infant?
ANSWER: D

Having the teenager describe how the infant will affect her life will allow the teen to think more
realistically. Her description will allow the nurse to assess the teens perception and reality
orientation. Asking the teenager if she has talked to her parents is not particularly helpful to the
teen or the nurse and may terminate the communication. A direct question about continuing
school and how the teenager will support the child will not facilitate communication. Open- ended
questions encourage communication.
10. In an interview with the nurse, a mother states that she is concerned that her 14-year-old teen is
critical and finding fault with her. The nurse counsels the mother that:
a. the family needs to change its value system to meet the teenagers changing needs.
b. the parentteen relationship is important for the teenager and conflicts are to be
expected.
c. teenagers create psychological distance from the parent to separate from the
parent.
d. parents need to relinquish their relationship with their teenager to the teens peers.
ANSWER: C
The teenager uses critical and fault-finding behavior as a mechanism to separate from the parent
and become independent. Changing the familys value system to meet the teenagers needs is not
realistic and will result only in the teenagers being critical of the new system. The parentteen
relationship is not as important to the teenager as it was in earlier years. Friends and peers become
more important. Parents should not relinquish their relationship with their teenager to the teens
peers. Maintaining a consistent parental relationship with the adolescent is important.
11. A nurse is teaching adolescent boys about pubertal changes. Which is the first sign of
pubertal change seen with boys?
a. Testicular enlargement
b. Facial hair
c. Scrotal enlargement
d. Voice deepens

ANSWER: A
The first sign of pubertal changes in boys is testicular enlargement in response to testosterone
secretion, which usually occurs in Tanner stage 2. Slight pubic hair is present and the smooth skin
texture of the scrotum is somewhat altered. As testosterone secretion increases, the penis, testes,
and scrotum enlarge. During Tanner stages 4 and 5, rising levels of testosterone cause the voice to
deepen and facial hair appears at the corners of the upper lip and chin.
MULTIPLE RESPONSE
1. Parents of a teenager ask the nurse what signs they should look for if their child is in a gang.
The nurse should include which signs when answering? Select all that apply.
a. Plans to try out for the debate team at school
b. Skips classes to go to the mall
c. Hangs out with friends they have had since childhood
d. Has an unexplained source of money
e. Fears the police
ANSWER: B, D, E
Signs of gang involvement include skipping classes, unexplained sources of money, and fear of the
police. Associating with new friends while ignoring old friends is another sign, so hanging out with
friends they have had since childhood is not a sign of gang involvement. A change in attitude
toward participating in activities is another sign of gang involvement. Plans to tryout for the debate
team at school are not a sign of gang involvement.
OTHER
1. Place in order the signs of female sexual maturity beginning with the first sign and ending
with the last. Use the following format for your answers: A, B, C, D
a. Growth of pubic hair
b. Menarche

c. Appearance of breast buds
d. Ovulation is established
ANSWER:
C, A, B, D
Sexual maturation in girls begins with the appearance of breast buds (thelarche), which is the first
sign of ovarian function. Thelarche occurs at approximately age 8 to 11 years and is followed by the
growth of pubic hair. Linear growth slows, and menarche begins approximately 1 year after the
peak height velocity (PHV). Ovulation occurs with menarche but may or may not accompany the
first 2 years of menarche so it is not established until later.
Chapter 4. Adolescent Substance Abuse
42.The nurse assessing a typical family with an adolescent child would more often than not find the
arguments between caregivers and child to be about:
a. adolescent sexuality c. drugs and drug abuse
b. religion or politics d. ordinary family matters
ANSWER: D
Feedback
Incorrect. The nurse assessing a typical family with an adolescent child would not
A
find the arguments between caregivers and child to be about adolescent sexuality.
Incorrect. The nurse assessing a typical family with an adolescent child would not find
the arguments between caregivers and child to be about religion or politics.
B
Incorrect. The nurse assessing a typical family with an adolescent child would not find
the arguments between caregivers and child to be about drugs and drug abuse.
C

Correct. The nurse assessing a typical family with an adolescent child would more often
than not find the arguments between caregivers and child to be about ordinary
D family matters.
Chapter 5. Eating Disorders
1. The nurse is assessing a child admitted to the hospital for abdominal pain. Which of the
following findings by the nurse would be typical of those seen in appendicitis?
anorexia, nausea, and vomiting preceded the pain according to the historyprovided
a. by the caregivers
b. a subnormal temperature for the last 2 days
pain that was vague and somewhat localized to the periumbilical area and gradually
c. migrated to the right lower quadrant
d. night time chills for 1 week
Feedback
Incorrect. Anorexia, nausea, and vomiting preceding the pain according to the history
provided by the caregivers is not the typical finding seen in appendicitis.
A
Incorrect. A subnormal temperature for the last 2 days is not the typical finding seen
B
in appendicitis.
Correct. Pain that was vague and somewhat localized to the periumbilical area and
gradually migrated to the right lower quadrant is the typical finding seen in
C
appendicitis.
Incorrect. Night time chills for 1 week is not the typical finding seen in appendicitis.
D
2. A pediatric client presents to the emergency department with acute abdominal pain followed by
anorexia and nausea. The nurse suspects appendicitis. Upon palpation, the nurse anticipates
identifying pain localized in which area(s) of the abdomen? Select all that apply.
ANSW
ER: C

a. costovertebral angle c. left lower quadrant
b. right lower quadrant d. periumbilical area
ANSWER: B, D
Feedback
Correct
The pain associated with appendicitis typically is localized at the periumbilical
area, gradually migrating to the right lower quadrant.
The pain associated with appendicitis typically is localized at the periumbilical
area, gradually migrating to the right lower quadrant.
Incorrect
The pain of appendicitis is not associated with discomfort in the costovertebral
angle.
The pain of appendicitis is not associated with discomfort in the left lower
quadrant.
3. The infant with hypertrophic pyloric stenosis will eventually:
a. experience spontaneous recovery in 75% of cases
b. stop eating and go into a life-threatening decline
c. have projectile vomitus propelled up to several feet
d. pass an unusually large bowel movement
Feedback
Incorrect. The infant with hypertrophic pyloric stenosis will not eventually experience
spontaneous recovery in 75% of cases. Treatment for pyloric stenosis is a surgical
procedure called a pyloromyotomy.
A
ANSW
ER: C

Incorrect. The infant with hypertrophic pyloric stenosis is hungry and wants to be fed
again, in spite of feeding and vomiting.
B
Correct. The infant with hypertrophic pyloric stenosis will eventually have projectile
C vomitus propelled up to several feet.
Incorrect. Because food does not pass through the pylorus, bowel movements are small.
D
4. Which of the following is an early warning sign of hypertrophic pyloric stenosis?
a. the infant looking and acting somewhat sick
b. the infant being hungry and wanting to feed again very soon after vomiting
c. milk running out of the infants mouth periodically during the feeding
d. unusually loud burping sounds
Feedback
Incorrect. The infant with hypertrophic pyloric stenosis does not act or look sick.
A Correct. An early warning sign of hypertrophic pyloric stenosis is the infant being
B hungry and wanting to be fed again very soon after vomiting.
Incorrect. An early warning sign of hypertrophic pyloric stenosis is not milk running out
of the infants mouth periodically during the feeding. The infant experiences
C vomiting which eventually becomes projectile, being propelled up to several feet.
Incorrect. An early warning sign of hypertrophic pyloric stenosis is not unusually
D loud burping sounds.
5. Diagnosis of hypertrophic pyloric stenosis can be made on history and what other finding?
epigastric tenderness over several
a. days c. failure to gain weight
ANSW
ER: B

b. crying without producing any tears d.
olive-shaped mass in the
epigastrium
Feedback
Incorrect. Epigastric tenderness over several days is not a manifestation of hypertrophic
pyloric stenosis.
A
Incorrect. Crying without producing any tears is a sign of dehydration.
B
Incorrect. Failure to gain weight accompanies hypertrophic pyloric stenosis but is not
a diagnostic indicator.
C
Correct. Diagnosis of hypertrophic pyloric stenosis can be made on history and
palpation of an olive-shaped mass in the epigastrium.
D
6. Which of the following are appropriate goals in working with a child or adolescent with a
diagnosis of anorexia nervosa? Select all that apply.
a. weight gain to within 5% of ideal body weight within 1 weeks time frame
b. weight gain to within 10% of ideal body weight at a gain of 1-2 pounds per week
c. eat 100% of a 2,500-calorie diet each day
d. eat a balanced diet with sufficient calories to allow weight gain
ANSWER: B, D
Feedback
Correct
When working with a child or adolescent with anorexia nervosa, appropriate
goals include weight gain to within 10% of body weight at 1-2 pounds of weight
gain per week.
The client should be encouraged to eat a balanced diet with sufficient calories to
allow weight gain.
ANSW
ER: D

Weight gain to within 5% of the ideal body weight within 1 weeks time would
require rapid weight to be gained too quickly. This rapid weight gain is medically
unsafe and may lead to cardiac overload and death.
Weight gain should not be too rapid, such as that which would occur with eating
100% of a 2,500-calorie diet daily.
Chapter 6. Child and Adolescent Psychiatric Disorders
1. A nurse is assessing a child with a depressive disorder. Which symptom is likely to be
manifested by the child?
a. Increased nighttime waking
b. Impulsivity and distractibility
c. Carelessness and inattention to details
d. Refusal to leave the house
ANSWER: A
Sleep pattern disturbances are often associated with depression. These include insomnia or
hypersomnia. Impulsivity and distractibility are manifestations of attention-deficit hyperactivity
disorder (ADHD). A diminished ability to think or concentrate, carelessness, and inattention to
details are clinical manifestations of a depressive disorder. A refusal to leave the house, even to play
with friends, is characteristic of separation anxiety disorder.
2. A nurse is teaching parents about symptoms associated with suicide. Which statement about
suicide should the nurse include in the teaching plan?

a. Children younger than 10 years of age do not attempt suicide.
b. A child who attempts suicide is usually depressed and has low self-esteem.
c. Suicide is usually an isolated event in a school community.
d. The suicide rate among females is higher than among males.
ANSWER: B
Poor self-concept and depression contribute significantly to suicidal behaviors. Children as young
as 3 years of age who have attempted suicide have been evaluated and found to be cognizant of
their actions. It is common for suicide to occur in a cluster within a community (e.g., schools).
Males have a higher incidence of both suicide attempts and completed suicides.
3. What is the best response for the nurse to make to an adolescent who states, I am very sad. I
wish I wasnt alive.?
a. Everyone feels sad once in a while.
b. You are just trying to escape your problems.
c. Have you told your parents how you feel?
d. Have you thought about hurting yourself?
ANSWER: D
Have you thought about hurting yourself? acknowledges the adolescents suicide gesture and
further assesses the adolescents condition. Everyone feels sad once in a while is a judgmental
response that ignores the adolescents obvious statement indicating a need for professional help.
The parents should be made aware of an adolescents precarious mental state; however, Have you
told your parents how you feel? does not address the adolescents statement.
4. A nurse is teaching parents about family relationship patterns associated with eating disorders.
Which family relationship pattern should the nurse teach that is consistent for an adolescent female
diagnosed with an eating disorder?
a. The adolescent is viewed as an extension of the parent.
b. There is an overprotective mother and an emotionally distant father.

c. The mother is domineering and the father is passive.
d. The adolescent is the youngest child or is an only child.
ANSWER: A
One of the most salient factors associated with eating disorders is enmeshed family relationships in
which the child is considered to be an extension of the parent or is viewed as a means of meeting
the parents needs. The family dynamics for males with anorexia are reported to include a mother
who is overinvolved with the child and a father who typifies a strong, cultural image. A domineering
mother and passive father are not characteristic of the family dynamics associated with eating
disorders. Birth order and number of children in the family were not identified as factors in
enmeshed family relationships.
5. The long-term treatment plan for an adolescent with an eating disorder focuses on:
a. managing the effects of malnutrition.
b. establishing sufficient caloric intake.
c. improving family dynamics.
d. restructuring the perception of body image.
ANSWER: D
The focus of treatment in individual therapy for an eating disorder involves restructuring cognitive
perceptions about the individuals body image. The treatment of eating disorders is initially focused
on reestablishing physiological homeostasis. Once body systems are stabilized, the next goal of
treatment for eating disorders is maintaining adequate caloric intake. Although family therapy is
indicated when dysfunctional family relationships exist, the primary focus of therapy for eating
disorders is to help the adolescent cope with complex issues.
6. A parent of a child with a psychosocial disorder states, I dont know how mychild developed
this problem. The nurse should base a response on which information?
a. Neurobiological, family, and sociocultural factors can contribute to the
development of psychosocial disorders in children.

b. Like many conditions affecting children, the etiology of psychosocial disorders is
unknown.
c. The majorityof psychosocial disorders have a clear pattern of genetic inheritance.
d. Dysfunctional family patterns are usually identified as the cause of a psychosocial
disorder.
ANSWER: A
Psychosocial disorders are responses to stress and may be manifested as disturbances in feeling,
body functions, behavior, or performance. The etiology of many psychosocial disorders in children
can be identified. Some psychosocial disorders are inheritable disorders. Others have been
identified as having a familial predisposition. Research consistently shows that psychosocial
disorders are caused by a combination of predisposing or inherent factors and environmental or
interactional factors.
7. A nurse is caring for a child admitted for substance abuse. The nurse plans care with the
recognition that substance abuse primarily affects which organ of the body?
a. Heart
b. Liver
c. Brain
d. Lungs
ANSWER: C
The primary affect of substance abuse is on the brain and residually on the rest of the body.
Although an excessive amount of a chemical can cause cardiac abnormalities, the brain is the most
commonly affected organ. Long-term alcohol use is known to impair the liver; however, brain
function is decreased by any amount of alcohol intake. The pulmonary system is not the primary
target; however, one commonly abused drug known to cause pulmonary problems is tobacco.
8. A 14-year-old child admits to using marijuana everyday. Which phase of substance abuse
should the nurse assess for?

a. Experimentation
b. Early drug use
c. True drug addiction
d. Severe drug addiction
ANSWER: C
True drug addiction is identified as regular use of drugs. Physical dependence may be present.
Social functioning has a drug focus. With experimentation, the individual tries the drug to see what
it is like or to satisfy peers. Early drug use is identified as using drugs with some degree of regularity
for their desirable effects. In severe drug addiction, the physical condition of the individual
deteriorates and all activities are related to drug use.
9. The school nurse observes an unkempt child dressed in inappropriate clothing who repeatedly
asks for food. The nurse is concerned about which problem?
a. Physical abuse
b. Physical neglect
c. Emotional abuse
d. Sexual abuse
ANSWER: B
These physical and behavioral indicators suggest that parental attention is not being given to the
childs physical needs. The child is being neglected. There are no physical indicators of actual abuse
in this description. Behavioral indicators of physical abuse reflect an impaired relationship with
parents and other adults. Emotional abuse is manifested by developmental problems or
maladaptive behaviors. Physical indicators of sexual abuse are focused on the genitourinary system.
A variety of behavioral indicators range from bizarre sexual behavior to eating and sleeping
disturbances.
10. Which should be the most appropriate nursing intervention for the infant who is not gaining
weight?

a. Instruct the primary caregiver on proper feeding techniques.
b. Observe and document the parentinfant interaction.
c. Assign different nurses to care for the infant.
d. Feed the infant on a predetermined schedule.
ANSWER: B
Observation and documentation of the parentinfant interaction may offer insight into the cause of
malnutrition. Instruction alone is not the best teaching strategy. Role modeling and supervised
practice along with parental instruction will facilitate the parents learning to feed the infant. A
consistent caregiver will facilitate trust in the infant. The infants caloric intake is increased by
feeding the infant on demand rather than on a schedule.
11. Which statement made by a parent of a toddler who is not gaining weight indicates the need
for education about feeding small children?
a. He doesnt want to eat, so I put the cereal in his bottle.
b. I put him in a high chair for meals and snacks.
c. I turn off the television and we eat together for every meal.
d. I try to feed him at the same times every day.
ANSWER: A
Large quantities of cereal or baby food in bottles do not provide sufficient nutritional intake for the
small child. The young child should be placed in a high chair for feeding. Distraction during
feedings, such as watching television, is identified as a reason for inadequate nutritional intake in
young children. Having the parents or others eat with the child makes meals and snacks a pleasant
time. A regular pattern or schedule for meals facilitates nutritional intake.
12. Which intervention should the nurse teach parents about caring for an infant experiencing
drug withdrawal?
a. Keep rooms in the home well lighted.
b. Play music or the television continuously.

c. Organize care to minimize disruptions.
d. Let the infant calm himself if irritable.
ANSWER: C
The infants care should be coordinated to limit the number of times the infant is disturbed. Light
levels should be maintained at the minimum necessary level. Sound levels should be kept to the
minimum necessary level. Comfort measures should be provided immediately when the infant
exhibits irritability.
13. A child who has symptoms of irritable mood and changes in sleep and appetite patterns
lasting 3 weeks meets the criteria for which depressive disorder?
a. Major depressive disorder
b. Dysthymic disorder
c. Cyclothymic disorder
d. Panic disorder
ANSWER: A
A 2-week (or longer) episode of depressed or irritable mood in addition to disturbances in appetite,
sleep, energy, or self-esteem meets the criteria for a major depressive disorder. A dysthymic
disorder is associated with a depressed or irritable mood for at least a year. A cyclothymic or
bipolar mood disorder is characterized by chronic, fluctuating mood disturbances between
depressive lows and highs for a year. A panic disorder is a type of anxiety disorder.
14. What is the goal of therapeutic management for a child diagnosed with attention-deficit
hyperactivity (ADHD) disorder?
a. Administer stimulant medications.
b. Assess the child for other psychosocial disorders.
c. Correct nutritional imbalances.
d. Reduce the frequency and intensity of unsocialized behaviors.

ANSWER: D
The primary goal of therapeutic management for the child with ADHD is to reduce the intensity
and frequency of unsocialized behaviors. Although medications are effective in managing behaviors
associated with ADHD, all families do not choose to give their child medication.
Administering medication is not the primary goal. Children with ADHD may have other
psychosocial or learning problems; however, diagnosing these is not the primary goal. Interventions
to correct nutritional imbalances are the primary focus of care for eating disorders.
15. Which behavior demonstrated by an adolescent should alert the school nurse to a problem of
substance abuse?
a. States feelings of worthlessness
b. Increased desire for social conformity
c. Does not feel the need for peer approval
d. Rebellious behavior
ANSWER: D
Rebellious or aggressive behavior is a behavior that may indicate substance abuse. Feelings of
worthlessness are suggestive of a depressive disorder. An adolescent with a substance abuse
problem may be depressed, but this behavior is not a manifestation of substance abuse. The clinical
manifestations of substance abuse are marked by an increase in antisocial behavior as the desire for
social conformity decreases and the need for the substance increases. The adolescent with a
substance abuse problem may demonstrate an excessive dependence on peer influence.
16. A nurse is caring for an infant with neonatal abstinence syndrome. Which manifestation
should the nurse expect to assess?
a. Weight gain
b. Respiratory acidosis
c. High-pitched persistent cry
d. Hypotonus

ANSWER: C
A high-pitched persistent cry is one of the many manifestations of infant drug withdrawal. The
infant undergoing drug withdrawal may lose weight or fail to gain weight. Respiratory alkalosis and
respiratory distress are manifestations of withdrawal. An infant undergoing drug withdrawal would
have hypertonus, hyperreflexia, and hyperactivity.
17. Which finding noted bythe nurse on a physical assessment may suggest that a child has been
sexually abused?
a. Swelling of the genitalia and pain on urination
b. Smooth philtrum and thin upper lip
c. Speech and physical development delays
d. Historyof constipation, drowsiness, and constricted pupils
ANSWER: A
Physical indicators of sexual abuse may include swelling or itching of the genitalia and pain on
urination. Other indicators may include bruises, bleeding, or lacerations of the external genitalia,
vagina, or anal area. The infant with fetal alcohol syndrome may have microphthalmia or
abnormally small eyes or short palpebral fissures, a thin upper lip, and a poorly developed philtrum.
Children who have been emotionally abused may exhibit speech disorders, lags in physical
development, failure to thrive, or hyperactive and disruptive behaviors. Opiates can cause these
behaviors: detachment and apathy, drowsiness, constricted pupils, constipation, slurred speech, and
impaired judgment.
18. A nurse is assessing a child with attention-deficit hyperactivity disorder (ADHD). Which
manifestation should the nurse not expect to assess?
a. Talking incessantly
b. Blurting out the answers to questions before the questions have been completed
c. Acting withdrawn in social situations
d. Fidgeting with hands or feet

ANSWER: C
The child with ADHD tends to be talkative, often interrupting conversations, rather than
withdrawn in social situations. Talking excessively is a characteristic of impulsivity/hyperactivity.
Blurting out the answers to questions before the questions have been completed is an indication of
the impulse control that is often lacking in children with ADHD. The child with ADHD tends to
be talkative, often interrupting conversations, rather than withdrawn in social situations.
MULTIPLE RESPONSE
1. A nurse working on the pediatric unit should be aware that children admitted with which
assessment findings are suggestive of physical child abuse? Select all that apply.
a. Bruises in various stages of healing
b. Bruises over the shins or bony prominences
c. Burns on the palms of the hands
d. A fracture of the right wrist from a sports accident
e. Rib fractures in an infant
ANSWER: A, C, E
Bruises in various stages of healing and burns on the palms of the hand may be indicative of
physical abuse. Rib fractures in an infant are another indicator of physical abuse. Bruises over the
shins or bony prominences are seen in children beginning to walk. A fracture of the right wrist
can occur as the child begins to participate in sports activities.
2. The nurse is aware that suicide risk increases if the child displays which characteristics? Select all
that apply.
a. Previous suicide attempt
b. No previous exposure to violence in the home
c. Recent loss
d. Effective social network

e. History of physical abuse
ANSWER: A, C, E
The risk of suicide increases if the child has had a previous suicide attempt, a recent loss, or a
history of physical abuse. No previous violence in the home or having an effective social network
decreases the risk of suicide.
Chapter 7. Child Abuse and Neglect
1. Which of the following statements best defines the term child maltreatment?
a.intentional injury of a child c.failure to provide what a child needs
b.not giving a child what he or she wantsd.accidental harm to a child by someone
ANSWER: A
Feedback
ACorrect: Child maltreatment is the intentional injury of a child.
BIncorrect: Child maltreatment is not considered failure to give a child what the child wants.
CIncorrect: Child maltreatment is not considered the failure to provide what a child needs.
DIncorrect: Child maltreatment is not considered accidental harm to a child by someone else. The
harm or injury is intentional, not accidental.
2. Which of the following statements best defines the term physical abuse?
a.bodily injury to a person that seems to have been inflicted by other than accidental means
b.purposefully beating a child so that there are highly visible marks on the childs body c.use
of the hands applied to a child in an excessively forceful manner
d.any damage to a child that involves the use of muscle-applied force
ANSWER: A
Feedback

ACorrect: Physical abuse is defined as bodily injury to a person that seems to have been
inflicted by other than accidental means. Such injuries may include damage to the skin,
including bruise, burns, bite marks, and lacerations; damage to the head; or shaken baby
syndrome.
BIncorrect: In physical abuse, marks may not be visible on the childs body. For example, with
shaken baby syndrome, there may not be any visible signs of injury.
CIncorrect: Physical abuse may include more than the use of the hands applied to a child in an
excessively forceful manner.
DIncorrect: Muscle-applied force may not be the etiology of physical abuse in the child.
3.The school nurse observes parents interacting with a school-aged child and notices that they do
not show any affection toward the child and there is no evidence of emotional support or
supervision. Later the nurse learns from the child that he must take care of all his own hygiene
tasks, has to find something to eat on his own, and his parents never say anything nice about him.
The nurse at this point believes that the parents are engaging in:
a.physical abuse c.poor parenting
b.psychological abused.withholding of love
ANSWER: B
Feedback
AIncorrect: These characteristics are not specific for physical abuse.
BCorrect: Psychological abuse results from the recurrent lack of attention to the childs needs, and
includes lack of affection, emotional support, or supervision.
CIncorrect: These characteristics are not specific for poor parenting.
DIncorrect: These characteristics are not specific for withholding of love.
4.The majority of perpetrators of abuse to children reported to state Child Protective Service
agencies as suspected victims of abuse and neglect are:
a.neighbors within one blockc.parents
b.strangers d.relatives other than parents
ANSWER: C
Feedback
AIncorrect: Neighbors within one block are not the majorityof perpetrators.
BIncorrect: Strangers are not the majorityof perpetrators.
CCorrect: Three-fourths of all perpetrators of abuse to children reported to the Child Protective
Service agencies are caregivers.
DIncorrect: Relatives other than parents are not the majorityof perpetrators.

5. The majority of child abuse victims fall into which of the following age ranges?
a.over 10 yearsc.6 to 8 years
b.8 to 10 years d.under 6 years
ANSWER: D
Feedback
AIncorrect: The majority of child abuse victims are under 6 years, not over 10 years. BIncorrect:
The majority of child abuse victims are under 6 years, not 8 to 10 years. CIncorrect: The
majority of child abuse victims are under 6 years, not 6 to 8 years. DCorrect: The majority of
child abuse victims are under 6 years.
6. Which of the following is the most common type of mistreatment of children?
a.physical abusec.sexual abuse
b.neglect d.emotional maltreatment
ANSWER: B
Feedback
AIncorrect: The most common type of mistreatment of children is not physical abuse. Twenty- five
percent of child victims are physically abused.
BCorrect: The most common type of mistreatment of children is neglect. Fifty-five percent of
child victims suffer from neglect.
CIncorrect: The most common type of mistreatment of children is not sexual abuse. Twelve
percent of victims are sexually abused.
DIncorrect: The most common type of mistreatment of children is not emotional maltreatment.
Six percent of victims are emotionally abused.
7. In the sociological model of family violence, family violence is viewed as:
a.a pattern of behavior that is passed from generation to generation
b.a pattern of harm within the nuclear family with no outside persons involved
c. any harmful action(s) between related persons no matter how distant the relationship is
d.harmful activities within a group designated as family no matter what the relationship
ANSWER: A
Feedback
ACorrect: In the sociological model of family violence, family violence is viewed as a pattern of
behavior that is passed from generation to generation. Although the form of abuse may change,
the pattern continues. In one generation the abuse may be physical, but may change to

sexual abuse in the next generation. Caregivers will construct similar abusive relationships
with their own children based on their experiences of having violent caregivers.
BIncorrect: In the sociological model of family violence, family violence is not viewed as a pattern
of harm within the nuclear family with no outside persons involved.
CIncorrect: In the sociological model of family violence, family violence is not viewed as any
harmful action(s) between related persons no matter how distant the relationship is.
DIncorrect: In the sociological model of family violence, family violence is not viewed as
harmful activities within a group designated as family no matter what the relationship.
8.When family violence is passed from generation to generation, this type of abuse has which of
the following characteristics?
a.It continues without changing to another type.
b.The form of abuse may change.
c.It usually gets more violent.
d.It is more detrimental to the child from generation to generation.
ANSWER: B
Feedback
AIncorrect: Intergenerational patterns of violence do not necessarily continue without changing to
another type of abuse.
BCorrect: When family violence is passed from generation to generation, the form of abuse
may change.
CIncorrect: When family violence is passed from generation to generation, it does not
necessarily get more violent.
DIncorrect: This type of abuse is not more detrimental to the child from generation to generation.
9.Which of the following children is in a high-risk family for less nurturing and more hurtful
behavior?
a.a child being raised by grandparents
b.a child who is forbidden from playing with other children
c.a child being raised by two men
d.a child in a nuclear family there both parents have full-time jobs
ANSWER: B
Feedback
AIncorrect: A child being raised by grandparents is not necessarily in a high-risk family for
abuse. The characteristics of the grandparents would have to be known.
BCorrect: Children at high risk for less nurturing and more hurtful behavior live in a family system
that has little contact with community groups such as school or church. These children

are not involved in after-school activities and are not allowed to play with other neighborhood
children.
CIncorrect: A child being raised by two men is not necessarily in a high-risk situation for abuse.
DIncorrect: A child in a nuclear family there both parents have full-time jobs is probably not in a
high-risk family for abuse. One of the risk factors for abuse is stress. Families who spend
increased time together under stressful conditions may not have appropriate social supports.
Examples of this type of stress are poverty and unemployment.
10. The social-interactional systemic perspective of child abuse and neglect says that the
legitimization of violence in the family is due to which of the following factors?
a. family pathology of a genetic nature b.increased
availability of pornography c.emphasis on hiding
sexuality and not being open d.societys attitudes,
beliefs, and values
ANSWER: D
Feedback
AIncorrect: According to the social-interactional systemic perspective of child abuse, the
legitimization of violence in the family is not due to family pathology of a genetic nature.
BIncorrect: The legitimization of violence in the family is not due to increased availability of
pornography.
CIncorrect: The legitimization of violence in the family is not due to emphasis on hiding sexuality
and not being open.
DCorrect: The social-interactional systemic perspective suggests society contains the attitudes,
values, and beliefs that legitimize violence in families. For example, violent acts, interactions, and
roles are part of society, and television, movies and videos demonstrate and illustrate the value
society places on violence. Our society tends to accept violence as a matter of course, treating it
casually or exploiting it to gain an audience.
11. According to the social-interactional systemic perspective of child abuse and neglect, four
factors place the family members at risk for abuse. These risk factors are the family itself, the
caregiver, the child, and:
a. chronic povertyc.the presence of a family crisis
b.genetics d.the national emphasis on sex
ANSWER: C
Feedback
AIncorrect: These four factors are the family itself, the caregiver, the child, but not chronic poverty.
BIncorrect: These four factors are the family itself, the caregiver, the child, but not genetics.

CCorrect: These four factors are the family itself, the caregiver, the child, and the presence of a
family crisis.
DIncorrect: These four factors are the family itself, the caregiver, the child, but not the national
emphasis on sex.
12. When caregivers lack knowledge about parenting, lack parenting skills, and are emotionally
immature, the child often assumes which of the following roles?
a. victim
b.caregiver role toward the caregiver c.regressed
child of regressed caregivers d.scapegoat
ANSWER: B
Feedback
AIncorrect: The child does not assume the role of victim in this situation.
BCorrect: When caregivers lack knowledge about parenting, lack parenting skills, and are
emotionally immature, the child often assumes a caregiver role toward the caregiver. An
example of this is then a 5-year old consoles an unemployed parent.
CIncorrect: The child does not assume the role of regressed child of regressed caregivers.
DIncorrect: The child does not assume the role of scapegoat.
13. Which of the following examples best defines the term role reversal?
a.The child assumes a caregiver role toward the caregiver.
b.The good child takes on a bad child role.
c.A person who has been a good provider quits his or her job.
d.A lazy person becomes very productive in the family.
ANSWER: A
Feedback
ACorrect: Role reversal occurs then the child assumes a caregiver role toward the caregiver.
BIncorrect: Role reversal is not exemplified by the good child taking on a bad child role.
CIncorrect: Role reversal is not defined as a person who has been a good provider quitting his or
her job.
DIncorrect: Role reversal is not defined as a lazy person becoming veryproductive in the family.
14. When there is a depressed parent in the family, it is most likelythat the depression will have
which of the following effects?
a.will not affect the persons ability or performance in parenting
b.will cause the parent who is depressed to try harder to be a good parent

c. places the parent at risk for physically or emotionally abusing the children d.will
be seen in the child during the growing-up years
ANSWER: C
Feedback
AIncorrect: Depression will affect the persons abilityor performance in parenting.
BIncorrect: Depression will not cause the parent who is depressed to try harder to be a good
parent.
CCorrect: A depressed parent is at risk for physically or emotionally abusing the children. Such an
individual may be irritable or withdrawn from family members, not have the emotional energy to
manage the demanding needs of a child, or become provoked and use harsher punishment than
is necessary or appropriate.
DIncorrect: The most likely effect of depression in a parent is not that depression will be seen in
the child during the growing-up years.
15. The nurse working in the pediatric clinic notices that a newborn seems particularly fussy. The
mother verifies that this is a very fussy baby and that it is impossible to soothe the baby. In
thinking through what to further assess and what to teach the mother, the nurse will keep in mind
that fussy babies are:
a.often in some kind of pain c.often victims of the mothers drug use
b.somewhat neurologically unstabled.at greater risk for abuse
ANSWER: D
Feedback
AIncorrect: Fussy babies are not necessarily in some kind of pain. Some infants are born with a
fussy temperament.
BIncorrect: Fussy babies are not somewhat neurologically unstable.
CIncorrect: Fussy babies are not necessarily the victim of the mothers drug use.
DCorrect: Infants with a fussy, unsoothable, difficult temperament are most likely to resist a
caregivers attempt at comforting, placing them at greater risk for abuse.
16. Which of the following children are at greatest risk of abuse or neglect bythe parents?
a. postmaturity babies
b.13-year-old children
c.children with high intelligent quotient (IQ)
d.premature infants
ANSWER: D

Feedback
AIncorrect: Postmature babies are not at greatest risk of abuse or neglect by the parents.
BIncorrect: 13-year-old children are not at greatest risk of abuse or neglect by the parents. Instead
young children (particularly those younger than 3 years) are at high risk for abuse or neglect.
CIncorrect: Children with high intelligent quotient (IQ) are not at greatest risk of abuse or
neglect by the parents.
DCorrect: Premature infants are at greatest risk of abuse or neglect bythe parents because they
place great demands on the parents.
17. An infant is separated from his parents for a few minutes while the nurse weighs him. The
infant seems distressed and looks around for the mother. The mother soothes the infant then the
nurse is through weighing him. This type of attachment between mother and baby is most likely
which of the following types of attachment?
a.avoidant c. secure
b.disorganizedd.strange
ANSWER: C
Feedback
AIncorrect: This type of attachment between mother and baby is not likely an avoidant attachment.
In avoidant attachment the infant realizes the caregiver will not always be available to provide
comfort. The infant exhibits independent behavior without acknowledging the caregiver prior to
separation, exhibits minimal distress during separation, and avoids emotional support offered by
the caregiver upon reunion.
BIncorrect: This type of attachment is not disorganized attachment. In this situation the infant is
confused and cannot understand how to get physiological and psychological needs met by the
caregiver. This infant may be rejected or comforted by the caregiver.
CCorrect: This type of attachment between mother and baby is most likely a secure attachment.
DIncorrect: This type of attachment is not strange attachment. Strange is not a type of
attachment.
18. The nurse is caring for an infant who shows no distress then her parents leave, and then they
return the infant ignores her parents. There was no evidence of distress while the parents were
gone. This type of attachment between the infant and parents is most likely which of the
following types of attachment?
a.secure c.ambivalent
b.avoidantd.detached
ANSWER: B

IF YOU WANT THIS TEST BANK OR
SOLUTION MANUAL EMAIL ME
kevinkariuki227@gmail.com TO RECEIVE ALL
CHAPTERS IN PDF FORMAT
IF YOU WANT THIS TEST BANK OR
SOLUTION MANUAL EMAIL ME
kevinkariuki227@gmail.com TO RECEIVE ALL
CHAPTERS IN PDF FORMAT

Test bank for current diagnosis and treatment pediatrics twenty fourth edition 24th edition william hay (1).pdf

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