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Nursing Care Of Children Principles And Practice 4th Edition By Susan R. James – Test Bank 

 

SAMPLE QUESTIONS

 

01: Introduction to Nursing Care of Children

Chapter 01: Introduction to Nursing Care of Children Test Bank

MULTIPLE CHOICE

1. A nurse is reviewing changes in healthcare delivery and funding for pediatric populations. Which current trend in the pediatric setting should the nurse expect to find?

࿿࿿࿿2劚漀࿿࿿࿿࿿࿿࿿࿿࿿࿿3댰ࠅ࿿࿿࿿࿿࿿࿿࿿࿿࿿4ᑢ؊࿿࿿࿿࿿࿿࿿࿿࿿࿿5ㄲ䍷࿿࿿࿿࿿࿿࿿࿿࿿࿿6䬢ᚬ࿿࿿࿿࿿࿿࿿࿿࿿࿿7乎盄࿿࿿࿿࿿࿿࿿࿿࿿࿿8ค࿿࿿࿿࿿࿿࿿࿿࿿࿿939 Increased hospitalization of children

࿿࿿࿿2劚漀࿿࿿࿿࿿࿿࿿࿿࿿࿿3댰ࠅ࿿࿿࿿࿿࿿࿿࿿࿿࿿4ᑢ؊࿿࿿࿿࿿࿿࿿࿿࿿࿿5ㄲ䍷࿿࿿࿿࿿࿿࿿࿿࿿࿿6䬢ᚬ࿿࿿࿿࿿࿿࿿࿿࿿࿿7乎盄࿿࿿࿿࿿࿿࿿࿿࿿࿿8ค࿿࿿࿿࿿࿿࿿࿿࿿࿿940 Decreased number of uninsured children

࿿࿿࿿2劚漀࿿࿿࿿࿿࿿࿿࿿࿿࿿3댰ࠅ࿿࿿࿿࿿࿿࿿࿿࿿࿿4ᑢ؊࿿࿿࿿࿿࿿࿿࿿࿿࿿5ㄲ䍷࿿࿿࿿࿿࿿࿿࿿࿿࿿6䬢ᚬ࿿࿿࿿࿿࿿࿿࿿࿿࿿7乎盄࿿࿿࿿࿿࿿࿿࿿࿿࿿8ค࿿࿿࿿࿿࿿࿿࿿࿿࿿941 An increase in ambulatory care

࿿࿿࿿2劚漀࿿࿿࿿࿿࿿࿿࿿࿿࿿3댰ࠅ࿿࿿࿿࿿࿿࿿࿿࿿࿿4ᑢ؊࿿࿿࿿࿿࿿࿿࿿࿿࿿5ㄲ䍷࿿࿿࿿࿿࿿࿿࿿࿿࿿6䬢ᚬ࿿࿿࿿࿿࿿࿿࿿࿿࿿7乎盄࿿࿿࿿࿿࿿࿿࿿࿿࿿8ค࿿࿿࿿࿿࿿࿿࿿࿿࿿942 Decreased use of managed care

ANS: C

One effect of managed care is that pediatric healthcare delivery has shifted dramatically from the acute care setting to the ambulatory setting. The number of hospital beds being used has decreased as more care is provided in outpatient and home settings. The number of uninsured children in the United States continues to grow. One of the biggest changes in healthcare has been the growth of managed care.

DIF: Cognitive Level: Comprehension REF: p. 3

OBJ: Nursing Process Step: Planning MSC: Safe and Effective Care Environment

0 A nurse is referring a low-income family with three children under the age of 5 years to a program that assists with supplemental food supplies. Which program should the nurse refer this
family to?

0 Medicaid

1 Medicare

2 Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program

3 Women, Infants, and Children (WIC) program

ANS: D

WIC is a federal program that provides supplemental food supplies to low-income women who are pregnant or breast-feeding and to their children until the age of 5 years. Medicaid and the Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program provides for well-child examinations and related treatment of medical problems. Children in the WIC program are often referred for immunizations, but that is not the primary focus of the program. Public Law 99-457 provides financial incentives to states to establish comprehensive early

intervention services for infants and toddlers with, or at risk for, developmental disabilities.

Medicare is the program for Senior Citizens.

DIF: Cognitive Level: Application REF: p. 7

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

3. In most states, adolescents who are not emancipated minors must have parental permission before:

5888 treatment for drug abuse.

5889 treatment for sexually transmitted diseases (STDs).

5890 obtaining birth control.

5891 surgery.

ANS: D

An emancipated minor is a minor child who has the legal competence of an adult. Legal counsel may be consulted to verify the status of the emancipated minor for consent purposes. Most states allow minors to obtain treatment for drug or alcohol abuse and STDs and allow access to birth control without parental consent.

DIF: Cognitive Level: Application REF: p. 12

OBJ: Nursing Process Step: Planning MSC: Safe and Effective Care Environment

4. A nurse is completing a clinical pathway for a child admitted to the hospital with pneumonia. Which characteristic of a clinical pathway is correct?

0 Developed and implemented by nurses

1 Used primarily in the pediatric setting

2 Specific time lines for sequencing interventions

3 One of the steps in the nursing process

ANS: C

Clinical pathways measure outcomes of client care and are developed by multiple healthcare professionals. Each pathway outlines specific time lines for sequencing interventions and reflects interdisciplinary interventions. Clinical pathways are used in multiple settings and for clients throughout the life span. The steps of the nursing process are assessment, diagnosis, planning, implementation, and evaluation.

DIF: Cognitive Level: Comprehension REF: p. 6

OBJ: Nursing Process Step: Planning MSC: Safe and Effective Care Environment

5. When planning a parenting class, the nurse should explain that the leading cause of death in children 1 to 4 years of age in the United States is:

0 premature birth.

1 congenital anomalies.

2 accidental death.

3 respiratory tract illness.

ANS: C

Accidents are the leading cause of death in children ages 1 to 19 years. Disorders of short gestation and unspecified low birth weight make up one of the leading causes of death in neonates. One of the leading causes of infant death after the first month of life is congenital anomalies. Respiratory tract illnesses are a major cause of morbidity in children. DIF: Cognitive Level: Application REF: p. 9

OBJ: Nursing Process Step: Implementation

MSC: Safe and Effective Care Environment

6. Which statement is true regarding the “quality assurance” or “incident” report?

23 The report assures the legal department that there is no problem.

24 Reports are a permanent part of the client’s chart.

25 The nurse’s notes should contain the following: “Incident report filed and copy placed in chart.”

26 This report is a form of documentation of an event that may result in legal action.

ANS: D

An incident report is a warning to the legal department to be prepared for potential legal action; it is not a part of the client’s chart or nurse documentation. DIF: Cognitive Level: Knowledge REF: p. 14

OBJ: Nursing Process Step: Implementation

MSC: Safe and Effective Care Environment

7. Which client situation fails to meet the first requirement of informed consent?

23 The parent does not understand the physician’s explanations.

24 The physician gives the parent only a partial list of possible side effects and complications.

25 No parent is available and the physician asks the adolescent to sign the consent form.

26 The infant’s teenage mother signs a consent form because her parent tells her to.

ANS: C

The first requirement of informed consent is that the person giving consent must be competent. Minors are not allowed to give consent. An understanding of information, full disclosure, and

voluntary consent are requirements of informed consent, but none of these is the first requirement.

DIF: Cognitive Level: Comprehension REF: p. 12

OBJ: Nursing Process Step: Implementation

MSC: Safe and Effective Care Environment

8. A nurse assigned to a child does not know how to perform a treatment that has been prescribed for the child. What should the nurse’s first action be?

23 Delay the treatment until another nurse can do it.

24 Make the child’s parents aware of the situation.

25 Inform the nursing supervisor of the problem.

26 Arrange to have the child transferred to another unit.

ANS: C

If a nurse is not competent to perform a particular nursing task, the nurse must immediately communicate this fact to the nursing supervisor or physician. The nurse could endanger the child by delaying the intervention until another nurse is available. Telling the child’s parents would most likely increase their anxiety and will not resolve the difficulty. Transfer to another unit delays needed treatment and would create unnecessary disruption for the child and family. DIF: Cognitive Level: Application REF: p. 11

OBJ: Nursing Process Step: Implementation

MSC: Safe and Effective Care Environment

9. A nurse is completing a care plan for a child and is finishing the assessment phase. Which activity is not part of a nursing assessment?

23 Writing nursing diagnoses

24 Reviewing diagnostic reports

25 Collecting data

26 Setting priorities

ANS: D

Setting priorities is a part of planning. Writing nursing diagnoses, reviewing diagnostic reports, and collecting data are parts of assessment.

DIF: Cognitive Level: Comprehension REF: p. 19

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity 10. Which patient outcome is stated correctly?

23 The child will administer his insulin injection before breakfast on 10/31.

23 The child will accept the diagnosis of type 1 diabetes mellitus before discharge.

24 The parents will understand how to determine the child’s daily insulin dosage.

25 The nurse will monitor blood glucose levels before meals and at bedtime.

ANS: A

The outcome is stated in client terms, with a measurable verb and a time frame for action. The verb “accept” is difficult to measure. The goal of accepting a diagnosis before hospital discharge is unrealistic. Outcomes should be stated in client terms. Nursing actions are determined after outcomes are developed in the implementation phase of the nursing process. DIF: Cognitive Level: Application REF: p. 20

OBJ: Nursing Process Step: Planning MSC: Safe and Effective Care Environment

MULTIPLE RESPONSE

1. A nurse is reviewing the nursing care plan for a hospitalized child. Which statements are collaborative problems? Select all that apply.

23 Risk for injury

24 Potential complication of seizure disorder

25 Altered nutrition: Less than body requirements

26 Fluid volume deficit

27 Potential complication of respiratory acidosis

ANS: B, E

In addition to nursing diagnoses, which describe problems that respond to independent nursing functions, nurses must also deal with problems that are beyond the scope of independent nursing practice. These are sometimes termed collaborative problems—physiological complications that usually occur in association with a specific pathological condition or treatment. The potential complications of seizure disorder and respiratory acidosis are physiological complications that will require physician collaboration to treat. Risk for injury, altered nutrition, and fluid volume deficit will respond to independent nursing functions. DIF: Cognitive Level: Application REF: p. 20

OBJ: Nursing Process Step: Planning MSC: Safe and Effective Care Environment 2. Which nursing activities do not meet the standard of care? Select all that apply.

23 Failure to notify a physician about a child’s worsening condition

24 Calling the supervisor about staffing concerns

25 Delegating assessment of a new admit to the Unlicensed Assistive Personnel (UAP)

26 Asking the Unlicensed Assistive Personnel (UAP) to take vital signs

23 Documenting that a physician was unavailable and the nursing supervisor was notified

ANS: A, C

A nurse who fails to notify a physician about a child’s worsening condition and delegating the assessment of a new admit to a UAP do not meet the standard of care. Calling the supervisor about staffing concerns, asking the UAP to take vital signs, and documenting that a physician could not be reached and the nursing supervisor was notified all meet the standard of care. DIF: Cognitive Level: Analysis REF: p. 11|p. 12|p. 14

OBJ: Nursing Process Step: Evaluation MSC: Safe and Effective Care Environment

02: Family-Centered Nursing Care

Chapter 02: Family-Centered Nursing Care

Test Bank

MULTIPLE CHOICE

23 A nurse is teaching parents how to apply “time-out” as a disciplinary method for their 4 year old. Parents have understood the teaching if they state which formula correctly guides the use of

“time-out”?

5888 Use the guideline of 1 minute per each year of the child’s age.

5889 Relate the length of the time-out to the severity of the behavior.

5890 Never use time-out for a child younger than age 4 years.

5891 Follow the time-out with a treat.

ANS: A

In time-out, the child is told to sit on a chair for a predetermined time, usually 1 minute per year of age. Relating time to a behavior is subjective and inappropriate when the child is very young. Time-out can be used with a toddler. Negative behavior should not be reinforced with a positive action.

DIF: Cognitive Level: Comprehension REF: p. 34

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

2. What is the nurse’s best approach when an 8-year-old boy frequently causes a disruption in the playroom by taking toys from other children?

256⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀЀЀĀȀ⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀЀĀȀ⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀЀĀȀ⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀ Exclude the child from the playroom.

257⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀЀЀĀȀ⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀЀĀȀ⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀЀĀȀ⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀ Explain to the children in the playroom that he is very ill and should be allowed to have the toys.

258⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀЀЀĀȀ⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀЀĀȀ⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀЀĀȀ⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀ Approach the child in his room and ask, “Would you like it if the other children took your toys from y Approach the child in his room and state, “I am concerned that you are taking the other children’s toy
259⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀЀЀĀȀ⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀЀĀȀ⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀЀĀȀ⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀ me.”

ANS: D

The nurse can focus on the behavior most effectively by using “I” rather than “you” messages. A “you” message criticizes the child and uses guilt in an attempt to change behavior. Banning the child from the playroom will not solve the problem. The problem is the child’s behavior, not the place where the child exhibits it. Illness is not a reason for a child to be undisciplined. When the child recovers, the parents will have to deal with a child who is undisciplined and unruly. The child should not be made to feel guilty and to have his or her self-esteem attacked. DIF: Cognitive Level: Application REF: p. 34

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

3. Families that deal most effectively with stress have which behavior patterns?

0 Focus on family problems.

1 Feel weakened by stress.

2 Expect that some stress is normal.

3 Feel guilty when stress exists.

ANS: C

Healthy families recognize that some stress is normal in all families, focus on family strengths rather than on the problems, and know that stress is temporary and may be positive. Because some stress is normal in all families, there is no reason to feel guilty. Guilt only immobilizes the family and does not lead to a resolution of the stress. DIF: Cognitive Level: Comprehension REF: p. 25

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

4. Which family will most likely have the greatest difficulty in coping with an ill child?

23 A single-parent mother who has the support of her parents and siblings

24 Parents who have just moved to the area and are living in an apartment while they look for a house The family of a child who has had multiple hospitalizations related to asthma and has adequate relatio
25 nursing staff

26 A family in which there is a young child and four older married children who live in the area

ANS: B

Parents who are in a new environment will have increased stress related to their lack of a support system. If only one parent is available but has the support of her extended family, this will assist in her adjustment to the crisis. The family that has had positive experiences in the past with hospitalizations can draw from those experiences and feel confident about the current setting. For

the family with one younger child and four older married children who live in the area, the family has an extensive support system, which will assist the parents in adjusting to the crisis. DIF: Cognitive Level: Application REF: p. 27

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity

5. Which is the priority nursing intervention for the family of a child who has been admitted to the hospital?

23 Begin discharge teaching.

24 Identify and mobilize internal and external strengths.

25 Identify ways in which the family could have prevented their child’s hospitalization.

26 Instruct the parents on normal growth and development.

ANS: B

Family interventions should be directed toward enhancing positive coping strategies and directing the family to appropriate resources. Although discharge teaching is begun as soon as possible, it is ineffective if trust has not been established with the parents or if the level of stress precludes learning. By identifying weaknesses instead of focusing on strengths, the family’s anxiety and feelings of powerlessness or guilt may increase. Normal growth and development should be interwoven into teaching; however, teaching cannot take place until the parents have less stress and are open to information.

DIF: Cognitive Level: Application REF: p. 27

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

6. A nurse is planning culturally competent care for a child of Hispanic descent. Which characteristic found in a Hispanic family should the nurse include in the plan of care?

23 Stoicism

24 Close extended family

25 Docile children are considered weak

26 Very interested in health-promoting lifestyles

ANS: B

Most Mexican-American families are very close and it is not unusual for children to be surrounded by parents, siblings, grandparents, and godparents. It is important to respect this cultural characteristic and to see it as a strength, not a weakness. Although stoicism may be present in any family, Mexican-American families tend to be more expressive. Considering docile children as weak is a characteristic of American Indians. Although there is a trend for

everyone to embrace more health-promoting lifestyles, it is more prominent in Anglo-Americans.

DIF: Cognitive Level: Application REF: p. 28

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity

23 While reviewing nursing documentation on dietary intake for a 7-year-old child of Asian descent, the nurse notes that he consistently refuses to eat the food on his tray. Which assumption

is most likely accurate?

23 He is a picky eater.

24 He needs less food because he is on bed rest.

25 He may have culturally related food preferences.

26 He is probably eating between meals and spoiling his appetite.

ANS: C

When cultural differences are noted, food preferences should always be obtained. A child will often not eat unfamiliar foods. Although the child may be a picky eater, the key point is that he is from a different culture. The foods he is being served may seem strange to him. Nutrition plays an important role in healing. Although the child expends less energy while on bed rest, he has increased needs for good nutrition. Although it should be determined whether the child is eating food the family has brought from home, it is more important to determine his food preferences. DIF: Cognitive Level: Application REF: p. 28

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

8. To resolve family conflict, it is necessary to have open communication, accurate perception of the problem, and a(n):

23 intact family structure.

24 arbitrator.

25 willingness to consider the view of others.

26 balance in personality types.

ANS: C

Without the willingness of the members of a group to consider the views of others, conflict resolution cannot take place. The structure of a family may affect their dynamics, but it is still possible to resolve conflict without an intact family structure if all the ingredients of conflict resolution are present. Conflicts can be resolved without the assistance of an arbitrator. Most families have diverse personality types among their members. This may make conflict resolution

more difficult; however, it should not impede it if the ingredients of conflict resolution are present.

DIF: Cognitive Level: Knowledge REF: p. 27

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

9. A nurse is planning a parenting class for expectant parents. Which statement is true about the characteristics of a healthy family?

23 The parents and children have rigid assignments for all the family tasks.

24 Young families assume total responsibility for the parenting tasks, refusing any assistance.

25 The family is overwhelmed by the significant changes that occur as a result of childbirth.

26 Adults agree on the majority of basic parenting principles.

ANS: D

A trait of a healthy family is that adults agree on the basic principles of parenting so that minimal discord exists. A significant stressor for families is lack of shared responsibility in the family. Lack of flexibility in parental tasks is likely to create stress and conflict. Admitting to and seeking help with problems, rather than refusing assistance, is a trait of a healthy family. Adjusting to the birth of a child is a significant change for a family. A sense of feeling overwhelmed by this change indicates that the family is not coping effectively. DIF: Cognitive Level: Comprehension REF: p. 25

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity

10. A nurse determines that a child consistently displays predictable behavior and is regular in performing daily habits. Which temperament is the child displaying?

23 Easy

24 Slow-to-warm-up

25 Difficult

26 Shy

ANS: A

Children with an easy temperament are even tempered, predictable, and regular in their habits. They react positively to new stimuli. A high activity level and adapting slowly to new stimuli are characteristics of a difficult temperament. The slow-to-warm-up temperament type prefers to be inactive and moody. Shyness is a personality type and not a characteristic of temperament. Being moody is a characteristic of a slow-to-warm up temperament. DIF: Cognitive Level: Analysis REF: p. 33

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

23 The parent of a child who has had numerous hospitalizations asks the nurse for advice because her child has been having behavior problems at home and in school. In discussing

effective discipline, which is an essential component?

23 All children display some degree of acting out and this behavior is normal.

24 The child is manipulative and should have firmer limits set on her behavior.

25 Use positive reinforcement and encouragement to promote cooperation and the desired behaviors. Underlying reasons for rules should be given and the child should be allowed to decide on which rule
26 followed.

ANS: C

Using positive reinforcement and encouragement to promote cooperation and desired behaviors is one of the three essential components of effective discipline. Behavior problems should not be disregarded as normal. It would be incorrect to assume the child is being manipulative and should have firmer limits set on her behaviors. Providing the underlying reasons for rules and giving the child a choice concerning which rules to follow constitute a component of permissive parenting and are not considered an essential component of effective discipline. DIF: Cognitive Level: Comprehension REF: p. 33

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

12. A nurse assesses that parents discuss rules with their children when the children do not agree with the rules. Which style of parenting is being displayed?

23 Authoritarian

24 Authoritative

25 Permissive

26 Disciplinarian

ANS: B

A parent who discusses the rules with which children do not agree is using an authoritative parenting style. A parent who expects children to follow rules without questioning is using an authoritarian parenting style. A parent who does not consistently enforce rules and allows the child to decide whether he or she wishes to follow rules is using a permissive parenting style. A disciplinarian style would be similar to the authoritarian style. DIF: Cognitive Level: Analysis REF: p. 32

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

23 Which should the nurse expect to be problematic for a family whose religious affiliation is

Jehovah’s Witness?

23 Immunizations

24 Autopsy

25 Organ donation

26 Blood transfusion

ANS: D

Jehovah’s Witness believers are opposed to blood transfusions. They may accept alternatives to transfusions, such as nonblood plasma expanders; they can make individual decisions about autopsy. Christian Science believers may seek exemption from immunizations. Believers in Islam are opposed to organ donation.

DIF: Cognitive Level: Comprehension REF: p. 29

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

MULTIPLE RESPONSE

1. The nurse is caring for a child from a Middle Eastern family. Which interventions should the nurse include in planning care? Select all that apply.

23 Include the father in the decision making.

24 Ask for a dietary consult to maintain religious dietary practices.

25 Plan for a male nurse to care for a female patient.

26 Ask the housekeeping staff to interpret if needed.

ANS: A, B

The man is typically the head of the household in Muslim families. So the father should be included in all decision making. Muslims do not eat pork and do not use alcohol. Many are vegetarians. The dietician should be consulted for dietary preferences. Muslim women often prefer a female healthcare provider because of laws of modesty; the female client should not be assigned a male nurse. A housekeeping staff should not be asked to interpret. When interpreters are used, they should be of the same country and religion, if possible, because of regional differences and hostilities.

DIF: Cognitive Level: Application REF: p. 31

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

2. A nurse is caring for a child with the religion of Christian Science. What interventions should the nurse include in the care plan for this child? Select all that apply.

23 Offer iced tea to the child who is experiencing fluid volume deficit.

24 Inform the Christian Science practitioner that the child has been admitted to the hospital.

25 Allow parents to sign a form opting out of routine immunizations.

23 Ask parents if the child has been baptized and if parents want a pastor to visit.

ANS: B, C

When a Christian Science believer is hospitalized, a parent or client may request that a Christian Science practitioner be notified. Christian Science believers seek exemption from immunizations but obey legal requirements. Coffee and tea are declined as a drink. Baptism is not a ceremony for the Christian Science religion.

DIF: Cognitive Level: Application REF: p. 29

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

03: Communicating with Children

Chapter 03: Communicating with Children Test Bank

MULTIPLE CHOICE

1. Which information should the nurse include when preparing a 5-year-old child for a cardiac catheterization?

23 A detailed explanation of the procedure

24 A description of what the child will feel and see during the procedure

25 An explanation about the dye that will go directly into his vein

26 An assurance to the child that he and the nurse can talk about the procedure when it is over

ANS: B

For a preschooler, the provision of sensory information about what to expect during the procedure will enhance the child’s ability to cope with the events of the procedure and will decrease anxiety. Explaining the procedure in detail is probably more than the 5-year-old child can comprehend and it will produce anxiety. Using the word “dye” with a preschooler can be frightening for the child. The child needs information before the procedure. DIF: Cognitive Level: Application REF: pp. 44-45

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

2. Who are the “experts” in planning for the care of a 9-year-old child with a profound sensory impairment who is hospitalized for surgery?

23 The child’s parents

24 The child’s teacher

25 The case manager

26 The primary nurse

ANS: A

The parents, as primary caregivers, can identify the child’s needs to help develop an effective, individualized plan of care. The child’s teacher is not as “expert” as the child’s parents for planning her care. The case manager is not as aware as the parents are of the child’s individual needs. The primary nurse would use the child’s parents as resources in planning the best approach to the child’s care.

DIF: Cognitive Level: Comprehension REF: p. 48

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity

3. Which is an effective technique for communicating with toddlers?

23 Have the toddler make up a story from a picture.

24 Involve the toddler in dramatic play with dress-up clothing.

25 Repeatedly read familiar stories to the child.

26 Ask the toddler to draw pictures of his fears.

ANS: C

Ritualism is a characteristic of the toddler period. By repeating familiar stories and other rituals, the toddler feels a sense of control, which facilitates communication. Most toddlers do not have the vocabulary to make up stories. Dramatic play is associated with older children. Toddlers probably are not capable of drawing or verbally articulating their fears. DIF: Cognitive Level: Application REF: p. 44

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

4. What is the most important consideration for effectively communicating with a child?

The child’s chronological age

The parent–child interaction

The child’s receptiveness

The child’s developmental level

ANS: D

The child’s developmental level is the basis for selecting the terminology and structure of the message most likely to be understood by the child. The child’s age may not correspond to the developmental level; therefore, it is not the most important consideration for communicating with children. Parent–child interaction is useful in planning communication with children, but it is not the primary factor in establishing effective communication. The child’s receptiveness is a consideration in evaluating the effectiveness of communication. DIF: Cognitive Level: Comprehension REF: p. 43

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

5. Which behavior is most likely to encourage open communication?

Avoiding eye contact

Folding arms across the chest

Standing with head bowed

Soft stance with arms loose at the side

ANS: D

A swaying body with arms loose at the sides suggests openness. Avoiding eye contact does not facilitate communication. Folding arms across the chest and standing with head bowed are closed-body postures, which do not facilitate communication. DIF: Cognitive Level: Comprehension REF: pp. 39-40

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

6. Which strategy is most likely to encourage a child to express feelings about the hospital experience?

Asking close-ended questions

Asking direct questions

Sharing personal experiences

Actively listening

ANS: D

Active listening encourages conversation. Direct questions and close-ended questions can threaten and block communication. Talking about yourself shifts the focus of the conversation away from the child.

DIF: Cognitive Level: Application REF: p. 38

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity

7. Which is the most appropriate question to ask to encourage conversation when interviewing an adolescent?

“Are you in school?”

“Are you doing well in school?”

“How is school going for you?”

“How do your parents feel about your grades?”

ANS: C

Open-ended questions encourage communication. Direct questions with “yes” or “no” answers

do not encourage conversation. Direct questions that can be interpreted as judgmental do not

enhance communication. Asking adolescents about their parents’ feelings may block communication.

DIF: Cognitive Level: Application REF: p. 45

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

8. What is the most appropriate response for the nurse to make to the parent of a 3-year-old child found in a bed with the side rails down?

“You must never leave the child in the room alone with the side rails down.”

“I am very concerned about your child’s safety when you leave the side rails down. The hospital has g
that side rails need to be up if the child is in the bed.”

“It is hospital policy that side rails need to be up if the child is in bed.”

“When parents leave side rails down, they might be considered as uncaring.”

ANS: B

To express concern and then choose words that convey a policy is appropriate. Framing the communication in the negative does not facilitate effective communication. Stating a policy to parents conveys the attitude that the hospital has authority over parents in matters concerning their children and may be perceived negatively. No statement should convey blame and judgment to the parent.

DIF: Cognitive Level: Application REF: p. 41

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

9. Which is an appropriate preoperative teaching plan for a school-age child?

Begin preoperative teaching the morning of surgery.

Schedule a tour of the hospital a few weeks before surgery.

Show the child books and pictures 4 days before surgery.

Limit teaching to 5 minutes and use simple terminology.

ANS: C

Preparatory material can be introduced to the school-age child several days (1 to 5) in advance of the event. Books, pictures, charts, and videos are appropriate. Preoperative teaching a few hours before surgery is more appropriate for the preschool child. Preparation too far in advance of the procedure can be forgotten or cause undue anxiety for an extended period of time. A very short, simple explanation of the surgery is appropriate for a younger child such as a toddler. DIF: Cognitive Level: Comprehension REF: p. 45

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

10. A primary nurse bought a hospitalized child a new toy to replace a broken one. What is the best interpretation of the nurse’s behavior?

The nurse is displaying signs of overinvolvement.

The nurse is a kind and generous person.

The nurse feels a special closeness to the child.

The nurse wants to make the child happy.

ANS: A

Buying gifts for individual children is a warning sign of overinvolvement. Nurses are kind and generous people, but buying gifts for individual children is unprofessional. Nurses may feel closer to some clients and families. This does not make giving gifts to children or families acceptable from a professional standpoint and becoming overly involved with a child can inhibit a healthy relationship. It is also not the nurse’s responsibility to replace lost or broken items. DIF: Cognitive Level: Analysis REF: p. 42

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

11. When meeting a toddler for the first time, the nurse initiates contact by:

calling the toddler by name and picking the toddler up.

asking the toddler for her first name.

kneeling in front of the toddler and speaking softly to the child.

telling the toddler that you are her nurse.

ANS: C

More positive interactions occur when the toddler perceives the meeting in a nonthreatening way. Placing yourself at the toddler’s level and speaking softly can be less threatening for the child. Picking a toddler up at an initial meeting is a threatening action and will more likely result in a negative response from the child. Toddlers are unlikely to respond to direct questions at a first meeting. Telling the toddler you are the nurse is not likely to facilitate or encourage cooperation. The toddler perceives you as a stranger and will find the action threatening. DIF: Cognitive Level: Application REF: p. 44

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

MULTIPLE RESPONSE

1. A nurse is admitting a school-age child with a visual impairment to the hospital. To effectively communicate the nurse should plan which interventions? Select all that apply.

Orient the child to his or her surroundings.

Enter quietly and touch the child before speaking.

Put the nurse call bell close to the parent.

Allow the child to handle equipment.

Explain sounds the child may hear frequently.

ANS: A, D, E

For a child with a visual impairment, to improve communication the nurse should orient the child to the surroundings, allow the child to handle equipment as the procedure is explained, and explain sounds the child may frequently hear. The nurse should identify herself when entering the room, and tell the child when departing so touching the child before speaking is not accurate. The call bell should be kept in the same place and within the child’s reach, not with the parent as the parent may leave for a break or be sleeping when the child needs something. DIF: Cognitive Level: Application REF: p. 48

OBJ: Nursing Process Step: Implementation

MSC: Safe and Effective Care Environment

A preschool age child is being admitted for some diagnostic tests and possible surgery. The nurse planning care should use which statements when explaining procedures to the child? Select

all that apply.

“Fluids will be given through tubing connected to a small tiny tube inserted into your arm.”

“After surgery, we will be doing dressing changes.”

“You will get a shot before surgery.”

“The doctor will give you medicine that will help you go into a deep sleep.”

“We will take you to surgery on a bed on wheels.”

ANS: A, D, E

A preschool child needs simple concrete explanations that cannot be misinterpreted. An IV should be explained as fluids going into a tube connected to a small tube in your hand, anesthesia can be explained as a medicine that will help you go into a deep sleep (put to sleep should be avoided), and a stretcher can be described as riding on a bed with wheels. Dressing changes are ambiguous and getting a shot can be misinterpreted by a preschool child. DIF: Cognitive Level: Application REF: p. 46

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

Chapter 04: Health Promotion for the Developing Child

Chapter 04: Health Promotion for the Developing Child Test Bank

MULTIPLE CHOICE

1. A nurse is reviewing developmental concepts for infants and children. Which statement best describes development in infants and children?

Development, a predictable and orderly process, occurs at varying rates within normal limits.

Development is primarily related to the growth in the number and size of cells.

Development occurs in a proximodistal direction with fine muscle development occurring first.

Development is more easily and accurately measured than growth.

ANS: A

Development, a continuous orderly process, provides the basis for increases in the child’s function and complexity of behavior. The increases in rate of function and complexity can vary normally within limits for each child. An increase in the number and size of cells is a definition for growth. Development proceeds in a proximodistal direction with fine muscle organization occurring as a result of large muscle organization. Development is a more complex process that is affected by many factors; therefore, it is less easily and accurately measured. Growth is a predictable process with standard measurement methods. DIF: Cognitive Level: Comprehension REF: p. 50|p. 52

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance 2. Frequent developmental assessments are important for which reason?

Stable developmental periods during infancy provide an opportunity to identify any delays or deficits.

Infants need stimulation specific to the stage of development.

Critical periods of development occur during childhood.

Child development is unpredictable and needs monitoring.

ANS: C

Critical periods are blocks of time during which children are ready to master specific developmental tasks. Children can master these tasks more easily during particular periods of time in their growth and developmental process. Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage. Normal growth and development are orderly and proceed in a predictable pattern on the basis of each individual’s abilities and potentials. DIF: Cognitive Level: Comprehension REF: p. 52

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance 3. Which factor has the greatest influence on child growth and development?

Culture

Environment

Genetics

Nutrition

ANS: C

Genetic factors (heredity) determine each individual’s growth and developmental rate. Although factors such as environment, culture, nutrition, and family can influence genetic traits, they do not eliminate the effect of the genetic endowment, which is permanent. Culture is a significant factor that influences how children grow toward adulthood. Culture influences both growth and development but does not eliminate inborn genetic influences. Environment has a significant role in determining growth and development both before and after birth. The environment can influence how and to which extent genetic traits are manifested, but environmental factors cannot eliminate the effect of genetics. Nutrition is critical for growth and plays a significant role throughout childhood.

DIF: Cognitive Level: Comprehension REF: pp. 52-53

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

A nurse is planning a teaching session with a child. According to Piagetian theory, the period of cognitive development in which the child is able to distinguish fact from fantasy is the _____

period of cognitive development.

sensorimotor

formal operations

concrete operations

preoperational

ANS: C

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

DIF: Cognitive Level: Application REF: pp. 56-57

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

5. The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is:

Erikson.

Freud.

Kohlberg.

Piaget.

ANS: A

Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled. Sigmund Freud proposed a psychosexual theory of development in which certain parts of the body assume psychological significance as foci of sexual energy. The foci shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of development. Lawrence Kohlberg described moral development as having three levels (preconventional, conventional, and postconventional). His theory closely parallels Piaget’s. Jean Piaget’s cognitive theory interprets how children learn and think and how this thinking progresses and differs from adult thinking. Stages of his theory include sensorimotor, preoperations, concrete operations, and formal operations. DIF: Cognitive Level: Comprehension REF: p. 57

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

6. What does the nurse need to know when observing chronically ill children at play?

Play is not important to hospitalized children.

Children need to have structured play periods.

Children’s play is an indication of a child’s response to treatment.

Play is to be discouraged because it tires hospitalized children.

ANS: C

Play for all children is an activity woven with meaning and purpose and is a mechanism for mastering their environment. For chronically ill children, play can indicate their state of wellness and response to treatment. Play is important to all children in all environments. Although children’s play activities appear unorganized and at times chaotic, play has purpose and meaning. Imposing structure on play interferes with the tasks being worked on. Children who

have fewer energy reserves still require play. For these children, less-active play activities will be important.

DIF: Cognitive Level: Application REF: p. 66

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

7. Which child is most likely to be frightened by hospitalization?

A 4-month-old infant admitted with a diagnosis of bronchiolitis

A 2-year-old toddler admitted for cystic fibrosis

A 9-year-old child hospitalized with a fractured femur

A 15-year-old adolescent admitted for abdominal pain

ANS: B

Toddlers are most likely to be frightened by hospitalization because their thought processes are egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange environments. Young infants are not as likely to be frightened as toddlers by hospitalization because they are not as aware of the environment. The 9-year-old child’s cognitive ability is sufficient enough for the child to understand the reason for the hospitalization. The 15-year-old adolescent has the cognitive ability to interpret the reason for the hospitalization. DIF: Cognitive Level: Comprehension REF: p. 56

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

Which statement made by a 15-year-old adolescent with a diagnosis of neurofibromatosis (an autosomal dominant genetic disorder) best demonstrates an understanding of the mechanism of
inheritance for the disease?

“My babies will probably not have neurofibromatosis.”

“My babies have a 50% chance of having neurofibromatosis.”

“Whether my babies have problems depends on the father.”

“My babies have a 25% chance of having neurofibromatosis.”

ANS: B

Neurofibromatosis is an autosomal dominant genetic disorder that occurs when the abnormal gene is carried on the affected chromosome with a normal gene. Because the abnormal gene is dominant, an individual with the defective gene has a 50% chance of transmitting the defect to an infant with each pregnancy. Neurofibromatosis is not a sex-linked genetic disease; therefore, either the father or the mother genetically transfers it to the infant. A parent with the defective

gene will genetically transfer either a normal or abnormal gene to an infant. Because the defective gene is dominant, there is a 50% probability of the child inheriting the disease. DIF: Cognitive Level: Application REF: p. 61

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

During a routine healthcare visit, a parent asks the nurse why her 9-month-old infant is not walking as her older child did at the same age. Which response by the nurse best demonstrates an
understanding of child development?

“She’s a little slow.”

“If she is pulling up, you can help her by holding her hand.”

“Babies progress at different rates. Your infant’s development is within normal limits.”

“Maybe she needs to see a behavioral specialist.”

ANS: C

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

DIF: Cognitive Level: Application REF: p. 52

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

10. Which “expected outcome” would be developmentally appropriate for a hospitalized 4-year-old child?

The child will be dressed and fed by the parents.

The child will independently ask for play materials or other personal needs.

The child will be able to verbalize an understanding of the reason for the hospitalization.

The child will have a parent stay in the room at all times.

ANS: B

Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrate developmental appropriateness. Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. A 4-year-old child cannot be expected to cognitively understand the reason for his or her hospitalization. Expecting the child to verbalize an understanding for the hospitalization is an

inappropriate outcome. Parents staying with the child throughout a hospitalization is an inappropriate outcome. Although children benefit from parental involvement, parents may not have the support structure to stay in the room with the child at all times. DIF: Cognitive Level: Application REF: p. 55

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

A nurse has completed a teaching session with parents of preschool aged children. Which statement made by the parent identifies an appropriate level of language development for a 4-
year-old child?

The child has a vocabulary of 300 words and uses simple sentences.

The child uses correct grammar in sentences.

The child is able to pronounce consonants clearly.

The child uses language to express abstract thought.

ANS: B

The 4-year-old child is able to use correct grammar in sentence structure and typically has difficulty in pronouncing consonants. Simple sentences and a 300-word vocabulary are appropriate for a 2-year-old child. The use of language to express abstract thought is developmentally appropriate for the adolescent. DIF: Cognitive Level: Application REF: p. 58

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

12. Which should the nurse evaluate before administering the Denver Developmental Screening Test II (DDST-II)?

The child’s height and weight

The parent’s ability to comprehend the results

The child’s mood

The parent–child interaction

ANS: C

The results of the screening test are valid if the child acted in a normal and expected manner. The child’s height and weight are not relevant to the DDST-II screening process. The parent’s ability to understand the results of the screening is not relevant to the validity of the test. The parent– child interaction is not significantly relevant to the test results. DIF: Cognitive Level: Application REF: p. 65

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance 13. Which children are at greater risk for not receiving immunizations?

Children who attend licensed day care programs

Children entering school

Children who are home schooled

Young adults entering college

ANS: C

Home schooled children are at risk for being underimmunized and need to be monitored. All states require immunizations for children in day care programs and entering school. Most colleges require a record of immunizations as part of a health history. DIF: Cognitive Level: Comprehension REF: p. 70

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

14. Which developmental assessment instrument is appropriate to assess a 5-year-old child?

Brazelton Behavioral Scale

Denver Developmental Screening Test II (DDST-II)

Dubowitz Scale

New Ballard Scale

ANS: B

The DDST-II is used for infants and children between birth and 6 years of age. Brazelton’s Behavioral Scale is used for newborn assessment. The Dubowitz Scale is used for estimation of gestational age. The New Ballard Scale is used for newborn screening. DIF: Cognitive Level: Application REF: p. 65

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

15. A 2-month-old child has not received any immunizations. Which immunizations should the nurse give?

DTaP, Hib, HepB, IPV, varicella

DTaP, Hib, HepB, MMR, IPV

DTaP, Hib, HepB, PCV, IPV, rotavirus

DTaP, Hib, HepB, PCV, IPV, HepA

ANS: C

DTaP, Hib, HepB, PCV, IPV, and rotavirus are appropriate immunizations for an unimmunized 2-month-old child. The child should not receive varicella until at or after 12 months of age. MMR is not given to children until at or after 12 months of age. HepA is recommended for all children at 1 year of age.

DIF: Cognitive Level: Application REF: pp. 68-69

OBJ: Nursing Process Step: Analysis MSC: Health Promotion and Maintenance

16. You are preparing immunizations for a 12-month-old child who is immunocompromised. Which immunization cannot be given?

DTaP

HepA

IPV

Varicella

ANS: D

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

DIF: Cognitive Level: Analysis REF: p. 71

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

17. Which immunization can cause fever and rash to occur 1 to 2 weeks after administration?

HepB

DTaP

Hib

MMR

ANS: D

MMR is a live virus vaccine and can cause fever and rash 1 to 2 weeks after administration.

HepB, DTaP, and Hib do not cause fever or rash.

DIF: Cognitive Level: Application REF: p. 70