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Test Bank for Wong’s Essentials of Pediatric Nursing,
11th Edition, Marilyn Hockenberry, Cheryl Rodgers
Chapters 1 - 31
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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
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Congenital anomalies account for 20.1% of deaths in infants younger than 1 year. Sudden infant
death syndrome accounts for 8.2% of deaths in this age group. Respiratory distress syndrome accounts for 3.4% of deaths in this age group. Infections specific to the perinatal period account for
2.7% of deaths in this age group.
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 of African-American
boys ranging in age from 15 to 19 years?
a.
b.
c.
d.
Suicide
Cancer
Firearm homicide
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 adolescence. Congenital anomalies are the leading cause of death in those younger than 1 year. Cancer
ranks either second or fourth, depending on the age group, and heart disease ranks fifth in the
majority of the age groups.
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.
b.
c.
d.
Mechanical suffocation
Drowning
Motor vehicle–related fatalities
Fire- and burn-related fatalities
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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.
b.
c.
d.
Physical health of the child
Developmental level of the child
Educational level of the child
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”?
a.
Limitations in the major activities of daily
b.
c.
d.
living
Unintentional injuries that cause chronic
health problems
Discoveries of new therapies to treat health
problems
Behavioral, social, and educational problem s
that alter health
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
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9. A nurse on a pediatric unit is practicing family-centered care. Which is most descriptive of the
care the nurse is delivering?
a.
b.
c.
d.
Taking over total care of the child to reduce
stress on the family
Encouraging family dependence on health
care systems
Recognizing that the family is the constant n
a child’s life
Excluding families from the decision-makin
process
ANSWER: C
The three key components of family-centered care are respect, collaboration, and support. Fam- ilycentered 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?
a.
Prepare the child for separation from parent s
during hospitalization by reviewing a video
b.
Prepare the child before any unfamiliar trea t
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.
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?
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a.
b.
c.
d.
Staff is concerned about the nurse’s actions
with the patient and family.
Staff assignments allow the nurse to care fo
same patient and family over an extended
time.
Nurse is able to withdraw emotionally whe
emotional overload occurs but still remains
committed.
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 transitioning 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 deliberate 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
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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
d.
dressing changes
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 enhanced 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 documentation of this procedure?
a.
Dressing change to appendectomy incision
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b.
c.
d.
completed, child tolerated procedure well,
parent present
No complications noted during dressing
change to appendectomy incision
Appendectomy incision non-reddened, sutures intact, no drainage noted on old dressing, new dressing applied, procedure tolerat ed
well by child
No changes to appendectomy incisional area,
dressing changed, child complained of pain
during procedure, new dressing clean, dry and
intact
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.
b.
c.
d.
Appropriate use of car seat restraints
Safety crossing the street
Helmet use when riding a bicycle
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
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b.
c.
d.
Diagnosis
Assessment
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 identification 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 effectiveness of the program. During the assessment phase, the nurse would identify the resources necessary 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.
b.
c.
d.
Primary
Secondary
Tertiary
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
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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 importance 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?
a.
Ask others what they want to know.
b.
Share everything known about the family.
c.
Restrict communication to clinically releva
d.
information.
Recognize that confidentiality is not possibl 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 confidentiality. The nurse is not permitted to share information about clients, except clinically relevant information 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
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c.
d.
A workshop training day, with a professiona l
speaker, where nurses can interact with eac
other
One-on-one continuing education training
with each nurse
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 support 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.)
a.
b.
c.
d.
e.
Spending off-duty time with children and
families
Asking questions if families are not participating in the care
Clarifying information for families
Buying toys for a hospitalized child
Learning about the family’s religious prefer ences
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 children 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
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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 concise, organized way that allows for clear answers. Good clinical questions should be asked in the
PICOT (population, intervention, control, outcome, time) format to assist with clarity and literature searching. PICOT questions assist with clarifying the scope of the problem and clinical topic of
interest.
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
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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?
Interactional theory
Developmental systems theory
Family stress theory
Duvall’s developmental theory
a.
b.
c.
d.
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.
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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.”
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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
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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
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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
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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
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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. Timeout 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 timeout 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
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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
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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?
Sensitive period
Sequential period
Terminal points
Differentiation points
a.
b.
c.
d.
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?
14
16
18
21
a.
b.
c.
d.
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
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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
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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.
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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
Full download please email me stoneklopp@gmail.com
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:
selfishness.
self-centeredness.
preferring to play alone.
unable to put self in another’s place.
a.
b.
c.
d.
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
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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?
Egocentrism
Transductive reasoning
Intuitive reasoning
Conservation
a.
b.
c.
d.
ANSWER: B
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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?
Obeying the rules of correct behavior is important.
Showing respect for authority is important behavior.
Behavior that pleases others is considered good.
Actions are determined as good or bad in terms of their consequences.
a.
b.
c.
d.
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
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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?
Preconventional
Conventional
Postconventional
Undifferentiated
a.
b.
c.
d.
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?
Solitary
Parallel
Associative
Cooperative
a.
b.
c.
d.
ANSWER: C
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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?
Kimberly and Amanda sharing clay to each make things
Brian playing with his truck next to Kristina playing with her truck
Adam playing a board game with Kyle, Steven, and Erich
Danielle playing with a music box on her mother’s lap
a.
b.
c.
d.
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
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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?
“Your child would enjoy playing a board game.”
“A toy your child can push or pull would help develop muscles.”
“An action figure toy would be a good choice.”
“A 25-piece puzzle would help your child develop recognition of shapes.”
a.
b.
c.
d.
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?
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a.
b.
c.
d.
“I will be able to continue taking isotretinoin (Accutane) for my acne.”
“I can continue to clean my cat’s litter box.”
“I should avoid any alcoholic beverages.”
“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.
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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?
Absence of one of the X chromosomes
Presence of an incomplete Y chromosome
Precocious puberty in an otherwise healthy child
Excess production of both androgens and estrogens
a.
b.
c.
d.
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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.)
Abnormal newborn screen
Family history of a hereditary disease
History of hypertension in the family
Severe colic as an infant
Metabolic disorder
a.
b.
c.
d.
e.
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
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3. A nurse is preparing to administer a Denver II. Which is a correct statement about the Denver
II? (Select all that apply.)
All items intersected by the age line should be administered.
There is no correction for a child born preterm.
The tool is an intelligence test.
Toddlers and preschoolers should be prepared by presenting the test as a game.
Presentation of the toys from the kit should be done one at a time.
a.
b.
c.
d.
e.
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
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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.
b.
c.
d.
Introduce self.
Make family comfortable.
Explain purpose of interview.
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.
b.
c.
d.
Be sympathetic.
Use direct questions.
Use open-ended questions.
Avoid periods of silence.
ANSWER: C
Closed-ended questions should be avoided when attempting to elicit parents’ feelings. Open-
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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 effective 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.
b.
c.
d.
Using silence
Using clichés
Directing the focus
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 relationship 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
Full download please email me stoneklopp@gmail.com
MSC: Area of Client Needs: Psychosocial Integrity
5. Which approach would be best to use to ensure a positive response from a toddler?
a.
Assume an eye-level position and talk quiet ly.
b.
Call the toddler’s name while picking him o
c.
d.
her up.
Call the toddler’s name and say, “I’m your
nurse.”
Stand by the toddler, addressing him or her by
name.
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.
b.
c.
d.
ANSWER: A
Focus communication on child.
Explain experiences of others to child.
Use easy analogies when possible.
Assure child that communication is private.
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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.
b.
c.
d.
Toddler
Preschooler
School-age child
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.
b.
c.
d.
Ask her why she wants to know.
Determine why she is so anxious.
Explain in simple terms how it works.
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.
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b.
c.
d.
Allow an opportunity to express feelings.
Emphasize that confidentiality will always
maintained.
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 relationship 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.
b.
c.
d.
Suggest that the child keep a diary.
Suggest that the parent read fairy tales to th
child.
Ask the parent if the child is always uncom
municative.
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-yearold 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 important
d.
Acceptable, if there is adequate time
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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.
b.
c.
d.
Ask for detailed listing of symptoms.
Ask adolescent, “Why did you come here to
day?”
Use what adolescent says to determine, in
correct medical terminology, what the problem is.
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. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief
complaint. A detailed listing of symptoms will make it difficult to determine the chief complaint.
The adolescent should be prompted to tell which symptom caused him to seek help at this time.
The chief complaint is usually written in the words that the parent or adolescent uses to describe the
reason for seeking help. The parent and adolescent may be interviewed separately, but the
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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?
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a.
b.
c.
d.
Dosage of immunizations received
Occurrence of any reaction after an immunization
The exact date the immunizations were received
Practitioner who administered the immuniz a
tions
ANSWER: B
The occurrence of any reaction after an immunization was given is the most important to document in a history because of possible future reactions, especially allergic reactions. Exact dosage of
the immunization received may not be recorded on the immunization record. Exact dates are
important to obtain but not as important as a history of reaction to an immunization. The practitioner who administered the immunization does not need to be recorded in the health history. A
potentially severe physiologic response is the most threatening and most important information to
document for safety reasons.
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?
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
a.
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. Developmental milestones provide important information about the child’s physical, social, and neurologic 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.
b.
c.
Ask her, “Are you sexually active?”
Ask her, “Are you having sex with anyone? ”
Ask her, “Are you having sex with a
boyfriend?”
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d.
Ask both the girl and her parent whether sh
is sexually active.
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.
b.
c.
d.
Height
Weight
Skinfold thickness
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
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22. A nurse is preparing to perform a physical assessment on a toddler. Which approach should the
nurse use for this child?
a.
b.
c.
d.
Always proceed in a head-to-toe direction.
Perform traumatic procedures first.
Use minimal physical contact initially.
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 interpreted?
a.
Appropriate because of child’s age
b.
Appropriate because mother would be uncomfortable 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
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ANSWER: C
Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th
percentile are at risk for being overweight. Children in the 9th and 11th percentiles are within
normal limits. Children who are greater than or equal to the 95th percentile are considered
overweight.
DIF: Cognitive Level: Apply
REF: p. 79
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance
25. The nurse is using the Centers for Disease Control and Prevention (CDC) growth chart for an
African-American child. Which statement should the nurse consider?
a.
This growth chart should not be used.
b.
Growth patterns of African-American children are the same as for all other ethnic
groups.
c.
A correction factor is necessary when the
CDC growth chart is used for non-Caucasia n
ethnic groups.
d.
The CDC charts are accurate for US Africa
American children.
ANSWER: D
The CDC growth charts can serve as reference guides for all racial or ethnic groups. US AfricanAmerican children were included in the sample population. The growth chart can be used with the
perspective that different groups of children have varying normal distributions on the growth
curves. No correction factor exists.
DIF: Cognitive Level: Understand
REF: p. 77
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
26. Which tool measures body fat most accurately?
a.
Stadiometer
b.
Calipers
c.
Cloth tape measure
d.
Paper or metal tape measure
ANSWER: B
Calipers are used to measure skinfold thickness, which is an indicator of body fat content. Stadiometers are used to measure height. Cloth tape measures should not be used because they can
stretch. Paper or metal tape measures can be used for recumbent lengths and other body measurements that must be made.
DIF: Cognitive Level: Understand
REF: p. 80
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
27. The nurse is using calipers to measure skinfold thickness over the triceps muscle in a school-age
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child. What is the purpose of doing this?
a.
b.
c.
d.
To measure body fat
To measure muscle mass
To determine arm circumference
To determine accuracy of weight measurement
ANSWER: A
Measurement of skinfold thickness is an indicator of body fat. Arm circumference is an indirect
measure of muscle mass. The accuracy of weight measurement should be verified with a properly balanced scale. Body fat is just one indicator of weight.
DIF: Cognitive Level: Remember
REF: p. 80
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
28. A nurse notes that a 10-month-old infant has a larger head circumference than chest. The nurse
interprets this as a normal finding because the head and chest circumference become equal at
which age?
a.
1 month
b.
6 to 9 months
c.
1 to 2 years
d.
to 3 years
ANSWER: C
Head circumference begins larger than chest circumference. Between ages 1 and 2 years, they
become approximately equal. Head circumference is larger than chest circumference before age
1. Chest circumference is larger than head circumference at to 3 years.
DIF: Cognitive Level: Remember
REF: p. 80
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
29. Which would be best for the nurse to use when determining the temperature of a preterm infant
under a radiant heater?
a.
b.
c.
d.
Axillary sensor
Tympanic membrane sensor
Rectal mercury glass thermometer
Rectal electronic thermometer
ANSWER: A
The axillary sensor measures the infrared heat energy radiating from the axilla. It can be used on wet
skin, in incubators, or under radiant warmers. Ear thermometry does not show sufficient correlation with established methods of measurement. It should not be used when body temperature
must be assessed with precision. Mercury thermometers should never be used. The release of
mercury, should the thermometer be broken, can cause harmful vapors. Rectal temperatures should
be avoided unless no other suitable way exists for the temperature to be measured.
DIF: Cognitive Level: Apply
REF: p. 85
Full download please email me stoneklopp@gmail.com
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
30. What is the earliest age at which a satisfactory radial pulse can be taken in children?
a.
1 year
b.
2 years
c.
3 years
d.
6 years
ANSWER: B
Satisfactory radial pulses can be used in children older than 2 years. In infants and young chil- dren,
the apical pulse is more reliable. The apical pulse can be used for assessment at these ages.
DIF: Cognitive Level: Remember
REF: p. 103
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
31. Pulses can be graded according to certain criteria. Which is a description of a normal pulse?
a.
0
b.
+1
c.
+2
d.
+3
ANSWER: D
A normal pulse is described as +3. A pulse that is easy to palpate and not easily obliterated with
pressure is considered normal. A pulse graded 0 is not palpable. A pulse graded +1 is difficult to
palpate, thready, weak, and easily obliterated with pressure. A pulse graded +2 is difficult to palpate and may be easily obliterated with pressure.
DIF: Cognitive Level: Remember
REF: p. 85
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Techniques of Physical Assessment
32. Where is the best place to observe for the presence of petechiae in dark-skinned individuals?
a.
Face
b.
Buttocks
c.
Oral mucosa
d.
Palms and soles
ANSWER: C
Petechiae, small distinct pinpoint hemorrhages, are difficult to see in dark skin unless they are in the
mouth or conjunctiva.
DIF: Cognitive Level: Remember
REF: p. 89
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Techniques of Physical Assessment
33. The nurse observes yellow staining in the sclera of eyes, soles of feet, and palms of hands. How
should the nurse document these findings?
a.
Normal
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b.
c.
d.
Erythema
Jaundice
Ecchymosis
ANSWER: C
Jaundice is defined as the yellow staining of the skin, usually by bile pigments. Yellow staining is not
a normal appearance of the skin. Erythema is redness that results from increased blood flow to the
area. Ecchymosis is large, diffuse areas, usually black and blue, caused by hemorrhage of blood into
the skin.
DIF: Cognitive Level: Understand
REF: p. 89
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
34. When palpating the child’s cervical lymph nodes, the nurse notes that they are tender, enlarged,
and warm. What is the best explanation for this?
Some form of cancer
Local scalp infection common in children
Infection or inflammation distal to the site
Infection or inflammation close to the site
a.
b.
c.
d.
ANSWER: D
Small nontender nodes are normal. Tender, enlarged, and warm lymph nodes may indicate infection or inflammation close to their location. Tender lymph nodes are not usually indicative of
cancer. A scalp infection would usually not cause inflamed lymph nodes. The lymph nodes close to
the site of inflammation or infection would be inflamed.
DIF: Cognitive Level: Analyze
REF: p. 89
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
35. During a routine health assessment, the nurse notes that an 8-month-old infant has significant
head lag. Which is the nurse’s most appropriate action?
a.
Teach parents appropriate exercises.
b.
Recheck head control at next visit.
c.
Refer child for further evaluation.
d.
Refer child for further evaluation if anterior
fontanel is still open.
ANSWER: C
Significant head lag after age 6 months strongly indicates cerebral injury and is referred for fur- ther
evaluation. Reduction of head lag is part of normal development. Exercises will not be effec- tive.
The lack of achievement of this developmental milestone must be evaluated.
DIF: Cognitive Level: Apply
REF: p. 89
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
36. The nurse has just started assessing a young child who is febrile and appears very ill. There is hy-
Full download please email me stoneklopp@gmail.com
perextension of the child’s head (opisthotonos) with pain on flexion. Which is the most appropri- ate
action?
a.
Refer for immediate medical evaluation.
b.
Continue assessment to determine cause of
neck pain.
c.
Ask parent when neck was injured.
d.
Record “head lag” on assessment record, an
continue assessment of child.
ANSWER: A
Hyperextension of the child’s head with pain on flexion is indicative of meningeal irritation and
needs immediate evaluation; it is not descriptive of head lag. The pain is indicative of meningeal
irritation. No indication of injury is present.
DIF: Cognitive Level: Apply
REF: p. 90
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
37. At what age should the nurse expect the anterior fontanel to close?
a.
2 months
b.
2 to 4 months
c.
6 to 8 months
d.
12 to 18 months
ANSWER: D
The anterior fontanel normally closes between ages 12 and 18 months. Two to 8 months is too early.
The expected closure of the anterior fontanel occurs between ages 12 and 18 months; if it closes
between ages 2 and 8 months, the child should be referred for further evaluation.
DIF: Cognitive Level: Remember
REF: p. 90
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
38. During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red
reflex in both eyes. How should the nurse interpret this finding?
a.
Normal finding
b.
Abnormal finding, so child needs referral to
ophthalmologist
c.
Sign of possible visual defect, so child need
vision screening
d.
Sign of small hemorrhages, which will usually resolve spontaneously
ANSWER: A
A brilliant, uniform red reflex is an important normal finding. It rules out many serious defects of
the cornea, aqueous chamber, lens, and vitreous chamber.
DIF: Cognitive Level: Understand
REF: p. 91
TOP: Integrated Process: Nursing Process: Assessment