TEST BANK
Pediatric Physical Examination: An Illustrated Handbook
KAREN G. DUDERSTADT, VICTORIA F. KEETON
4th Edition
,Chapter 1: Approach to Care and Assessment of Children and Adolescents
MULTIPLE CHOICE
1. A nurse is reviewing developmental concepts for infants and children. Which statement best
describes development in infants and children?
a. Development, a predictable and orderly process, occurs at varying rates within
normal limits.
b. Development is primarily related to the growth in the number and size of cells.
c. Development occurs in a proximodistal direction with fine muscle development
occurring first.
d. Development is more easily and accurately measured than growth.
ANS: A
Development, a continuous orderly process, provides the basis for increases in the childs function and
complexity of behavior. The increases in rate of function and complexity can vary normally within
limits for each child. An increase in the number and size of cells is a definition for growth.
Development proceeds in a proximodistal direction with fine muscle organization occurring as a result
of large muscle organization. Development is a more complex process that is affected by many
factors; therefore, it is less easily and accurately measured. Growth is a predictable process with
standard measurement methods.
2. Frequent developmental assessments are important for which reason?
a. Stable developmental periods during infancy provide an opportunity to identify any
delays or deficits.
b. Infants need stimulation specific to the stage of development.
c. Critical periods of development occur during childhood.
d. Child development is unpredictable and needs monitoring.
ANS: C
Critical periods are blocks of time during which children are ready to master specific developmental
tasks. Children can master these tasks more easily during particular periods of time in their growth and
developmental process. Infancy is a dynamic time of development that requires frequent evaluations to
assess appropriate developmental progress. Infants in a nurturing environment will develop
appropriately and will not necessarily need stimulation specific to their developmental stage. Normal
growth and development are orderly and proceed in a predictable pattern on the basis of each
individuals abilities and potentials.
3. Which factor has the greatest influence on child growth and development?
a. Culture
b. Environment
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, c. Genetics
d. Nutrition
ANS: C
Genetic factors (heredity) determine each individuals growth and developmental rate. Although factors
such as environment, culture, nutrition, and family can influence genetic traits, they do not eliminate
the effect of the genetic endowment, which is permanent. Culture is a significant factor that
influences how children grow toward adulthood. Culture influences both growth and development but
does not eliminate inborn genetic influences. Environment has a significant role in determining growth
and development both before and after birth. The environment can influence how and to which extent
genetic traits are manifested, but environmental factors cannot eliminate the effect of genetics.
Nutrition is critical for growth and plays a significant role throughout childhood.
4. A nurse is planning a teaching session with a child. According to Piagetian theory, the period of
cognitive development in which the child is able to distinguish fact from fantasy is the period of
cognitive development.
a. sensorimotor
b. formal operations
c. concrete operations
d. preoperational
ANS: C
Concrete operations is the period of cognitive development in which childrens thinking is shifted from
egocentric to being able to see anothers point of view. They develop the ability to distinguish fact
from fantasy. The sensorimotor stage occurs in infancy and is a period of reflexive behavior. During
this period, the infants world becomes more permanent and organized. The stage ends with the infant
demonstrating some evidence of reasoning. Formal operations is a period in development in which new
ideas are created through previous thoughts. Analytic reason and abstract thought emerge in this
period. The preoperational stage is a period of egocentrism in which the childs judgments are illogical
and dominated by magical thinking and animism.
5. The theorist who viewed developmental progression as a lifelong series of conflicts that need
resolution is:
a. Erikson.
b. Freud.
c. Kohlberg.
d. Piaget.
ANS: A
Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each
conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving
the child emotionally disabled. Sigmund Freud proposed a psychosexual theory of development in
which certain parts of the body assume psychological significance as foci of sexual energy. The foci
shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of
development. Lawrence Kohlberg described moral development as having three levels
(preconventional, conventional, and postconventional). His theory closely parallels Piagets. Jean
Piagets cognitive theory interprets how children learn and think and how this thinking progresses and
differs from adult thinking. Stages of his theory include sensorimotor, preoperations, concrete
2|Page
, operations, and formal operations.
6. What does the nurse need to know when observing chronically ill children at play?
a. Play is not important to hospitalized children.
b. Children need to have structured play periods.
c. Childrens play is an indication of a childs response to treatment.
d. Play is to be discouraged because it tires hospitalized children.
ANS: C
Play for all children is an activity woven with meaning and purpose and is a mechanism for mastering
their environment. For chronically ill children, play can indicate their state of wellness and response to
treatment. Play is important to all children in all environments. Although childrens play activities
appear unorganized and at times chaotic, play has purpose and meaning. Imposing structure on play
interferes with the tasks being worked on. Children who have fewer energy reserves still require play.
For these children, less-active play activities will be important.
7. Which child is most likely to be frightened by hospitalization?
a. A 4-month-old infant admitted with a diagnosis of bronchiolitis
b. A 2-year-old toddler admitted for cystic fibrosis
c. A 9-year-old child hospitalized with a fractured femur
d. A 15-year-old adolescent admitted for abdominal pain
ANS: B
Toddlers are most likely to be frightened by hospitalization because their thought processes are
egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange
environments. Young infants are not as likely to be frightened as toddlers by hospitalization because
they are not as aware of the environment. The 9-year-old childs cognitive ability is sufficient enough
for the child to understand the reason for the hospitalization. The 15-year-old adolescent has the
cognitive ability to interpret the reason for the hospitalization.
8. Which statement made by a 15-year-old adolescent with a diagnosis of neurofibromatosis (an
autosomal dominant genetic disorder) best demonstrates an understanding of the mechanism of
inheritance for the disease?
a. My babies will probably not have neurofibromatosis.
b. My babies have a 50% chance of having neurofibromatosis.
c. Whether my babies have problems depends on the father.
d. My babies have a 25% chance of having neurofibromatosis.
ANS: B
Neurofibromatosis is an autosomal dominant genetic disorder that occurs when the abnormal gene is
carried on the affected chromosome with a normal gene. Because the abnormal gene is dominant, an
individual with the defective gene has a 50% chance of transmitting the defect to an infant with each
pregnancy. Neurofibromatosis is not a sex-linked genetic disease; therefore, either the father or the
mother genetically transfers it to the infant. A parent with the defective gene will genetically transfer
either a normal or abnormal gene to an infant. Because the defective gene is dominant, there is a 50%
3|Page
Pediatric Physical Examination: An Illustrated Handbook
KAREN G. DUDERSTADT, VICTORIA F. KEETON
4th Edition
,Chapter 1: Approach to Care and Assessment of Children and Adolescents
MULTIPLE CHOICE
1. A nurse is reviewing developmental concepts for infants and children. Which statement best
describes development in infants and children?
a. Development, a predictable and orderly process, occurs at varying rates within
normal limits.
b. Development is primarily related to the growth in the number and size of cells.
c. Development occurs in a proximodistal direction with fine muscle development
occurring first.
d. Development is more easily and accurately measured than growth.
ANS: A
Development, a continuous orderly process, provides the basis for increases in the childs function and
complexity of behavior. The increases in rate of function and complexity can vary normally within
limits for each child. An increase in the number and size of cells is a definition for growth.
Development proceeds in a proximodistal direction with fine muscle organization occurring as a result
of large muscle organization. Development is a more complex process that is affected by many
factors; therefore, it is less easily and accurately measured. Growth is a predictable process with
standard measurement methods.
2. Frequent developmental assessments are important for which reason?
a. Stable developmental periods during infancy provide an opportunity to identify any
delays or deficits.
b. Infants need stimulation specific to the stage of development.
c. Critical periods of development occur during childhood.
d. Child development is unpredictable and needs monitoring.
ANS: C
Critical periods are blocks of time during which children are ready to master specific developmental
tasks. Children can master these tasks more easily during particular periods of time in their growth and
developmental process. Infancy is a dynamic time of development that requires frequent evaluations to
assess appropriate developmental progress. Infants in a nurturing environment will develop
appropriately and will not necessarily need stimulation specific to their developmental stage. Normal
growth and development are orderly and proceed in a predictable pattern on the basis of each
individuals abilities and potentials.
3. Which factor has the greatest influence on child growth and development?
a. Culture
b. Environment
1|Page
, c. Genetics
d. Nutrition
ANS: C
Genetic factors (heredity) determine each individuals growth and developmental rate. Although factors
such as environment, culture, nutrition, and family can influence genetic traits, they do not eliminate
the effect of the genetic endowment, which is permanent. Culture is a significant factor that
influences how children grow toward adulthood. Culture influences both growth and development but
does not eliminate inborn genetic influences. Environment has a significant role in determining growth
and development both before and after birth. The environment can influence how and to which extent
genetic traits are manifested, but environmental factors cannot eliminate the effect of genetics.
Nutrition is critical for growth and plays a significant role throughout childhood.
4. A nurse is planning a teaching session with a child. According to Piagetian theory, the period of
cognitive development in which the child is able to distinguish fact from fantasy is the period of
cognitive development.
a. sensorimotor
b. formal operations
c. concrete operations
d. preoperational
ANS: C
Concrete operations is the period of cognitive development in which childrens thinking is shifted from
egocentric to being able to see anothers point of view. They develop the ability to distinguish fact
from fantasy. The sensorimotor stage occurs in infancy and is a period of reflexive behavior. During
this period, the infants world becomes more permanent and organized. The stage ends with the infant
demonstrating some evidence of reasoning. Formal operations is a period in development in which new
ideas are created through previous thoughts. Analytic reason and abstract thought emerge in this
period. The preoperational stage is a period of egocentrism in which the childs judgments are illogical
and dominated by magical thinking and animism.
5. The theorist who viewed developmental progression as a lifelong series of conflicts that need
resolution is:
a. Erikson.
b. Freud.
c. Kohlberg.
d. Piaget.
ANS: A
Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each
conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving
the child emotionally disabled. Sigmund Freud proposed a psychosexual theory of development in
which certain parts of the body assume psychological significance as foci of sexual energy. The foci
shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of
development. Lawrence Kohlberg described moral development as having three levels
(preconventional, conventional, and postconventional). His theory closely parallels Piagets. Jean
Piagets cognitive theory interprets how children learn and think and how this thinking progresses and
differs from adult thinking. Stages of his theory include sensorimotor, preoperations, concrete
2|Page
, operations, and formal operations.
6. What does the nurse need to know when observing chronically ill children at play?
a. Play is not important to hospitalized children.
b. Children need to have structured play periods.
c. Childrens play is an indication of a childs response to treatment.
d. Play is to be discouraged because it tires hospitalized children.
ANS: C
Play for all children is an activity woven with meaning and purpose and is a mechanism for mastering
their environment. For chronically ill children, play can indicate their state of wellness and response to
treatment. Play is important to all children in all environments. Although childrens play activities
appear unorganized and at times chaotic, play has purpose and meaning. Imposing structure on play
interferes with the tasks being worked on. Children who have fewer energy reserves still require play.
For these children, less-active play activities will be important.
7. Which child is most likely to be frightened by hospitalization?
a. A 4-month-old infant admitted with a diagnosis of bronchiolitis
b. A 2-year-old toddler admitted for cystic fibrosis
c. A 9-year-old child hospitalized with a fractured femur
d. A 15-year-old adolescent admitted for abdominal pain
ANS: B
Toddlers are most likely to be frightened by hospitalization because their thought processes are
egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange
environments. Young infants are not as likely to be frightened as toddlers by hospitalization because
they are not as aware of the environment. The 9-year-old childs cognitive ability is sufficient enough
for the child to understand the reason for the hospitalization. The 15-year-old adolescent has the
cognitive ability to interpret the reason for the hospitalization.
8. Which statement made by a 15-year-old adolescent with a diagnosis of neurofibromatosis (an
autosomal dominant genetic disorder) best demonstrates an understanding of the mechanism of
inheritance for the disease?
a. My babies will probably not have neurofibromatosis.
b. My babies have a 50% chance of having neurofibromatosis.
c. Whether my babies have problems depends on the father.
d. My babies have a 25% chance of having neurofibromatosis.
ANS: B
Neurofibromatosis is an autosomal dominant genetic disorder that occurs when the abnormal gene is
carried on the affected chromosome with a normal gene. Because the abnormal gene is dominant, an
individual with the defective gene has a 50% chance of transmitting the defect to an infant with each
pregnancy. Neurofibromatosis is not a sex-linked genetic disease; therefore, either the father or the
mother genetically transfers it to the infant. A parent with the defective gene will genetically transfer
either a normal or abnormal gene to an infant. Because the defective gene is dominant, there is a 50%
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