PEDIATRIC NURSING
5TH EDITION
• AUTHOR(S)NANCY HATFIELD;
CYNTHIA KINCHELOE
TEST BANK
1
Reference: Ch. 1 — The Nurse’s Role in a Changing Maternal–
Child Healthcare Environment
Stem: A 24-year-old primigravida at 32 weeks gestation arrives
for a routine prenatal visit with her partner. She appears
anxious and reports intermittent headaches; BP is 142/88 mm
Hg, pulse 86, fundal height appropriate for dates. She asks
whether the nurse will “tell the doctor everything” and seems
reluctant to discuss substance use. Which nursing action takes
priority now?
,A. Ask direct questions about substance use in a nonjudgmental
manner.
B. Document the BP and schedule a follow-up in two weeks.
C. Advise the partner to remain outside during the assessment
to maintain privacy.
D. Encourage the client to attend childbirth classes to reduce
anxiety.
Correct Answer: A
Rationale — Correct: Asking direct, nonjudgmental questions
about substance use applies therapeutic communication and
assessment skills; substance use is a safety concern in
pregnancy and could explain headaches and elevated BP. It
aligns with nursing priorities to identify immediate risks and
gather data to guide interventions (e.g., further evaluation for
preeclampsia or toxic exposures). Early disclosure enables
appropriate referrals and protective measures.
Rationale — Incorrect:
B. Scheduling routine follow-up without further assessment
may delay identification of a potentially serious issue; two
weeks may be unsafe given elevated BP.
C. Excluding the partner may reduce family-centered support;
privacy should be offered but not imposed without assessing
the client's preference.
D. Childbirth classes are helpful but are a lower priority than
assessing possible substance exposure and elevated BP.
,Teaching Point: Prioritize assessment of safety risks (e.g.,
substance use, hypertension) before anticipatory teaching.
Citation: Hatfield, N., & Kincheloe, C. (2023). Introductory
maternity & pediatric nursing (5th ed.). Ch. 1.
2
Reference: Ch. 1 — The Nurse’s Role in a Changing Maternal–
Child Healthcare Environment
Stem: A 6-month-old infant is brought to clinic for a well-child
check. The mother reports that immunizations were delayed
due to transportation issues and is worried. The clinic nurse
notes the infant’s weight percentile dropped from 50th to 20th
over two visits. Which nursing action best reflects family-
centered care and clinical judgment?
A. Insist the mother bring the infant to the clinic weekly for
weigh-ins.
B. Explore family barriers (transportation, work) and arrange
community resources plus immunization catch-up.
C. Teach the mother about formula preparation and handouts
on growth charts.
D. Schedule the next well-child at the routine 9-month visit and
document concerns.
Correct Answer: B
, Rationale — Correct: Exploring barriers and arranging
community resources aligns with family-centered care and
addresses the root causes of missed care while ensuring catch-
up immunizations and growth monitoring. It reflects clinical
judgment by combining assessment (weight decline, missed
vaccines) with coordinated interventions (resource linkage),
improving safety and continuity.
Rationale — Incorrect:
A. Weekly clinic visits may be unrealistic and burdensome
without addressing barriers; may worsen access issues.
C. Teaching is useful but insufficient alone; does not address
transportation or ensure timely immunizations.
D. Waiting until routine visit delays needed interventions for a
weight decline and missed immunizations.
Teaching Point: Address barriers and coordinate community
resources for equitable, family-centered care.
Citation: Hatfield, N., & Kincheloe, C. (2023). Introductory
maternity & pediatric nursing (5th ed.). Ch. 1.
3
Reference: Ch. 1 — The Nurse’s Role in a Changing Maternal–
Child Healthcare Environment
Stem: During a postpartum home visit, a nurse finds a 19-year-
old mother and her newborn in a crowded household. The
mother seems overwhelmed and admits she is returning to