Child Health Nursing Partnering With Children & Families, 3rd Edition by Jane W. Ball -Test Bank

Ball, Child Health Nursing, 3/E Chapter 2 Question 1 Type: MCSA A seven-year-old client tells you, "Grandpa, Mommy, Daddy, and my brother live at my house." The nurse identifies this family type as a(n): 1. Extended family. 2. Traditional nuclear family. 3. Binuclear family. 4. Heterosexual cohabitating family. Correct Answer: 1 Rationale 1: An extended family contains a parent or a couple who share the house with their children and another adult relative. Rationale 2: The traditional nuclear family consists of both biological parents, the children, and no other relatives or persons living in the household. Rationale 3: A binuclear family includes divorced parents who have joint custody of their biological children; the children alternate spending varying amounts of time in the home of each parent. Rationale 4: A heterosexual cohabitating family consists of a heterosexual couple, with or without children, living together outside of marriage. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2-2 Question 2 Type: MCSA During assessment of a child's biological family history, it is especially important that the nurse asking the mother for information uses the term "child's father" instead of "your husband" in the situation of a: 1. Traditional nuclear family. 2. Two-income nuclear family. 3. Traditional extended family. 4. Heterosexual cohabitating family. Correct Answer: 4 Rationale 1: In the traditional nuclear family, the child's father is the same person as the mother's husband. Rationale 2: The two-income nuclear family consists of children living with both biological parents where both parents are employed. The child’s father is the same person as the mother’s husband. Rationale 3: In the traditional extended family, the child's father is the same person as the mother's husband. In this family group, there will be other adult relatives living as a member of the family. Rationale 4: The couple in a heterosexual cohabitating family is not married, so no husband exists; the nurse should be asking about the child's father. Global Rationale: Cognitive Level: Analyzing Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2-2 Question 3 Type: MCSA The community health nurse is assessing several families for various strengths and needs in regard to afterschool and backup child care arrangements. The family type that typically will benefit most from this assessment and subsequent interventions is the: 1. Traditional nuclear family. 2. Extended family. 3. Binuclear family. 4. Single-parent family. Correct Answer: 4 Rationale 1: The traditional nuclear family has two adults who can share in the care and nurturing of its children. Rationale 2: The extended family generally has two or more adults who can share in the care and nurturing of its children. Rationale 3: The binuclear family generally has at least two adults who can share in the care and nurturing of its children. Rationale 4: The single-parent family most typically lacks social, emotional, and financial resources. Nursing considerations for such families should include referrals to options that will enable the parent to fulfill work commitments while providing the child with access to resources that can support the child's growth and development. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 2-2 Question 4 Type: MCSA The community health nurse is making an initial visit to a family. The most effective and efficient way for the nurse to assess the parenting style in use is to: 1. Ask the parents, "What rule is hardest for your child to obey?" 2. Ask the children what happens when they break the rules. 3. Ask the parents, "How often do you hug or kiss your children?" 4. Observe the parent interacting with the child for five minutes. Correct Answer: 2 Rationale 1: Learning about rules is less helpful than is an explanation of enforcement efforts and success. Rationale 2: Parental styles are assessed while the family explains how it handles situations that require limit setting. Rationale 3: Learning about how the parents express affection will not provide adequate information about parenting styles. Rationale 4: While under short term observation, parental behavior may not be accurate. A less complete picture of parenting style is obtained during a brief artificial observation. Global Rationale: Cognitive Level: Analyzing Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2-3 Question 5 Type: MCSA The nurse is working on parenting skills with a group of mothers. Which style of parenting tends to produce adolescents who tend to be self-reliant and socially competent? 1. Authoritarian 2. Permissive 3. Indifferent 4. Authoritative Correct Answer: 4 Rationale 1: Children in the authoritarian parenting family are denied the opportunity to develop some skills in the areas of self-direction, communication, and negotiation. Rationale 2: Under the permissive parenting style, children do not learn the socially acceptable limits of behaviors. Rationale 3: The indifferent parenting style results in children who often exhibit destructive behaviors and delinquency. Rationale 4: The authoritative parenting style is one that results in positive outcomes for the behavior and learning of children. Nurses have observed that children from homes using this parental style more frequently have personalities manifesting self-reliance, self-control, and social competence. These parents should be praised for using the preferred approach. Global Rationale: Cognitive Level: Analyzing Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-3 Question 6 Type: MCSA The nurse is working with a mother of three children on parenting skills. The nurse demonstrates a strategy that uses reward to increase positive behavior. This strategy is called: 1. Time-out. 2. Experiencing consequences of misbehavior. 3. Reasoning. 4. Behavior modification. Correct Answer: 4 Rationale 1: Time-out involves removing the child to an isolated, toy-free area for a short period of time to demonstrate that there are consequences of misbehavior. Rationale 2: Experiencing consequences allows the child to learn that misbehavior results in negative experiences, such as losing privileges. Rationale 3: Reasoning involves discussions about behaviors to help the child understand positive and negative behaviors. Rationale 4: Behavior modification reinforces good behavior by giving rewards for desired behaviors. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-3 Question 7 Type: MCSA The nurse is assigned to a child in a spica cast for a fractured femur suffered in an automobile accident. The child's teenage brother was driving the car, which was totaled. The nurse learns that the father lost his job three weeks ago and that the mother has just accepted a temporary waitress job. An appropriate diagnosis for this family is: 1. Interrupted Family Processes related to a child with significant disability requiring alteration in family functioning. 2. Risk for Caregiver Role Strain related to a child with a newly acquired disability and the associated financial burden. 3. Impaired Social Interaction (parent and child) related to the lack of family or respite support. 4. Compromised Family Coping related to multiple simultaneous stressors. Correct Answer: 4 Rationale 1: The spica cast might require alteration in family functioning; however, the situation describes no signs and symptoms to indicate this. In addition, fractures generally are not considered a significant long-term disability. Rationale 2: The need for a spica cast is not considered a newly acquired disability. Nothing about the situation describes caregiver role strain. Rationale 3: Lack of family members and lack of respite support were not mentioned in the scenario. Rationale 4: The situation describes multiple changes, or stressors, in the family’s situation that compromise family coping skills. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 2-4 Question 8 Type: MCSA Several children arrived at the emergency department accompanied only by their fathers. The nurse knows that the father who legally may sign emergency medical consent for treatment is: 1. The non-biologic one from the heterosexual cohabitating family. 2. The divorced one from the binuclear family. 3. The divorced one when the single-parent mother has custody. 4. The stepfather from the blended or reconstituted family. Correct Answer: 2 Rationale 1: The non-biologic father from the heterosexual cohabitating family does not have legal authority to seek emergency medical care for the child. Rationale 2: The divorced father from the binuclear family may sign informed consent because he has equal legal rights with the mother under joint custody arrangements. Rationale 3: When the single-parent mother has custody, the divorced non-biologic father does not have legal authority to seek emergency medical care for the child. Rationale 4: The non-biologic stepfather from the blended or reconstituted family does not have legal authority to seek emergency medical care for the child. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 2-5 Question 9 Type: MCSA The camp nurse is assessing a group of children attending summer camp. Which child will be most likely to have problems perceiving a sense of belonging? 1. The child whose parents divorced recently 2. The child recently placed into foster care 3. The child whose mother remarried and who gained a stepparent recently 4. The child adopted as an infant Correct Answer: 2 Rationale 1: Children whose parents divorce often fear abandonment. Rationale 2: Children in foster care are more likely to have problems perceiving a sense of belonging. Rationale 3: Children who gain a stepparent might have problems trusting the new parent. Rationale 4: Infants who are adopted at birth can have minimal problems with acceptance when parents follow pre-adoption counseling about disclosure. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2-5 Question 10 Type: MCSA A new pediatric hospital will open soon. While planning nursing care, the hospital administration is considering two models of providing health care: family-focused care and family-centered care. The best example of a nursing action in the family-centered care approach would be when the nurse: 1. Assumes the role of an expert professional to direct the health care. 2. Encourages the parents to stay with and comfort the child during an invasive procedure. 3. Assumes the role of a healthcare authority and intervenes for the child and family as a unit. 4. Tells the family what must be done for the family's health. Correct Answer: 2 Rationale 1: Directing the care as a professional is an example of family-focused care. In family-focused care, the health care worker assumes the role of professional expert while missing the multiple contributions the family brings to the health care meeting. Rationale 2: Encouraging parents to be present during procedures exemplifies family-centered care. The benefit of employing the family-centered care philosophy is that the priorities and needs as seen by the family are addressed as a partnership between a family and a nurse develops. Rationale 3: Intervening for the family as a health care authority is an example of family-focused care. In family-focused care, the health care worker assumes the role of professional expert while missing the multiple contributions the family brings to the health care meeting. Rationale 4: Telling the family what should be done is family-focused care. In family-focused care, the health care worker assumes the role of professional expert. Though a good way of providing pediatric health care, those participating in this type of care will miss contributions that the family brings to the health care meeting, as in family-centered care. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 2-6 Question 11 Type: MCSA A nurse is working with the family of a pediatric client. The nurse is planning to obtain an accurate family assessment. The initial step would be to: 1. Select the most relevant family assessment tool. 2. Establish a trusting relationship with the family. 3. Focus primarily on the mother, learning her greatest concern. 4. Observe the family in the home setting, since this step always proves indispensable. Correct Answer: 2 Rationale 1: There is benefit when the tool used matches the family's strengths and resources; however, selecting the most relevant family assessment tool is not the initial step in obtaining a family assessment. Rationale 2: Establishment of a trusting relationship between the family and the nurse is the essential preliminary step in obtaining an accurate family assessment. Rationale 3: Focusing primarily on the mother while learning her greatest concern is counterproductive and prevents the nurse from acknowledging multiple perceptions held by the family's members. Rationale 4: Observing the family in the home setting is recommended only in some cases. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2-8 Question 12 Type: SEQ The nurse working in a family-centered hospital sees families at all stages of the family life cycle. Place each of the following families along the continuum of the family life cycle, beginning with the earliest stage and proceeding to the last stage. Standard Text: Click and drag the options below to move them up or down. Choice 1. The husband who retired from his job four years ago. He has been widowed six months. Choice 2. Newlyweds Choice 3. Family with three children, ages 17, 13, and 9 Choice 4. Family taking their first child home from the birth hospital Choice 5. Family with grown children. Both parents hold full time jobs. Choice 6. Family whose oldest child will start kindergarten next year and whose third child will be born shortly Correct Answer: 2,4,6,3,5,1 Rationale 1: Stage VIII--Family in retirement and old age. This is the final stage of the family life cycle. Rationale 2: Stage I-- Beginning family. This is the first stage of the family life cycle. Rationale 3: Stage V--Families with teenagers Rationale 4: Stage II--Childbearing family Rationale 5: Stage VII--Middle-aged parents Rationale 6: Stage III-- Families with preschool children Global Rationale: Cognitive Level: Analyzing Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2--6 Question 13 Type: MCSA A pediatric clinic serves several children who were adopted. The clinic nurse recognizes that the adopted child who is most likely to blame himself for being “given away” by the biologic parents is the: 1. Adopted child entering high school. 2. Child under three who was adopted as an infant. 3. Preschooler whose skin color is different from the adopted parents. 4. Child entering kindergarten. Correct Answer: 4 Rationale 1: The adolescent often fantasizes about his biological parents. Rationale 2: This child does not understand adoption and doesn’t recognize himself as different from his parents. Rationale 3: This child recognizes differences in appearance and enjoys hearing his “adoption story.” Rationale 4: The five-year-old child is most likely to shoulder the blame for being “given up” by the biologic parents. Global Rationale: Cognitive Level: Analyzing Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2-5 Question 14 Type: MCMA While performing a family assessment, the nurse identifies which symptoms associated with dysfunctional family coping strategies? Standard Text: Select all that apply. 1. Father acknowledges an addiction to alcohol. 2. The mother is a stay-at-home mother, and the father works two jobs to make ends meet. 3. The family has deep religious beliefs. 4. The father makes all of the decisions for the family, and the mother is compliant with the father’s decisions. 5. Direct, open communication among family members is observed. Correct Answer: 1,4 Rationale 1: Drug and alcohol addictions are symptoms of dysfunctional coping strategies. Rationale 2: This is a family decision related to family finances and preferences and is not a dysfunctional coping strategy. Rationale 3: Spiritual supports are associated with functioning coping. Rationale 4: This could be a symptom of extreme dominance and submission. Rationale 5: This is a functional coping strategy. Global Rationale: Cognitive Level: Analyzing Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2-4 Question 15 Type: MCSA As a component of the family assessment, the family assists the nurse in developing an ecomap. Prior to beginning the ecomap, the nurse explains that the ecomap: 1. Provides information about the family structure including family life events, health, and illness. 2. Illustrates family relationships and interactions with community activities including school, parental jobs, and children’s activities. 3. Is a short questionnaire of five questions that measures family growth, affection, and resolve. 4. Is a family assessment that consists of three categories of information about the family’s strengths and problems. Correct Answer: 2 Rationale 1: Information of this type is called a genogram. Rationale 2: This is the description of the ecogram. Rationale 3: The five-item questionnaire measuring family growth, affection, resolve, adaptability, and partnership is a Family Apgar. Rationale 4: This describes a Calgary Family Assessment Model. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2-7 Ball, Child Health Nursing, 3/E Chapter 5 Question 1 Type: MCSA While being comforted in the emergency department, the six-year-old sibling of a pediatric trauma victim blurts out to the nurse, "It's all my fault! When we were fighting yesterday, I told him I wished he was dead!" The nurse, realizing that the child is experiencing magical thinking, should respond by: 1. Asking the child if he would like to sit down and drink some water. 2. Sitting the child down in an empty room with markers and paper so that he can draw a picture. 3. Reassuring the child that it is normal to get angry and say things that we do not mean, but that we have no control over whether an accident happens. 4. Calmly discussing the catheters, tubes, and equipment that the patient requires, and explaining to the sibling why the patient needs them. Correct Answer: 3 Rationale 1: Ignoring the child's outburst will not help the child understand it really was not his fault. Rationale 2: Asking the child to draw a picture might be appropriate later, but the nurse first needs to make sure the child knows the trauma did not occur because of anything he said. Rationale 3: Magical thinking is the belief that events occur because of one's thoughts or actions, and the most therapeutic way to respond to this is to correct any misconceptions that the child might have and reassure him that he is not to blame for any accident or illness. Rationale 4: Addressing the sibling's needs and equipment reinforces the child's magical thinking that the trauma was his fault. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-1 Question 2 Type: MCSA Utilizing Bronfenbrenner's ecologic theory of development, the nurse caring for a child would discuss the parents' work environment as part of an assessment of that child's: 1. Chronosystem. 2. Mesosystem. 3. Macrosystem. 4. Exosystem. Correct Answer: 4 Rationale 1: The chronosystem involves the perspective of time in the child's life. Rationale 2: The relationships of one microsystem to another involve a child's mesosystem. Rationale 3: Political and cultural beliefs comprise a child's macrosystem. Rationale 4: A child's exosystem is composed of the settings that influence a child even though she is not in daily contact with that system. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-2 Question 3 Type: MCSA The parents of a one-month-old infant are concerned that their baby seems different from their other child, and they ask the nurse if this is normal. The nurse informs them that it is normal for babies to have different temperaments and that according to the "temperament theory" of Chess and Thomas, one of the characteristics of the "slow-to-warm-up" child is that he: 1. Initially reacts to new situations by withdrawing. 2. Commonly has intense reactions to the environment. 3. Displays a predominately negative mood. 4. Shows a regularity in patterns of eating. Correct Answer: 1 Rationale 1: Slow-to-warm-up children adapt slowly to new situations and initially will withdraw. Rationale 2: Commonly having intense reactions to the environment is a characteristic of "difficult" children. Rationale 3: Displaying a predominately negative mood to the environment is a characteristic of "difficult" children. Rationale 4: Showing regularity in patterns of eating is a characteristic of an "easy" child. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-2 Question 4 Type: MCMA While in the pediatrician's office for their child's 12-month well-child exam, the parents ask the nurse for advice on age-appropriate toys for their child. Based on the child's developmental level, the nurse should suggest which types of toys? Standard Text: Select all that apply. 1. Soft toys that can be manipulated and mouthed 2. Toys with black-and-white patterns 3. Toys that can pop apart and go back together 4. Jack-in-the-box toys 5. Push-and-pull toys Correct Answer: 3,4,5 Rationale 1: One-year-olds are more mobile, so they have less interest in placing toys in their mouth and more interest in toys that can be manipulated. Rationale 2: Babies at 12 months tend to enjoy more colorful toys. Rationale 3: Both gross and fine motor skills are becoming more developed, and children at this age enjoy toys that can help them refine these skills. Rationale 4: Toys that the child can manipulate and have music will draw the child’s attention. Rationale 5: The 12-month-old child is learning to walk and will prize toys that promote mobility. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-3 Question 5 Type: MCSA While assessing the development of a nine-month-old infant, the nurse asks the mother if the child actively looks for toys when they are placed out of sight. The nurse is trying to determine whether the infant has developed: 1. Transductive reasoning 2. Conservation 3. Centration 4. Object permanence Correct Answer: 4 Rationale 1: Transductive reasoning is when a child connects two events in a cause-effect relationship because the events occurred at the same time. Rationale 2: Conservation is when a child knows that matter is not changed when its form is altered. Rationale 3: Centration is when a child focuses on only one particular aspect of a situation. Rationale 4: A child who has developed object permanence has the ability to understand that even though something is out of sight, it still exists. Global Rationale: Cognitive Level: Analyzing Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-3 Question 6 Type: MCSA A nurse is assessing language development in all the infants presenting at the physician's office for well-child visits. The nurse would want to evaluate the child further who is not able to verbalize the words “dada” and “mama” by the age of: 1. 18 months. 2. 8 months. 3. 5 months. 4. 12 months. Correct Answer: 4 Rationale 1: By the age of 18 months, the child will have names for more people than just “mama” and “dada.” Rationale 2: By eight months, infants will be making the sounds “mamamamam” and “dadadada” because they like to repeat sounds. At this time, they do not use these as names for the parents. Rationale 3: A five-month-old infant makes sounds, but the sounds are not words. Rationale 4: A child should be able to verbalize "mama" or "dada" to identify her parents by one year of age. Global Rationale: Cognitive Level: Analyzing Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 5-4 Question 7 Type: MCSA Two three-year-olds are playing in a hospital playroom together. One is working on a puzzle, while the other is stacking blocks. The mother of one of the children scolds them for not sharing their toys. The nurse counsels this mother that this is normal developmental behavior for this age, and the term for it is: 1. Cooperative play. 2. Solitary play. 3. Parallel play. 4. Associative play. Correct Answer: 3 Rationale 1: Cooperative play is when children demonstrate the ability to cooperate with others and to play a part in order to contribute to a unified whole. The school-age child participates in cooperative play. Rationale 2: Solitary play is when a child plays alone. Infants’ play style is described as solitary. Rationale 3: Parallel play is when two or more children play together, each engaging in her own activities. Rationale 4: Associative play is characterized by children interacting in groups and participating in similar activities. Preschoolers’ play style is associative. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-5 Question 8 Type: MCSA A neonatal nurse who encourages parents to hold their baby and provides opportunities for kangaroo care most likely is demonstrating concern for which aspect of the infant's psychosocial development? 1. Attachment 2. Assimilation 3. Resilience 4. Centration Correct Answer: 1 Rationale 1: Attachment is a strong emotional bond between a parent and child that forms the foundation for the fulfillment of the basic need of trust in the infant. Rationale 2: Assimilation describes the child's incorporation of new experiences. Rationale 3: Resilience is the ability to maintain healthy function even under significant stress and adversity. Rationale 4: Centration is the ability to consider only one aspect of a situation at a time. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-5 Question 9 Type: MCSA While trying to inform a five-year-old girl about what will occur during an upcoming CT scan, the nurse notices that the child is engaged in a collective monologue, talking about a new puppy. The nurse's best response would be: 1. "You must be so excited to have a new puppy! They are so much fun. Now let me tell you again about going downstairs in a wheelchair to a special room." 2. "Please stop talking about your puppy. I need to tell you about your CT scan." 3. "I'll come back when you are ready to talk with me more about your CT scan." 4. Ignore the child's responses and continue discussing the procedure. Correct Answer: 1 Rationale 1: When a child becomes engaged in a collective monologue, it is best to respond to the content of her conversation and then attempt to reinsert facts about the content that needs to be covered. Rationale 2: Asking the child to stop talking about her puppy and then abruptly talking about the CT scan will alienate the child and possibly make her shut down. Rationale 3: Coming back later is not usually an option, as radiological exams are scheduled for a certain time. The nurse needs to address the inattention but should listen for a few moments before directing the patient's attention. Rationale 4: Ignoring the child's obvious lack of attention will not help prepare her for the upcoming procedure. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-5 Question 10 Type: MCSA The mother of a six-year-old boy who has recently had surgery for the removal of his tonsils and adenoids complains that he has begun sucking his thumb again. The nurse caring for the child should assure the mother that this is a normal response for a child who has undergone surgery and that it is a coping mechanism that children sometimes use called: 1. Repression. 2. Rationalization. 3. Fantasy. 4. Regression. Correct Answer: 4 Rationale 1: Repression is the involuntary forgetting of uncomfortable situations. Rationale 2: Rationalization is an attempt to make unacceptable feelings acceptable. Rationale 3: Fantasy is a creation of the mind to help deal with an unacceptable fear. Rationale 4: The correct answer is regression, which is a return to an earlier behavior. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-6 Question 11 Type: MCSA Prior to giving an intramuscular injection to a two-and-a-half-year-old child, the most appropriate statement by the nurse would be: 1. "It is all right to cry. I know that this hurts. After we are done, you can go to the box and pick out your favorite sticker." 2. "We will give you your shot when your mommy comes back." 3. "This is medicine that will make you better. First we will hold your leg, then I will wipe it off with this magic cloth that kills the germs on your leg right here. Then I will hold the needle like this and say 'one, two, three, go' and give you your shot. After the shot is over with, I will hold the cotton ball until it stops bleeding and then put the Band-Aid on. Are you ready?" 4. "This is a magic sword that will give you your medicine and make you all better." Correct Answer: 1 Rationale 1: The most appropriate response would be to acknowledge the child's feelings and give him something to look forward to. Rationale 2: Waiting for the mother to come back would be inappropriate because toddlers do not have an understanding of time. Rationale 3: Giving elaborate descriptions and using colorful language are inappropriate because the instructions are unclear and lengthy. Rationale 4: The nurse should not make statements that are not true and might confuse the child. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 5-7 Question 12 Type: MCSA A 14-year-old with cystic fibrosis suddenly becomes noncompliant with the medication regimen. The intervention by the nurse that would most likely improve compliance would be to: 1. Give the child a computer-animated game that presents information on the management of cystic fibrosis. 2. Set up a meeting with some older teens who have cystic fibrosis and have been managing their disease effectively. 3. Arrange for the physician to sit down and talk to the child about the risks related to noncompliance with medications. 4. Discuss with the child's parents that privileges, such as a cell phone, can be taken away if compliance fails to improve. Correct Answer: 2 Rationale 1: Interest in games might begin to wane at this age. Rationale 2: Providing an adolescent with positive role models who are in her peer group is the intervention most likely to improve compliance. Rationale 3: Adult opinions, even from a physician, could be viewed negatively and challenged. Rationale 4: Threatening punishment could further incite rebellion. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 5-7 Question 13 Type: MCSA The home health nurse is visiting a family at home when the toddler has an “accident” and has a bowel movement in his diaper. The mother becomes angry with the child and calls him a baby for messing himself. The nurse considers Erikson’s theory and recognizes that the mother’s behavior may have an effect on the child’s: 1. Cognitive development. 2. Sense of independence. 3. Conscience. 4. Development of superego. Correct Answer: 2 Rationale 1: Erikson’s theory is related to psychosocial development. The mother’s criticism will not affect the child’s ability to think. Rationale 2: Erikson’s toddler stage is autonomy (independence) versus shame and doubt. Rationale 3: Conscience is what controls our knowledge of right and wrong and is a component of Kohlberg’s theory. Rationale 4: In Freudian theory, the superego is the moral and ethical system of the personality. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-4 Question 14 Type: MCSA The clinic administrator has suggested that the nurse teach all children newly diagnosed with diabetes in a single class to save nursing time. The children recently diagnosed range in age from 6 to 15. The argument the nurse will use in to advocate for more than one group session would be based on: 1. Freud’s theory of psychosexual development, which states that the six-year-old child’s sexual energy is at rest while the adolescent has developed mature sexuality. 2. Erikson’s psychosocial theory, which discusses how children learn to relate to others. 3. Piaget’s cognitive development theory, which says the six-year-old learns by concrete examples while the 15-year-old can think abstractly. 4. Kohlberg’s theory, which says the young child is conventional in his thinking and will want to learn to please others while the older child can internalize values and will learn for his own principles. Correct Answer: 3 Rationale 1: This theory would not explain why it would be best to separate the group by age. Rationale 2: Erikson’s theory is about relationships, not learning ability. Rationale 3: The younger child will need to handle the equipment and observe demonstrations while the older child will require more discussion and less demonstration. Rationale 4: Kohlberg’s theory may explain the reasons the child learns the material but does not discuss the learning style. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-4 Question 15 Type: SEQ As children grow and develop, their style of play changes. Place the following descriptions of play styles in order from infancy to school-age. Standard Text: Click and drag the options below to move them up or down. Choice 1. Plays beside but not with other children Choice 2. Plays games with other children and is able to follow the rules of the game Choice 3. Plays alone with play directed by others Choice 4. Plays with others in loose groups Correct Answer: 3,1,4,2 Rationale 1: This describes parallel play, seen in toddlers. Rationale 2: This describes cooperative play, seen in the school-age child. Rationale 3: This describes infant style play, called solitary play. Rationale 4: This describes associative play, which is seen in the preschooler. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-3 Question 16 Type: MCSA A 10-year-old child has been struggling with his self-esteem. Which activity would best help this child have a positive resolution of Erikson’s Industry versus Inferiority stage? 1. Playing sports with his older brother and the brother’s friends. 2. Have his mother compliment him when he completes his homework. 3. Encourage the child to participate in boy scouts and earn badges. 4. Suggest to the mother that she allow the child to babysit his younger siblings. Correct Answer: 3 Rationale 1: This would not help the child develop a positive self-esteem because the older boys will be more skilled at the sport than this child. Rationale 2: Positive reinforcement is beneficial but does not support the development of Industry. Rationale 3: The badges will be a visible documentation of his accomplishments. Rationale 4: The 10-year-old cannot safely babysit the younger children, and this is unrelated to Erikson’s sense of industry. Global Rationale: Cognitive Level: Applying Client Need: Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-5