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Test Bank for Wong’s Essentials of Pediatric Nursing,
11th Edition, Marilyn Hockenberry, Cheryl Rodgers
Chapters 1 - 31
Chapter 01: Perspectives of Pediatric Nursing
Hockenberry: Wong’s Essentials of Pediatric Nursing, 11th Edition
MULTIPLE CHOICE
1. A nurse is planning a teaching session for parents of preschool children. Which statement ex-
plains why the nurse should include information about morbidity and mortality?
a. Life span statistics are included in the data.
b. It explains effectiveness of treatment.
c. Cost-effective treatment is detailed for the
general population.
d. High-risk age groups for certain disorders o
hazards are identified.
ANSWER: D
Analysis of morbidity and mortality data provides the parents with information about which
groups of individuals are at risk for which health problems. Life span statistics is a part of the
mortality data. Treatment modalities and cost are not included in morbidity and mortality data.
DIF: Cognitive Level: Apply REF: p. 11
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance
2. A clinic nurse is planning a teaching session about childhood obesity prevention for parents of
school-age children. The nurse should include which associated risk of obesity in the teaching
plan?
a. Type I diabetes
b. Respiratory disease
c. Celiac disease
d. Type II diabetes
ANSWER: D
Childhood obesity has been associated with the rise of type II diabetes in children. Type I dia-
betes is not associated with obesity and has a genetic component. Respiratory disease is not asso-
ciated with obesity, and celiac disease is the inability to metabolize gluten in foods and is not as-
sociated with obesity.
DIF: Cognitive Level: Apply REF: p. 2
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance
3. Which is the leading cause of death in infants younger than 1 year?
a. Congenital anomalies
b. Sudden infant death syndrome
c. Respiratory distress syndrome
d. Bacterial sepsis of the newborn
ANSWER: A
Congenital anomalies account for 20.1% of deaths in infants younger than 1 year. Sudden infant
death syndrome accounts for 8.2% of deaths in this age group. Respiratory distress syndrome ac-
counts for 3.4% of deaths in this age group. Infections specific to the perinatal period account for
2.7% of deaths in this age group.
DIF: Cognitive Level: Remember REF: p. 6
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
4. Which leading cause of death topic should the nurse emphasize to a group ofAfrican-American
boys ranging in age from 15 to 19 years?
a. Suicide
b. Cancer
c. Firearm homicide
d. Occupational injuries
ANSWER: C
Firearm homicide is the second overall cause of death in this age group and the leading cause of
death in African-American males. Suicide is the third-leading cause of death in this population.
Cancer, although a major health problem, is the fourth-leading cause of death in this age group.
Occupational injuries do not contribute to a significant death rate for this age group.
DIF: Cognitive Level: Understand REF: p. 7
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance
5. Which is the major cause of death for children older than 1 year?
a. Cancer
b. Heart disease
c. Unintentional injuries
d. Congenital anomalies
ANSWER: C
Unintentional injuries (accidents) are the leading cause of death after age 1 year through adoles-
cence. Congenital anomalies are the leading cause of death in those younger than 1 year. Cancer
ranks either second or fourth, depending on the age group, and heart disease ranks fifth in the
majority of the age groups.
DIF: Cognitive Level: Remember REF: p. 7
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance
6. Which is the leading cause of death from unintentional injuries for females ranging in age from 1
to 14?
a. Mechanical suffocation
b. Drowning
c. Motor vehicle–related fatalities
d. Fire- and burn-related fatalities
ANSWER: C
Motor vehicle–related fatalities are the leading cause of death for females ranging in age from 1
to 14, either as passengers or as pedestrians. Mechanical suffocation is fourth or fifth, depending
on the age. Drowning is the second- or third-leading cause of death, depending on the age. Fire-
and burn-related fatalities are the second-leading cause of death.
DIF: Cognitive Level: Remember REF: p. 3
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
7. Which factor most impacts the type of injury a child is susceptible to, according to the child’s
age?
a. Physical health of the child
b. Developmental level of the child
c. Educational level of the child
d. Number of responsible adults in the home
ANSWER: B
The child’s developmental stage determines the type of injury that is likely to occur. The child’s
physical health may facilitate the child’s recovery from an injury but does not impact the type of
injury. Educational level is related to developmental level, but it is not as important as the child’s
developmental level in determining the type of injury. The number of responsible adults in the
home may affect the number of unintentional injuries, but the type of injury is related to the
child’s developmental stage.
DIF: Cognitive Level: Understand REF: p. 3
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance
8. Which is now referred to as the “new morbidity”?
s
ANSWER: D
The new morbidity reflects the behavioral, social, and educational problems that interfere with
the child’s social and academic development. It is currently estimated that the incidence of these
issues is from 5% to 30%. Limitations in major activities of daily living and unintentional in-
juries that result in chronic health problems are included in morbidity data. Discovery of new
therapies would be reflected in changes in morbidity data over time.
DIF: Cognitive Level: Remember REF: p. 2
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
a. Limitations in the major activities of daily
living
b. Unintentional injuries that cause chronic
health problems
c. Discoveries of new therapies to treat health
problems
d. Behavioral, social, and educational problem
that alter health
9. A nurse on a pediatric unit is practicing family-centered care. Which is most descriptive of the
care the nurse is delivering?
n
ANSWER: C
The three key components of family-centered care are respect, collaboration, and support. Fam-
ily-centered care recognizes the family as the constant in the child’s life. Taking over total care
does not include the family in the process and may increase stress instead of reducing stress. The
family should be enabled and empowered to work with the health care system. The family is ex-
pected to be part of the decision-making process.
DIF: Cognitive Level: Remember REF: p. 7
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance
10. The nurse is preparing an in-service education to staff about atraumatic care for pediatric pa-
tients. Which intervention should the nurse include?
s
t
ANSWER: B
Preparing the child for any unfamiliar treatments, controlling pain, allowing privacy, providing
play activities for expression of fear and aggression, providing choices, and respecting cultural
differences are components of atraumatic care. In the provision of atraumatic care, the separation
of child from parents during hospitalization is minimized. The nurse should promote a sense of
control for the child. Preventing and minimizing bodily injury and pain are major components of
atraumatic care.
DIF: Cognitive Level: Understand REF: p. 8
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Psychosocial Integrity
11. Which is most suggestive that a nurse has a nontherapeutic relationship with a patient and fam-
ily?
a. Taking over total care of the child to reduce
stress on the family
b. Encouraging family dependence on health
care systems
c. Recognizing that the family is the constant
a child’s life
d. Excluding families from the decision-makin
process
a. Prepare the child for separation from parent
during hospitalization by reviewing a video
b. Prepare the child before any unfamiliar trea
ment or procedure by demonstrating on a
stuffed animal.
c. Help the child accept the loss of control asso
ciated with hospitalization.
d. Help the child accept pain that is connected
with a treatment or procedure.
a. Staff is concerned about the nurse’s actions
with the patient and family.
b. Staff assignments allow the nurse to care fo
same patient and family over an extended
time.
c. Nurse is able to withdraw emotionally whe
emotional overload occurs but still remains
committed.
d. Nurse uses teaching skills to instruct patient
and family rather than doing everything for
them.
ANSWER: A
An clue to a nontherapeutic staff-patient relationship is concern of other staff members. Allowing
the nurse to care for the same patient over time would be therapeutic for the patient and family.
Nurses who are able to somewhat withdraw emotionally can protect themselves while providing
therapeutic care. Nurses using teaching skills to instruct patient and family will assist in transi-
tioning the child and family to self-care.
DIF: Cognitive Level: Analyze REF: p. 8
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Psychosocial Integrity
12. Which is most descriptive of clinical reasoning?
a. A simple developmental process
b. Purposeful and goal-directed
c. Based on deliberate and irrational thought
d. Assists individuals in guessing what is most
appropriate
ANSWER: B
Clinical reasoning is a complex, developmental process based on rational and deliberate thought.
Clinical reasoning is not a developmental process. Clinical reasoning is based on rational and de-
liberate thought. Clinical reasoning is not a guessing process.
DIF: Cognitive Level: Understand REF: p. 10
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care
13. A nurse makes the decision to apply a topical anesthetic to a child’s skin before drawing blood.
Which ethical principle is the nurse demonstrating?
a. Autonomy
b. Beneficence
c. Justice
d. Truthfulness
ANSWER: B
Beneficence is the obligation to promote the patient’s well-being. Applying a topical anesthetic
before drawing blood promotes reducing the discomfort of the venipuncture. Autonomy is the
patient’s right to be self-governing. Justice is the concept of fairness. Truthfulness is the concept
of honesty.
DIF: Cognitive Level: Understand REF: p. 10
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiological Integrity
14. Which action by the nurse demonstrates use of evidence-based practice (EBP)?
a. Gathering equipment for a procedure
b. Documenting changes in a patient’s status
c. Questioning the use of daily central line
dressing changes
d. Clarifying a physician’s prescription for mo
phine
ANSWER: C
The nurse who questions the daily central line dressing change is ascertaining whether clinical
interventions result in positive outcomes for patients. This demonstrates EBP, which implies
questioning why something is effective and whether a better approach exists. Gathering equip-
ment for a procedure and documenting changes in a patient’s status are practices that follow es-
tablished guidelines. Clarifying a physician’s prescription for morphine constitutes safe nursing
care.
DIF: Cognitive Level: Apply REF: p. 10
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care
15. A nurse is admitting a toddler to the hospital. The toddler is with both parents and is currently sit-
ting comfortably on a parent’s lap. The parents state they will need to leave for a brief period.
Which type of nursing diagnosis should the nurse formulate for this child?
a. Risk for anxiety
b. Anxiety
c. Readiness for enhanced coping
d. Ineffective coping
ANSWER: A
A potential problem is categorized as a risk. The toddler has a risk to become anxious when the
parents leave. Nursing interventions will be geared toward reducing the risk. The child is not
showing current anxiety or ineffective coping. The child is not at a point for readiness for en-
hanced coping, especially because the parents will be leaving.
DIF: Cognitive Level: Remember REF: p. 11
TOP: Integrated Process: Nursing Process: Diagnosis
MSC: Area of Client Needs: Health Promotion and Maintenance
16. A child has a postoperative appendectomy incision covered by a dressing. The nurse has just
completed a prescribed dressing change for this child. Which description is an accurate docu-
mentation of this procedure?
a. Dressing change to appendectomy incision
ed
ANSWER: C
The nurse should document assessments and reassessments. Appearance of the incision described
in objective terms should be included during a dressing change. The nurse should document pa-
tient’s response and the outcomes of the care provided. In this example, these include drainage
on the old dressing, the application of the new dressing, and the child’s response. The other state-
ments partially fulfill the requirements of documenting assessments and reassessments, patient’s
response, and outcome, but do not include all three.
DIF: Cognitive Level: Analyze REF: p. 12
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care
17. A nurse is planning a class on accident prevention for parents of toddlers. Which safety topic is
the priority for this class?
a. Appropriate use of car seat restraints
b. Safety crossing the street
c. Helmet use when riding a bicycle
d. Poison control numbers
ANSWER: A
Motor vehicle accidents (MVAs) continue to be the most common cause of death in children
older than 1 year, therefore the priority topic is appropriate use of car seat restraints. Safety
crossing the street and bicycle helmet use are topics that should be included for preschool parents
but are not priorities for parents of toddlers. Information about poison control is important for
parents of toddlers and would be a safety topic to include but is not the priority over appropriate
use of car seat restraints.
DIF: Cognitive Level: Apply REF: p. 3
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance
18. A nurse is collecting subjective and objective information about target populations to diagnose
problems based on community needs. This describes which step in the community nursing
process?
a. Planning
completed, child tolerated procedure well,
parent present
b. No complications noted during dressing
change to appendectomy incision
c. Appendectomy incision non-reddened, su-
tures intact, no drainage noted on old dress-
ing, new dressing applied, procedure tolerat
well by child
d. No changes to appendectomy incisional area,
dressing changed, child complained of pain
during procedure, new dressing clean, dry and
intact
b. Diagnosis
c. Assessment
d. Establishing objectives
ANSWER: C
The nursing process stages are similar, whether the client is one child or a population of children.
The assessment phase of the nursing process focuses on collecting subjective and objective data.
Planning is the development of community-centered goals and objectives. Diagnosis is the iden-
tification of problems specific to the community.
DIF: Cognitive Level: Understand REF: p. 11
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care
19. A nurse is establishing several health programs, such as bicycle safety, to improve the health sta-
tus of a target population. This describes which step in the community nursing process?
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANSWER: D
The nurse working with the community to put into practice a program to reach community goals
is the implementation phase of the community nursing process. Planning involves designing the
program to meet community-centered goals. The evaluation stage would determine the effective-
ness of the program. During the assessment phase, the nurse would identify the resources neces-
sary and the barriers that would interfere with implementation.
DIF: Cognitive Level: Understand REF: p. 11
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care
20. A school nurse is conducting vision and hearing testing on fifth-grade children. Which level of
prevention is the nurse demonstrating?
a. Primary
b. Secondary
c. Tertiary
d. Health promotion
ANSWER: B
Secondary prevention focuses on screening and early diagnosis of disease. Vision and hearing
testing are screening tests to detect problems. Primary prevention focuses on health promotion
and prevention of disease or injury. Tertiary prevention focuses on optimizing function for chil-
dren with a disability or chronic disease. Health promotion is focused on preventing disease or
illness.
DIF: Cognitive Level: Understand REF: p. 2
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance
21. The home health nurse asks a child’s mother many questions as part of the assessment. The
mother answers many questions, then stops and says, “I don’t know why you ask me all this.
Who gets to know this information?” The nurse should take which action?
a. Determine why the mother is so suspicious.
b. Determine what the mother does not want t
tell.
c. Explain who will have access to the inform
tion.
d. Explain that everything is confidential and
that no one else will know what is said.
ANSWER: C
Communication with the family should not be invasive. The nurse needs to explain the impor-
tance of collecting the information, its applicability to the child’s care, and who will have access
to the information. The mother is not being suspicious and is not necessarily withholding impor-
tant information. She has a right to understand how the information she provides will be used.
The nurse will need to share, through both oral and written communication, clinically relevant
information with other involved health professionals.
DIF: Cognitive Level: Apply REF: p. 9
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care
22. When communicating with other professionals, what is important for the nurse to do?
e.
ANSWER: C
The nurse will need to share, through both oral and written communication, clinically relevant
information with other involved health professionals. Asking others what they want to know and
sharing everything known about the family is inappropriate. Patients have a right to confidential-
ity. The nurse is not permitted to share information about clients, except clinically relevant infor-
mation that pertains to the child’s care. Confidentiality permits the disclosure of information to
other health professionals on a need-to-know basis.
DIF: Cognitive Level: Apply REF: p. 9
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care
23. A nurse manager at a home-care agency is planning a continuing education program for the
home-care staff nurses. Which type of continuing education program should the nurse manager
plan?
a. On-line training modules
b. A structured written teaching module each
nurse completes individually
a. Ask others what they want to know.
b. Share everything known about the family.
c. Restrict communication to clinically releva
information.
d. Recognize that confidentiality is not possibl
l
ANSWER: C
Because of the unique practice environment of home care nurses, it is important for an agency to
facilitate sharing among peers to decrease work-related stress, increase job satisfaction, and sup-
port high-quality patient care. On-line training, written teaching modules, and one-on-one train-
ing would not allow for any sharing with peers.
DIF: Cognitive Level: Apply REF: p. 7
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care
MULTIPLE RESPONSE
1. Which behaviors by the nurse indicate a therapeutic relationship with children and families? (Se-
lect all that apply.)
-
ANSWER: B, C, E
Asking questions if families are not participating in the care, clarifying information for families,
and learning about the family’s religious preferences are positive actions and foster therapeutic
relationships with children and families. Spending off-duty time with children and families and
buying toys for a hospitalized child are negative actions and indicate overinvolvement with chil-
dren and families, which is nontherapeutic.
DIF: Cognitive Level: Understand REF: p. 8
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Psychosocial Integrity
2. Which behaviors by the nurse indicate therapeutic nurse-family boundaries? (Select all that ap-
ply.)
a. Nurse visits family on days off.
b. House rules are negotiated.
c. Nurse buys child expensive gifts.
d. Communication is open and two-way.
ANSWER: B, D
A home care nurse can establish therapeutic nurse-family boundaries by negotiating house rules
c. A workshop training day, with a professiona
speaker, where nurses can interact with eac
other
d. One-on-one continuing education training
with each nurse
a. Spending off-duty time with children and
families
b. Asking questions if families are not partici-
pating in the care
c. Clarifying information for families
d. Buying toys for a hospitalized child
e. Learning about the family’s religious prefer
ences
and ensuring that communication is open and two-way. Visiting the family of off-duty days and
buying expensive gifts for the child would be boundary crossing and nontherapeutic.
DIF: Cognitive Level: Analyze REF: p. 8
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Psychosocial Integrity
OTHER
1. A nurse is formulating a clinical question for evidence-based practice. Place in order the steps the
nurse should use to clarify the scope of the problem and clinical topic of interest. Begin with the
first step of the process and proceed ordering the steps ending with the final step of the process.
Provide answer as lowercase letters separated by commas (e.g., a, b, c, d, e).
a. Intervention
b. Outcome
c. Population
d. Time
e. Control
ANSWER:
c, a, e, b, d
When formulating a clinical question for evidence-based practice, the nurse should follow a con-
cise, organized way that allows for clear answers. Good clinical questions should be asked in the
PICOT (population, intervention, control, outcome, time) format to assist with clarity and litera-
ture searching. PICOT questions assist with clarifying the scope of the problem and clinical topic
of interest.
DIF: Cognitive Level: Understand REF: p. 10
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
Chapter 02: Family, Social, Cultural, and Religious Influences on Child Health
Promotion
Hockenberry: Wong’s Essentials of Pediatric Nursing, 11th Edition
MULTIPLE CHOICE
1. A nurse is selecting a family theory to assess a patient’s family dynamics. Which family
theory best describes a series of tasks for the family throughout its life span?
a. Interactional theory
b. Developmental systems theory
c. Structural-functional theory
d. Duvall’s developmental theory
ANSWER: D
Duvall’s developmental theory describes eight developmental tasks of the family throughout
its life span. Interactional theory and structural-functional theory are not family theories.
Developmental systems theory is an outgrowth of Duvall’s theory. The family is described as
a small group, a semiclosed system of personalities that interact with the larger cultural
system. Changes do not occur in one part of the family without changes in others.
DIF: Cognitive Level: Understand REF: p. 17
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
2. Which family theory explains how families react to stressful events and suggests factors that
promote adaptation to these events?
a. Interactional theory
b. Developmental systems theory
c. Family stress theory
d. Duvall’s developmental theory
ANSWER: C
Family stress theory explains the reaction of families to stressful events. In addition, the
theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and
negative, are cumulative and affect the family. Adaptation requires a change in family
structure or interaction. Interactional theory is not a family theory. Interactions are the basis
of general systems theory. Developmental systems theory is an outgrowth of Duvall’s theory.
The family is described as a small group, a semiclosed system of personalities that interact
with the larger cultural system. Changes do not occur in one part of the family without
changes in others. Duvall’s developmental theory describes eight developmental tasks of the
family throughout its life span.
DIF: Cognitive Level: Understand REF: p. 16
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
3. Which is the term for a family in which the paternal grandmother, the parents, and two minor
children live together?
a. Blended
b. Nuclear
c. Binuclear
d. Extended
ANSWER: D
An extended family contains at least one parent, one or more children, and one or more
members (related or unrelated) other than a parent or sibling. A blended family contains at
least one stepparent, step-sibling, or half-sibling. The nuclear family consists of two parents
and their children. No other relatives or nonrelatives are present in the household. In
binuclear families, parents continue the parenting role while terminating the spousal unit. For
example, when joint custody is assigned by the court, each parent has equal rights and
responsibilities for the minor child or children.
DIF: Cognitive Level: Remember REF: p. 18
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance
4. A nurse is assessing a family’s structure. Which describes a family in which a mother, her
children, and a stepfather live together?
a. Blended
b. Nuclear
c. Binuclear
d. Extended
ANSWER: A
A blended family contains at least one stepparent, step-sibling, or half-sibling. The nuclear
family consists of two parents and their children. No other relatives or nonrelatives are
present in the household. In binuclear families, parents continue the parenting role while
terminating the spousal unit. For example, when joint custody is assigned by the court, each
parent has equal rights and responsibilities for the minor child or children. An extended
family contains at least one parent, one or more children, and one or more members (related
or unrelated) other than a parent or sibling.
DIF: Cognitive Level: Understand REF: p. 18
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
5. Parents of a firstborn child are asking whether it is normal for their child to be extremely
competitive. The nurse should respond to the parents that studies about the ordinal position of
children suggest that firstborn children tend to:
a. be praised less often.
b. be more achievement oriented.
c. be more popular with the peer group.
d. identify with peer group more than parents.
ANSWER: B
Firstborn children, like only children, tend to be more achievement oriented. Being praised
less often, being more popular with the peer group, and identifying with peer groups more
than parents are characteristics of later-born children.
DIF: Cognitive Level: Apply REF: p. 29
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance
6. The nurse is teaching a group of new parents about the experience of role transition. Which
statement by a parent would indicate a correct understanding of the teaching?
a. “My marital relationship can have a positive or negative effect on the role
transition.”
b. “If an infant has special care needs, the parents’ sense of confidence in their new
role is strengthened.”
c. “Young parents can adjust to the new role easier than older parents.”
d. “A parent’s previous experience with children makes the role transition more
difficult.”
ANSWER: A
If parents are supportive of each other, they can serve as positive influences on establishing
satisfying parental roles. When marital tensions alter caregiving routines and interfere with
the enjoyment of the infant, then the marital relationship has a negative effect. Infants with
special care needs can be a significant source of added stress. Older parents are usually more
able to cope with the greater financial responsibilities, changes in sleeping habits, and
reduced time for each other and other children. Parents who have previous experience with
parenting appear more relaxed, have less conflict in disciplinary relationships, and are more
aware of normal growth and development.
DIF: Cognitive Level: Understand REF: p. 17
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Health Promotion and Maintenance
7. When assessing a family, the nurse determines that the parents exert little or no control over
their children. What is this style of parenting called?
a. Permissive
b. Dictatorial
c. Democratic
d. Authoritarian
ANSWER: A
Permissive parents avoid imposing their own standards of conduct and allow their children to
regulate their own activity as much as possible. The parents exert little or no control over
their children’s actions. Dictatorial or authoritarian parents attempt to control their children’s
behavior and attitudes through unquestioned mandates. They establish rules and regulations
or standards of conduct that they expect to be followed rigidly and unquestioningly.
Democratic parents combine permissive and dictatorial styles. They direct their children’s
behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing
deviations. They respect the child’s individual nature.
DIF: Cognitive Level: Remember REF: p. 20
TOP: Integrated Process: Nursing Process: Diagnosis
MSC: Area of Client Needs: Health Promotion and Maintenance
8. When discussing discipline with the mother of a 4-year-old child, the nurse should include
which instruction?
a. Children as young as 4 years old rarely need to be punished.
b. Parental control should be consistent.
c. Withdrawal of love and approval is effective at this age.
d. One should expect rules to be followed rigidly and unquestioningly.
ANSWER: B
For effective discipline, parents must be consistent and must follow through with agreed-on
actions. Realistic goals should be set for this age group. Parents should structure the
environment to prevent unnecessary difficulties. Requests for behavior change should be
phrased in a positive manner to provide direction for the child. Withdrawal of love and
approval is never appropriate or effective. Discipline strategies should be appropriate to the
child’s age, temperament, and severity of the misbehavior. Following rules rigidly and
unquestioningly is beyond the developmental capabilities of a 4-year-old.
DIF: Cognitive Level: Apply REF: p. 20
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
9. Which is most characteristic of the physical punishment of children, such as spanking?
a. Psychological impact is usually minimal.
b. Children rarely become accustomed to spanking.
c. Children’s development of reasoning increases.
d. Misbehavior is likely to occur when parents are not present.
ANSWER: D
Through the use of physical punishment, children learn what they should not do. When
parents are not around, it is more likely that children will misbehave because they have not
learned to behave well for their own sake, but rather out of fear of punishment. Spanking can
cause severe physical and psychological injury and interfere with effective parent-child
interaction. Children do become accustomed to spanking, requiring more severe corporal
punishment each time. The use of corporal punishment may interfere with the child’s
development of moral reasoning.
DIF: Cognitive Level: Understand REF: p. 20
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
10. A 3-year-old girl was adopted immediately after birth. The parents have just asked the nurse
how they should tell the child that she is adopted. Which guidelines concerning adoption
should the nurse use in planning a response?
a. Telling the child is an important aspect of their parental responsibilities.
b. The best time to tell the child is between ages 7 and 10 years.
c. It is not necessary to tell the child who was adopted so young.
d. It is best to wait until the child asks about it.
ANSWER: A
It is important for the parents not to withhold information about the adoption from the child.
It is an essential component of the child’s identity. There is no recommended best time to tell
children. It is believed that children should be told young enough so they do not remember a
time when they did not know. It should be done before the children enter school to keep third
parties from telling the children before the parents have had the opportunity.
DIF: Cognitive Level: Understand REF: p. 22
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
11. A parent of a school-age child is going through a divorce. The parent tells the school nurse
the child has not been doing well in school and sometimes has trouble sleeping. The nurse
should recognize this as which implication?
a. Indication of maladjustment
b. Common reaction to divorce
c. Lack of adequate parenting
d. Unusual response that indicates need for referral
ANSWER: B
Parental divorce affects school-age children in many ways. In addition to difficulties in
school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of
appetite, and sleep disorders. This is not an indication of maladjustment, suggestive of lack of
adequate parenting, or an unusual response that indicates need for referral in school-age
children after parental divorce.
DIF: Cognitive Level: Apply REF: p. 24
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Psychosocial Integrity
12. A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, “I
want to go back to work, but I don’t want Eric to suffer because I’ll have less time with him.”
The nurse’s most appropriate answer would be which statement?
a. “I’m sure he’ll be fine if you get a good babysitter.”
b. “You will need to stay home until Eric starts school.”
c. “You should go back to work so Eric will get used to being with others.”
d. “Let’s talk about the child care options that will be best for Eric.”
ANSWER: D
Let’s talk about the child care options that will be best for Eric is an open-ended statement
that will assist the mother in exploring her concerns about what is best for both her and Eric.
I’m sure he’ll be fine if you get a good babysitter, You will need to stay home until Eric starts
school, and You should go back to work so Eric will get used to being with others are
directive statements. They do not address the effect of her working on Eric.
DIF: Cognitive Level: Apply REF: p. 27
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Psychosocial Integrity
13. Which term best describes a group of people who share a set of values, beliefs, practices,
social relationships, law, politics, economics, and norms of behavior?
a. Race
b. Culture
c. Ethnicity
d. Social group
ANSWER: B
Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides
the outlook and decisions of a group of people. A culture is composed of individuals who
share a set of values, beliefs, and practices that serve as a frame of reference for individual
perceptions and judgments. Race is defined as a division of humankind possessing traits that
are transmissible by descent and are sufficient to characterize it as a distinct human type.
Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic
heritage. A social group consists of systems of roles carried out in groups. Examples of
primary social groups include the family and peer groups.
DIF: Cognitive Level: Remember REF: p. 29
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Psychosocial Integrity
14. Which term best describes the emotional attitude that one’s own ethnic group is superior to
others?
a. Culture
b. Ethnicity
c. Superiority
d. Ethnocentrism
ANSWER: D
Ethnocentrism is the belief that one’s way of living and behaving is the best way. This
includes the emotional attitude that the values, beliefs, and perceptions of one’s ethnic group
are superior to those of others. Culture is a pattern of assumptions, beliefs, and practices that
unconsciously frames or guides the outlook and decisions of a group of people. A culture is
composed of individuals who share a set of values, beliefs, and practices that serves as a
frame of reference for individual perception and judgments. Ethnicity is an affiliation of a set
of persons who share a unique cultural, social, and linguistic heritage. Superiority is the state
or quality of being superior; it does not include ethnicity.
DIF: Cognitive Level: Understand REF: p. 30
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Psychosocial Integrity
MULTIPLE RESPONSE
1. Dunst, Trivette, and Deal identified the qualities of strong families that help them function
effectively. Which qualities are included? (Select all that apply.)
a. Ability to stay connected without spending time together
b. Clear set of family values, rules, and beliefs
c. Adoption of one coping strategy that always promotes positive functioning in
dealing with life events
d. Sense of commitment toward growth of individual family members as opposed to
that of the family unit
e. Ability to engage in problem-solving activities
f. Sense of balance between the use of internal and external family resources
ANSWER: B, E, F
A clear set of family rules, values, and beliefs that establishes expectations about acceptable
and desired behavior is one of the qualities of strong families that help them function
effectively. Strong families also are able to engage in problem-solving activities and to find a
balance between internal and external forces. Strong families have a sense of congruence
among family members regarding the value and importance of assigning time and energy to
meet needs. Strong families also use varied coping strategies. The sense of commitment is
toward the growth and well-being of individual family members, as well as the family unit.
DIF: Cognitive Level: Understand REF: p. 19
TOP: Integrated Process: Nursing Process: Diagnosis
MSC: Area of Client Needs: Health Promotion and Maintenance
2. A nurse is conducting a teaching session on the use of time-out as a discipline measure to
parents of toddlers. Which are correct strategies the nurse should include in the teaching
session? (Select all that apply.)
a. Time-out as a discipline measure cannot be used when in a public place.
b. A rule for the length of time-out is 1 minute per year.
c. When the child misbehaves, one warning should be given.
d. The area for time-out can be in the family room where the child can see the
television.
e. When the child is quiet for the specified time, he or she can leave the room.
ANSWER: B, C, E
A rule for the length of time-out is 1 minute per year of age; use a kitchen timer with an
audible bell to record the time rather than a watch. When the child misbehaves, one warning
should be given. When the child is quiet for the duration of the time, he or she can then leave
the room. Time-out can be used in public places and the parents should be consistent on the
use of time-out. Implement time-out in a public place by selecting a suitable area or explain
to children that time-out will be spent immediately on returning home. The time-out should
not be spent in an area from which the child can view the television. Select an area for time-
out that is safe, convenient, and unstimulating but where the child can be monitored, such as
the bathroom, hallway, or laundry room.
DIF: Cognitive Level: Apply REF: p. 21
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
3. Divorced parents of a preschool child are asking whether their child will display any feelings
or behaviors related to the effect of the divorce. The nurse is correct when explaining that the
parents should be prepared for which types of behaviors? (Select all that apply.)
a. Displaying fears of abandonment
b. Verbalizing that he or she “is the reason for the divorce”
c. Displaying fear regarding the future
d. Ability to disengage from the divorce proceedings
e. Engaging in fantasy to understand the divorce
ANSWER: A, B, E
A child 3 to 5 years of age (preschool) may display fears of abandonment, verbalize feelings
that he or she is the reason for the divorce, and engage in fantasy to understand the divorce.
He or she would not be displaying fear regarding the future until school age, and the ability to
disengage from the divorce proceedings would be characteristic of an adolescent.
DIF: Cognitive Level: Apply REF: p. 24
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Teaching and Learning
COMPLETION
1. A nurse is admitting a child, in foster care, to the hospital. The nurse recognizes that foster
parents care for the child hours a day. (Record your answer as a whole number.)
ANSWER:
24
The term foster care is defined as 24-hour substitute care for children outside of their own
homes.
DIF: Cognitive Level: Understand REF: p. 27
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
Chapter 03: Developmental and Genetic Influences on Child Health Promotion
Hockenberry: Wong’s Essentials of Pediatric Nursing, 11th Edition
MULTIPLE CHOICE
1. An infant gains head control before sitting unassisted. The nurse recognizes that this is which
type of development?
a. Cephalocaudal
b. Proximodistal
c. Mass to specific
d. Sequential
ANSWER: A
The pattern of development that is head-to-tail, or cephalocaudal, direction is described by an
infant’s ability to gain head control before sitting unassisted. The head end of the organism
develops first and is large and complex, whereas the lower end is smaller and simpler, and
development takes place at a later time. Proximodistal, or near to far, is another pattern of
development. Limb buds develop before fingers and toes. Postnatally, the child has control of
the shoulder before achieving mastery of the hands. Mass to specific is not a specific pattern
of development. In all dimensions of growth, a definite, sequential pattern is followed.
DIF: Cognitive Level: Understand REF: p. 38
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
2. Which refers to those times in an individual’s life when he or she is more susceptible to
positive or negative influences?
a. Sensitive period
b. Sequential period
c. Terminal points
d. Differentiation points
ANSWER: A
Sensitive periods are limited times during the process of growth when the organism will
interact with a particular environment in a specific manner. These times make the organism
more susceptible to positive or negative influences. The sequential period, terminal points,
and differentiation points are developmental times that do not make the organism more
susceptible to environmental interaction.
DIF: Cognitive Level: Remember REF: p. 39
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance
3. An infant who weighs 7 pounds at birth would be expected to weigh how many pounds at age
1 year?
a. 14
b. 16
c. 18
d. 21
ANSWER: D
In general, birth weight triples by the end of the first year of life. For an infant who was 7
pounds at birth, 21 pounds would be the anticipated weight at the first birthday; 14, 16, or 18
pounds is below what would be expected for an infant with a birth weight of 7 pounds.
DIF: Cognitive Level: Understand REF: p. 41
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
4. By what age does birth length usually double?
a. 1 year
b. 2 years
c. 4 years
d. 6 years
ANSWER: C
Linear growth or height occurs almost entirely as a result of skeletal growth and is considered
a stable measurement of general growth. On average, most children have doubled their birth
length at age 4 years. One and 2 years are too young for doubling of length. Most children
will have achieved the doubling by age 4 years.
DIF: Cognitive Level: Remember REF: p. 41
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
5. Parents of an 8-year-old child ask the nurse how many inches their child should grow each
year. The nurse bases the answer on the knowledge that after age 7 years, school-age children
usually grow what number of inches per year?
a. 1
b. 2
c. 3
d. 4
ANSWER: B
The growth velocity after age 7 years is approximately 5 cm (2 inches) per year. One inch is
too small an amount. Three and 4 inches are greater than the average yearly growth after age
7 years.
DIF: Cognitive Level: Apply REF: p. 41
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance
6. Parents express concern that their pubertal daughter is taller than the boys in her class. The
nurse should respond with which statement regarding how the onset of pubertal growth spurt
compares in girls and boys?
a. It occurs earlier in boys.
b. It occurs earlier in girls.
c. It is about the same in both boys and girls.
d. In both boys and girls, the pubertal growth spurt depends on growth in infancy.
ANSWER: B
Usually, the pubertal growth spurt begins earlier in girls. It typically occurs between the ages
of 10 and 14 years for girls and 11 and 16 years for boys. The average earliest age at onset is
1 year earlier for girls. There does not appear to be a relation to growth during infancy.
DIF: Cognitive Level: Apply REF: p. 41
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance
7. A 13-year-old girl asks the nurse how much taller she will get. She has been growing about 2
inches per year but grew 4 inches this past year. Menarche recently occurred. The nurse
should base her response on which statement?
a. Growth cannot be predicted.
b. Pubertal growth spurt lasts about 1 year.
c. Mature height is achieved when menarche occurs.
d. Approximately 95% of mature height is achieved when menarche occurs.
ANSWER: D
At the time of the beginning of menstruation or the skeletal age of 13 years, most girls have
grown to about 95% of their adult height. They may have some additional growth (5%) until
the epiphyseal plates are closed. Although growth cannot be definitively predicted, on
average, 95% of adult height has been reached with the onset of menstruation. Pubertal
growth spurt lasts about 1 year does not address the girl’s question. Young women usually
will grow approximately 5% more after the onset of menstruation.
DIF: Cognitive Level: Apply REF: p. 41
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
8. How is a child’s skeletal age best determined?
a. Assessment of dentition
b. Assessment of height over time
c. Facial bone development
d. Radiographs of the hand and wrist
ANSWER: D
The most accurate measure of skeletal age is radiologic examinations of the growth plates.
These are the epiphyseal cartilage plates. Radiographs of the hand and wrist provide the most
useful screening to determine skeletal age. Age of tooth eruption has considerable variation in
children. It would not be a good determinant of skeletal age. Assessment of height over time
will provide a record of the child’s height but not skeletal age. Facial bone development will
not reflect the child’s skeletal age, which is determined by radiographic assessment.
DIF: Cognitive Level: Remember REF: p. 41
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
9. Trauma to which site can result in a growth problem for children’s long bones?
a. Matrix
b. Connective tissue
c. Calcified cartilage
d. Epiphyseal cartilage plate
ANSWER: D
The epiphyseal cartilage plate is the area of active growth. Bone injury at the epiphyseal plate
can significantly affect subsequent growth and development. Trauma or infection can result
in deformity. The matrix, connective tissue, and calcified cartilage are not areas of active
growth. Trauma in these sites will not result in growth problems for the long bones.
DIF: Cognitive Level: Comprehend REF: p. 41
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
10. A nurse has completed a teaching session for adolescents regarding lymphoid tissue growth.
Which statement, by the adolescents, indicates understanding of the teaching?
a. The tissue reaches adult size by age 1 year.
b. The tissue quits growing by 6 years of age.
c. The tissue is poorly developed at birth.
d. The tissue is twice the adult size by ages 10 to 12 years.
ANSWER: D
Lymphoid tissue continues growing until it reaches maximal development at ages 10 to 12
years, which is twice its adult size. A rapid decline in size occurs until it reaches adult size by
the end of adolescence. The tissue reaches adult size at 6 years of age but continues to grow.
The tissue is well developed at birth.
DIF: Cognitive Level: Analyze REF: p. 42
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Health Promotion and Maintenance
11. Which statement is true about the basal metabolic rate (BMR) in children?
a. It is reduced by fever.
b. It is slightly higher in boys than in girls at all ages.
c. It increases with age of child.
d. It decreases as proportion of surface area to body mass increases.
ANSWER: B
The BMR is the rate of metabolism when the body is at rest. At all ages, the rate is slightly
higher in boys than in girls. The rate is increased by fever. The BMR is highest in infancy and
then closely relates to the proportion of surface area to body mass. As the child grows, the
proportion decreases progressively to maturity.
DIF: Cognitive Level: Understand REF: p. 42
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development
12. A mother reports that her 6-year-old child is highly active, irritable, and irregular in habits
and that the child adapts slowly to new routines, people, or situations. How should the nurse
chart this type of temperament?
a. Easy
b. Difficult
c. Slow-to-warm-up
d. Fast-to-warm-up
ANSWER: B
Being highly active, irritable, irregular in habits, and adapting slowly to new routines, people,
or situations is a description of difficult children, which compose about 10% of the
population. Negative withdrawal responses are typical of this type of child, who requires a
more structured environment. Mood expressions are usually intense and primarily negative.
These children exhibit frequent periods of crying and often violent tantrums. Easy children
are even tempered, regular, and predictable in their habits. They are open and adaptable to
change. Approximately 40% of children fit this description. Slow-to-warm-up children
typically react negatively and with mild intensity to new stimuli and adapt slowly with
repeated contact. Approximately 10% of children fit this description. “Fast-to-warm-up” is
not one of the categories identified.
DIF: Cognitive Level: Apply REF: p. 43
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Health Promotion and Maintenance
13. A 12-year-old child enjoys collecting stamps, playing soccer, and participating in Boy Scout
activities. The nurse recognizes that the child is displaying which developmental task?
a. Identity
b. Industry
c. Integrity
d. Intimacy
ANSWER: B
Industry is engaging in tasks that can be carried through to completion, learning to compete
and cooperate with others, and learning rules. Industry is the developmental task
characteristic of the school-age child. Identity is the developmental task of adolescence.
Integrity and intimacy are not developmental tasks of childhood.
DIF: Cognitive Level: Understand REF: p. 38
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
14. A nurse is conducting parenting classes for parents of children ranging in ages 2 to 7 years.
The parents understand the term egocentrism when they indicate it meANSWER:
a. selfishness.
b. self-centeredness.
c. preferring to play alone.
d. unable to put self in another’s place.
ANSWER: D
According to Piaget, children ages 2 to 7 years are in the preoperational stage of
development. Children interpret objects and events not in terms of their general properties but
in terms of their relationships or their use to them. This egocentrism does not allow children
of this age to put themselves in another’s place. Selfishness, self-centeredness, and preferring
to play alone do not describe the concept of egocentricity.
DIF: Cognitive Level: Apply REF: p. 45
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Health Promotion and Maintenance
15. The nurse is observing parents playing with their 10-month-old child. Which should the nurse
recognize as evidence that the child is developing object permanence?
a. Looks for the toy that parents hide under the blanket
b. Returns the blocks to the same spot on the table
c. Recognizes that a ball of clay is the same when flattened out
d. Bangs two cubes held in her hands
ANSWER: A
Object permanence is the realization that items that leave the visual field still exist. When the
infant searches for the toy under the blanket, it is an indication that object permanence has
developed. Returning the blocks to the same spot on the table is not an example of object
permanence. Recognizing that a ball of clay is the same when flattened out is an example of
conservation, which occurs during the concrete operations stage from 7 to 11 years. Banging
two cubes together is a simple repetitive activity characteristic of developing a sense of cause
and effect.
DIF: Cognitive Level: Apply REF: p. 45
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
16. A father tells the nurse that his child is “filling up the house with collections” like seashells,
bottle caps, baseball cards, and pennies. What should the nurse recognize the child is
developing?
a. Object permanence
b. Preoperational thinking
c. Concrete operational thinking
d. Ability to use abstract symbols
ANSWER: C
During concrete operations, children develop logical thought processes. They are able to
classify, sort, order, and otherwise organize facts about the world. This ability fosters the
child’s ability to create collections. Object permanence is the realization that items that leave
the visual field still exist. This is a task of infancy and does not contribute to collections.
Preoperational thinking is concrete and tangible. Children in this age group cannot reason
beyond the observable, and they lack the ability to make deductions or generalizations.
Collections are not typical for this developmental level. The ability to use abstract symbols is
a characteristic of formal operations, which develops during adolescence. These children can
develop and test hypotheses.
DIF: Cognitive Level: Understand REF: p. 45
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
17. A visitor arrives at a daycare center during lunchtime. The preschool children think that every
time they have lunch a visitor will arrive. Which preoperational characteristic is being
displayed?
a. Egocentrism
b. Transductive reasoning
c. Intuitive reasoning
d. Conservation
ANSWER: B
Transductive reasoning is when two events occur together, they cause each other. The
expectation that every time lunch is served a visitor will arrive is descriptive of transductive
reasoning. Egocentrism is the inability to see things from any perspective than their own.
Intuitive reasoning (e.g., the stars have to go to bed just as they do) is predominantly
egocentric thought. Conservation (able to realize that physical factors such as volume,
weight, and number remain the same even though outward appearances are changed) does not
occur until school age.
DIF: Cognitive Level: Analyze REF: p. 44
TOP: Integrated Process: Nursing Process: Diagnosis
MSC: Area of Client Needs: Health Promotion and Maintenance
18. Which behavior is most characteristic of the concrete operations stage of cognitive
development?
a. Progression from reflex activity to imitative behavior
b. Inability to put oneself in another’s place
c. Increasingly logical and coherent thought processes
d. Ability to think in abstract terms and draw logical conclusions
ANSWER: C
During the concrete operations stage of development, which occurs approximately between
ages 7 and 11 years, increasingly logical and coherent thought processes occur. This is
characterized by the child’s ability to classify, sort, order, and organize facts to use in problem
solving. The progression from reflex activity to imitative behavior is characteristic of the
sensorimotor stage of development. The inability to put oneself in another’s place is
characteristic of the preoperational stage of development. The ability to think in abstract
terms and draw logical conclusions is characteristic of the formal operations stage of
development.
DIF: Cognitive Level: Understand REF: p. 45
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
19. According to Kohlberg, children develop moral reasoning as they mature. Which statement is
most characteristic of a preschooler’s stage of moral development?
a. Obeying the rules of correct behavior is important.
b. Showing respect for authority is important behavior.
c. Behavior that pleases others is considered good.
d. Actions are determined as good or bad in terms of their consequences.
ANSWER: D
Preschoolers are most likely to exhibit characteristics of Kohlberg’s preconventional level of
moral development. During this stage, they are culturally oriented to labels of good or bad,
right or wrong. Children integrate these concepts based on the physical or pleasurable
consequences of their actions. Obeying the rules of correct behavior, showing respect for
authority, and engaging in behavior that pleases others are characteristics of Kohlberg’s
conventional level of moral development.
DIF: Cognitive Level: Understand REF: p. 46
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance
20. A school nurse notes that school-age children generally obey the rules at school. The nurse
recognizes that the children are displaying which stage of moral development?
a. Preconventional
b. Conventional
c. Postconventional
d. Undifferentiated
ANSWER: B
Conventional stage of moral development is described as obeying the rules, doing one’s duty,
showing respect for authority, and maintaining the social order. This stage is characteristic of
school-age children’s behavior. The preconventional stage is characteristic of the toddler and
preschool age. At this stage, the child has no concept of the basic moral order that supports
being good or bad. The postconventional level is characteristic of an adolescent and occurs at
the formal stage of operation. Undifferentiated describes an infant’s understanding of moral
development.
DIF: Cognitive Level: Analyze REF: p. 46
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Health Promotion and Maintenance
21. A nurse observes a toddler playing with sand and water. How should the nurse document this
type of play?
a. Skill
b. Dramatic
c. Social-affective
d. Sense-pleasure
ANSWER: D
The toddler playing with sand and water is engaging in sense-pleasure play. This is
characterized by nonsocial situations in which the child is stimulated by objects in the
environment. Infants engage in skill play when they persistently demonstrate and exercise
newly acquired abilities. Dramatic play is the predominant form of play in the preschool
period. Children pretend and fantasize. Social-affective play is one of the first types of play in
which infants engage. The infant responds to interactions with people.
DIF: Cognitive Level: Apply REF: p. 47
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Health Promotion and Maintenance
22. In which type of play are children engaged in similar or identical activity, without
organization, division of labor, or mutual goal?
a. Solitary
b. Parallel
c. Associative
d. Cooperative
ANSWER: C
In associative play, no group goal is present. Each child acts according to his or her own
wishes. Although the children may be involved in similar activities, no organization, division
of labor, leadership assignment, or mutual goal exists. Solitary play describes children
playing alone with toys different from those used by other children in the same area. Parallel
play describes children playing independently but being among other children. Cooperative
play is organized. Children play in a group with other children who play in activities for a
common goal.
DIF: Cognitive Level: Understand REF: p. 48
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
23. The nurse observes some children in the playroom. Which play situation exhibits the
characteristics of parallel play?
a. Kimberly and Amanda sharing clay to each make things
b. Brian playing with his truck next to Kristina playing with her truck
c. Adam playing a board game with Kyle, Steven, and Erich
d. Danielle playing with a music box on her mother’s lap
ANSWER: B
Playing with trucks next to each other but not together is an example of parallel play. Both
children are engaged in similar activities in proximity to each other; however, they are each
engaged in their own play. Sharing clay to make things is characteristic of associative play.
Friends playing a board game together is characteristic of cooperative play. A child playing
with something by herself on her mother’s lap is an example of solitary play.
DIF: Cognitive Level: Analyze REF: p. 48
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
24. A nurse is planning play activities for school-age children. Which type of a play activity
should the nurse plan?
a. Solitary
b. Parallel
c. Associative
d. Cooperative
ANSWER: D
School-age children engage in cooperative play where it is organized and interactive. Playing
a game is a good example of cooperative play. Solitary play is appropriate for infants, parallel
play is an activity appropriate for toddlers, and associative play is an activity appropriate for
preschool-age children.
DIF: Cognitive Level: Apply REF: p. 48
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance
25. Which following function of play is a major component of play at all ages?
a. Creativity
b. Socialization
c. Intellectual development
d. Sensorimotor activity
ANSWER: D
Sensorimotor activity is a major component of play at all ages. Active play is essential for
muscle development and allows the release of surplus energy. Through sensorimotor play,
children explore their physical world by using tactile, auditory, visual, and kinesthetic
stimulation. Creativity, socialization, and intellectual development are each functions of play
that are major components at different ages.
DIF: Cognitive Level: Understand REF: p. 49
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Developmental Stages and
Transitions
26. Parents are asking the clinic nurse about an appropriate toy for their toddler. Which response
by the nurse is appropriate?
a. “Your child would enjoy playing a board game.”
b. “A toy your child can push or pull would help develop muscles.”
c. “An action figure toy would be a good choice.”
d. “A 25-piece puzzle would help your child develop recognition of shapes.”
ANSWER: B
Toys should be appropriate for the child’s age. A toddler would benefit from a toy he or she
could push or pull. The child is too young for a board game, action figure, or 25-piece puzzle.
DIF: Cognitive Level: Apply REF: p. 50
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
27. Which is probably the single most important influence on growth at all stages of
development?
a. Nutrition
b. Heredity
c. Culture
d. Environment
ANSWER: A
Nutrition is the single most important influence on growth. Dietary factors regulate growth at
all stages of development, and their effects are exerted in numerous and complex ways.
Adequate nutrition is closely related to good health throughout life. Heredity, culture, and
environment contribute to the child’s growth and development. However, good nutrition is
essential throughout the life span for optimal health.
DIF: Cognitive Level: Understand REF: p. 43
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance
28. A nurse is counseling an adolescent, in her second month of pregnancy, about the risk of
teratogens. The adolescent has understood the teaching if she makes which statement?
a. “I will be able to continue taking isotretinoin (Accutane) for my acne.”
b. “I can continue to clean my cat’s litter box.”
c. “I should avoid any alcoholic beverages.”
d. “I will ask my physician to adjust my phenytoin (Dilantin) dosage.”
ANSWER: C
Teratogens are agents that cause birth defects when present in the prenatal period. Avoidance
of alcoholic beverages is recommended to prevent fetal alcohol syndrome. Isotretinoin
(Accutane) and phenytoin (Dilantin) have been shown to have teratogenic effects and should
not be taken during pregnancy. Cytomegalovirus, an infectious agent and a teratogen, can be
transmitted through cat feces, and cleaning the litter box during pregnancy should be avoided.
DIF: Cognitive Level: Analyze REF: p. 52
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
29. What should the nurse consider when discussing language development with parents of
toddlers?
a. Sentences by toddlers include adverbs and adjectives.
b. The toddler expresses himself or herself with verbs or combination words.
c. The toddler uses simple sentences.
d. Pronouns are used frequently by the toddler.
ANSWER: B
The first parts of speech used are nouns, sometimes verbs (e.g., “go”), and combination
words (e.g., “bye-bye”). Responses are usually structurally incomplete during the toddler
period. The preschool child begins to use adjectives and adverbs to qualify nouns followed by
adverbs to qualify nouns and verbs. Pronouns are not added until the later preschool years.
By the time children enter school, they are able to use simple, structurally complete sentences
that average five to seven words.
DIF: Cognitive Level: Apply REF: p. 46
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
30. A nurse is observing children at play. Which figure depicts associative play?
a.
b.
c.
d.
ANSWER: C
The children depicted in the figure at the carnival ride are demonstrating associative play.
They are engaged in similar or identical activities. The child depicted playing alone is
demonstrating solitary play. The children playing on the beach depict parallel play. They are
playing side by side but are participating in different activities. The children depicted playing
a board game are engaging in cooperative play.
DIF: Cognitive Level: Analyze REF: p. 48
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Health Promotion and Maintenance
31. Which syndrome involves a common sex chromosome defect?
a. Down
b. Turner
c. Marfan
d. Hemophilia
ANSWER: B
Turner syndrome is caused by an absence of one of the X chromosomes. Down syndrome is
caused by trisomy 21, three copies rather than two copies of chromosome 21. Marfan
syndrome is a connective tissue disorder inherited in an autosomal dominant pattern.
Hemophilia is a disorder of blood coagulation inherited in an X-linked recessive pattern.
DIF: Cognitive Level: Understand REF: p. 52
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
32. Turner syndrome is suspected in an adolescent girl with short stature. What is the cause of
this syndrome?
a. Absence of one of the X chromosomes
b. Presence of an incomplete Y chromosome
c. Precocious puberty in an otherwise healthy child
d. Excess production of both androgens and estrogens
ANSWER: A
Turner syndrome is caused by an absence of one of the X chromosomes. Most girls who have
this disorder have one X chromosome missing from all cells. No Y chromosome is present in
individuals with Turner syndrome. This young woman has 45 rather than 46 chromosomes.
DIF: Cognitive Level: Understand REF: p. 52
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
MULTIPLE RESPONSE
1. Play serves many purposes. In teaching parents about appropriate activities, the nurse should
inform them that play serves which of the following function? (Select all that apply.)
a. Intellectual development
b. Physical development
c. Socialization
d. Creativity
e. Temperament development
ANSWER: A, C, D
A common statement is that play is the work of childhood. Intellectual development is
enhanced through the manipulation and exploration of objects. Socialization is encouraged by
interpersonal activities and learning of social roles. In addition, creativity is developed
through the experimentation characteristic of imaginative play. Physical development
depends on many factors; play is not one of them. Temperament refers to behavioral
tendencies that are observable from the time of birth. The actual behaviors, but not the child’s
temperament attributes, may be modified through play.
DIF: Cognitive Level: Understand REF: p. 49
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
2. What factors indicate parents should seek genetic counseling for their child? (Select all that
apply.)
a. Abnormal newborn screen
b. Family history of a hereditary disease
c. History of hypertension in the family
d. Severe colic as an infant
e. Metabolic disorder
ANSWER: A, B, E
Factors that are indicative parents should seek genetic counseling for their child include an
abnormal newborn screen, family history of a hereditary disease, and a metabolic disorder. A
history of hypertension or severe colic as an infant is not an indicator of a genetic disease.
DIF: Cognitive Level: Understand REF: p. 53
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
3. A nurse is preparing to administer a Denver II. Which is a correct statement about the Denver
II? (Select all that apply.)
a. All items intersected by the age line should be administered.
b. There is no correction for a child born preterm.
c. The tool is an intelligence test.
d. Toddlers and preschoolers should be prepared by presenting the test as a game.
e. Presentation of the toys from the kit should be done one at a time.
ANSWER: A, D, E
To identify “cautions,” all items intersected by the age line are administered. Toddlers and
preschoolers should be tested by presenting the Denver II as a game. Because children are
easily distracted, perform each item quickly and present only one toy from the kit at a time.
Before beginning the screening, ask whether the child was born preterm and correctly
calculate the adjusted age. Up to 24 months of age, allowances are made for preterm infants
by subtracting the number of weeks of missed gestation from their present age and testing
them at the adjusted age. Explain to the parents and child, if appropriate, that the screenings
are not intelligence tests but rather are a method of showing what the child can do at a
particular age.
DIF: Cognitive Level: Apply REF: p. 50
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance
COMPLETION
1. The nurse is recording a normal interpretation of a Denver II assessment. The nurse
understands that the maximum number of cautions determined for a normal interpretation is
. (Record your answer in a whole number.)
ANSWER:
1
Interpretation of normal for a Denver II is no delays and a maximum of one caution.
DIF: Cognitive Level: Apply REF: p. 50
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance
OTHER
1. Place in order the sequence of cephalocaudal development that the nurse expects to find in
the infant. Begin with the first development expected, sequencing to the final. Provide
answers using lowercase letters separated by commas (e.g., a, b, c, d).
a. Crawl
b. Sit unsupported
c. Lift head when prone
d. Gain complete head control
e. Walk
ANSWER:
c, d, b, a, e
Cephalocaudal development is head-to-tail. Infants achieve structural control of the head
before they have control of their trunks and extremities, they lift their head while prone,
obtain complete head control, sit unsupported, crawl, and walk sequentially.
DIF: Cognitive Level: Apply REF: p. 38
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance
Chapter 04: Communication and Physical Assessment of the Child and Family
Hockenberry: Wong’s Essentials of Pediatric Nursing, 11th Edition
MULTIPLE CHOICE
1. The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should
the nurse do first?
a. Introduce self.
b. Make family comfortable.
c. Explain purpose of interview.
d. Give assurance of privacy.
ANSWER: A
The first thing that nurses should do is to introduce themselves to the patient and family. Parents
and other adults should be addressed with appropriate titles unless they specify a preferred name.
During the initial part of the interview, the nurse should include general conversation to help
make the family feel at ease. Clarification of the purpose of the interview and the nurse’s role is
the next thing that should be done. The interview should take place in an environment as free of
distraction as possible. In addition, the nurse should clarify which information will be shared
with other members of the health care team and any limits to the confidentiality.
DIF: Cognitive Level: Apply REF: p. 57
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Psychosocial Integrity
2. Which is most likely to encourage parents to talk about their feelings related to their child’s ill-
ness?
a. Be sympathetic.
b. Use direct questions.
c. Use open-ended questions.
d. Avoid periods of silence.
ANSWER: C
Closed-ended questions should be avoided when attempting to elicit parents’ feelings. Open-
ended questions require the parent to respond with more than a brief answer. Sympathy is having
feelings or emotions in common with another person rather than understanding those feelings
(empathy). Sympathy is not therapeutic in helping the relationship. Direct questions may obtain
limited information. In addition, the parent may consider them threatening. Silence can be an ef-
fective interviewing tool. It allows sharing of feelings in which two or more people absorb the
emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for
responses to questions.
DIF: Cognitive Level: Apply REF: p. 58
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Psychosocial Integrity
3. Which communication technique should the nurse avoid when interviewing children and their
families?
a. Using silence
b. Using clichés
c. Directing the focus
d. Defining the problem
ANSWER: B
Using stereotyped comments or clichés can block effective communication, and this technique
should be avoided. After use of such trite phrases, parents will often not respond. Silence can be
an effective interviewing tool. Silence permits the interviewee to sort out thoughts and feelings
and search for responses to questions. To be effective, the nurse must be able to direct the focus
of the interview while allowing maximal freedom of expression. By using open-ended questions,
along with guiding questions, the nurse can obtain the necessary information and maintain the re-
lationship with the family. The nurse and parent must collaborate and define the problem that
will be the focus of the nursing intervention.
DIF: Cognitive Level: Understand REF: p. 59
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Psychosocial Integrity
4. What is the single most important factor to consider when communicating with children?
a. The child’s physical condition
b. Presence or absence of the child’s parent
c. The child’s developmental level
d. The child’s nonverbal behaviors
ANSWER: C
The nurse must be aware of the child’s developmental stage to engage in effective communica-
tion. The use of both verbal and nonverbal communication should be appropriate to the develop-
mental level. Although the child’s physical condition is a consideration, developmental level is
much more important. The parents’ presence is important when communicating with young chil-
dren but may be detrimental when speaking with adolescents. Nonverbal behaviors will vary in
importance, based on the child’s developmental level.
DIF: Cognitive Level: Understand REF: p. 60
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Psychosocial Integrity
5. Which approach would be best to use to ensure a positive response from a toddler?
ly.
by
ANSWER: A
It is important that the nurse assume a position at the child’s level when communicating with the
child. By speaking quietly and focusing on the child, the nurse should be able to obtain a positive
response. The nurse should engage the child and inform the toddler what is going to occur. If the
nurse picks up the child without explanation, the child is most likely going to become upset. The
toddler may not understand the meaning of the phrase, “I’m your nurse.” If a positive response is
desired, the nurse should assume the child’s level when speaking if possible.
DIF: Cognitive Level: Apply REF: p. 60
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Psychosocial Integrity
6. What is an important consideration for the nurse who is communicating with a very young child?
a. Speak loudly, clearly, and directly.
b. Use transition objects, such as a doll.
c. Disguise own feelings, attitudes, and anxiety.
d. Initiate contact with child when parent is no
present.
ANSWER: B
Using a transition object allows the young child an opportunity to evaluate an unfamiliar person
(the nurse). This will facilitate communication with a child this age. Speaking in this manner will
tend to increase anxiety in very young children. The nurse must be honest with the child. At-
tempts at deception will lead to a lack of trust. Whenever possible, the parent should be present
for interactions with young children.
DIF: Cognitive Level: Understand REF: p. 61
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Psychosocial Integrity
7. A nurse is preparing to assess a 3-year-old child. What communication technique should the
nurse use for this child?
a. Focus communication on child.
b. Explain experiences of others to child.
c. Use easy analogies when possible.
d. Assure child that communication is private.
ANSWER: A
a. Assume an eye-level position and talk quiet
b. Call the toddler’s name while picking him o
her up.
c. Call the toddler’s name and say, “I’m your
nurse.”
d. Stand by the toddler, addressing him or her
name.
Because children of this age are able to see things only in terms of themselves, the best approach
is to focus communication directly on them. Children should be provided with information about
what they can do and how they will feel. With children who are egocentric, experiences of oth-
ers, analogies, and assurances that the communication is private will not be effective because the
child is not capable of understanding.
DIF: Cognitive Level: Apply REF: p. 61
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Psychosocial Integrity
8. A nurse is assigned to four children of different ages. In which age group should the nurse under-
stand that body integrity is a concern?
a. Toddler
b. Preschooler
c. School-age child
d. Adolescent
ANSWER: C
School-age children have a heightened concern about body integrity. They place importance and
value on their bodies and are oversensitive to anything that constitutes a threat or suggestion of
injury. Body integrity is not as important a concern to toddlers, preschoolers, or adolescents.
DIF: Cognitive Level: Understand REF: p. 61
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance
9. An 8-year-old girl asks the nurse how the blood pressure apparatus works. What is the most ap-
propriate nursing action?
a. Ask her why she wants to know.
b. Determine why she is so anxious.
c. Explain in simple terms how it works.
d. Tell her she will see how it works as it is
used.
ANSWER: C
School-age children require explanations and reasons for everything. They are interested in the
functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to ex-
plain how equipment works and what will happen to the child. A nurse should respond positively
for requests for information about procedures and health information. By not responding, the
nurse may be limiting communication with the child. The child is not exhibiting anxiety, just re-
questing clarification of what will be occurring. The nurse must explain how the blood pressure
cuff works so that the child can then observe during the procedure.
DIF: Cognitive Level: Apply REF: p. 61
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
10. When the nurse interviews an adolescent, which is especially important?
a. Focus the discussion on the peer group.
b. Allow an opportunity to express feelings.
c. Emphasize that confidentiality will always
maintained.
d. Use the same type of language as the adoles
cent.
ANSWER: B
Adolescents, like all children, need an opportunity to express their feelings. Often they will inter-
ject feelings into their words. The nurse must be alert to the words and feelings expressed. Al-
though the peer group is important to this age group, the focus of the interview should be on the
adolescent. The nurse should clarify which information will be shared with other members of the
health care team and any limits to confidentiality. The nurse should maintain a professional rela-
tionship with adolescents. To avoid misinterpretation of words and phrases that the adolescent
may use, the nurse should clarify terms frequently.
DIF: Cognitive Level: Understand REF: p. 62
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Psychosocial Integrity
11. The nurse is having difficulty communicating with a hospitalized 6-year-old child. What tech-
nique might be most helpful?
a. Suggest that the child keep a diary.
b. Suggest that the parent read fairy tales to th
child.
c. Ask the parent if the child is always uncom
municative.
d. Ask the child to draw a picture.
ANSWER: D
Drawing is one of the most valuable forms of communication. Children’s drawings tell a great
deal about them because they are projections of the child’s inner self. It would be difficult for a
6-year-old child who is most likely learning to read to keep a diary. Parents reading fairy tales to
the child is a passive activity involving the parent and child. It would not facilitate communica-
tion with the nurse. The child is in a stressful situation and is probably uncomfortable with
strangers.
DIF: Cognitive Level: Apply REF: p. 64
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Psychosocial Integrity
12. The nurse is meeting a 5-year-old child for the first time and would like the child to cooperate
during a dressing change. The nurse decides to do a simple magic trick using gauze. How should
this action be interpreted?
a. Inappropriate, because of child’s age
b. A way to establish rapport
c. Too distracting, when cooperation is impor-
tant
d. Acceptable, if there is adequate time
ANSWER: B
A magic trick or other simple game may help alleviate anxiety for a 5-year-old. It is an excellent
method to build rapport and facilitate cooperation during a procedure. Magic tricks appeal to the
natural curiosity of young children. The nurse should establish rapport with the child. Failure to
do so may cause the procedure to take longer and be more traumatic.
DIF: Cognitive Level: Analyze REF: p. 64
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Psychosocial Integrity
13. The nurse must assess a 10-month-old infant. The infant is sitting on the father’s lap and appears
to be afraid of the nurse and of what might happen next. Which initial action by the nurse would
be most appropriate?
a. Initiate a game of peek-a-boo.
b. Ask father to place the infant on the examin
tion table.
c. Undress the infant while he is still sitting on
his father’s lap.
d. Talk softly to the infant while taking him
from his father.
ANSWER: A
Peek-a-boo is an excellent means of initiating communication with infants while maintaining a
safe, nonthreatening distance. The child will most likely become upset if separated from his fa-
ther. As much of the assessment as possible should be done on the father’s lap. The nurse should
have the father undress the child as needed for the examination.
DIF: Cognitive Level: Apply REF: p. 62
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Psychosocial Integrity
14. The nurse is taking a health history on an adolescent. Which best describes how the chief com-
plaint should be determined?
a. Ask for detailed listing of symptoms.
b. Ask adolescent, “Why did you come here to
day?”
c. Use what adolescent says to determine, in
correct medical terminology, what the prob-
lem is.
d. Interview parent away from adolescent to d
termine chief complaint.
ANSWER: B
The chief complaint is the specific reason for the child’s visit to the clinic, office, or hospital. Be-
cause the adolescent is the focus of the history, this is an appropriate way to determine the chief
complaint. A detailed listing of symptoms will make it difficult to determine the chief complaint.
The adolescent should be prompted to tell which symptom caused him to seek help at this time.
The chief complaint is usually written in the words that the parent or adolescent uses to describe
the reason for seeking help. The parent and adolescent may be interviewed separately, but the
nurse should determine the reason the adolescent is seeking attention at this time.
DIF: Cognitive Level: Apply REF: p. 62
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
15. Where in the health history should the nurse describe all details related to the chief complaint?
a. Past history
b. Chief complaint
c. Present illness
d. Review of systems
ANSWER: C
The history of the present illness is a narrative of the chief complaint from its earliest onset
through its progression to the present. The focus of the present illness is on all factors relevant to
the main problem, even if they have disappeared or changed during the onset, interval, and
present. Past history refers to information that relates to previous aspects of the child’s health, not
to the current problem. The chief complaint is the specific reason for the child’s visit to the
clinic, office, or hospital. It does not contain the narrative portion describing the onset and pro-
gression. The review of systems is a specific review of each body system.
DIF: Cognitive Level: Understand REF: p. 64
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Health Promotion and Maintenance
16. The nurse is interviewing the mother of an infant. She reports, “I had a difficult delivery, and my
baby was born preterm.” This information should be recorded under which of the following
headings?
a. Past history
b. Present illness
c. Chief complaint
d. Review of systems
ANSWER: A
The past history refers to information that relates to previous aspects of the child’s health, not to
the current problem. The mother’s difficult delivery and prematurity are important parts of the
past history of an infant. The history of the present illness is a narrative of the chief complaint
from its earliest onset through its progression to the present. Unless the chief complaint is di-
rectly related to the prematurity, this information is not included in the history of present illness.
The chief complaint is the specific reason for the child’s visit to the clinic, office, or hospital. It
would not include the birth information. The review of systems is a specific review of each body
system. It does not include the preterm birth. Sequelae such as pulmonary dysfunction would be
included.
DIF: Cognitive Level: Understand REF: p. 65
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Health Promotion and Maintenance
17. Which is most important to document about immunizations in the child’s health history?
a
ANSWER: B
The occurrence of any reaction after an immunization was given is the most important to docu-
ment in a history because of possible future reactions, especially allergic reactions. Exact dosage
of the immunization received may not be recorded on the immunization record. Exact dates are
important to obtain but not as important as a history of reaction to an immunization. The practi-
tioner who administered the immunization does not need to be recorded in the health history. A
potentially severe physiologic response is the most threatening and most important information
to document for safety reasons.
DIF: Cognitive Level: Analyze REF: p. 65
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Health Promotion and Maintenance
18. When interviewing the mother of a 3-year-old child, the nurse asks about developmental mile-
stones such as the age of walking without assistance. How should this question be considered?
a. Unnecessary information because child is a
3 years
b. An important part of the family history
c. An important part of the child’s past history
d. An important part of the child’s review of
systems
ANSWER: C
Information about the attainment of developmental milestones is important to obtain. It provides
data about the child’s growth and development that should be included in the past history. Devel-
opmental milestones provide important information about the child’s physical, social, and neuro-
logic health and should be included in the history for a 3-year-old child. If pertinent, attainment
of milestones by siblings would be included in the family history. The review of systems does
not include the developmental milestones.
DIF: Cognitive Level: Understand REF: p. 65
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Health Promotion and Maintenance
19. The nurse is taking a sexual history on an adolescent girl. Which is the best way to determine
whether she is sexually active?
”
a. Dosage of immunizations received
b. Occurrence of any reaction after an immu-
nization
c. The exact date the immunizations were re-
ceived
d. Practitioner who administered the immuniz
tions
a. Ask her, “Are you sexually active?”
b. Ask her, “Are you having sex with anyone?
c. Ask her, “Are you having sex with a
boyfriend?”
ANSWER: B
Asking the adolescent girl whether she is having sex with anyone is a direct question that is well
understood. The phrase sexually active is broadly defined and may not provide specific informa-
tion to the nurse to provide necessary care. The word anyone is preferred to using gender-specific
terms such as boyfriend or girlfriend. Because homosexual experimentation may occur, it is
preferable to use gender-neutral terms. Questioning about sexual activity should occur when the
adolescent is alone.
DIF: Cognitive Level: Apply REF: p. 65
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
20. When doing a nutritional assessment on a Hispanic family, the nurse learns that their diet con-
sists mainly of vegetables, legumes, and starches. How should the nurse assess this diet?
a. Indicates they live in poverty
b. Is lacking in protein
c. May provide sufficient amino acids
d. Should be enriched with meat and milk
ANSWER: C
The diet that contains vegetable, legumes, and starches may provide sufficient essential amino
acids, even though the actual amount of meat or dairy protein is low. Many cultures use diets that
contain this combination of foods. It is not indicative of poverty. Combinations of foods contain
the essential amino acids necessary for growth. A dietary assessment should be done, but many
vegetarian diets are sufficient for growth.
DIF: Cognitive Level: Understand REF: p. 66
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
21. Which following parameters correlates best with measurements of the body’s total protein
stores?
a. Height
b. Weight
c. Skinfold thickness
d. Upper arm circumference
ANSWER: D
Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves
as the body’s major protein reserve and is considered an index of the body’s protein stores.
Height is reflective of past nutritional status. Weight is indicative of current nutritional status.
Skinfold thickness is a measurement of the body’s fat content.
DIF: Cognitive Level: Understand REF: p. 72
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
d. Ask both the girl and her parent whether sh
is sexually active.
22. A nurse is preparing to perform a physical assessment on a toddler. Which approach should the
nurse use for this child?
a. Always proceed in a head-to-toe direction.
b. Perform traumatic procedures first.
c. Use minimal physical contact initially.
d. Demonstrate use of equipment.
ANSWER: C
Parents can remove clothing, and the child can remain on the parent’s lap. The nurse should use
minimal physical contact initially to gain the child’s cooperation. The head-to-toe assessment can
be done in older children but usually must be adapted in younger children. Traumatic procedures
should always be performed last. These will most likely upset the child and inhibit cooperation.
The nurse should introduce the equipment slowly. The child can inspect the equipment, but
demonstrations are usually too complex for toddlers.
DIF: Cognitive Level: Apply REF: p. 77
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance
23. The nurse is preparing to perform a physical assessment on a 10-year-old girl. The nurse gives
her the option of her mother either staying in the room or leaving. How should this action be in-
terpreted?
a. Appropriate because of child’s age
b. Appropriate because mother would be un-
comfortable making decisions for child
c. Inappropriate because of child’s age
d. Inappropriate because child is same sex as
mother
ANSWER: A
The older school-age child should be given the option of having the parent present or not. During
the examination, the nurse should respect the child’s need for privacy. Although the question was
appropriate for the child’s age, the mother is responsible for making decisions for the child. It is
appropriate because of the child’s age. During the examination, the nurse must respect the child’s
privacy. The child should help determine who is present during the examination.
DIF: Cognitive Level: Apply REF: p. 77
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
24. A nurse is counseling parents of a child beginning to show signs of being overweight. The nurse
accurately relates which body mass index (BMI)-for-age percentile indicates a risk for being
overweight?
a. 11th percentile
b. 9th percentile
c. 85th percentile
d. 95th percentile
TEST BANK For Wong’s Essentials of Pediatric Nursing, 11th Edition by Marilyn Hockenberry, Cheryl Rodgers, Verified Chapters 1 - 31, Complete Newest Version.pdf
TEST BANK For Wong’s Essentials of Pediatric Nursing, 11th Edition by Marilyn Hockenberry, Cheryl Rodgers, Verified Chapters 1 - 31, Complete Newest Version.pdf
TEST BANK For Wong’s Essentials of Pediatric Nursing, 11th Edition by Marilyn Hockenberry, Cheryl Rodgers, Verified Chapters 1 - 31, Complete Newest Version.pdf
TEST BANK For Wong’s Essentials of Pediatric Nursing, 11th Edition by Marilyn Hockenberry, Cheryl Rodgers, Verified Chapters 1 - 31, Complete Newest Version.pdf
TEST BANK For Wong’s Essentials of Pediatric Nursing, 11th Edition by Marilyn Hockenberry, Cheryl Rodgers, Verified Chapters 1 - 31, Complete Newest Version.pdf
TEST BANK For Wong’s Essentials of Pediatric Nursing, 11th Edition by Marilyn Hockenberry, Cheryl Rodgers, Verified Chapters 1 - 31, Complete Newest Version.pdf

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  • 2.
  • 3. Chapter 01: Perspectives of Pediatric Nursing Hockenberry: Wong’s Essentials of Pediatric Nursing, 11th Edition MULTIPLE CHOICE 1. A nurse is planning a teaching session for parents of preschool children. Which statement ex- plains why the nurse should include information about morbidity and mortality? a. Life span statistics are included in the data. b. It explains effectiveness of treatment. c. Cost-effective treatment is detailed for the general population. d. High-risk age groups for certain disorders o hazards are identified. ANSWER: D Analysis of morbidity and mortality data provides the parents with information about which groups of individuals are at risk for which health problems. Life span statistics is a part of the mortality data. Treatment modalities and cost are not included in morbidity and mortality data. DIF: Cognitive Level: Apply REF: p. 11 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 2. A clinic nurse is planning a teaching session about childhood obesity prevention for parents of school-age children. The nurse should include which associated risk of obesity in the teaching plan? a. Type I diabetes b. Respiratory disease c. Celiac disease d. Type II diabetes ANSWER: D Childhood obesity has been associated with the rise of type II diabetes in children. Type I dia- betes is not associated with obesity and has a genetic component. Respiratory disease is not asso- ciated with obesity, and celiac disease is the inability to metabolize gluten in foods and is not as- sociated with obesity. DIF: Cognitive Level: Apply REF: p. 2 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 3. Which is the leading cause of death in infants younger than 1 year? a. Congenital anomalies b. Sudden infant death syndrome c. Respiratory distress syndrome d. Bacterial sepsis of the newborn ANSWER: A
  • 4. Congenital anomalies account for 20.1% of deaths in infants younger than 1 year. Sudden infant death syndrome accounts for 8.2% of deaths in this age group. Respiratory distress syndrome ac- counts for 3.4% of deaths in this age group. Infections specific to the perinatal period account for 2.7% of deaths in this age group. DIF: Cognitive Level: Remember REF: p. 6 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 4. Which leading cause of death topic should the nurse emphasize to a group ofAfrican-American boys ranging in age from 15 to 19 years? a. Suicide b. Cancer c. Firearm homicide d. Occupational injuries ANSWER: C Firearm homicide is the second overall cause of death in this age group and the leading cause of death in African-American males. Suicide is the third-leading cause of death in this population. Cancer, although a major health problem, is the fourth-leading cause of death in this age group. Occupational injuries do not contribute to a significant death rate for this age group. DIF: Cognitive Level: Understand REF: p. 7 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 5. Which is the major cause of death for children older than 1 year? a. Cancer b. Heart disease c. Unintentional injuries d. Congenital anomalies ANSWER: C Unintentional injuries (accidents) are the leading cause of death after age 1 year through adoles- cence. Congenital anomalies are the leading cause of death in those younger than 1 year. Cancer ranks either second or fourth, depending on the age group, and heart disease ranks fifth in the majority of the age groups. DIF: Cognitive Level: Remember REF: p. 7 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 6. Which is the leading cause of death from unintentional injuries for females ranging in age from 1 to 14? a. Mechanical suffocation b. Drowning c. Motor vehicle–related fatalities d. Fire- and burn-related fatalities
  • 5. ANSWER: C Motor vehicle–related fatalities are the leading cause of death for females ranging in age from 1 to 14, either as passengers or as pedestrians. Mechanical suffocation is fourth or fifth, depending on the age. Drowning is the second- or third-leading cause of death, depending on the age. Fire- and burn-related fatalities are the second-leading cause of death. DIF: Cognitive Level: Remember REF: p. 3 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 7. Which factor most impacts the type of injury a child is susceptible to, according to the child’s age? a. Physical health of the child b. Developmental level of the child c. Educational level of the child d. Number of responsible adults in the home ANSWER: B The child’s developmental stage determines the type of injury that is likely to occur. The child’s physical health may facilitate the child’s recovery from an injury but does not impact the type of injury. Educational level is related to developmental level, but it is not as important as the child’s developmental level in determining the type of injury. The number of responsible adults in the home may affect the number of unintentional injuries, but the type of injury is related to the child’s developmental stage. DIF: Cognitive Level: Understand REF: p. 3 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 8. Which is now referred to as the “new morbidity”? s ANSWER: D The new morbidity reflects the behavioral, social, and educational problems that interfere with the child’s social and academic development. It is currently estimated that the incidence of these issues is from 5% to 30%. Limitations in major activities of daily living and unintentional in- juries that result in chronic health problems are included in morbidity data. Discovery of new therapies would be reflected in changes in morbidity data over time. DIF: Cognitive Level: Remember REF: p. 2 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance a. Limitations in the major activities of daily living b. Unintentional injuries that cause chronic health problems c. Discoveries of new therapies to treat health problems d. Behavioral, social, and educational problem that alter health
  • 6. 9. A nurse on a pediatric unit is practicing family-centered care. Which is most descriptive of the care the nurse is delivering? n ANSWER: C The three key components of family-centered care are respect, collaboration, and support. Fam- ily-centered care recognizes the family as the constant in the child’s life. Taking over total care does not include the family in the process and may increase stress instead of reducing stress. The family should be enabled and empowered to work with the health care system. The family is ex- pected to be part of the decision-making process. DIF: Cognitive Level: Remember REF: p. 7 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance 10. The nurse is preparing an in-service education to staff about atraumatic care for pediatric pa- tients. Which intervention should the nurse include? s t ANSWER: B Preparing the child for any unfamiliar treatments, controlling pain, allowing privacy, providing play activities for expression of fear and aggression, providing choices, and respecting cultural differences are components of atraumatic care. In the provision of atraumatic care, the separation of child from parents during hospitalization is minimized. The nurse should promote a sense of control for the child. Preventing and minimizing bodily injury and pain are major components of atraumatic care. DIF: Cognitive Level: Understand REF: p. 8 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Psychosocial Integrity 11. Which is most suggestive that a nurse has a nontherapeutic relationship with a patient and fam- ily? a. Taking over total care of the child to reduce stress on the family b. Encouraging family dependence on health care systems c. Recognizing that the family is the constant a child’s life d. Excluding families from the decision-makin process a. Prepare the child for separation from parent during hospitalization by reviewing a video b. Prepare the child before any unfamiliar trea ment or procedure by demonstrating on a stuffed animal. c. Help the child accept the loss of control asso ciated with hospitalization. d. Help the child accept pain that is connected with a treatment or procedure.
  • 7. a. Staff is concerned about the nurse’s actions with the patient and family. b. Staff assignments allow the nurse to care fo same patient and family over an extended time. c. Nurse is able to withdraw emotionally whe emotional overload occurs but still remains committed. d. Nurse uses teaching skills to instruct patient and family rather than doing everything for them. ANSWER: A An clue to a nontherapeutic staff-patient relationship is concern of other staff members. Allowing the nurse to care for the same patient over time would be therapeutic for the patient and family. Nurses who are able to somewhat withdraw emotionally can protect themselves while providing therapeutic care. Nurses using teaching skills to instruct patient and family will assist in transi- tioning the child and family to self-care. DIF: Cognitive Level: Analyze REF: p. 8 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity 12. Which is most descriptive of clinical reasoning? a. A simple developmental process b. Purposeful and goal-directed c. Based on deliberate and irrational thought d. Assists individuals in guessing what is most appropriate ANSWER: B Clinical reasoning is a complex, developmental process based on rational and deliberate thought. Clinical reasoning is not a developmental process. Clinical reasoning is based on rational and de- liberate thought. Clinical reasoning is not a guessing process. DIF: Cognitive Level: Understand REF: p. 10 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care 13. A nurse makes the decision to apply a topical anesthetic to a child’s skin before drawing blood. Which ethical principle is the nurse demonstrating? a. Autonomy b. Beneficence c. Justice d. Truthfulness ANSWER: B Beneficence is the obligation to promote the patient’s well-being. Applying a topical anesthetic before drawing blood promotes reducing the discomfort of the venipuncture. Autonomy is the
  • 8. patient’s right to be self-governing. Justice is the concept of fairness. Truthfulness is the concept of honesty. DIF: Cognitive Level: Understand REF: p. 10 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiological Integrity 14. Which action by the nurse demonstrates use of evidence-based practice (EBP)? a. Gathering equipment for a procedure b. Documenting changes in a patient’s status c. Questioning the use of daily central line dressing changes d. Clarifying a physician’s prescription for mo phine ANSWER: C The nurse who questions the daily central line dressing change is ascertaining whether clinical interventions result in positive outcomes for patients. This demonstrates EBP, which implies questioning why something is effective and whether a better approach exists. Gathering equip- ment for a procedure and documenting changes in a patient’s status are practices that follow es- tablished guidelines. Clarifying a physician’s prescription for morphine constitutes safe nursing care. DIF: Cognitive Level: Apply REF: p. 10 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care 15. A nurse is admitting a toddler to the hospital. The toddler is with both parents and is currently sit- ting comfortably on a parent’s lap. The parents state they will need to leave for a brief period. Which type of nursing diagnosis should the nurse formulate for this child? a. Risk for anxiety b. Anxiety c. Readiness for enhanced coping d. Ineffective coping ANSWER: A A potential problem is categorized as a risk. The toddler has a risk to become anxious when the parents leave. Nursing interventions will be geared toward reducing the risk. The child is not showing current anxiety or ineffective coping. The child is not at a point for readiness for en- hanced coping, especially because the parents will be leaving. DIF: Cognitive Level: Remember REF: p. 11 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance 16. A child has a postoperative appendectomy incision covered by a dressing. The nurse has just completed a prescribed dressing change for this child. Which description is an accurate docu- mentation of this procedure? a. Dressing change to appendectomy incision
  • 9. ed ANSWER: C The nurse should document assessments and reassessments. Appearance of the incision described in objective terms should be included during a dressing change. The nurse should document pa- tient’s response and the outcomes of the care provided. In this example, these include drainage on the old dressing, the application of the new dressing, and the child’s response. The other state- ments partially fulfill the requirements of documenting assessments and reassessments, patient’s response, and outcome, but do not include all three. DIF: Cognitive Level: Analyze REF: p. 12 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care 17. A nurse is planning a class on accident prevention for parents of toddlers. Which safety topic is the priority for this class? a. Appropriate use of car seat restraints b. Safety crossing the street c. Helmet use when riding a bicycle d. Poison control numbers ANSWER: A Motor vehicle accidents (MVAs) continue to be the most common cause of death in children older than 1 year, therefore the priority topic is appropriate use of car seat restraints. Safety crossing the street and bicycle helmet use are topics that should be included for preschool parents but are not priorities for parents of toddlers. Information about poison control is important for parents of toddlers and would be a safety topic to include but is not the priority over appropriate use of car seat restraints. DIF: Cognitive Level: Apply REF: p. 3 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 18. A nurse is collecting subjective and objective information about target populations to diagnose problems based on community needs. This describes which step in the community nursing process? a. Planning completed, child tolerated procedure well, parent present b. No complications noted during dressing change to appendectomy incision c. Appendectomy incision non-reddened, su- tures intact, no drainage noted on old dress- ing, new dressing applied, procedure tolerat well by child d. No changes to appendectomy incisional area, dressing changed, child complained of pain during procedure, new dressing clean, dry and intact
  • 10. b. Diagnosis c. Assessment d. Establishing objectives ANSWER: C The nursing process stages are similar, whether the client is one child or a population of children. The assessment phase of the nursing process focuses on collecting subjective and objective data. Planning is the development of community-centered goals and objectives. Diagnosis is the iden- tification of problems specific to the community. DIF: Cognitive Level: Understand REF: p. 11 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care 19. A nurse is establishing several health programs, such as bicycle safety, to improve the health sta- tus of a target population. This describes which step in the community nursing process? a. Planning b. Evaluation c. Assessment d. Implementation ANSWER: D The nurse working with the community to put into practice a program to reach community goals is the implementation phase of the community nursing process. Planning involves designing the program to meet community-centered goals. The evaluation stage would determine the effective- ness of the program. During the assessment phase, the nurse would identify the resources neces- sary and the barriers that would interfere with implementation. DIF: Cognitive Level: Understand REF: p. 11 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care 20. A school nurse is conducting vision and hearing testing on fifth-grade children. Which level of prevention is the nurse demonstrating? a. Primary b. Secondary c. Tertiary d. Health promotion ANSWER: B Secondary prevention focuses on screening and early diagnosis of disease. Vision and hearing testing are screening tests to detect problems. Primary prevention focuses on health promotion and prevention of disease or injury. Tertiary prevention focuses on optimizing function for chil- dren with a disability or chronic disease. Health promotion is focused on preventing disease or illness. DIF: Cognitive Level: Understand REF: p. 2 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance
  • 11. 21. The home health nurse asks a child’s mother many questions as part of the assessment. The mother answers many questions, then stops and says, “I don’t know why you ask me all this. Who gets to know this information?” The nurse should take which action? a. Determine why the mother is so suspicious. b. Determine what the mother does not want t tell. c. Explain who will have access to the inform tion. d. Explain that everything is confidential and that no one else will know what is said. ANSWER: C Communication with the family should not be invasive. The nurse needs to explain the impor- tance of collecting the information, its applicability to the child’s care, and who will have access to the information. The mother is not being suspicious and is not necessarily withholding impor- tant information. She has a right to understand how the information she provides will be used. The nurse will need to share, through both oral and written communication, clinically relevant information with other involved health professionals. DIF: Cognitive Level: Apply REF: p. 9 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care 22. When communicating with other professionals, what is important for the nurse to do? e. ANSWER: C The nurse will need to share, through both oral and written communication, clinically relevant information with other involved health professionals. Asking others what they want to know and sharing everything known about the family is inappropriate. Patients have a right to confidential- ity. The nurse is not permitted to share information about clients, except clinically relevant infor- mation that pertains to the child’s care. Confidentiality permits the disclosure of information to other health professionals on a need-to-know basis. DIF: Cognitive Level: Apply REF: p. 9 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care 23. A nurse manager at a home-care agency is planning a continuing education program for the home-care staff nurses. Which type of continuing education program should the nurse manager plan? a. On-line training modules b. A structured written teaching module each nurse completes individually a. Ask others what they want to know. b. Share everything known about the family. c. Restrict communication to clinically releva information. d. Recognize that confidentiality is not possibl
  • 12. l ANSWER: C Because of the unique practice environment of home care nurses, it is important for an agency to facilitate sharing among peers to decrease work-related stress, increase job satisfaction, and sup- port high-quality patient care. On-line training, written teaching modules, and one-on-one train- ing would not allow for any sharing with peers. DIF: Cognitive Level: Apply REF: p. 7 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Which behaviors by the nurse indicate a therapeutic relationship with children and families? (Se- lect all that apply.) - ANSWER: B, C, E Asking questions if families are not participating in the care, clarifying information for families, and learning about the family’s religious preferences are positive actions and foster therapeutic relationships with children and families. Spending off-duty time with children and families and buying toys for a hospitalized child are negative actions and indicate overinvolvement with chil- dren and families, which is nontherapeutic. DIF: Cognitive Level: Understand REF: p. 8 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Psychosocial Integrity 2. Which behaviors by the nurse indicate therapeutic nurse-family boundaries? (Select all that ap- ply.) a. Nurse visits family on days off. b. House rules are negotiated. c. Nurse buys child expensive gifts. d. Communication is open and two-way. ANSWER: B, D A home care nurse can establish therapeutic nurse-family boundaries by negotiating house rules c. A workshop training day, with a professiona speaker, where nurses can interact with eac other d. One-on-one continuing education training with each nurse a. Spending off-duty time with children and families b. Asking questions if families are not partici- pating in the care c. Clarifying information for families d. Buying toys for a hospitalized child e. Learning about the family’s religious prefer ences
  • 13. and ensuring that communication is open and two-way. Visiting the family of off-duty days and buying expensive gifts for the child would be boundary crossing and nontherapeutic. DIF: Cognitive Level: Analyze REF: p. 8 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Psychosocial Integrity OTHER 1. A nurse is formulating a clinical question for evidence-based practice. Place in order the steps the nurse should use to clarify the scope of the problem and clinical topic of interest. Begin with the first step of the process and proceed ordering the steps ending with the final step of the process. Provide answer as lowercase letters separated by commas (e.g., a, b, c, d, e). a. Intervention b. Outcome c. Population d. Time e. Control ANSWER: c, a, e, b, d When formulating a clinical question for evidence-based practice, the nurse should follow a con- cise, organized way that allows for clear answers. Good clinical questions should be asked in the PICOT (population, intervention, control, outcome, time) format to assist with clarity and litera- ture searching. PICOT questions assist with clarifying the scope of the problem and clinical topic of interest. DIF: Cognitive Level: Understand REF: p. 10 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance Chapter 02: Family, Social, Cultural, and Religious Influences on Child Health Promotion Hockenberry: Wong’s Essentials of Pediatric Nursing, 11th Edition MULTIPLE CHOICE 1. A nurse is selecting a family theory to assess a patient’s family dynamics. Which family theory best describes a series of tasks for the family throughout its life span? a. Interactional theory b. Developmental systems theory c. Structural-functional theory d. Duvall’s developmental theory
  • 14. ANSWER: D Duvall’s developmental theory describes eight developmental tasks of the family throughout its life span. Interactional theory and structural-functional theory are not family theories. Developmental systems theory is an outgrowth of Duvall’s theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. DIF: Cognitive Level: Understand REF: p. 17 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 2. Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Interactional theory b. Developmental systems theory c. Family stress theory d. Duvall’s developmental theory ANSWER: C Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction. Interactional theory is not a family theory. Interactions are the basis of general systems theory. Developmental systems theory is an outgrowth of Duvall’s theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. Duvall’s developmental theory describes eight developmental tasks of the family throughout its life span. DIF: Cognitive Level: Understand REF: p. 16 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 3. Which is the term for a family in which the paternal grandmother, the parents, and two minor children live together? a. Blended b. Nuclear c. Binuclear d. Extended ANSWER: D An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one stepparent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.
  • 15. DIF: Cognitive Level: Remember REF: p. 18 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 4. A nurse is assessing a family’s structure. Which describes a family in which a mother, her children, and a stepfather live together? a. Blended b. Nuclear c. Binuclear d. Extended ANSWER: A A blended family contains at least one stepparent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. DIF: Cognitive Level: Understand REF: p. 18 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 5. Parents of a firstborn child are asking whether it is normal for their child to be extremely competitive. The nurse should respond to the parents that studies about the ordinal position of children suggest that firstborn children tend to: a. be praised less often. b. be more achievement oriented. c. be more popular with the peer group. d. identify with peer group more than parents. ANSWER: B Firstborn children, like only children, tend to be more achievement oriented. Being praised less often, being more popular with the peer group, and identifying with peer groups more than parents are characteristics of later-born children. DIF: Cognitive Level: Apply REF: p. 29 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance 6. The nurse is teaching a group of new parents about the experience of role transition. Which statement by a parent would indicate a correct understanding of the teaching? a. “My marital relationship can have a positive or negative effect on the role transition.” b. “If an infant has special care needs, the parents’ sense of confidence in their new role is strengthened.” c. “Young parents can adjust to the new role easier than older parents.” d. “A parent’s previous experience with children makes the role transition more difficult.”
  • 16. ANSWER: A If parents are supportive of each other, they can serve as positive influences on establishing satisfying parental roles. When marital tensions alter caregiving routines and interfere with the enjoyment of the infant, then the marital relationship has a negative effect. Infants with special care needs can be a significant source of added stress. Older parents are usually more able to cope with the greater financial responsibilities, changes in sleeping habits, and reduced time for each other and other children. Parents who have previous experience with parenting appear more relaxed, have less conflict in disciplinary relationships, and are more aware of normal growth and development. DIF: Cognitive Level: Understand REF: p. 17 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance 7. When assessing a family, the nurse determines that the parents exert little or no control over their children. What is this style of parenting called? a. Permissive b. Dictatorial c. Democratic d. Authoritarian ANSWER: A Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their children’s actions. Dictatorial or authoritarian parents attempt to control their children’s behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their children’s behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect the child’s individual nature. DIF: Cognitive Level: Remember REF: p. 20 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance 8. When discussing discipline with the mother of a 4-year-old child, the nurse should include which instruction? a. Children as young as 4 years old rarely need to be punished. b. Parental control should be consistent. c. Withdrawal of love and approval is effective at this age. d. One should expect rules to be followed rigidly and unquestioningly. ANSWER: B
  • 17. For effective discipline, parents must be consistent and must follow through with agreed-on actions. Realistic goals should be set for this age group. Parents should structure the environment to prevent unnecessary difficulties. Requests for behavior change should be phrased in a positive manner to provide direction for the child. Withdrawal of love and approval is never appropriate or effective. Discipline strategies should be appropriate to the child’s age, temperament, and severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old. DIF: Cognitive Level: Apply REF: p. 20 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 9. Which is most characteristic of the physical punishment of children, such as spanking? a. Psychological impact is usually minimal. b. Children rarely become accustomed to spanking. c. Children’s development of reasoning increases. d. Misbehavior is likely to occur when parents are not present. ANSWER: D Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake, but rather out of fear of punishment. Spanking can cause severe physical and psychological injury and interfere with effective parent-child interaction. Children do become accustomed to spanking, requiring more severe corporal punishment each time. The use of corporal punishment may interfere with the child’s development of moral reasoning. DIF: Cognitive Level: Understand REF: p. 20 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 10. A 3-year-old girl was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guidelines concerning adoption should the nurse use in planning a response? a. Telling the child is an important aspect of their parental responsibilities. b. The best time to tell the child is between ages 7 and 10 years. c. It is not necessary to tell the child who was adopted so young. d. It is best to wait until the child asks about it. ANSWER: A It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the child’s identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to keep third parties from telling the children before the parents have had the opportunity. DIF: Cognitive Level: Understand REF: p. 22 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance
  • 18. 11. A parent of a school-age child is going through a divorce. The parent tells the school nurse the child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as which implication? a. Indication of maladjustment b. Common reaction to divorce c. Lack of adequate parenting d. Unusual response that indicates need for referral ANSWER: B Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. This is not an indication of maladjustment, suggestive of lack of adequate parenting, or an unusual response that indicates need for referral in school-age children after parental divorce. DIF: Cognitive Level: Apply REF: p. 24 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Psychosocial Integrity 12. A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, “I want to go back to work, but I don’t want Eric to suffer because I’ll have less time with him.” The nurse’s most appropriate answer would be which statement? a. “I’m sure he’ll be fine if you get a good babysitter.” b. “You will need to stay home until Eric starts school.” c. “You should go back to work so Eric will get used to being with others.” d. “Let’s talk about the child care options that will be best for Eric.” ANSWER: D Let’s talk about the child care options that will be best for Eric is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. I’m sure he’ll be fine if you get a good babysitter, You will need to stay home until Eric starts school, and You should go back to work so Eric will get used to being with others are directive statements. They do not address the effect of her working on Eric. DIF: Cognitive Level: Apply REF: p. 27 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 13. Which term best describes a group of people who share a set of values, beliefs, practices, social relationships, law, politics, economics, and norms of behavior? a. Race b. Culture c. Ethnicity d. Social group ANSWER: B
  • 19. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perceptions and judgments. Race is defined as a division of humankind possessing traits that are transmissible by descent and are sufficient to characterize it as a distinct human type. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. A social group consists of systems of roles carried out in groups. Examples of primary social groups include the family and peer groups. DIF: Cognitive Level: Remember REF: p. 29 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity 14. Which term best describes the emotional attitude that one’s own ethnic group is superior to others? a. Culture b. Ethnicity c. Superiority d. Ethnocentrism ANSWER: D Ethnocentrism is the belief that one’s way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of one’s ethnic group are superior to those of others. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serves as a frame of reference for individual perception and judgments. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. Superiority is the state or quality of being superior; it does not include ethnicity. DIF: Cognitive Level: Understand REF: p. 30 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Dunst, Trivette, and Deal identified the qualities of strong families that help them function effectively. Which qualities are included? (Select all that apply.) a. Ability to stay connected without spending time together b. Clear set of family values, rules, and beliefs c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events d. Sense of commitment toward growth of individual family members as opposed to that of the family unit e. Ability to engage in problem-solving activities f. Sense of balance between the use of internal and external family resources ANSWER: B, E, F
  • 20. A clear set of family rules, values, and beliefs that establishes expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families also are able to engage in problem-solving activities and to find a balance between internal and external forces. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Strong families also use varied coping strategies. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit. DIF: Cognitive Level: Understand REF: p. 19 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance 2. A nurse is conducting a teaching session on the use of time-out as a discipline measure to parents of toddlers. Which are correct strategies the nurse should include in the teaching session? (Select all that apply.) a. Time-out as a discipline measure cannot be used when in a public place. b. A rule for the length of time-out is 1 minute per year. c. When the child misbehaves, one warning should be given. d. The area for time-out can be in the family room where the child can see the television. e. When the child is quiet for the specified time, he or she can leave the room. ANSWER: B, C, E A rule for the length of time-out is 1 minute per year of age; use a kitchen timer with an audible bell to record the time rather than a watch. When the child misbehaves, one warning should be given. When the child is quiet for the duration of the time, he or she can then leave the room. Time-out can be used in public places and the parents should be consistent on the use of time-out. Implement time-out in a public place by selecting a suitable area or explain to children that time-out will be spent immediately on returning home. The time-out should not be spent in an area from which the child can view the television. Select an area for time- out that is safe, convenient, and unstimulating but where the child can be monitored, such as the bathroom, hallway, or laundry room. DIF: Cognitive Level: Apply REF: p. 21 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 3. Divorced parents of a preschool child are asking whether their child will display any feelings or behaviors related to the effect of the divorce. The nurse is correct when explaining that the parents should be prepared for which types of behaviors? (Select all that apply.) a. Displaying fears of abandonment b. Verbalizing that he or she “is the reason for the divorce” c. Displaying fear regarding the future d. Ability to disengage from the divorce proceedings e. Engaging in fantasy to understand the divorce ANSWER: A, B, E
  • 21. A child 3 to 5 years of age (preschool) may display fears of abandonment, verbalize feelings that he or she is the reason for the divorce, and engage in fantasy to understand the divorce. He or she would not be displaying fear regarding the future until school age, and the ability to disengage from the divorce proceedings would be characteristic of an adolescent. DIF: Cognitive Level: Apply REF: p. 24 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Teaching and Learning COMPLETION 1. A nurse is admitting a child, in foster care, to the hospital. The nurse recognizes that foster parents care for the child hours a day. (Record your answer as a whole number.) ANSWER: 24 The term foster care is defined as 24-hour substitute care for children outside of their own homes. DIF: Cognitive Level: Understand REF: p. 27 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance Chapter 03: Developmental and Genetic Influences on Child Health Promotion Hockenberry: Wong’s Essentials of Pediatric Nursing, 11th Edition MULTIPLE CHOICE 1. An infant gains head control before sitting unassisted. The nurse recognizes that this is which type of development? a. Cephalocaudal b. Proximodistal c. Mass to specific d. Sequential ANSWER: A The pattern of development that is head-to-tail, or cephalocaudal, direction is described by an infant’s ability to gain head control before sitting unassisted. The head end of the organism develops first and is large and complex, whereas the lower end is smaller and simpler, and development takes place at a later time. Proximodistal, or near to far, is another pattern of development. Limb buds develop before fingers and toes. Postnatally, the child has control of the shoulder before achieving mastery of the hands. Mass to specific is not a specific pattern of development. In all dimensions of growth, a definite, sequential pattern is followed. DIF: Cognitive Level: Understand REF: p. 38
  • 22. TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 2. Which refers to those times in an individual’s life when he or she is more susceptible to positive or negative influences? a. Sensitive period b. Sequential period c. Terminal points d. Differentiation points ANSWER: A Sensitive periods are limited times during the process of growth when the organism will interact with a particular environment in a specific manner. These times make the organism more susceptible to positive or negative influences. The sequential period, terminal points, and differentiation points are developmental times that do not make the organism more susceptible to environmental interaction. DIF: Cognitive Level: Remember REF: p. 39 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 3. An infant who weighs 7 pounds at birth would be expected to weigh how many pounds at age 1 year? a. 14 b. 16 c. 18 d. 21 ANSWER: D In general, birth weight triples by the end of the first year of life. For an infant who was 7 pounds at birth, 21 pounds would be the anticipated weight at the first birthday; 14, 16, or 18 pounds is below what would be expected for an infant with a birth weight of 7 pounds. DIF: Cognitive Level: Understand REF: p. 41 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 4. By what age does birth length usually double? a. 1 year b. 2 years c. 4 years d. 6 years ANSWER: C Linear growth or height occurs almost entirely as a result of skeletal growth and is considered a stable measurement of general growth. On average, most children have doubled their birth length at age 4 years. One and 2 years are too young for doubling of length. Most children will have achieved the doubling by age 4 years. DIF: Cognitive Level: Remember REF: p. 41
  • 23. TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 5. Parents of an 8-year-old child ask the nurse how many inches their child should grow each year. The nurse bases the answer on the knowledge that after age 7 years, school-age children usually grow what number of inches per year? a. 1 b. 2 c. 3 d. 4 ANSWER: B The growth velocity after age 7 years is approximately 5 cm (2 inches) per year. One inch is too small an amount. Three and 4 inches are greater than the average yearly growth after age 7 years. DIF: Cognitive Level: Apply REF: p. 41 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance 6. Parents express concern that their pubertal daughter is taller than the boys in her class. The nurse should respond with which statement regarding how the onset of pubertal growth spurt compares in girls and boys? a. It occurs earlier in boys. b. It occurs earlier in girls. c. It is about the same in both boys and girls. d. In both boys and girls, the pubertal growth spurt depends on growth in infancy. ANSWER: B Usually, the pubertal growth spurt begins earlier in girls. It typically occurs between the ages of 10 and 14 years for girls and 11 and 16 years for boys. The average earliest age at onset is 1 year earlier for girls. There does not appear to be a relation to growth during infancy. DIF: Cognitive Level: Apply REF: p. 41 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance 7. A 13-year-old girl asks the nurse how much taller she will get. She has been growing about 2 inches per year but grew 4 inches this past year. Menarche recently occurred. The nurse should base her response on which statement? a. Growth cannot be predicted. b. Pubertal growth spurt lasts about 1 year. c. Mature height is achieved when menarche occurs. d. Approximately 95% of mature height is achieved when menarche occurs. ANSWER: D
  • 24. At the time of the beginning of menstruation or the skeletal age of 13 years, most girls have grown to about 95% of their adult height. They may have some additional growth (5%) until the epiphyseal plates are closed. Although growth cannot be definitively predicted, on average, 95% of adult height has been reached with the onset of menstruation. Pubertal growth spurt lasts about 1 year does not address the girl’s question. Young women usually will grow approximately 5% more after the onset of menstruation. DIF: Cognitive Level: Apply REF: p. 41 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 8. How is a child’s skeletal age best determined? a. Assessment of dentition b. Assessment of height over time c. Facial bone development d. Radiographs of the hand and wrist ANSWER: D The most accurate measure of skeletal age is radiologic examinations of the growth plates. These are the epiphyseal cartilage plates. Radiographs of the hand and wrist provide the most useful screening to determine skeletal age. Age of tooth eruption has considerable variation in children. It would not be a good determinant of skeletal age. Assessment of height over time will provide a record of the child’s height but not skeletal age. Facial bone development will not reflect the child’s skeletal age, which is determined by radiographic assessment. DIF: Cognitive Level: Remember REF: p. 41 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 9. Trauma to which site can result in a growth problem for children’s long bones? a. Matrix b. Connective tissue c. Calcified cartilage d. Epiphyseal cartilage plate ANSWER: D The epiphyseal cartilage plate is the area of active growth. Bone injury at the epiphyseal plate can significantly affect subsequent growth and development. Trauma or infection can result in deformity. The matrix, connective tissue, and calcified cartilage are not areas of active growth. Trauma in these sites will not result in growth problems for the long bones. DIF: Cognitive Level: Comprehend REF: p. 41 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 10. A nurse has completed a teaching session for adolescents regarding lymphoid tissue growth. Which statement, by the adolescents, indicates understanding of the teaching? a. The tissue reaches adult size by age 1 year. b. The tissue quits growing by 6 years of age. c. The tissue is poorly developed at birth.
  • 25. d. The tissue is twice the adult size by ages 10 to 12 years. ANSWER: D Lymphoid tissue continues growing until it reaches maximal development at ages 10 to 12 years, which is twice its adult size. A rapid decline in size occurs until it reaches adult size by the end of adolescence. The tissue reaches adult size at 6 years of age but continues to grow. The tissue is well developed at birth. DIF: Cognitive Level: Analyze REF: p. 42 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance 11. Which statement is true about the basal metabolic rate (BMR) in children? a. It is reduced by fever. b. It is slightly higher in boys than in girls at all ages. c. It increases with age of child. d. It decreases as proportion of surface area to body mass increases. ANSWER: B The BMR is the rate of metabolism when the body is at rest. At all ages, the rate is slightly higher in boys than in girls. The rate is increased by fever. The BMR is highest in infancy and then closely relates to the proportion of surface area to body mass. As the child grows, the proportion decreases progressively to maturity. DIF: Cognitive Level: Understand REF: p. 42 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development 12. A mother reports that her 6-year-old child is highly active, irritable, and irregular in habits and that the child adapts slowly to new routines, people, or situations. How should the nurse chart this type of temperament? a. Easy b. Difficult c. Slow-to-warm-up d. Fast-to-warm-up ANSWER: B Being highly active, irritable, irregular in habits, and adapting slowly to new routines, people, or situations is a description of difficult children, which compose about 10% of the population. Negative withdrawal responses are typical of this type of child, who requires a more structured environment. Mood expressions are usually intense and primarily negative. These children exhibit frequent periods of crying and often violent tantrums. Easy children are even tempered, regular, and predictable in their habits. They are open and adaptable to change. Approximately 40% of children fit this description. Slow-to-warm-up children typically react negatively and with mild intensity to new stimuli and adapt slowly with repeated contact. Approximately 10% of children fit this description. “Fast-to-warm-up” is not one of the categories identified. DIF: Cognitive Level: Apply REF: p. 43 TOP: Integrated Process: Communication and Documentation
  • 26. MSC: Area of Client Needs: Health Promotion and Maintenance 13. A 12-year-old child enjoys collecting stamps, playing soccer, and participating in Boy Scout activities. The nurse recognizes that the child is displaying which developmental task? a. Identity b. Industry c. Integrity d. Intimacy ANSWER: B Industry is engaging in tasks that can be carried through to completion, learning to compete and cooperate with others, and learning rules. Industry is the developmental task characteristic of the school-age child. Identity is the developmental task of adolescence. Integrity and intimacy are not developmental tasks of childhood. DIF: Cognitive Level: Understand REF: p. 38 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 14. A nurse is conducting parenting classes for parents of children ranging in ages 2 to 7 years. The parents understand the term egocentrism when they indicate it meANSWER: a. selfishness. b. self-centeredness. c. preferring to play alone. d. unable to put self in another’s place. ANSWER: D According to Piaget, children ages 2 to 7 years are in the preoperational stage of development. Children interpret objects and events not in terms of their general properties but in terms of their relationships or their use to them. This egocentrism does not allow children of this age to put themselves in another’s place. Selfishness, self-centeredness, and preferring to play alone do not describe the concept of egocentricity. DIF: Cognitive Level: Apply REF: p. 45 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance 15. The nurse is observing parents playing with their 10-month-old child. Which should the nurse recognize as evidence that the child is developing object permanence? a. Looks for the toy that parents hide under the blanket b. Returns the blocks to the same spot on the table c. Recognizes that a ball of clay is the same when flattened out d. Bangs two cubes held in her hands ANSWER: A
  • 27. Object permanence is the realization that items that leave the visual field still exist. When the infant searches for the toy under the blanket, it is an indication that object permanence has developed. Returning the blocks to the same spot on the table is not an example of object permanence. Recognizing that a ball of clay is the same when flattened out is an example of conservation, which occurs during the concrete operations stage from 7 to 11 years. Banging two cubes together is a simple repetitive activity characteristic of developing a sense of cause and effect. DIF: Cognitive Level: Apply REF: p. 45 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 16. A father tells the nurse that his child is “filling up the house with collections” like seashells, bottle caps, baseball cards, and pennies. What should the nurse recognize the child is developing? a. Object permanence b. Preoperational thinking c. Concrete operational thinking d. Ability to use abstract symbols ANSWER: C During concrete operations, children develop logical thought processes. They are able to classify, sort, order, and otherwise organize facts about the world. This ability fosters the child’s ability to create collections. Object permanence is the realization that items that leave the visual field still exist. This is a task of infancy and does not contribute to collections. Preoperational thinking is concrete and tangible. Children in this age group cannot reason beyond the observable, and they lack the ability to make deductions or generalizations. Collections are not typical for this developmental level. The ability to use abstract symbols is a characteristic of formal operations, which develops during adolescence. These children can develop and test hypotheses. DIF: Cognitive Level: Understand REF: p. 45 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 17. A visitor arrives at a daycare center during lunchtime. The preschool children think that every time they have lunch a visitor will arrive. Which preoperational characteristic is being displayed? a. Egocentrism b. Transductive reasoning c. Intuitive reasoning d. Conservation ANSWER: B
  • 28. Transductive reasoning is when two events occur together, they cause each other. The expectation that every time lunch is served a visitor will arrive is descriptive of transductive reasoning. Egocentrism is the inability to see things from any perspective than their own. Intuitive reasoning (e.g., the stars have to go to bed just as they do) is predominantly egocentric thought. Conservation (able to realize that physical factors such as volume, weight, and number remain the same even though outward appearances are changed) does not occur until school age. DIF: Cognitive Level: Analyze REF: p. 44 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance 18. Which behavior is most characteristic of the concrete operations stage of cognitive development? a. Progression from reflex activity to imitative behavior b. Inability to put oneself in another’s place c. Increasingly logical and coherent thought processes d. Ability to think in abstract terms and draw logical conclusions ANSWER: C During the concrete operations stage of development, which occurs approximately between ages 7 and 11 years, increasingly logical and coherent thought processes occur. This is characterized by the child’s ability to classify, sort, order, and organize facts to use in problem solving. The progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage of development. The inability to put oneself in another’s place is characteristic of the preoperational stage of development. The ability to think in abstract terms and draw logical conclusions is characteristic of the formal operations stage of development. DIF: Cognitive Level: Understand REF: p. 45 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 19. According to Kohlberg, children develop moral reasoning as they mature. Which statement is most characteristic of a preschooler’s stage of moral development? a. Obeying the rules of correct behavior is important. b. Showing respect for authority is important behavior. c. Behavior that pleases others is considered good. d. Actions are determined as good or bad in terms of their consequences. ANSWER: D Preschoolers are most likely to exhibit characteristics of Kohlberg’s preconventional level of moral development. During this stage, they are culturally oriented to labels of good or bad, right or wrong. Children integrate these concepts based on the physical or pleasurable consequences of their actions. Obeying the rules of correct behavior, showing respect for authority, and engaging in behavior that pleases others are characteristics of Kohlberg’s conventional level of moral development. DIF: Cognitive Level: Understand REF: p. 46
  • 29. TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 20. A school nurse notes that school-age children generally obey the rules at school. The nurse recognizes that the children are displaying which stage of moral development? a. Preconventional b. Conventional c. Postconventional d. Undifferentiated ANSWER: B Conventional stage of moral development is described as obeying the rules, doing one’s duty, showing respect for authority, and maintaining the social order. This stage is characteristic of school-age children’s behavior. The preconventional stage is characteristic of the toddler and preschool age. At this stage, the child has no concept of the basic moral order that supports being good or bad. The postconventional level is characteristic of an adolescent and occurs at the formal stage of operation. Undifferentiated describes an infant’s understanding of moral development. DIF: Cognitive Level: Analyze REF: p. 46 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance 21. A nurse observes a toddler playing with sand and water. How should the nurse document this type of play? a. Skill b. Dramatic c. Social-affective d. Sense-pleasure ANSWER: D The toddler playing with sand and water is engaging in sense-pleasure play. This is characterized by nonsocial situations in which the child is stimulated by objects in the environment. Infants engage in skill play when they persistently demonstrate and exercise newly acquired abilities. Dramatic play is the predominant form of play in the preschool period. Children pretend and fantasize. Social-affective play is one of the first types of play in which infants engage. The infant responds to interactions with people. DIF: Cognitive Level: Apply REF: p. 47 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Health Promotion and Maintenance 22. In which type of play are children engaged in similar or identical activity, without organization, division of labor, or mutual goal? a. Solitary b. Parallel c. Associative d. Cooperative ANSWER: C
  • 30. In associative play, no group goal is present. Each child acts according to his or her own wishes. Although the children may be involved in similar activities, no organization, division of labor, leadership assignment, or mutual goal exists. Solitary play describes children playing alone with toys different from those used by other children in the same area. Parallel play describes children playing independently but being among other children. Cooperative play is organized. Children play in a group with other children who play in activities for a common goal. DIF: Cognitive Level: Understand REF: p. 48 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 23. The nurse observes some children in the playroom. Which play situation exhibits the characteristics of parallel play? a. Kimberly and Amanda sharing clay to each make things b. Brian playing with his truck next to Kristina playing with her truck c. Adam playing a board game with Kyle, Steven, and Erich d. Danielle playing with a music box on her mother’s lap ANSWER: B Playing with trucks next to each other but not together is an example of parallel play. Both children are engaged in similar activities in proximity to each other; however, they are each engaged in their own play. Sharing clay to make things is characteristic of associative play. Friends playing a board game together is characteristic of cooperative play. A child playing with something by herself on her mother’s lap is an example of solitary play. DIF: Cognitive Level: Analyze REF: p. 48 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 24. A nurse is planning play activities for school-age children. Which type of a play activity should the nurse plan? a. Solitary b. Parallel c. Associative d. Cooperative ANSWER: D School-age children engage in cooperative play where it is organized and interactive. Playing a game is a good example of cooperative play. Solitary play is appropriate for infants, parallel play is an activity appropriate for toddlers, and associative play is an activity appropriate for preschool-age children. DIF: Cognitive Level: Apply REF: p. 48 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 25. Which following function of play is a major component of play at all ages? a. Creativity b. Socialization
  • 31. c. Intellectual development d. Sensorimotor activity ANSWER: D Sensorimotor activity is a major component of play at all ages. Active play is essential for muscle development and allows the release of surplus energy. Through sensorimotor play, children explore their physical world by using tactile, auditory, visual, and kinesthetic stimulation. Creativity, socialization, and intellectual development are each functions of play that are major components at different ages. DIF: Cognitive Level: Understand REF: p. 49 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance: Developmental Stages and Transitions 26. Parents are asking the clinic nurse about an appropriate toy for their toddler. Which response by the nurse is appropriate? a. “Your child would enjoy playing a board game.” b. “A toy your child can push or pull would help develop muscles.” c. “An action figure toy would be a good choice.” d. “A 25-piece puzzle would help your child develop recognition of shapes.” ANSWER: B Toys should be appropriate for the child’s age. A toddler would benefit from a toy he or she could push or pull. The child is too young for a board game, action figure, or 25-piece puzzle. DIF: Cognitive Level: Apply REF: p. 50 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 27. Which is probably the single most important influence on growth at all stages of development? a. Nutrition b. Heredity c. Culture d. Environment ANSWER: A Nutrition is the single most important influence on growth. Dietary factors regulate growth at all stages of development, and their effects are exerted in numerous and complex ways. Adequate nutrition is closely related to good health throughout life. Heredity, culture, and environment contribute to the child’s growth and development. However, good nutrition is essential throughout the life span for optimal health. DIF: Cognitive Level: Understand REF: p. 43 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 28. A nurse is counseling an adolescent, in her second month of pregnancy, about the risk of teratogens. The adolescent has understood the teaching if she makes which statement?
  • 32. a. “I will be able to continue taking isotretinoin (Accutane) for my acne.” b. “I can continue to clean my cat’s litter box.” c. “I should avoid any alcoholic beverages.” d. “I will ask my physician to adjust my phenytoin (Dilantin) dosage.” ANSWER: C Teratogens are agents that cause birth defects when present in the prenatal period. Avoidance of alcoholic beverages is recommended to prevent fetal alcohol syndrome. Isotretinoin (Accutane) and phenytoin (Dilantin) have been shown to have teratogenic effects and should not be taken during pregnancy. Cytomegalovirus, an infectious agent and a teratogen, can be transmitted through cat feces, and cleaning the litter box during pregnancy should be avoided. DIF: Cognitive Level: Analyze REF: p. 52 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 29. What should the nurse consider when discussing language development with parents of toddlers? a. Sentences by toddlers include adverbs and adjectives. b. The toddler expresses himself or herself with verbs or combination words. c. The toddler uses simple sentences. d. Pronouns are used frequently by the toddler. ANSWER: B The first parts of speech used are nouns, sometimes verbs (e.g., “go”), and combination words (e.g., “bye-bye”). Responses are usually structurally incomplete during the toddler period. The preschool child begins to use adjectives and adverbs to qualify nouns followed by adverbs to qualify nouns and verbs. Pronouns are not added until the later preschool years. By the time children enter school, they are able to use simple, structurally complete sentences that average five to seven words. DIF: Cognitive Level: Apply REF: p. 46 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 30. A nurse is observing children at play. Which figure depicts associative play? a. b.
  • 33. c. d. ANSWER: C The children depicted in the figure at the carnival ride are demonstrating associative play. They are engaged in similar or identical activities. The child depicted playing alone is demonstrating solitary play. The children playing on the beach depict parallel play. They are playing side by side but are participating in different activities. The children depicted playing a board game are engaging in cooperative play. DIF: Cognitive Level: Analyze REF: p. 48 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance 31. Which syndrome involves a common sex chromosome defect? a. Down b. Turner c. Marfan d. Hemophilia ANSWER: B Turner syndrome is caused by an absence of one of the X chromosomes. Down syndrome is caused by trisomy 21, three copies rather than two copies of chromosome 21. Marfan syndrome is a connective tissue disorder inherited in an autosomal dominant pattern. Hemophilia is a disorder of blood coagulation inherited in an X-linked recessive pattern. DIF: Cognitive Level: Understand REF: p. 52 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation 32. Turner syndrome is suspected in an adolescent girl with short stature. What is the cause of this syndrome? a. Absence of one of the X chromosomes b. Presence of an incomplete Y chromosome c. Precocious puberty in an otherwise healthy child d. Excess production of both androgens and estrogens
  • 34. ANSWER: A Turner syndrome is caused by an absence of one of the X chromosomes. Most girls who have this disorder have one X chromosome missing from all cells. No Y chromosome is present in individuals with Turner syndrome. This young woman has 45 rather than 46 chromosomes. DIF: Cognitive Level: Understand REF: p. 52 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Play serves many purposes. In teaching parents about appropriate activities, the nurse should inform them that play serves which of the following function? (Select all that apply.) a. Intellectual development b. Physical development c. Socialization d. Creativity e. Temperament development ANSWER: A, C, D A common statement is that play is the work of childhood. Intellectual development is enhanced through the manipulation and exploration of objects. Socialization is encouraged by interpersonal activities and learning of social roles. In addition, creativity is developed through the experimentation characteristic of imaginative play. Physical development depends on many factors; play is not one of them. Temperament refers to behavioral tendencies that are observable from the time of birth. The actual behaviors, but not the child’s temperament attributes, may be modified through play. DIF: Cognitive Level: Understand REF: p. 49 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 2. What factors indicate parents should seek genetic counseling for their child? (Select all that apply.) a. Abnormal newborn screen b. Family history of a hereditary disease c. History of hypertension in the family d. Severe colic as an infant e. Metabolic disorder ANSWER: A, B, E Factors that are indicative parents should seek genetic counseling for their child include an abnormal newborn screen, family history of a hereditary disease, and a metabolic disorder. A history of hypertension or severe colic as an infant is not an indicator of a genetic disease. DIF: Cognitive Level: Understand REF: p. 53 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance
  • 35. 3. A nurse is preparing to administer a Denver II. Which is a correct statement about the Denver II? (Select all that apply.) a. All items intersected by the age line should be administered. b. There is no correction for a child born preterm. c. The tool is an intelligence test. d. Toddlers and preschoolers should be prepared by presenting the test as a game. e. Presentation of the toys from the kit should be done one at a time. ANSWER: A, D, E To identify “cautions,” all items intersected by the age line are administered. Toddlers and preschoolers should be tested by presenting the Denver II as a game. Because children are easily distracted, perform each item quickly and present only one toy from the kit at a time. Before beginning the screening, ask whether the child was born preterm and correctly calculate the adjusted age. Up to 24 months of age, allowances are made for preterm infants by subtracting the number of weeks of missed gestation from their present age and testing them at the adjusted age. Explain to the parents and child, if appropriate, that the screenings are not intelligence tests but rather are a method of showing what the child can do at a particular age. DIF: Cognitive Level: Apply REF: p. 50 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance COMPLETION 1. The nurse is recording a normal interpretation of a Denver II assessment. The nurse understands that the maximum number of cautions determined for a normal interpretation is . (Record your answer in a whole number.) ANSWER: 1 Interpretation of normal for a Denver II is no delays and a maximum of one caution. DIF: Cognitive Level: Apply REF: p. 50 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance OTHER 1. Place in order the sequence of cephalocaudal development that the nurse expects to find in the infant. Begin with the first development expected, sequencing to the final. Provide answers using lowercase letters separated by commas (e.g., a, b, c, d). a. Crawl b. Sit unsupported c. Lift head when prone d. Gain complete head control
  • 36. e. Walk ANSWER: c, d, b, a, e Cephalocaudal development is head-to-tail. Infants achieve structural control of the head before they have control of their trunks and extremities, they lift their head while prone, obtain complete head control, sit unsupported, crawl, and walk sequentially. DIF: Cognitive Level: Apply REF: p. 38 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance Chapter 04: Communication and Physical Assessment of the Child and Family Hockenberry: Wong’s Essentials of Pediatric Nursing, 11th Edition MULTIPLE CHOICE 1. The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the nurse do first? a. Introduce self. b. Make family comfortable. c. Explain purpose of interview. d. Give assurance of privacy. ANSWER: A The first thing that nurses should do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. During the initial part of the interview, the nurse should include general conversation to help make the family feel at ease. Clarification of the purpose of the interview and the nurse’s role is the next thing that should be done. The interview should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality. DIF: Cognitive Level: Apply REF: p. 57 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 2. Which is most likely to encourage parents to talk about their feelings related to their child’s ill- ness? a. Be sympathetic. b. Use direct questions. c. Use open-ended questions. d. Avoid periods of silence. ANSWER: C Closed-ended questions should be avoided when attempting to elicit parents’ feelings. Open-
  • 37. ended questions require the parent to respond with more than a brief answer. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in helping the relationship. Direct questions may obtain limited information. In addition, the parent may consider them threatening. Silence can be an ef- fective interviewing tool. It allows sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. DIF: Cognitive Level: Apply REF: p. 58 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 3. Which communication technique should the nurse avoid when interviewing children and their families? a. Using silence b. Using clichés c. Directing the focus d. Defining the problem ANSWER: B Using stereotyped comments or clichés can block effective communication, and this technique should be avoided. After use of such trite phrases, parents will often not respond. Silence can be an effective interviewing tool. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. To be effective, the nurse must be able to direct the focus of the interview while allowing maximal freedom of expression. By using open-ended questions, along with guiding questions, the nurse can obtain the necessary information and maintain the re- lationship with the family. The nurse and parent must collaborate and define the problem that will be the focus of the nursing intervention. DIF: Cognitive Level: Understand REF: p. 59 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 4. What is the single most important factor to consider when communicating with children? a. The child’s physical condition b. Presence or absence of the child’s parent c. The child’s developmental level d. The child’s nonverbal behaviors ANSWER: C The nurse must be aware of the child’s developmental stage to engage in effective communica- tion. The use of both verbal and nonverbal communication should be appropriate to the develop- mental level. Although the child’s physical condition is a consideration, developmental level is much more important. The parents’ presence is important when communicating with young chil- dren but may be detrimental when speaking with adolescents. Nonverbal behaviors will vary in importance, based on the child’s developmental level. DIF: Cognitive Level: Understand REF: p. 60 TOP: Integrated Process: Communication and Documentation
  • 38. MSC: Area of Client Needs: Psychosocial Integrity 5. Which approach would be best to use to ensure a positive response from a toddler? ly. by ANSWER: A It is important that the nurse assume a position at the child’s level when communicating with the child. By speaking quietly and focusing on the child, the nurse should be able to obtain a positive response. The nurse should engage the child and inform the toddler what is going to occur. If the nurse picks up the child without explanation, the child is most likely going to become upset. The toddler may not understand the meaning of the phrase, “I’m your nurse.” If a positive response is desired, the nurse should assume the child’s level when speaking if possible. DIF: Cognitive Level: Apply REF: p. 60 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 6. What is an important consideration for the nurse who is communicating with a very young child? a. Speak loudly, clearly, and directly. b. Use transition objects, such as a doll. c. Disguise own feelings, attitudes, and anxiety. d. Initiate contact with child when parent is no present. ANSWER: B Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This will facilitate communication with a child this age. Speaking in this manner will tend to increase anxiety in very young children. The nurse must be honest with the child. At- tempts at deception will lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children. DIF: Cognitive Level: Understand REF: p. 61 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Psychosocial Integrity 7. A nurse is preparing to assess a 3-year-old child. What communication technique should the nurse use for this child? a. Focus communication on child. b. Explain experiences of others to child. c. Use easy analogies when possible. d. Assure child that communication is private. ANSWER: A a. Assume an eye-level position and talk quiet b. Call the toddler’s name while picking him o her up. c. Call the toddler’s name and say, “I’m your nurse.” d. Stand by the toddler, addressing him or her name.
  • 39. Because children of this age are able to see things only in terms of themselves, the best approach is to focus communication directly on them. Children should be provided with information about what they can do and how they will feel. With children who are egocentric, experiences of oth- ers, analogies, and assurances that the communication is private will not be effective because the child is not capable of understanding. DIF: Cognitive Level: Apply REF: p. 61 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 8. A nurse is assigned to four children of different ages. In which age group should the nurse under- stand that body integrity is a concern? a. Toddler b. Preschooler c. School-age child d. Adolescent ANSWER: C School-age children have a heightened concern about body integrity. They place importance and value on their bodies and are oversensitive to anything that constitutes a threat or suggestion of injury. Body integrity is not as important a concern to toddlers, preschoolers, or adolescents. DIF: Cognitive Level: Understand REF: p. 61 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 9. An 8-year-old girl asks the nurse how the blood pressure apparatus works. What is the most ap- propriate nursing action? a. Ask her why she wants to know. b. Determine why she is so anxious. c. Explain in simple terms how it works. d. Tell her she will see how it works as it is used. ANSWER: C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to ex- plain how equipment works and what will happen to the child. A nurse should respond positively for requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. The child is not exhibiting anxiety, just re- questing clarification of what will be occurring. The nurse must explain how the blood pressure cuff works so that the child can then observe during the procedure. DIF: Cognitive Level: Apply REF: p. 61 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 10. When the nurse interviews an adolescent, which is especially important? a. Focus the discussion on the peer group.
  • 40. b. Allow an opportunity to express feelings. c. Emphasize that confidentiality will always maintained. d. Use the same type of language as the adoles cent. ANSWER: B Adolescents, like all children, need an opportunity to express their feelings. Often they will inter- ject feelings into their words. The nurse must be alert to the words and feelings expressed. Al- though the peer group is important to this age group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional rela- tionship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently. DIF: Cognitive Level: Understand REF: p. 62 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 11. The nurse is having difficulty communicating with a hospitalized 6-year-old child. What tech- nique might be most helpful? a. Suggest that the child keep a diary. b. Suggest that the parent read fairy tales to th child. c. Ask the parent if the child is always uncom municative. d. Ask the child to draw a picture. ANSWER: D Drawing is one of the most valuable forms of communication. Children’s drawings tell a great deal about them because they are projections of the child’s inner self. It would be difficult for a 6-year-old child who is most likely learning to read to keep a diary. Parents reading fairy tales to the child is a passive activity involving the parent and child. It would not facilitate communica- tion with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers. DIF: Cognitive Level: Apply REF: p. 64 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 12. The nurse is meeting a 5-year-old child for the first time and would like the child to cooperate during a dressing change. The nurse decides to do a simple magic trick using gauze. How should this action be interpreted? a. Inappropriate, because of child’s age b. A way to establish rapport c. Too distracting, when cooperation is impor- tant d. Acceptable, if there is adequate time
  • 41. ANSWER: B A magic trick or other simple game may help alleviate anxiety for a 5-year-old. It is an excellent method to build rapport and facilitate cooperation during a procedure. Magic tricks appeal to the natural curiosity of young children. The nurse should establish rapport with the child. Failure to do so may cause the procedure to take longer and be more traumatic. DIF: Cognitive Level: Analyze REF: p. 64 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 13. The nurse must assess a 10-month-old infant. The infant is sitting on the father’s lap and appears to be afraid of the nurse and of what might happen next. Which initial action by the nurse would be most appropriate? a. Initiate a game of peek-a-boo. b. Ask father to place the infant on the examin tion table. c. Undress the infant while he is still sitting on his father’s lap. d. Talk softly to the infant while taking him from his father. ANSWER: A Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his fa- ther. As much of the assessment as possible should be done on the father’s lap. The nurse should have the father undress the child as needed for the examination. DIF: Cognitive Level: Apply REF: p. 62 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 14. The nurse is taking a health history on an adolescent. Which best describes how the chief com- plaint should be determined? a. Ask for detailed listing of symptoms. b. Ask adolescent, “Why did you come here to day?” c. Use what adolescent says to determine, in correct medical terminology, what the prob- lem is. d. Interview parent away from adolescent to d termine chief complaint. ANSWER: B The chief complaint is the specific reason for the child’s visit to the clinic, office, or hospital. Be- cause the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. A detailed listing of symptoms will make it difficult to determine the chief complaint. The adolescent should be prompted to tell which symptom caused him to seek help at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help. The parent and adolescent may be interviewed separately, but the
  • 42. nurse should determine the reason the adolescent is seeking attention at this time. DIF: Cognitive Level: Apply REF: p. 62 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 15. Where in the health history should the nurse describe all details related to the chief complaint? a. Past history b. Chief complaint c. Present illness d. Review of systems ANSWER: C The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. The focus of the present illness is on all factors relevant to the main problem, even if they have disappeared or changed during the onset, interval, and present. Past history refers to information that relates to previous aspects of the child’s health, not to the current problem. The chief complaint is the specific reason for the child’s visit to the clinic, office, or hospital. It does not contain the narrative portion describing the onset and pro- gression. The review of systems is a specific review of each body system. DIF: Cognitive Level: Understand REF: p. 64 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Health Promotion and Maintenance 16. The nurse is interviewing the mother of an infant. She reports, “I had a difficult delivery, and my baby was born preterm.” This information should be recorded under which of the following headings? a. Past history b. Present illness c. Chief complaint d. Review of systems ANSWER: A The past history refers to information that relates to previous aspects of the child’s health, not to the current problem. The mother’s difficult delivery and prematurity are important parts of the past history of an infant. The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. Unless the chief complaint is di- rectly related to the prematurity, this information is not included in the history of present illness. The chief complaint is the specific reason for the child’s visit to the clinic, office, or hospital. It would not include the birth information. The review of systems is a specific review of each body system. It does not include the preterm birth. Sequelae such as pulmonary dysfunction would be included. DIF: Cognitive Level: Understand REF: p. 65 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Health Promotion and Maintenance 17. Which is most important to document about immunizations in the child’s health history?
  • 43. a ANSWER: B The occurrence of any reaction after an immunization was given is the most important to docu- ment in a history because of possible future reactions, especially allergic reactions. Exact dosage of the immunization received may not be recorded on the immunization record. Exact dates are important to obtain but not as important as a history of reaction to an immunization. The practi- tioner who administered the immunization does not need to be recorded in the health history. A potentially severe physiologic response is the most threatening and most important information to document for safety reasons. DIF: Cognitive Level: Analyze REF: p. 65 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Health Promotion and Maintenance 18. When interviewing the mother of a 3-year-old child, the nurse asks about developmental mile- stones such as the age of walking without assistance. How should this question be considered? a. Unnecessary information because child is a 3 years b. An important part of the family history c. An important part of the child’s past history d. An important part of the child’s review of systems ANSWER: C Information about the attainment of developmental milestones is important to obtain. It provides data about the child’s growth and development that should be included in the past history. Devel- opmental milestones provide important information about the child’s physical, social, and neuro- logic health and should be included in the history for a 3-year-old child. If pertinent, attainment of milestones by siblings would be included in the family history. The review of systems does not include the developmental milestones. DIF: Cognitive Level: Understand REF: p. 65 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Health Promotion and Maintenance 19. The nurse is taking a sexual history on an adolescent girl. Which is the best way to determine whether she is sexually active? ” a. Dosage of immunizations received b. Occurrence of any reaction after an immu- nization c. The exact date the immunizations were re- ceived d. Practitioner who administered the immuniz tions a. Ask her, “Are you sexually active?” b. Ask her, “Are you having sex with anyone? c. Ask her, “Are you having sex with a boyfriend?”
  • 44. ANSWER: B Asking the adolescent girl whether she is having sex with anyone is a direct question that is well understood. The phrase sexually active is broadly defined and may not provide specific informa- tion to the nurse to provide necessary care. The word anyone is preferred to using gender-specific terms such as boyfriend or girlfriend. Because homosexual experimentation may occur, it is preferable to use gender-neutral terms. Questioning about sexual activity should occur when the adolescent is alone. DIF: Cognitive Level: Apply REF: p. 65 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 20. When doing a nutritional assessment on a Hispanic family, the nurse learns that their diet con- sists mainly of vegetables, legumes, and starches. How should the nurse assess this diet? a. Indicates they live in poverty b. Is lacking in protein c. May provide sufficient amino acids d. Should be enriched with meat and milk ANSWER: C The diet that contains vegetable, legumes, and starches may provide sufficient essential amino acids, even though the actual amount of meat or dairy protein is low. Many cultures use diets that contain this combination of foods. It is not indicative of poverty. Combinations of foods contain the essential amino acids necessary for growth. A dietary assessment should be done, but many vegetarian diets are sufficient for growth. DIF: Cognitive Level: Understand REF: p. 66 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 21. Which following parameters correlates best with measurements of the body’s total protein stores? a. Height b. Weight c. Skinfold thickness d. Upper arm circumference ANSWER: D Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves as the body’s major protein reserve and is considered an index of the body’s protein stores. Height is reflective of past nutritional status. Weight is indicative of current nutritional status. Skinfold thickness is a measurement of the body’s fat content. DIF: Cognitive Level: Understand REF: p. 72 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance d. Ask both the girl and her parent whether sh is sexually active.
  • 45. 22. A nurse is preparing to perform a physical assessment on a toddler. Which approach should the nurse use for this child? a. Always proceed in a head-to-toe direction. b. Perform traumatic procedures first. c. Use minimal physical contact initially. d. Demonstrate use of equipment. ANSWER: C Parents can remove clothing, and the child can remain on the parent’s lap. The nurse should use minimal physical contact initially to gain the child’s cooperation. The head-to-toe assessment can be done in older children but usually must be adapted in younger children. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for toddlers. DIF: Cognitive Level: Apply REF: p. 77 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 23. The nurse is preparing to perform a physical assessment on a 10-year-old girl. The nurse gives her the option of her mother either staying in the room or leaving. How should this action be in- terpreted? a. Appropriate because of child’s age b. Appropriate because mother would be un- comfortable making decisions for child c. Inappropriate because of child’s age d. Inappropriate because child is same sex as mother ANSWER: A The older school-age child should be given the option of having the parent present or not. During the examination, the nurse should respect the child’s need for privacy. Although the question was appropriate for the child’s age, the mother is responsible for making decisions for the child. It is appropriate because of the child’s age. During the examination, the nurse must respect the child’s privacy. The child should help determine who is present during the examination. DIF: Cognitive Level: Apply REF: p. 77 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 24. A nurse is counseling parents of a child beginning to show signs of being overweight. The nurse accurately relates which body mass index (BMI)-for-age percentile indicates a risk for being overweight? a. 11th percentile b. 9th percentile c. 85th percentile d. 95th percentile