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Wong’s Essentials of Pediatric Nursing 9th Ed By Marilyn J. Hockenberry – 

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Chapter 03: Family Influences on Child Health Promotion

 

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

 

 

ANS:  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.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   24-26

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events?
a. Interactional theory
b. Developmental systems theory
c. Family stress theory
d. Duvall’s developmental theory

 

 

ANS:  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.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   24

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. 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

 

 

ANS:  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 step-parent, 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.

 

PTS:   1                    DIF:    Cognitive Level: Remember           REF:   24-26

TOP:   Integrated Process: Nursing Process: Planning

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. 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

 

 

ANS:  A

A blended family contains at least one step-parent, 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.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   24-26

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. Which is considered characteristic of children who are the youngest in their family?
a. More dependent than firstborn children
b. More outgoing than firstborn children
c. Identify more with parents than with peers
d. Are subject to greater parental expectations

 

 

ANS:  B

Later-born children are obliged to interact with older siblings from birth and seem to be more outgoing and make friends more easily than firstborns. Being more dependent, identifying more with parents than peers, and being subject to greater parental expectations are characteristics of firstborn children and only children.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   29-30

TOP:   Integrated Process: Nursing Process: Planning

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. 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.

 

 

ANS:  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.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   29

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. A 35-year-old client is currently on fertility treatments. When responding to a question from the client about multiple births, which statement by the nurse is accurate?
a. Use of fertility treatments has been associated with an increase in multiple births.
b. Your chance of having multiple births is at the same rate as all women of childbearing age.
c. There is not enough evidence about the use of fertility treatments increasing the rate of multiple births.
d. Because of your age and the fertility treatments, you have almost a 100% chance of a multiple birth.

 

 

ANS:  A

Because women in their thirties are almost 2.5 times as likely as women in their twenties to have higher-order plural births, increased childbearing among older women and the expanded use of fertility drugs have been associated with an increase in the multiple-birth ratio. The rate of having a multiple birth for this client is not the same for all women of childbearing age. There are data indicating that fertility treatments increase the rate of multiple births, but fertility treatments do not have a 100% rate of multiple births.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   30

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Health Promotion and Maintenance: Family Systems

 

  1. Nicole and Kelly, age 5 years, are identical twins. Their parents tell the nurse that the girls always want to be together. The nurse’s suggestions should be based on which statement?
a. Some twins thrive best when they are constantly together.
b. Individuation cannot occur if twins are together too much.
c. Separating twins at an early age helps them develop mentally.
d. When twins are constantly together, pathologic bonding occurs.

 

 

ANS:  A

Twins work out a relationship that is reasonably satisfactory to both. They develop a remarkable capacity for cooperative play and considerable loyalty and generosity toward each other. Parents should foster individual differences and allow the children to follow their natural inclinations. Individuation does occur. In twinship, one member of the pair is more dominant, outgoing, and assertive than the other. Early separation may produce unnecessary stresses for the children. There is no evidence that pathologic bonding occurs when twins are constantly together.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   30-31

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. 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.”

 

 

ANS:  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.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   31-32

TOP:   Integrated Process: Nursing Process: Evaluation

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. When assessing a family, the nurse determines that the parents exert little or no control over their children. This style of parenting is called:
a. permissive.
b. dictatorial.
c. democratic.
d. authoritarian.

 

 

ANS:  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.

 

PTS:   1                    DIF:    Cognitive Level: Remember           REF:   33

TOP:   Integrated Process: Nursing Process: Diagnosis

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. 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.

 

 

ANS:  B

For effective discipline, parents must be consistent and must follow through with agreed-on actions. Realistic goals should be set for this age group. Parents should structure the environment to prevent unnecessary difficulties. Requests for behavior change should be phrased in a positive manner to provide direction for the child. Withdrawal of love and approval is never appropriate or effective. Discipline strategies should be appropriate to the child’s age, temperament, and severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   33

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. 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.

 

 

ANS:  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.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   35

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. 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.

 

 

ANS:  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.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   36

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. 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

 

 

ANS:  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 parent, or an unusual response that indicates need for referral in school-age children after parental divorce.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   37

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. 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.”

 

 

ANS:  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.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   40

TOP:   Integrated Process: Communication and Documentation

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

 

 

ANS:  B, E, F

A clear set of family rules, values, and beliefs that establishes expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families also are able to engage in problem-solving activities and to find a balance between internal and external forces. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Strong families also use varied coping strategies. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   28

TOP:   Integrated Process: Nursing Process: Diagnosis

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. 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.

 

 

ANS:  B, C, E

A rule for the length of time-out is 1 minute per year of age; use a kitchen timer with an audible bell to record the time rather than a watch. When the child misbehaves, one warning should be given. When the child is quiet for the duration of the time, he or she can then leave the room. Time-out can be used in public places and the parents should be consistent on the use of time-out. Implement time-out in a public place by selecting a suitable area or explain to children that time-out will be spent immediately on returning home. The time-out should not be spent in an area from which the child can view the television. Select an area for time-out that is safe, convenient, and unstimulating but where the child can be monitored, such as the bathroom, hallway, or laundry room.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   35

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. 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 type 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

 

 

ANS:  A, B, E

A child 3 to 5 years of age (preschool) may display fears of abandonment, verbalize feelings that he or she is the reason for the divorce, and engage in fantasy to understand the divorce. They 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.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   38

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.)

 

ANS:

24

The term foster care is defined as 24-hour substitute care for children outside of their own homes.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   41

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. A parent of a newborn is expressing concern about returning to work after taking time off under the Family and Medical Leave Act (FMLA). The nurse understands that the Act allows a new parent to take off from work for _____ weeks. (Record your answer as a whole number.)

 

ANS:

12

The passage of the Family and Medical Leave Act (FMLA) in 1993 set the stage for a greater focus on the issues of contemporary families. FMLA allows eligible employees to take up to 12 weeks of unpaid leave each year to care for newborn or newly adopted children, parents, or spouses who have serious health conditions or to recover from their own serious health condition.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   41

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Health Promotion and Maintenance

Chapter 11: Health Problems of Infants

 

MULTIPLE CHOICE

 

  1. Recent studies indicate that a deficiency of which vitamin correlates with increased morbidity and mortality in children with measles?
a. A
b. C
c. Niacin
d. Folic acid

 

 

ANS:  A

Vitamin A deficiency is correlated with increased morbidity and mortality in children with measles. This vitamin deficiency also is associated with complications from diarrhea, and infections are often increased in infants and children with vitamin A deficiency. No correlation exists between vitamins C, niacin, or folic acid and measles.

 

PTS:   1                    DIF:    Cognitive Level: Remember           REF:   355

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. Which vitamin is recommended for all women of childbearing age to reduce the risk of neural tube defects such as spina bifida?
a. A
b. C
c. Niacin
d. Folic acid

 

 

ANS:  D

The vitamin supplement that is recommended for all women of childbearing age is a daily dose of 0.4 mg of folic acid. Folic acid taken before conception and during pregnancy can reduce the risk of neural tube defects by 70%. No correlation exists between vitamins A, C, or folic acid and neural tube defects.

 

PTS:   1                    DIF:    Cognitive Level: Remember           REF:   355

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. A nurse is assessing a child with kwashiorkor disease. Which assessment findings should the nurse expect?
a. Thin wasted extremities with a prominent abdomen
b. Constipation
c. Elevated hemoglobin
d. High levels of protein

 

 

ANS:  A

The child with kwashiorkor has thin, wasted extremities and a prominent abdomen from edema (ascites). Diarrhea (persistent diarrhea malnutrition syndrome) not constipation commonly occurs from a lowered resistance to infection and further complicates the electrolyte imbalance. Anemia and protein deficiency is a common finding in malnourished children with kwashiorkor.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   357

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. A nurse is preparing to accompany a medical mission’s team to a third world country. Marasmus is seen frequently in children 6 months to 2 years in this country. Which symptoms should the nurse expect for this condition?
a. Loose, wrinkled skin
b. Edematous skin
c. Depigmentation of the skin
d. Dermatoses

 

 

ANS:  A

Marasmus is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears to be very old, with loose and wrinkled skin, unlike the child with kwashiorkor, who appears more rounded from the edema. Fat metabolism is less impaired than in kwashiorkor; thus, deficiency of fat-soluble vitamins is usually minimal or absent. In general, the clinical manifestations of marasmus are similar to those seen in kwashiorkor with the following exceptions: With marasmus, there is no edema from hypoalbuminemia or sodium retention, which contributes to a severely emaciated appearance; no dermatoses caused by vitamin deficiencies; little or no depigmentation of hair or skin; moderately normal fat metabolism and lipid absorption; and a smaller head size and slower recovery after treatment.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   357

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. Rickets is caused by a deficiency in:
a. vitamin A.
b. vitamin C.
c. vitamin D and calcium.
d. folic acid and iron.

 

 

ANS:  C

Fat-soluble vitamin D and calcium are necessary in adequate amounts to prevent the development of rickets. No correlation exists between vitamins A, C, folic acid, or iron and rickets.

 

PTS:   1                    DIF:    Cognitive Level: Remember           REF:   355

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. A nurse is preparing to administer an oral iron supplement to a hospitalized infant. Which should not be given simultaneously with the iron supplement?
a. Milk
b. Multivitamin
c. Fruit juice
d. Meat, fish, poultry

 

 

ANS:  A

Many foods interfere with iron absorption and should be avoided when the iron is consumed. These foods include phosphates found in milk, phytates found in cereals, and oxalates found in many vegetables. Multivitamins may contain iron; no contraindication exists to taking the two together. Vitamin C–containing juices enhance the absorption of iron. Meat, fish, and poultry do not have an effect on absorption.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   356

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. Parents report that they have been giving a multivitamin to their 1-year-old infant. The nurse counsels the parents that which vitamin can cause a toxic reaction at a low dose?
a. Niacin
b. B6
c. D
d. C

 

 

ANS:  C

Hypervitaminosis of vitamin D presents the greatest problem because this fat-soluble vitamin is stored in the body. Vitamin D is the most likely of all vitamins to cause toxic reactions in relatively small overdoses. The water-soluble vitamins, primarily niacin, B6, and C, can also cause toxicity but not at the low dose that occurs with vitamin D.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   355

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. The nurse is helping parents achieve a more nutritionally adequate vegetarian diet for their child. Which is most likely lacking in their particular diet?
a. Fat
b. Protein
c. Vitamins C and A
d. Complete protein

 

 

ANS:  D

The vegetarian diet can be extremely healthy, meeting the overall nutrition objectives for Healthy People. Parents should be taught about food preparation to ensure that complete proteins are available for growth. When parents use a strict vegetarian diet, likelihood exists of inadequate protein for growth and calories for energy. Fat and vitamins C and A are readily available from vegetable sources. Plant proteins are available. Foods must be combined to provide complete proteins for growth.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   356

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. Which describes marasmus?
a. Deficiency of protein with an adequate supply of calories
b. Not confined to geographic areas where food supplies are inadequate
c. Syndrome that results solely from vitamin deficiencies
d. Characterized by thin, wasted extremities and a prominent abdomen resulting from edema (ascites)

 

 

ANS:  B

Marasmus is a syndrome of emotional and physical deprivation. It is not confined to geographic areas were food supplies are inadequate. Marasmus is a deficiency of both protein and calories. It is characterized by gradual wasting and atrophy of body tissues, especially of subcutaneous fat. The child appears very old, with flabby and wrinkled skin.

 

PTS:   1                    DIF:    Cognitive Level: Remember           REF:   357

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. Although infants may be allergic to a variety of foods, the most common allergens are:
a. fruit and eggs.
b. fruit, vegetables, and wheat.
c. cow’s milk and green vegetables.
d. eggs, cow’s milk, and wheat.

 

 

ANS:  D

Milk products, eggs, and wheat are three of the most common food allergens. Ingestion of these products can cause sensitization and, with subsequent exposure, an allergic reaction. Eggs are a common allergen, but fruit is not. Wheat is a common allergen, but fruit and vegetables are not. Cow’s milk is a common allergen, but green vegetables are not.

 

PTS:   1                    DIF:    Cognitive Level: Remember           REF:   358

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. Cow’s milk allergy (CMA) is diagnosed in a 6-month-old infant. Which should the nurse recommend as a substitute formula?
a. Nutramigen
b. Goat’s milk
c. Similac
d. Enfamil

 

 

ANS:  A

Treatment of CMA is elimination of cow’s milk–based formula and all other dairy products. For infants fed cow’s milk formula, this primarily involves changing the formula to a casein hydrolysate milk formula (Pregestimil, Nutramigen, or Alimentum). Goat’s milk (raw) is not an acceptable substitute because it cross-reacts with cow’s milk protein, is deficient in folic acid, has a high sodium and protein content, and is unsuitable as the only source of calories. Cow’s milk protein is contained in both Enfamil and Similac.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   360-361

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. A nurse is teaching parents about prevention and treatment of colic. Which should the nurse include in the teaching plan?
a. Avoid use of pacifiers.
b. Eliminate all second-hand smoke contact.
c. Lay infant flat after feeding.
d. Avoid swaddling the infant.

 

 

ANS:  B

To prevent and treat colic, teach parents that if household members smoke, avoid smoking near infant; preferably confine smoking activity to outside of home. A pacifier can be introduced for added sucking. The infant should be swaddled tightly with a soft, stretchy blanket and placed in an upright seat after feedings.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   367

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. A parent of an infant with colic tells the nurse, “All this baby does is scream at me; it is a constant worry.” The nurse’s best action is:
a. encourage parent to verbalize feelings.
b. encourage parent not to worry so much.
c. assess parent for other signs of inadequate parenting.
d. reassure parent that colic rarely lasts past age 9 months.

 

 

ANS:  A

Colic is multifactorial, and no single treatment is effective for all infants. The parent is verbalizing concern and worry. The nurse should allow the parent to put these feelings into words. An empathic, gentle, and reassuring attitude, in addition to suggestions about remedies, will help alleviate the parent’s anxieties. The nurse should reassure the parent that he or she is not doing anything wrong. Colic is multifactorial. The infant with colic is experiencing spasmodic pain that is manifested by loud crying, in some cases up to 3 hours each day. Telling the parent that it will eventually go away does not help him or her through the current situation.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   367-368

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. Parent guidelines for relieving colic in an infant include:
a. avoiding touching abdomen.
b. avoiding using a pacifier.
c. changing infant’s position frequently.
d. placing infant where family cannot hear the crying.

 

 

ANS:  C

Changing the infant’s position frequently may be beneficial. The parent can walk holding the child face down and with the child’s chest across the parent’s arm. The parent’s hand can support the child’s abdomen, applying gentle pressure. Gently massaging the abdomen is effective in some children. Pacifiers can be used for meeting additional sucking needs. The child should not be placed where monitoring cannot be done. The child can be placed in the crib and allowed to cry. Periodically, the child should be picked up and comforted.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   367-368

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. Clinical manifestations of failure to thrive caused by behavioral problems resulting in inadequate intake of calories include:
a. avoidance of eye contact.
b. an associated malabsorption defect.
c. weight that falls below the 15th percentile.
d. normal achievement of developmental landmarks.

 

 

ANS:  A

One of the clinical manifestations of nonorganic failure to thrive is the child’s avoidance of eye contact with the health professional. A malabsorption defect would result in a physiologic problem, not behavioral. Weight (but not height) below the 5th percentile is indicative of failure to thrive. Developmental delays, including social, motor, adaptive, and language, exist.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   362

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. Which is an important nursing consideration when caring for an infant with failure to thrive?
a. Establish a structured routine and follow it consistently.
b. Maintain a nondistracting environment by not speaking to child during feeding.
c. Place child in an infant seat during feedings to prevent overstimulation.
d. Limit sensory stimulation and play activities to alleviate fatigue.

 

 

ANS:  A

The infant with failure to thrive should have a structured routine that is followed consistently. Disruptions in other activities of daily living can have a great impact on feeding behaviors. Bathing, sleeping, dressing, playing, and feeding are structured. The nurse should talk to the child by giving directions about eating. This will help the child maintain focus. Young children should be held while being fed, and older children can sit at a feeding table. The child should be fed in the same manner at each meal. The child can engage in sensory and play activities at times other than mealtime.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   362-363

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. An important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS) is to:
a. explain how SIDS could have been predicted and prevented.
b. interview parents in depth concerning the circumstances surrounding the child’s death.
c. discourage parents from making a last visit with the infant.
d. make a follow-up home visit to parents as soon as possible after the child’s death.

 

 

ANS:  D

A competent, qualified professional should visit the family at home as soon as possible after the death and provide the family with printed information about SIDS. An explanation of how SIDS could have been predicted and prevented is inappropriate. SIDS cannot be prevented or predicted. Discussions about the cause will only increase parental guilt. The parents should be asked only factual questions to determine the cause of death. Parents should be allowed and encouraged to make a last visit with their child.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   372

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. Which is an appropriate action when an infant becomes apneic?
a. Shake vigorously.
b. Roll head side to side.
c. Hold by feet upside down with head supported.
d. Gently stimulate trunk by patting or rubbing.

 

 

ANS:  D

If the infant is apneic, the infant’s trunk should be gently stimulated by patting or rubbing. If the infant is prone, turn onto the back. The infant should not be shaken vigorously, the head rolled side to side, or held by the feet upside down with the head supported. These can cause injury.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   373

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. To prevent plagiocephaly, the nurse should teach parents to:
a. place infant prone for 30 to 60 minutes per day.
b. buy a soft mattress.
c. allow infant to nap in the car safety seat.
d. have infant sleep with the parents.

 

 

ANS:  A

Prevention of positional plagiocephaly may begin shortly after birth by implementing prone positioning or “tummy time” for approximately 30 to 60 minutes per day when the infant is awake. Soft mattresses or sleeping with parents (co-sleeping) are not recommended because they put the infant at a higher risk for a sudden infant death incident. To prevent plagiocephaly, prolonged placement in car safety seats should be avoided.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   367

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. An infant has been pronounced dead from sudden infant death syndrome (SIDS) in the emergency department. Which is an appropriate question to ask the parents?
a. “Did you hear the infant cry out?”
b. “Why didn’t you check on the infant earlier?”
c. “What time did you find the infant?”
d. “Was the head buried in a blanket?”

 

 

ANS:  C

During a SIDS incident, if the infant is not pronounced dead at the scene, he or she may be transported to the emergency department to be pronounced dead by a physician. While they are in the emergency department, the parents are asked only factual questions, such as when they found the infant, how he or she looked, and whom they called for help. The nurse avoids any remarks that may suggest responsibility, such as “Why didn’t you go in earlier?” “Didn’t you hear the infant cry out?” “Was the head buried in a blanket?”

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   371

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. An infant experienced an apparent life-threatening event (ALTE) and is being placed on home apnea monitoring. Parents have understood the instructions for use of a home apnea monitor when they state:
a. “We can adjust the monitor to eliminate false alarms.”
b. “We should sleep in the same bed as our monitored infant.”
c. “We will check the monitor several times a day to be sure the alarm is working.”
d. “We will place the monitor in the crib with our infant.”

 

 

ANS:  C

The parents should check the monitor several times a day to be sure the alarm is working and that it can be heard from room to room. The parents should not adjust the monitor to eliminate false alarms. Adjustments could compromise the monitor’s effectiveness. The monitor should be placed on a firm surface away from the crib and drapes. The parents should not sleep in the same bed as the monitored infant.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   373

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. What should the nurse suggest to the parents of an infant who has a prolonged need for middle-of-the-night feedings?
a. Decrease daytime feedings.
b. Allow child to go to sleep with a bottle.
c. Offer last feeding as late as possible at night.
d. Put infant to bed after asleep from rocking.

 

 

ANS:  C

To manage an infant who has a prolonged need for middle-of-the-night feedings parents should be taught to offer last feeding as late as possible at night. Parent should increase daytime feeding intervals to 4 hours or more (may need to be done gradually), offer no bottles in bed, put to bed awake and when child is crying, check at progressively longer intervals each night; reassure child but do not hold, rock, take to parent’s bed, or give bottle or pacifier.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   365-366

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. A nurse is preparing to feed a 12-month-old infant with failure to thrive. Which intervention should the nurse implement?
a. Provide stimulation during feeding.
b. Avoid being persistent during feeding time.
c. Limit feeding time to 10 minutes.
d. Maintain a face-to-face posture with the infant during feeding.

 

 

ANS:  D

The nurse preparing to feed an infant with failure to thrive should maintain a face-to-face posture with the infant when possible. Encourage eye contact and remain with the infant throughout the meal. Stimulation is not recommended; a quiet, unstimulating atmosphere should be maintained. Persistence during feeding may need to be implemented. Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Although forced feeding is avoided, “strictly encouraged” feeding is essential. The length of the feeding should be established (usually 30 minutes); limiting the feeding to 10 minutes would make the infant feel rushed.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   364

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity

 

MULTIPLE RESPONSE

 

  1. After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which of the following pediatric disorders? (Select all that apply.)
a. SIDS
b. Torticollis
c. Failure to thrive
d. Apnea of infancy
e. Plagiocephaly

 

 

ANS:  B, E

Plagiocephaly is a misshapen head caused by the prolonged pressure on one side of the skull. If that side becomes misshapen, facial asymmetry may result. The sternocleidomastoid muscle may tighten on the affected side, causing torticollis. SIDS has decreased by more than 40% with the introduction of the Back to Sleep campaign. Apnea of infancy and failure to thrive are unrelated to the Back to Sleep campaign.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   362 | 366

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. A nurse is conducting education classes for parents of infants. The nurse plans to discuss sudden infant death syndrome (SIDS). Which risk factors should the nurse include as increasing an infant’s risk of a sudden infant death syndrome incident? (Select all that apply.)
a. Breastfeeding
b. Low Apgar scores
c. Male sex
d. Birth weight in the 50th or higher percentile
e. Recent viral illness

 

 

ANS:  B, C, E

Certain groups of infants are at increased risk for SIDS: low birth weight, low Apgar scores, recent viral illness, and male sex. Breastfed infants and infants of average or above average weight are not at higher risk for SIDS.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   371

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. An infant has been diagnosed with cow’s milk allergy. What are the clinical manifestations the nurse expects to assess? (Select all that apply.)
a. Pink mucous membranes
b. Vomiting
c. Rhinitis
d. Abdominal pain
e. Moist skin

 

 

ANS:  B, C, D

An infant with cow’s milk allergy will possibly have vomiting, rhinitis, and abdominal pain. The mucous membranes may be pale due to anemia from blood lost in the GI tract, and the skin will be itchy with the possibility of atopic dermatitis.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   361

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity

 

  1. Which interventions should the nurse implement when caring for a family of a sudden infant death syndrome (SIDS) infant? (Select all that apply.)
a. Allow parents to say goodbye to their infant.
b. Once parents leave the hospital, no further follow-up is required.
c. Arrange for someone to take the parents home from the hospital.
d. Avoid requesting an autopsy of the deceased infant.
e. Conduct a debriefing session with the parents before they leave the hospital.

 

 

ANS:  A, C, E

An important aspect of compassionate care for parents experiencing a SIDS incident is allowing them to say good-bye to their infant. These are the parents’ last moments with their infant, and they should be as quiet, meaningful, peaceful, and undisturbed as possible. Because the parents leave the hospital without their infant, it is helpful to accompany them to the car or arrange for someone else to take them home. A debriefing session may help health care workers who dealt with the family and deceased infant to cope with emotions that are often engendered when a SIDS victim is brought into the acute care facility. An autopsy may clear up possible misconceptions regarding the death. When the parents return home, a competent, qualified professional should visit them after the death as soon as possible.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   372

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Psychosocial Integrity

 

SHORT ANSWER

 

  1. An infant is having an anaphylactic reaction, and the nurse is preparing to administer epinephrine 0.001 mg/kg. The child weighs 22 pounds. What is the epinephrine dose the nurse should administer? (Record your answer using two decimal places.)

 

ANS:

0.01

Convert the 22 pounds to kilograms by dividing 22 by 2.2 = 10. Multiply the 10 by 0.001 mg of epinephrine = 0.01 mg as the dose to be given.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   360

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity

 

ESSAY

 

  1. A school nurse observes a child, with a peanut allergy, in obvious distress, wheezing and cyanotic, after ingestion of some trail mix containing peanuts. Place the interventions the nurse should implement in order of the highest priority to the lowest priority. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d).
  2. Call Jason’s parents and notify them of the situation.
  3. Call Jason’s family practitioner to obtain further orders for medication.
  4. Promptly administer an intramuscular dose of epinephrine.
  5. Call 911 and wait for the emergency response personnel to arrive.

 

ANS:

c, d, b, a

The nurse should first administer epinephrine IM to a child with a food allergy who is in obvious distress, wheezing, and cyanotic. 911 should be called after the epinephrine is administered. The physician should be contacted for further orders and, last, the parents notified of the situation.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   359-360

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity

Chapter 17: Health Problems of School-Age Children and Adolescents

 

MULTIPLE CHOICE

 

  1. Which statement is true about smoking in adolescence?
a. Smoking is related to other high-risk behaviors.
b. Smoking will not continue unless peer pressure continues.
c. Smoking is less common when the adolescent’s parent(s) smokes.
d. Smoking among adolescents is becoming more prevalent.

 

 

ANS:  A

Cigarettes are considered a gateway drug. Teenagers who smoke are 11.4 times more likely to use an illicit drug. Teenagers begin smoking for a variety of reasons, such as imitation of adult behavior, peer pressure, imitation of behaviors portrayed in movies and advertisements, and a desire to control weight. The absence of peer pressure alone will not stop smoking. Teenagers who do not smoke usually have parents and friends who do not smoke or who oppose smoking. The percentage of young people who report current cigarette use and frequent cigarette use has declined significantly.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   527

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. Smokeless tobacco is:
a. not addicting.
b. proven to be carcinogenic.
c. easy to stop using.
d. a safe alternative to cigarette smoking.

 

 

ANS:  B

Smokeless tobacco is a popular substitute for cigarettes and poses serious health hazards to children and adolescents. Smokeless tobacco is associated with cancer of the mouth and jaw. The nicotine in the smokeless tobacco is addicting, and therefore it is very difficult to quit. Because the product is addicting and can cause cancer, it is not a safe alternative to cigarette smoking.

 

PTS:   1                    DIF:    Cognitive Level: Remember           REF:   528

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. A child has been diagnosed with enuresis. TCA imipramine (Tofranil) has been prescribed for the child. The nurse understands that this medication is in which category?
a. Antidepressant
b. Antidiuretic
c. Antispasmodic
d. Analgesic

 

 

ANS:  C

Drug therapy is increasingly being prescribed to treat enuresis. Three types of drugs are used: tricyclic antidepressants (TCAs), antidiuretics, and antispasmodics. The selection depends on the interpretation of the cause. The drug used most frequently is the TCA imipramine (Tofranil), which exerts an anticholinergic action in the bladder to inhibit urination. Tofranil is in the antispasmodic category. Analgesics are not used to treat enuresis.

 

PTS:   1                    DIF:    Cognitive Level: Remember           REF:   499

TOP:   Integrated Process: Nursing Process: Evaluation

MSC:  Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A 12-year-old male has short stature because of a constitutional growth delay. The nurse should be the most concerned about which of the following?
a. Proper administration of thyroid hormone
b. Proper administration of human growth hormones
c. Child’s self-esteem and sense of competence
d. Helping child understand that his height is most likely caused by chronic illness and is not his fault

 

 

ANS:  C

Most cases of constitutional growth delay are caused by simple constitutional delay of puberty, and the child can be assured that normal development will eventually take place. Listening to distressed adolescents and conveying interest and concern are important interventions for these children and adolescents. They should be encouraged to focus on the positives aspects of their bodies and personalities. Thyroid hormones and human growth hormones would not be beneficial in a constitutional growth delay. A constitutional growth delay is not caused by a chronic illness.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   507

TOP:   Integrated Process: Nursing Process: Planning

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. Which syndrome involves a common sex chromosome defect?
a. Down
b. Turner
c. Marfan
d. Hemophilia

 

 

ANS:  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.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   507

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. Turner syndrome is suspected in an adolescent girl with short stature. This is caused by:
a. absence of one of the X chromosomes.
b. presence of an incomplete Y chromosome.
c. precocious puberty in an otherwise healthy child.
d. excess production of both androgens and estrogens.

 

 

ANS:  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.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   507

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. An adolescent asks the nurse what causes primary dysmenorrhea. The nurse’s response should be based on which statement?
a. It is an inherited problem.
b. Excessive estrogen production causes uterine pain.
c. There is no physiologic cause; it is a psychological reaction.
d. There is a relation between prostaglandins and uterine contractility.

 

 

ANS:  D

The exact etiology of primary dysmenorrhea is debated. Overproduction of uterine prostaglandins has been implicated, as has overproduction of vasopressin. Dysmenorrhea is not known to be inherited. Excessive estrogen has not been implicated in the etiology. It has a physiologic cause. Women with dysmenorrhea have higher prostaglandin levels.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   508-509

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. An adolescent girl asks the school nurse for advice because she has dysmenorrhea. She says that a friend recommended she try an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). The nurse’s response should be based on which statement?
a. Aspirin is the drug of choice for the treatment of dysmenorrhea.
b. Over-the-counter NSAIDs are rarely strong enough to provide adequate pain relief.
c. NSAIDs are effective because of their analgesic effect.
d. NSAIDs are effective because they inhibit prostaglandins, leading to reduction in uterine activity.

 

 

ANS:  D

First-line therapy for adolescents with dysmenorrhea is NSAIDs. This group of drugs blocks the formation of prostaglandins. NSAIDs, not aspirin, are the drugs of choice in dysmenorrhea. NSAIDs are potent anti-inflammatory agents that inhibit prostaglandin. Although NSAIDs have analgesic effects, the mechanism of action in dysmenorrhea is most likely the antiprostaglandin effect.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   508

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. The school nurse is discussing testicular self-examination with adolescent boys. Why is this important?
a. Epididymitis is common during adolescence.
b. Asymptomatic sexually transmitted diseases may be present.
c. Testicular tumors during adolescence are generally malignant.
d. Testicular tumors, although usually benign, are common during adolescence.

 

 

ANS:  C

Tumors of the testes are not common, but when manifested in adolescence, they are generally malignant and demand immediate evaluation. Epididymitis is not common in adolescence. Asymptomatic sexually transmitted disease would not be evident during testicular self-examination. The focus of this examination is on testicular cancer. Testicular tumors are most commonly malignant.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   510

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. Which is the usual presenting symptom for testicular cancer?
a. Hard, painful mass
b. Hard, painless mass
c. Epididymis easily palpated
d. Scrotal swelling and pain

 

 

ANS:  B

The usual presenting symptom for testicular cancer is a heavy, hard, painless mass that is either smooth or nodular and palpated on the testes. A hard, painful mass, an epididymis easily palpated, and scrotal swelling and pain are not the clinical presentations of testicular cancer.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   509

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. A 14-year-old boy and his parents are concerned about bilateral breast enlargement. The nurse’s discussion of this should be based on which statement?
a. This is usually benign and temporary.
b. This is usually caused by Klinefelter syndrome.
c. Administration of estrogen effectively reduces gynecomastia.
d. Administration of testosterone effectively reduces gynecomastia.

 

 

ANS:  A

The male breast responds to hormonal changes. Some degree of bilateral or unilateral breast enlargement occurs frequently in boys during puberty. Although individuals with Klinefelter syndrome can have gynecomastia, it is not a common cause for male breast enlargement. Estrogen is not a therapy for gynecomastia. Administration of testosterone has no benefit for gynecomastia and may aggravate the condition.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   510

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4 months ago. She has not received any medical care. She smokes but denies any other substance use. The priority nursing action is to:
a. notify her parents.
b. refer for prenatal care.
c. explain the importance of not smoking.
d. discuss dietary needs for adequate fetal growth.

 

 

ANS:  B

Teenage girls and their unborn children are at greater risk for complications during pregnancy and delivery. With improved therapies, the mortality for teenage pregnancy is decreasing, but the morbidity is high. A pregnant teenager needs careful assessment by the nurse to determine the level of social support available to her and possibly her partner. Guidance from the adults in her life would be invaluable, but confidentiality should be maintained. Although it is important to explain the importance of not smoking and to discuss dietary needs for adequate fetal growth, because of her potential for having a high-risk pregnancy, she will need a comprehensive prenatal program to minimize maternal-fetal complications.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   510-511

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. An adolescent girl calls the nurse at the clinic because she had unprotected sex the night before and does not want to be pregnant. The nurse should explain that:
a. it is too late to prevent an unwanted pregnancy.
b. an abortion may be the best option if she is pregnant.
c. Norplant can be administered to prevent pregnancy for up to 5 years.
d. postcoital contraception is available to prevent implantation.

 

 

ANS:  D

Several emergency methods of contraception are available. Postcoital contraception options do exist. It is nontherapeutic to tell her it is too late or that an abortion is the best option. Norplant is not a postcoital contraceptive.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   514

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. A sexually active female adolescent asks the nurse about the contraceptive Depo-Provera. The nurse should explain that it:
a. requires injections every 3 months.
b. requires daily administration of medication by mouth.
c. provides long-term continuous protection, up to 5 years.
d. prevents pregnancy if given within 72 hours of unprotected sex.

 

 

ANS:  A

The contraceptive Depo-Provera is administered by injection every 3 months. Oral contraceptives, not Depo-Provera, require daily administration of medication by mouth. Norplant, not Depo-Provera, provides long-term continuous protection for up to 5 years. Postcoital contraception, not Depo-Provera, prevents pregnancy if given within 72 hours of unprotected sex.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   511

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. Which statement is true about gonorrhea?
a. It is caused by Treponema pallidum.
b. Treatment is by multidose administration of penicillin.
c. Treatment is by topical applications to lesions.
d. Treatment of all sexual contacts is an essential part of treatment.

 

 

ANS:  D

The treatment plan should include finding and treating all sexual partners. Gonorrhea is caused by Neisseria gonorrhoeae. Syphilis is caused by T. pallidum. Primary treatment is with different antibiotics because of N. gonorrhoeae resistance to penicillin. Systemic therapy is necessary to treat this disease.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   515

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. Which statement regarding chlamydia infection is correct?
a. Treatment of choice is oral penicillin.
b. Treatment of choice is nystatin or miconazole.
c. Clinical manifestations include dysuria and urethral itching in males.
d. Clinical manifestations include small, painful vesicles on genital areas.

 

 

ANS:  C

Symptoms of chlamydia infection in males include meatal erythema, tenderness, itching, dysuria, and urethral discharge. Some infected males have no symptoms. Oral penicillin and nystatin or miconazole are not the antibiotics of choice. Small, painful vesicles on genital areas are clinical manifestations true of chlamydia infection but may also indicate herpetic lesions.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   515

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. A nurse is conducting a class for adolescent girls about pelvic inflammatory disease (PID). Why should the nurse emphasize the importance of preventing pelvic inflammatory disease (PID)?
a. PID can be sexually transmitted.
b. PID cannot be treated.
c. PID can have devastating effects on the reproductive tract.
d. PID can cause serious defects in future children of affected adolescents.

 

 

ANS:  C

PID is a major concern because of its devastating effects on the reproductive tract. Short-term complications include abscess formation in the fallopian tubes, whereas long-term complications include ectopic pregnancy, infertility, and dyspareunia. PID is an infection of the upper female genital tract, most commonly caused by sexually transmitted infections but it is not sexually transmitted to another person. PID can be treated by treating the underlying cause. There is a possibility of ectopic pregnancy but not birth defects in children.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   514

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. Which statement is correct about childhood obesity?
a. Heredity is an important factor in the development of obesity.
b. Childhood obesity in the United States is decreasing.
c. Childhood obesity is the result of inactivity.
d. Childhood obesity can be attributed to an underlying disease in most cases.

 

 

ANS:  A

Heredity is an important fact that contributes to obesity. Identical twins reared apart tend to resemble their biologic parents to a greater extent than their adoptive parents. It is difficult to distinguish between hereditary and environmental factors. The number of overweight children is increasing in the United States. Inactivity is related to childhood obesity, but it is not the only component. Underlying diseases such as hypothyroidism and hyperinsulinism account for only a small number of cases of childhood obesity.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   518

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. The psychological effects of being obese during adolescence include:
a. sexual promiscuity.
b. poor body image.
c. feelings of contempt for thin peers.
d. accurate body image but self-deprecating attitude.

 

 

ANS:  B

Common emotional consequences of obesity include poor body image, low self-esteem, social isolation, and feelings of depression and isolation. Sexual promiscuity, feelings of contempt for thin peers, and accurate body image but self-deprecating attitude are not usually associated with obesity.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   519

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Psychosocial Integrity: Coping and Adaptation

 

  1. Anorexia nervosa may best be described as:
a. occurring most frequently in adolescent males.
b. occurring most frequently in adolescents from lower socioeconomic groups.
c. resulting from a posterior pituitary disorder.
d. resulting in severe weight loss in the absence of obvious physical causes.

 

 

ANS:  D

The etiology of anorexia remains unclear, but a distinct psychological component is present. The diagnosis is based primarily on psychological and behavioral criteria. Females account for 90% to 95% of the cases. No relation has been identified between socioeconomic groups and anorexia. Posterior pituitary disorders are not associated with anorexia nervosa.

 

PTS:   1                    DIF:    Cognitive Level: Remember           REF:   522

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. Young people with anorexia nervosa are often described as being:
a. independent.
b. disruptive.
c. conforming.
d. low achieving.

 

 

ANS:  C

Individuals with anorexia nervosa are described as perfectionist, academically high achievers, conforming, and conscientious. “Independent,” disruptive,” and “low achieving” are not part of the behavioral characteristics of anorexia nervosa.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   522

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. The weight loss of anorexia nervosa is usually triggered by
a. sexual abuse.
b. school failure.
c. independence from family.
d. traumatic interpersonal conflict.

 

 

ANS:  D

Weight loss may be triggered by a typical adolescent crisis such as the onset of menstruation or a traumatic interpersonal incident; situations of severe family stress, such as parental separation or divorce; or circumstances in which the young person lacks personal control, such as being teased, changing schools, or entering college. “Sexual abuse,” “school failure,” and “independence from family” are not part of the behavioral characteristics of anorexia nervosa.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   523

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. Which symptoms should the nurse expect to observe during the physical assessment of an adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa?
a. Dysmenorrhea and oliguria
b. Tachycardia and tachypnea
c. Heat intolerance and increased blood pressure
d. Lowered body temperature and brittle nails

 

 

ANS:  D

Symptoms of anorexia nervosa include lower body temperature, severe weight loss, decreased blood pressure, dry skin, brittle nails, altered metabolic activity, and presence of lanugo hair. Amenorrhea, rather than dysmenorrhea, and cold intolerance are manifestations of anorexia nervosa. Bradycardia, rather than tachycardia, may be present.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   523

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. Which is descriptive of bulimia during adolescence?
a. Strong sense of control over eating behavior
b. Feelings of elation after the binge-purge cycle
c. Profound lack of awareness that the eating pattern is abnormal
d. Weight that can be normal, slightly above normal, or below normal

 

 

ANS:  D

Individuals with bulimia are of normal or more commonly slightly above normal weight. Those who also restrict their intake can become severely underweight. The adolescent has a lack of control over eating during the episode. Patients with bulimia commonly have self-deprecating thoughts and a depressed mood after binge-purge cycles; they are also aware that the eating pattern is abnormal but are unable to stop.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   522

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. An adolescent teen has bulimia. Which assessment finding should the nurse expect to assess?
a. Diarrhea
b. Amenorrhea
c. Cold intolerance
d. Erosion of tooth enamel

 

 

ANS:  D

Some of the signs of bulimia include erosion of tooth enamel, increased dental caries from vomited gastric acid, throat complaints, fluid and electrolyte disturbances, and abdominal complaints from laxative abuse. Diarrhea is not a result of the vomiting. It may occur in patients with bulimia who also abuse laxatives. Amenorrhea and cold intolerance are characteristics of anorexia nervosa, which some bulimics have. These symptoms are related to the extreme low weight.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   522

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. Which is descriptive of attention deficit hyperactivity disorder (ADHD)?
a. Manifestations exhibited are so bizarre that the diagnosis is fairly easy.
b. Manifestations affect every aspect of the child’s life but are most obvious in the classroom.
c. Learning disabilities associated with ADHD eventually disappear when adulthood is reached.
d. Diagnosis of ADHD requires that all manifestations of the disorder be present.

 

 

ANS:  B

ADHD affects every aspect of the child’s life, but the disruption is most obvious in the classroom. The behaviors exhibited by the child with ADHD are not unusual aspects of behavior. The difference lies in the quality of motor activity and developmentally inappropriate inattention, impulsivity, and hyperactivity that the child displays. Some children experience decreased symptoms during late adolescence and adulthood, but a significant number carry their symptoms into adulthood. Any given child will not have every symptom of the condition. The manifestations may be numerous or few, mild or severe, and will vary with the child’s developmental level.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   501

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. The nurse is teaching the parents of a child recently diagnosed with ADHD who has been prescribed methylphenidate (Ritalin). Which should the nurse include in teaching about the side effects of methylphenidate?
a. “Your child may experience a sense of nervousness.”
b. “You may see an increase in your child’s appetite.”
c. “Your child may experience daytime sleepiness.”
d. “You may see a decrease in your child’s blood pressure.”

 

 

ANS:  A

Nervousness is one of the common side effects of Ritalin. Decreased appetite with subsequent weight loss, insomnia, and increased blood pressure are other common side effects.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   502

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. Which is an important consideration when the nurse is discussing enuresis with the parents of a young child?
a. Enuresis is more common in girls than in boys.
b. Enuresis is neither inherited nor has a familial tendency.
c. Organic causes that may be related to enuresis should be considered first.
d. Psychogenic factors that cause enuresis persist into adulthood.

 

 

ANS:  C

Organic causes that may be related to enuresis should be ruled out before psychogenic factors are considered. Enuresis is more common in boys than in girls and has a strong familial tendency. Psychogenic factors may influence enuresis, but it is doubtful that they are causative.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   499

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. The nurse is assisting the family of a child with a history of encopresis. Which should be included in the nurse’s discussion with this family?
a. Instruct the parents to sit the child on the toilet at twice-daily routine intervals.
b. Instruct the parents that the child will probably need to have daily enemas.
c. Suggest the use of stimulant cathartics weekly.
d. Reassure the family that most problems are resolved successfully, with some relapses during periods of stress.

 

 

ANS:  D

Children may be unaware of a prior sensation and unable to control the urge once it begins. They may be so accustomed to bowel accidents that they are unable to smell or feel it. Family counseling is directed toward reassurance that most problems resolve successfully, although relapses during periods of stress are possible. Sitting the child on the toilet is not recommended because it may intensify the parent-child conflict. Enemas may be needed for impactions, but long-term use prevents the child from assuming responsibility for defecation. Stimulant cathartics may cause cramping that can frighten child.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   501

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. A mother calls the school nurse saying that her daughter has developed a school phobia. She has been out of school 3 days. The nurse’s recommendations should include which intervention?
a. Immediately return child to school.
b. Explain to child that this is the last day she can stay home.
c. Determine cause of phobia before returning child to school.
d. Seek professional counseling before forcing child to return to school.

 

 

ANS:  A

The primary goal is to return the child to school. Parents must be convinced gently, but firmly, that immediate return is essential and that it is their responsibility to insist on school attendance. The longer the child is permitted to stay out of school, the more difficult it will be for the child to reenter. Trying to find the cause of phobia will only delay the return to school and inhibit the child’s ability to cope. Professional counseling is recommended if the problem persists, but the child’s return to school should not wait for the counseling.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   505

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. Parents have a concern that their child is depressed. The nurse relates that which characteristic best describes children with depression?
a. Increased range of affective response
b. Preoccupation with need to perform well in school
c. Change in appetite, resulting in weight loss or gain
d. Tendency to prefer play instead of schoolwork

 

 

ANS:  C

Physiologic characteristics of children with depression include change in appetite resulting in weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping pattern, insomnia or hypersomnia, and constipation. Children who are depressed have sad facial expressions with absence or diminished range of affective response. These children withdraw from previously enjoyed activities and engage in solitary play or work with a lack of interest in play. A lack of interest is seen in doing homework or achieving in school, resulting in lower grades in children who are depressed.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   506

TOP:   Integrated Process: Communication and Documentation

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. A teen asks a nurse, “What is physical dependence in substance abuse?” Which is the correct response by the nurse?
a. Problem that occurs in conjunction with addiction
b. Involuntary physiologic response to drug
c. Culturally defined use of drugs for purposes other than accepted medical purposes
d. Voluntary behavior based on psychosocial needs

 

 

ANS:  B

Physical dependence is an involuntary response to the pharmacologic characteristics of drugs such as opioids or alcohol. A person can be physically dependent on a narcotic/drug without being addicted; for example, patients who use opioids to control pain need increasing doses to achieve the same effect. Dependence is a physiologic response; it is not culturally determined or subject to voluntary control.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   527

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. Which is descriptive of central nervous system stimulants?
a. They produce strong physical dependence.
b. They can result in strong psychological dependence.
c. Withdrawal symptoms are life threatening.
d. Acute intoxication can lead to coma.

 

 

ANS:  B

Central nervous system stimulants such as amphetamines and cocaine produce a strong psychological dependence. This class of drugs does not produce strong physical dependence and can be withdrawn without much danger. Acute intoxication leads to violent, aggressive behavior or psychotic episodes characterized by paranoia, uncontrollable agitation, and restlessness.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   529

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Data collection should include what information?
a. Mode of administration
b. Drug’s actual content
c. Function the drug plays in the adolescent’s life
d. Adolescent’s level of interest in rehabilitation

 

 

ANS:  A

When the drug is questionable or unknown, every effort must be made to determine the type, amount of drug taken, the mode and time of administration, and factors relating to the onset of presenting symptoms. The actual content of most street drugs is highly questionable. Pharmacologic agents should be administered with caution, except for the narcotic antagonists in case of suspected opioid use. The function the drug plays in the adolescent’s life and the adolescent’s level of interest in rehabilitation are important considerations in the long-term management during the nonacute stage.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   528 | 530

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. A school nurse is conducting a class with adolescents on suicide. Which true statement about suicide should the nurse include in the teaching session?
a. A sense of hopelessness and despair are a normal part of adolescence.
b. Gay and lesbian adolescents are at a particularly high risk for suicide.
c. Problem-solving skills are of limited value to the suicidal adolescent.
d. Previous suicide attempts are not an indication of risk for completed suicides.

 

 

ANS:  B

A significant number of teenage suicides occur among homosexual youths. Gay and lesbian adolescents who live in families or communities that do not accept homosexuality are likely to suffer low self-esteem, self-loathing, depression, and hopelessness as a result of a lack of acceptance from their family or community. At-risk teenagers include those who are depressed, have poor problem-solving skills, or use drugs and alcohol. History of previous suicide attempt is a serious indicator for possible suicide completion in the future.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   531

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. Which is the most commonly used method in completed suicides?
a. Firearms
b. Drug overdose
c. Self-inflected laceration
d. Carbon monoxide poisoning

 

 

ANS:  A

Firearms are the most commonly used instruments in completed suicides among both males and females. For adolescent boys, firearms are followed by hanging and overdose. For adolescent females, overdose and strangulation are the next most common means of completed suicide. The most common method of suicide attempt is overdose or ingestion of potentially toxic substances such as drugs. The second most common method of suicide attempt is self-inflicted laceration. Carbon monoxide poisoning is not one of the more frequent forms of suicide completion.

 

PTS:   1                    DIF:    Cognitive Level: Remember           REF:   531

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. Which is the most significant factor in distinguishing those who commit suicide from those who make suicidal attempts or threats?
a. Social isolation
b. Level of stress
c. Degree of depression
d. Desire to punish others

 

 

ANS:  A

Social isolation is a significant factor in distinguishing adolescents who will kill themselves from those who will not. It is also more characteristic of those who complete suicide than of those who make attempts or threats. Level of stress, degree of depression, and desire to punish others are contributing factors in suicide, but they are not the most significant factor in distinguishing those who complete suicide from those who attempt suicide.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   532

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. An adolescent girl tells the nurse that she is very suicidal. The nurse asks her whether she has a specific plan. Asking this should be considered:
a. an appropriate part of the assessment.
b. not a critical part of the assessment.
c. suggesting that the adolescent needs a plan.
d. encouraging the adolescent to devise a plan.

 

 

ANS:  A

Routine health assessments of adolescents should include questions that assess the presence of suicidal ideation or intent. Questions such as, “Have you ever developed a plan to hurt yourself or kill yourself?” should be part of that assessment. Adolescents who express suicidal feelings and have a specific plan are at particular risk and require further assessment and constant monitoring. The information about having a plan is an essential part of the assessment and greatly affects the treatment plan.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   531

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Psychosocial Integrity

 

  1. An adolescent has been diagnosed with lactose maldigestion intolerance. The nurse teaches the adolescent about lactose maldigestion intolerance and notes the teen needs further teaching if which statement is made?
a. “I will limit my milk consumption to one to two glasses a day.”
b. “I should drink the milk alone and not with other foods.”
c. “Hard cheese, cottage cheese, or yogurt can be substituted for milk.”
d. “I will take a calcium supplement daily.”

 

 

ANS:  B

Most people are able to tolerate small amounts of lactose (1 cup of milk per day) even in the presence of deficient lactase activity. It is recommended that individuals with lactose maldigestion who do not experience lactose intolerance symptoms continue to consume small amounts of dairy products with meals to prevent reduced bone mass density and subsequent osteoporosis. Hard cheese, cottage cheese, and yogurt are sources of lactose that may be better tolerated. A calcium supplement should be taken daily. Milk taken at meals may be better tolerated than when taken alone.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   526

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. An adolescent has been diagnosed with Chlamydia infection. Which medication should the nurse expect to be prescribed for this condition?
a. Ceftriaxone (Rocephin) IM
b. Azithromycin (Zithromax) PO
c. Acyclovir (Zovirax) PO
d. Penicillin G benzathine (Bicillin) IV

 

 

ANS:  B

Azithromycin is used to treat Chlamydia. The patient should be rescreened in 3 to 4 months. Ceftriaxone is used to treat gonorrhea, acyclovir is used to suppress genital herpes simplex virus, and penicillin G benzathine is used to treat syphilis.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   514-515

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. A nurse is recommending strategies to a group of school-age children for prevention of obesity. Which should the nurse include? (Select all that apply.)
a. Eat breakfast daily.
b. Limit fruits and vegetables.
c. Have frequent family meals with parents present.
d. Eat frequently at restaurants.
e. Limit television viewing to 2 hours a day.

 

 

ANS:  A, C, E

The nurse should counsel school-age children to eat breakfast daily, have mealtimes with family, and limit television viewing to 2 hours a day to prevent obesity. Fruits and vegetables should be consumed in the recommended quantities, and eating at restaurants should be limited.

 

PTS:   1                    DIF:    Cognitive Level: Analyze               REF:   520

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. Which strategies should the school nurse recommend implementing in the classroom for a child with attention deficit hyperactive disorder (ADHD)? (Select all that apply.)
a. Schedule heavier subjects to be taught in the afternoon.
b. Accompany verbal instructions by written format.
c. Limit number of breaks taken during instructional periods.
d. Allow more time for testing.
e. Reduce homework and classroom assignments.

 

 

ANS:  B, D, E

Children with ADHD need an orderly, predictable, and consistent classroom environment with clear and consistent rules. Homework and classroom assignments may need to be reduced, and more time may need to be allotted for tests to allow the child to complete the task. Verbal instructions should be accompanied by visual references such as written instructions on the blackboard. Schedules may need to be arranged so that academic subjects are taught in the morning when the child is experiencing the effects of the morning dose of medication. Regular and frequent breaks in activity are helpful because sitting in one place for an extended time may be difficult.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   503

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. Which side effects should the nurse monitor when a child is taking an antipsychotic medication? (Select all that apply.)
a. Extrapyramidal effects
b. Hypertension
c. Bradycardia
d. Dizziness
e. Seizures

 

 

ANS:  A, D, E

Common side effects of antipsychotic medications include dizziness, drowsiness, tachycardia, hypotension, and extrapyramidal effects, such as abnormal movements and seizures.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   506-507

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

Chapter 27: The Child with Genitourinary Dysfunction

 

MULTIPLE CHOICE

 

  1. The nurse is conducting a staff in-service on renal ultrasounds. Which statement describes this diagnostic test?
a. Computed tomography uses external radiation to visualize the renal system.
b. Visualization of the renal system is accomplished without exposure to radiation or radioactive isotopes.
c. Contrast medium and x-rays allow for visualization of the renal system.
d. External radiation for x-ray films is used to visualize the renal system, before, during, and after voiding.

 

 

ANS:  A

A renal ultrasound transmits ultrasonic waves through the renal parenchyma allowing for visualization of the renal system without exposure to external beam radiation or radioactive isotopes. Computed tomography uses external radiation and sometimes contrast media to visualize the renal system. An intravenous pyelogram uses contrast medium and external radiation for x-ray films. The voiding cystourethrogram visualizes the renal system with injection of a contrast media into the bladder through the urethral opening and use of x-ray before, during, and after voiding.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   908

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate?
a. pH
b. Osmolality
c. Creatinine
d. Protein level

 

 

ANS:  C

The most useful clinical indication of glomerular filtration is the clearance of creatinine. It is a substance that is freely filtered by the glomerulus and secreted by the renal tubule cells. The pH and osmolality are not estimates of glomerular filtration. Although protein in the urine demonstrates abnormal glomerular permeability, it is not a measure of filtration rate.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   904

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. The nurse is conducting an assessment on a school-age child with urosepsis. Which assessment finding should the nurse expect?
a. Fever with a positive blood culture
b. Proteinuria and edema
c. Oliguria and hypertension
d. Anemia and thrombocytopenia

 

 

ANS:  A

Symptoms of urosepsis include a febrile UTI coexisting with systemic signs of bacterial illness; blood culture reveals presence of urinary pathogen. Proteinuria and edema are symptoms of minimal change nephrotic syndrome (MCNS). Oliguria and hypertension are symptoms of acute glomerulonephritis (AGN). Anemia and thrombocytopenia are symptoms of hemolytic uremic syndrome (HUS).

 

PTS:   1                    DIF:    Cognitive Level: Analyze               REF:   906

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. The nurse is teaching parents about prevention of urinary tract infections in children. Which factor predisposes the urinary tract to infection?
a. Increased fluid intake
b. Short urethra in young girls
c. Prostatic secretions in males
d. Frequent emptying of the bladder

 

 

ANS:  B

The short urethra in females provides a ready pathway for invasion of organisms. Increased fluid intake and frequent emptying of the bladder offer protective measures against urinary tract infections. Prostatic secretions have antibacterial properties that inhibit bacteria.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   908

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. Which should the nurse recommend to prevent urinary tract infections in young girls?
a. Wear cotton underpants.
b. Limit bathing as much as possible.
c. Increase fluids; decrease salt intake.
d. Cleanse perineum with water after voiding.

 

 

ANS:  A

Cotton underpants are preferable to nylon underpants. No evidence exists that limiting bathing, increasing fluids/decreasing salt intake, or cleansing the perineum with water after voiding decrease urinary tract infections in young girls.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   910

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. The nurse is admitting a newborn with hypospadias to the nursery. The nurse expects which finding in this newborn?
a. Absence of a urethral opening is noted.
b. Penis appears shorter than usual for age.
c. The urethral opening is along the dorsal surface of the penis.
d. The urethral opening is along the ventral surface of the penis.

 

 

ANS:  D

Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present, but not at the glans. Hypospadias refers to the urethral opening, not to the size of the penis. Urethral opening along ventral surface of penis is known as epispadias.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   912

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. The nurse is conducting a staff in-service on newborn defects of the genitourinary system. Which describes the narrowing of the preputial opening of the foreskin?
a. Chordee
b. Phimosis
c. Epispadias
d. Hypospadias

 

 

ANS:  B

Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

 

PTS:   1                    DIF:    Cognitive Level: Remember           REF:   912

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. Which is an objective of care for a 10-year-old child with minimal change nephrotic syndrome?
a. Reduce blood pressure.
b. Reduce excretion of urinary protein.
c. Increase excretion of urinary protein.
d. Increase ability of tissues to retain fluid.

 

 

ANS:  B

The objectives of therapy for the child with minimal change nephrotic syndrome include reduction of the excretion of urinary protein, reduction of fluid retention, prevention of infection, and minimization of complications associated with therapy. Blood pressure is usually not elevated in minimal change nephrotic syndrome. Excretion of urinary protein and fluid retention are part of the disease process and must be reversed.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   914

TOP:   Integrated Process: Nursing Process: Planning

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. Which is instituted for the therapeutic management of minimal change nephrotic syndrome?
a. Corticosteroids
b. Antihypertensive agents
c. Long-term diuretics
d. Increased fluids to promote diuresis

 

 

ANS:  A

Corticosteroids are the first line of therapy for minimal change nephrotic syndrome. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary. A diet that has fluid and salt restrictions may be indicated.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   914

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

 

  1. Which is a common side effect of short-term corticosteroid therapy?
a. Fever
b. Hypertension
c. Weight loss
d. Increased appetite

 

 

ANS:  D

Side effects of short-term corticosteroid therapy include an increased appetite. Fever is not a side effect of therapy. It may be an indication of infection. Hypertension is not usually associated with initial corticosteroid therapy. Weight gain, not weight loss, is associated with corticosteroid therapy.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   914

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

 

  1. The nurse closely monitors the temperature of a child with minimal change nephrotic syndrome. The purpose of this assessment is to detect an early sign of which possible complication?
a. Infection
b. Hypertension
c. Encephalopathy
d. Edema

 

 

ANS:  A

Infection is a constant source of danger to edematous children and those receiving corticosteroid therapy. An increased temperature could be an indication of an infection. Temperature is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with minimal change nephrotic syndrome. The child will most likely have neurologic signs and symptoms.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   914

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. Which is an appropriate nursing goal related to this?
a. Prevent infection.
b. Stimulate appetite.
c. Detect evidence of edema.
d. Ensure compliance with prophylactic antibiotic therapy.

 

 

ANS:  A

High-dose steroid therapy has an immunosuppressant effect. These children are particularly vulnerable to upper respiratory tract infections. A priority nursing goal is to minimize the risk of infection by protecting the child from contact with infectious individuals. Appetite is increased with prednisone therapy. The amount of edema should be monitored as part of the disease process, not necessarily related to the administration of prednisone. Antibiotics would not be used as prophylaxis.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   914

TOP:   Integrated Process: Nursing Process: Planning

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. Which is included in the diet of a child with minimal change nephrotic syndrome?
a. High protein
b. Salt restriction
c. Low fat
d. High carbohydrate

 

 

ANS:  B

Salt is usually restricted (but not eliminated) during the edema phase. The child has little appetite during the acute phase. Favorite foods are provided (with the exception of high-salt ones) in an attempt to provide nutritionally complete meals.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   914

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Basic Care and Comfort

 

  1. Which best describes acute glomerulonephritis?
a. Occurs after a urinary tract infection
b. Occurs after a streptococcal infection
c. Associated with renal vascular disorders
d. Associated with structural anomalies of genitourinary tract

 

 

ANS:  B

Acute glomerulonephritis is an immune-complex disease that occurs after a streptococcal infection with certain strains of the group A â-hemolytic streptococcus. Acute glomerulonephritis usually follows streptococcal pharyngitis and is not associated with renal vascular disorders or genitourinary tract structural anomalies.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   915

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. A child is admitted with acute glomerulonephritis. The nurse should expect the urinalysis during this acute phase to show:
a. bacteriuria, hematuria.
b. hematuria, proteinuria.
c. bacteriuria, increased specific gravity.
d. proteinuria, decreased specific gravity.

 

 

ANS:  B

Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   915

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse’s best response should be that the:
a. blood pressure will stabilize.
b. the child will have more energy.
c. urine will be free of protein.
d. urinary output will increase.

 

 

ANS:  D

An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   916

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of:
a. poor appetite.
b. increased potassium intake.
c. reduction of edema.
d. restriction to bed rest.

 

 

ANS:  C

This amount of weight loss in this period is a result of the improvement of renal function and mobilization of edema fluid. Poor appetite and bed rest would not result in a weight loss of 8 pounds in 4 days. Foods with substantial amounts of potassium are avoided until renal function is normalized.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   916

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching?
a. “You will need to decrease the number of calories in your child’s diet.”
b. “Your child’s diet will need an increased amount of protein.”
c. “You will need to avoid adding salt to your child’s food.”
d. “Your child’s diet will consist of low-fat, low-carbohydrate foods.”

 

 

ANS:  C

For most children, a regular diet is allowed, but it should contain no added salt. The child should be offered a regular diet with favorite foods. Severe sodium restrictions are not indicated.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   916

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Basic Care and Comfort

 

  1. Which is the most appropriate nursing diagnosis for the child with acute glomerulonephritis?
a. Risk for Injury related to malignant process and treatment
b. Fluid Volume Deficit related to excessive losses
c. Fluid Volume Excess related to decreased plasma filtration
d. Fluid Volume Excess related to fluid accumulation in tissues and third spaces

 

 

ANS:  C

Glomerulonephritis has a decreased filtration of plasma, which results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. A fluid volume excess is found. The fluid accumulation is secondary to the decreased plasma filtration.

 

PTS:   1                    DIF:    Cognitive Level: Analyze               REF:   915

TOP:   Integrated Process: Nursing Process: Nursing Diagnosis

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. The nurse is admitting a child with a Wilms tumor. Which is the initial assessment finding associated with this tumor?
a. Abdominal swelling
b. Weight gain
c. Hypotension
d. Increased urinary output

 

 

ANS:  A

The initial assessment finding with a Wilms (kidney) tumor is abdominal swelling. Weight loss, not weight gain, may be a finding. Hypertension occasionally occurs with a Wilms tumor. Urinary output is not increased, but hematuria may be noted.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   917

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. Which is the most common cause of acute renal failure in children?
a. Pyelonephritis
b. Tubular destruction
c. Urinary tract obstruction
d. Severe dehydration

 

 

ANS:  D

The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. Pyelonephritis and tubular destruction are not common causes of acute renal failure. Obstructive uropathy may cause acute renal failure, but it is not the most common cause.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   919

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. The nurse is conducting an admission assessment on a school-age child with acute renal failure. Which are the primary clinical manifestations the nurse expects to find with this condition?
a. Oliguria and hypertension
b. Hematuria and pallor
c. Proteinuria and muscle cramps
d. Bacteriuria and facial edema

 

 

ANS:  A

The principal feature of acute renal failure is oliguria; hypertension is a nonspecific clinical manifestation. Hematuria and pallor, proteinuria and muscle cramps, and bacteriuria and facial edema are not principal features of acute renal failure.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   919

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. The nurse is caring for a child with acute renal failure. Which clinical manifestation should the nurse recognize as a sign of hyperkalemia?
a. Dyspnea
b. Seizure
c. Oliguria
d. Cardiac arrhythmia

 

 

ANS:  D

Hyperkalemia is the most common threat to the life of the child. Signs of hyperkalemia include electrocardiograph anomalies such as prolonged QRS complex, depressed ST segments, peaked T waves, bradycardia, or heart block. Dyspnea, seizure, and oliguria are not manifestations of hyperkalemia.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   920

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. When a child has chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as:
a. uremia.
b. oliguria.
c. proteinuria.
d. pyelonephritis.

 

 

ANS:  A

Uremia is the retention of nitrogenous products, producing toxic symptoms. Oliguria is diminished urinary output. Proteinuria is the presence of protein, usually albumin, in the urine. Pyelonephritis is an inflammation of the kidney and renal pelvis.

 

PTS:   1                    DIF:    Cognitive Level: Remember           REF:   921

TOP:   Integrated Process: Nursing Process: Evaluation

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. Which is a major complication in a child with chronic renal failure?
a. Hypokalemia
b. Metabolic alkalosis
c. Water and sodium retention
d. Excessive excretion of blood urea nitrogen

 

 

ANS:  C

Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic renal failure.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   921

TOP:   Integrated Process: Nursing Process: Evaluation

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. Which clinical manifestation would be seen in a child with chronic renal failure?
a. Hypotension
b. Massive hematuria
c. Hypokalemia
d. Unpleasant “uremic” breath odor

 

 

ANS:  D

Children with chronic renal failure have a characteristic breath odor resulting from the retention of waste products. Hypertension may be a complication of chronic renal failure. With chronic renal failure, little or no urinary output occurs. Hyperkalemia is a concern in chronic renal failure.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   922

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. One of the clinical manifestations of chronic renal failure is uremic frost. Which best describes this term?
a. Deposits of urea crystals in urine
b. Deposits of urea crystals on skin
c. Overexcretion of blood urea nitrogen
d. Inability of body to tolerate cold temperatures

 

 

ANS:  B

Uremic frost is the deposition of urea crystals on the skin. The urea crystals are present on the skin, not in the urine. The kidneys are unable to excrete blood urea nitrogen, leading to elevated levels. There is no relation between cold temperatures and uremic frost.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   922

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. Calcium carbonate is given with meals to a child with chronic renal disease. The purpose of this is to:
a. prevent vomiting.
b. bind phosphorus.
c. stimulate appetite.
d. increase absorption of fat-soluble vitamins.

 

 

ANS:  B

Oral calcium carbonate preparations combine with phosphorus to decrease gastrointestinal absorption and the serum levels of phosphate. Serum calcium levels are increased by the calcium carbonate, and vitamin D administration is necessary to increase calcium absorption. Calcium carbonate does not prevent vomiting, stimulate appetite, or increase the absorption of fat-soluble vitamins.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   922

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

 

  1. Which should the nurse recommend for the diet of a child with chronic renal failure?
a. High in protein
b. Low in vitamin D
c. Low in phosphorus
d. Supplemented with vitamins A, E, and K

 

 

ANS:  C

Dietary phosphorus is controlled by the reduction of protein and milk intake to prevent or control the calcium-phosphorus imbalance. Protein should be limited in chronic renal failure to decrease intake of phosphorus. Vitamin D therapy is administered in chronic renal failure to increase calcium absorption. Supplementation of vitamins A, E, and K is not part of dietary management in chronic renal disease.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   922

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Basic Care and Comfort

 

  1. The nurse is caring for an adolescent who has just started dialysis. The child seems always angry, hostile, or depressed. The nurse should recognize that this is most likely related to:
a. neurologic manifestations that occur with dialysis.
b. physiologic manifestations of renal disease.
c. adolescents having few coping mechanisms.
d. adolescents often resenting the control and enforced dependence imposed by dialysis.

 

 

ANS:  D

Older children and adolescents need control. The necessity of dialysis forces the adolescent into a dependent relationship, which results in these behaviors. These are a function of the child’s age, not neurologic or physiologic manifestations of the dialysis. Feelings of anger, hostility, and depression are functions of the child’s age, not neurologic or physiologic manifestations of the dialysis. Adolescents do have coping mechanisms, but they need to have some control over their disease management.

 

PTS:   1                    DIF:    Cognitive Level: Analyze               REF:   923

TOP:   Integrated Process: Nursing Process: Evaluation

MSC:  Area of Client Needs: Health Promotion and Maintenance

 

  1. Which is an advantage of peritoneal dialysis?
a. Treatments are done in hospitals.
b. Protein loss is less extensive.
c. Dietary limitations are not necessary.
d. Parents and older children can perform treatments.

 

 

ANS:  D

Peritoneal dialysis is the preferred form of dialysis for parents, infants, and children who wish to remain independent. Parents and older children can perform the treatments themselves. Treatments can be done at home. Protein loss is not significantly different. The dietary limitations are necessary, but they are not as stringent as those for hemodialysis.

 

PTS:   1                    DIF:    Cognitive Level: Analyze               REF:   923

TOP:   Integrated Process: Nursing Process: Planning

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. Which statement is descriptive of renal transplantation in children?
a. It is an acceptable means of treatment after age 10 years.
b. It is the preferred means of renal replacement therapy in children.
c. Children can receive kidneys only from other children.
d. The decision for transplantation is difficult because a relatively normal lifestyle is not possible.

 

 

ANS:  B

Renal transplant offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease. Renal transplantation can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes. Renal transplantation affords the child a more normal lifestyle than dependence on dialysis.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   925

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. A preschool child is being admitted to the hospital with dehydration and a urinary tract infection (UTI). Which urinalysis result should the nurse expect with these conditions?
a. WBC <1; specific gravity 1.008
b. WBC <2; specific gravity 1.025
c. WBC >2; specific gravity 1.016
d. WBC >2; specific gravity 1.030

 

 

ANS:  D

WBC count in a routine urinalysis should be <1 or 2. Over that amount indicates a urinary tract inflammatory process. The urinalysis specific gravity for children with normal fluid intake is 1.016 to 1.022. When the specific gravity is high, dehydration is indicated. A low specific gravity is seen with excessive fluid intake, distal tubular dysfunction, or insufficient antidiuretic hormone secretion.

 

PTS:   1                    DIF:    Cognitive Level: Analyze               REF:   907

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. The nurse is conducting teaching for an adolescent being discharged to home after a renal transplant. The adolescent needs further teaching if which statement is made?
a. “I will report any fever to my primary health care provider.”
b. “I am glad I only have to take the immunosuppressant medication for two weeks.”
c. “I will observe my incision for any redness or swelling.”
d. “I won’t miss doing kidney dialysis every week.”

 

 

ANS:  B

The immunosuppressant medications are taken indefinitely after a renal transplant, so they should not be discontinued after two weeks. Reporting a fever and observing an incision for redness and swelling are accurate statements. The adolescent is correct in indicating dialysis will not need to be done after the transplant.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   925

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. The nurse is teaching parents of a child with chronic renal failure (CRF) about the use of recombinant human erythropoietin (rHuEPO) subcutaneous injections. Which statement indicates the parents have understood the teaching?
a. “These injections will help with the hypertension.”
b. “We’re glad the injections only need to be given once a month.”
c. “The red blood cell count should begin to improve with these injections.”
d. “Urine output should begin to improve with these injections.”

 

 

ANS:  C

Anemia in children with CRF is related to decreased production of erythropoietin. Recombinant human erythropoietin (rHuEPO) is being offered to these children as thrice-weekly or weekly subcutaneous injections and is replacing the need for frequent blood transfusions. The parents understand the teaching if they say that the red blood cell count will begin to improve with these injections.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   916 | 923

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. A school-age child with chronic renal failure is admitted to the hospital with a serum potassium level of 5.2 mEq/L. Which prescribed medication should the nurse plan to administer?
a. Spironolactone (Aldactone)
b. Sodium polystyrene sulfonate (Kayexalate)
c. Lactulose (Cephulac)
d. Calcium carbonate (Calcitab)

 

 

ANS:  B

Normal serum potassium levels in a school-age child are 3.5 to 5 mEq/L. Sodium polystyrene sulfonate is administered to reduce serum potassium levels. Spironolactone is a potassium sparing diuretic and should not be used if the serum potassium is elevated. Lactulose is administered to reduce ammonia levels in patients with liver disease. Calcium carbonate may be prescribed as a calcium supplement, but it will not reduce serum potassium levels.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   920

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

 

MULTIPLE RESPONSE

 

  1. The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations should be expected? (Select all that apply.)
a. Vomiting
b. Jaundice
c. Failure to gain weight
d. Swelling of the face
e. Back pain
f. Persistent diaper rash

 

 

ANS:  A, C, F

Vomiting, failure to gain weight, and persistent diaper rash are clinical manifestations observed in an infant with a UTI.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   909

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child? (Select all that apply.)
a. Apples
b. Bananas
c. Cheese
d. Carrot sticks
e. Strawberries

 

 

ANS:  A, D, E

Moderate sodium restriction and even fluid restriction may be instituted for children with acute glomerulonephritis. Foods with substantial amounts of potassium are generally restricted during the period of oliguria. Apples, carrot sticks, and strawberries would be items low in sodium and allowed. Bananas are high in potassium and cheese is high in sodium. Those items would be restricted.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   916

TOP:   Integrated Process: Nursing Process: Planning

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess? (Select all that apply.)
a. Weight loss
b. Facial edema
c. Cloudy smoky brown-colored urine
d. Fatigue
e. Frothy-appearing urine

 

 

ANS:  B, D, E

A child with nephrotic syndrome will present with facial edema, fatigue, and frothy-appearing urine (proteinuria). Weight gain, not loss, is expected because of the fluid retention. Cloudy smoky brown-colored urine is seen with acute glomerulonephritis but not with nephrotic syndrome because there is no gross hematuria associated with nephrotic syndrome.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   914

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. A 6-year-old child is scheduled for an IV urography (IVP) in the morning. Which preparatory interventions should the nurse plan to implement? (Select all that apply.)
a. Clear liquids in the morning before the procedure
b. Cathartic in the evening before the procedure
c. Soapsuds enema the morning of the procedure
d. Insertion of a Foley catheter before the procedure
e. Teaching with regard to insertion of an intravenous catheter before the procedure

 

 

ANS:  B, C, E

The IV urography is a test done to provide information about the integrity of the kidneys, ureters, and bladder. It requires an IV injection of a contrast medium with X-ray films made 5, 10, and 15 minutes after injection. Delayed films (30, 60 minutes, and so on) are also obtained. The preparation for children ages 2 to 14 years includes cathartic on the evening before examination, nothing orally after midnight, and an enema (soapsuds) on the morning of examination. Teaching about the insertion of an intravenous catheter should be part of the preoperative preparation. Insertion of a Foley catheter is not part of the preparation for an IVP.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   905

TOP:   Integrated Process: Nursing Process: Planning

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

SHORT ANSWER

 

  1. The nurse is performing a pH dipstick test on a urine specimen. Which is the average pH expected for this test? (Record your answer in a whole number.)

 

ANS:

6

The average pH for urine is 6. The normal range is 4.8 to 7.8. Abnormal pH levels are associated with urinary infection and metabolic alkalosis or acidosis.

 

PTS:   1                    DIF:    Cognitive Level: Analyze               REF:   907

TOP:   Integrated Process: Nursing Process: Evaluation

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation