Test Bank Wong’s Essentials of Pediatric Nursing 11th Edition Hockenberry Rodgers Wilson

Test Bank Wong’s Essentials of Pediatric Nursing 11th Edition Hockenberry Rodgers WilsonTable of Contents Chapter 1. Perspectives of Pediatric Nursing ......................................................................................... 2 Chapter 2. Family, Social, Cultural, and Religious Influences on Child Health Promotion ................. 8 Chapter 3. Developmental and Genetic Influences on Child Health Promotion .................................. 15 Chapter 4. Communication and Physical Assessment of the Child and Family .................................. 22 Chapter 5. Pain Assessment in and Management in Children .............................................................. 31 Chapter 6. Infectious Disease ............................................................................................................... 38 Chapter 7. Health Promotion of the Newborn and Family .................................................................. 44 Chapter 8. Health Problems of Newborns ........................................................................................... 50 Chapter 9. Health Promotion of the Infant and Family ....................................................................... 56 Chapter 10. Health Problem of Infants ................................................................................................ 62 Chapter 11. Health Promotion of the Toddler and Family ................................................................... 70 Chapter 12. Health Promotion of the Preschooler and Family ............................................................ 76 Chapter 13. Health Problems of Toddlers and Preschoolers ............................................................... 84 Chapter 14. Health Promotion of the School Age Child and Family .................................................... 90 Chapter 15. Health Promotion of the Adolescent and Family .............................................................. 97 Chapter 16. Health Problems of School Age Children and Adolescents ............................................ 108 Chapter 17. Quality of Life for Children Living with Chronic or Complex Diseases ........................... 114 Chapter 18. Impact of Cognitive or Sensory Impairment on the Child and Family .......................... 120 Chapter 19. Family-Centered Care of the Child During Illness and Hospitalization ......................... 127 Chapter 20. Pediatric Variations of Nursing Interventions ................................................................ 133 Chapter 21. The Child with Respiratory Dysfunction ........................................................................ 140 Chapter 22. The Child with Gastrointestinal Dysfunction .................................................................. 147 Chapter 23. The Child with Cardiovascular Dysfunction .................................................................... 153 Chapter 24. The Child with Hematologic or Immunologic Dysfunction ............................................ 159 Chapter 25. The Child with Cancer ..................................................................................................... 166 Chapter 26. The Child with Genitourinary Dysfunction ..................................................................... 172 Chapter 27. The Child with Cerebral Dysfunction .............................................................................. 179 Chapter 28. The Child with Endocrine Dysfunction .......................................................................... 185 Chapter 29. The Child with Musculoskeletal or Articular Dysfunction ............................................. 193 Chapter 30. The Child with Neuromuscular or Muscular Dysfunction ............................................. 201 1 | P a g elOMoARcPSD|9221363 Chapter 1. Perspectives of Pediatric Nursing MULTIPLE CHOICE 1. The clinic nurse is reviewing statistics on infant mortality for the United States versus other countries. Compared with other countries that have a population of at least 25 million, the nurse makes which determination? a. The United States is ranked last among 27 countries. b. c. d. The United States is ranked similar to 20 other developed countries. The United States is ranked in the middle of 20 other developed countries. The United States is ranked highest among 27 other industrialized countries. ANS: A Although the death rate has decreased, the United States still ranks last in infant mortality among nations with a population of at least 25 million. The United States has the highest infant death rate of developed nations. DIF: Cognitive Level: Remembering REF: dl. 6 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 2. Which is the leading cause of death in infants younger than 1 year in the United States? a. Congenital anomalies b. c. d. Sudden infant death syndrome Disorders related to short gestation and low birth weight Maternal complications specific to the perinatal period ANS: A Congenital anomalies account for 20.1% of deaths in infants younger than 1 year compared with sudden infant death syndrome, which accounts for 8.2%; disorders related to short gestation and unspecified low birth weight, which account for 16.5%; and maternal complications such as infections specific to the perinatal period, which account for 6.1% of deaths in infants younger than 1 year of age. DIF: Cognitive Level: Remembering REF: dl. 7 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 3. What is the major cause of death for children older than 1 year in the United States? a. Heart disease b. c. d. ANS: C Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. The leading cause of death for those younger than 1 year is congenital anomalies, and childhood cancers and heart disease cause a significantly lower percentage of deaths in children older than 1 year of age. DIF: Cognitive Level: Understanding REF: dl. 7 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 4. In addition to injuries, what are the leading causes of death in adolescents ages 15 to 19 years? a. Suicide and cancer b. c. 2 | P a g e Suicide and homicide Drowning and cancer Childhood cancer Unintentional injuries Congenital anomalieslOMoARcPSD|9221363 d. Homicide and heart disease ANS: B Suicide and homicide account for 16.7% of deaths in this age group. Suicide and cancer account for 10.9% of deaths, heart disease and cancer account for approximately 5.5%, and homicide and heart disease account for 10.9% of the deaths in this age group. DIF: Cognitive Level: Remembering REF: dl. 7 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 5. The nurse is planning a teaching session to adolescents about deaths by unintentional injuries. Which should the nurse include in the session with regard to deaths caused by injuries? a. More deaths occur in males. b. c. d. More deaths occur in females. The pattern of deaths does not vary according to age and sex. The pattern of deaths does not vary widely among different ethnic groups. ANS: A The majority of deaths from unintentional injuries occur in males. The pattern of death does vary greatly among different ethnic groups, and the causes of unintentional deaths vary with age and gender. DIF: Cognitive Level: Applying REF: pp. 7-8 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 6. What do mortality statistics describe? a. Disease occurring regularly within a geographic location b. c. d. The number of individuals who have died over a specific period The prevalence of specific illness in the population at a particular time Disease occurring in more than the number of expected cases in a community ANS: B Mortality statistics refer to the number of individuals who have died over a specific period. Morbidity statistics show the prevalence of specific illness in the population at a particular time. Data regarding disease within a geographic region, or in greater than expected numbers in a community, may be extrapolated from analyzing the morbidity statistics. DIF: Cognitive Level: Remembering REF: dl. 3 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 7. The nurse should assess which age group for suicide ideation since suicide in which age group is the third leading cause of death? a. Preschoolers b. c. d. Young school age Middle school age Late school age and adolescents ANS: D Suicide is the third leading cause of death in children ages 10 to 19 years; therefore, the age group should be late school age and adolescents. Suicide is not one of the leading causes of death for preschool and young or middle school-aged children. DIF: Cognitive Level: Understanding REF: dl. 6 3 | P a g elOMoARcPSD|9221363 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 8. Parents of a hospitalized toddler ask the nurse, What is meant by family-centered care? The nurse should respond with which statement? a. Family-centered care reduces the effect of cultural diversity on the family. b. c. d. Family-centered care encourages family dependence on the health care system. Family-centered care recognizes that the family is the constant in a childs life. Family-centered care avoids expecting families to be part of the decision-making process. ANS: C The three key components of family-centered care are respect, collaboration, and support. Family-centered care recognizes the family as the constant in the childs life. The family should be enabled and empowered to work with the health care system and is expected to be part of the decision-making process. The nurse should also support the familys cultural diversity, not reduce its effect. DIF: Cognitive Level: Applying REF: dl. 8 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 9. The nurse is describing clinical reasoning to a group of nursing students. Which is most descriptive of clinical reasoning? a. Purposeful and goal directed b. c. d. A simple developmental process Based on deliberate and irrational thought Assists individuals in guessing what is most appropriate ANS: A Clinical reasoning is a complex developmental process based on rational and deliberate thought. When thinking is clear, precise, accurate, relevant, consistent, and fair, a logical connection develops between the elements of thought and the problem at hand. DIF: Cognitive Level: Applying REF: dl. 12 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 10. Evidence-based practice (EBP), a decision-making model, is best described as which? a. Using information in textbooks to guide care b. c. d. Combining knowledge with clinical experience and intuition Using a professional code of ethics as a means for decision making Gathering all evidence that applies to the childs health and family situation ANS: B EBP helps focus on measurable outcomes; the use of demonstrated, effective interventions; and questioning what is the best approach. EBP involves decision making based on data, not all evidence on a particular situation, and involves the latest available data. Nurses can use textbooks to determine areas of concern and potential involvement. DIF: Cognitive Level: Remembering REF: dl. 11 TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment 11. Which best describes signs and symptoms as part of a nursing diagnosis? a. Description of potential risk factors b. c. d. 4 | P a g e Identification of actual health problems Human response to state of illness or health Cues and clusters derived from patientlOMoARcPSD|9221363 assessment ANS: D Signs and symptoms are the cues and clusters of defining characteristics that are derived from a patient assessment and indicate actual health problems. The first part of the nursing diagnosis is the problem statement, also known as the human response to the state of illness or health. The identification of actual health problems may be part of the medical diagnosis. The nursing diagnosis is based on the human response to these problems. The human response is therefore a component of the nursing diagnostic statement. Potential risk factors are used to identify nursing care needs to avoid the development of an actual health problem when a potential one exists. DIF: Cognitive Level: Understanding REF: dl. 13 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Safe and Effective Care Environment 12. The nurse is talking to a group of parents of school-age children at an after-school program about childhood health problems. Which statement should the nurse include in the teaching? a. Childhood obesity is the most common nutritional problem among children. b. Immunization rates are the same among children of different races and ethnicity. Dental caries is not a problem commonly seen in children since the introduction of fluoridated c. d. ANS: A water. Mental health problems are typically not seen in school-age children but may be diagnosed in adolescents. When teaching parents of school-age children about childhood health problems, the nurse should include information about childhood obesity because it is the most common problem among children and is associated with type 2 diabetes. Teaching parents about ways to prevent obesity is important to include. Immunization rates differ depending on the childs race and ethnicity; dental caries continues to be a common chronic disease in childhood; and mental health problems are seen in children as young as school age, not just in adolescents. DIF: Cognitive Level: Applying REF: dl. 3 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 13. The nurse is planning care for a hospitalized preschool-aged child. Which should the nurse plan to ensure atraumatic care? a. Limit explanation of procedures because the child is preschool aged. b. c. Ask that all family members leave the room when performing procedures. Allow the child to choose the type of juice to drink with the administration of oral medications. Explain that EMLA cream cannot be used for the morning lab draw because there is not time for d. ANS: C it to be effective. The overriding goal in providing atraumatic care is first, do no harm. Allowing the child a choice of juice to drink when taking oral medications provides the child with a sense of control. The 5 | P a g elOMoARcPSD|9221363 preschool child should be prepared before procedures, so limiting explanations of procedures would increase anxiety. The family should be allowed to stay with the child during procedures, minimizing stress. Lidocaine/prilocaine (EMLA) cream is a topical local anesthetic. The nurse should plan to use the prescribed cream in time for morning laboratory draws to minimize pain. DIF: Cognitive Level: Applying REF: pp. 8-9 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 14. Which situation denotes a nontherapeutic nursepatientfamily relationship? a. The nurse is planning to read a favorite fairy tale to a patient. b. c. During shift report, the nurse is criticizing parents for not visiting their child. The nurse is discussing with a fellow nurse the emotional draw to a certain patient. The nurse is working with a family to find ways to decrease the familys dependence on health d. ANS: B care providers. Criticizing parents for not visiting in shift report is nontherapeutic and shows an underinvolvement with the parents. Reading a fairy tale is a therapeutic and age appropriate action. Discussing feelings of an emotional draw with a fellow nurse is therapeutic and shows a willingness to understand feelings. Working with parents to decrease dependence on health care providers is therapeutic and helps to empower the family. DIF: Cognitive Level: Analyzing REF: dl. 9 TOP: Integrated Process: Caring MSC: Client Needs: Psychosocial Integrity 15. The nurse is aware that which age group is at risk for childhood injury because of the cognitive characteristic of magical and egocentric thinking? a. Preschool b. c. d. Young school age Middle school age Adolescent ANS: A Preschool children have the cognitive characteristic of magical and egocentric thinking, meaning they are unable to comprehend danger to self or others. Young and middle school-aged children have transitional cognitive processes, and they may attempt dangerous acts without detailed planning but recognize danger to themselves or others. Adolescents have formal operational cognitive processes and are preoccupied with abstract thinking. DIF: Cognitive Level: Understanding REF: dl. 4 TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment 16. The school nurse is assessing children for risk factors related to childhood injuries. Which child has the most risk factors related to childhood injury? a. Female, multiple siblings, stable home life b. c. d. Male, high activity level, stressful home life Male, even tempered, history of previous injuries Female, reacts negatively to new situations, no serious previous injuries ANS: B Boys have a preponderance for injuries over girls because of a difference in behavioral characteristics, a high activity temperament is associated with risk-taking behaviors, and stress predisposes children to increased risk taking and self-destructive behaviors. Therefore, a male child with a high activity level and living in a stressful environment has the highest number of risk factors. A girl with several siblings and a stable home life is low risk. A boy with previous 6 | P a g elOMoARcPSD|9221363 injuries has two risk factors, but an even temper is not a risk factor for injuries. A girl who reacts negatively to new situations but has no previous serious illnesses has only one risk factor. DIF: Cognitive Level: Analyzing REF: dl. 4 TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment 17. The school nurse is evaluating the number of school-age children classified as obese. The nurse recognizes that the percentile of body mass index that classifies a child as obese is greater than which? a. 50th percentile b. c. d. 75th percentile 80th percentile 95th percentile ANS: D Obesity in children and adolescents is defined as a body mass index at or greater than the 95th percentile for youth of the same age and gender. DIF: Cognitive Level: Remembering REF: dl. 3 TOP: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 18. The nurse is teaching parents about the types of behaviors children exhibit when living with chronic violence. Which statement made by the parents indicates further teaching is needed? a. b. c. d. ANS: C We should watch for aggressive play. Our child may show lasting symptoms of stress. We know that our child will show caring behaviors. Our child may have difficulty concentrating in school. The statement that the child will show caring behaviors needs further teaching. Children living with chronic violence may exhibit behaviors such as difficulty concentrating in school, memory impairment, aggressive play, uncaring behaviors, and lasting symptoms of stress. DIF: Cognitive Level: Applying REF: dl. 6 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 19. The nurse is evaluating research studies according to the GRADE criteria and has determined the quality of evidence on the subject is moderate. Which type of evidence does this determination indicate? a. b. c. d. Strong evidence from unbiased observational studies Evidence from randomized clinical trials showed inconsistent results Consistent evidence from well-performed randomized clinical trials Evidence for at least one critical outcome from randomized clinical trials had serious flaws ANS: B Evidence from randomized clinical trials with important limitations indicates that the evidence is of moderate quality. Strong evidence from unbiased observational studies and consistent evidence from well-performed randomized clinical trials indicates high quality. Evidence for at least one critical outcome from randomized clinical trials that has serious flaws indicates low 7 | P a g elOMoARcPSD|9221363 quality. DIF: Cognitive Level: Remembering REF: dl. 12 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment 20. An adolescent patient wants to make decisions about treatment options, along with his parents. Which moral value is the nurse displaying when supporting the adolescent to make decisions? a. b. c. d. Justice Autonomy Beneficence Nonmaleficence ANS: B Autonomy is the patients right to be self-governing. The adolescent is trying to be autonomous, so the nurse is supporting this value. Justice is the concept of fairness. Beneficence is the obligation to promote the patients well-being. Nonmaleficence is the obligation to minimize or prevent harm. DIF: Cognitive Level: Analyzing REF: dl. 11 TOP: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 21. The nurse manager is compiling a report for a hospital committee on the quality of nursing- sensitive indicators for a nursing unit. Which does the nurse manager include in the report? a. The average age of the nurses on the unit b. c. d. The salary ranges for the nurses on the unit The education and certification of the nurses on the unit The number of nurses who have applied but were not hired for the unit ANS: C Nursing-sensitive indicators reflect the structure, process, and outcomes of nursing care. For example, the number of nursing staff, the skill level of the nursing staff, and the education and certification of nursing staff indicate the structure of nursing care. The average age of the nurses, salary range, and number of nurses who have applied but were not hired for the unit are not nursing-sensitive indicators. Chapter 2. Family, Social, Cultural, and Religious Influences on Child Health Promotion MULTIPLE CHOICE 1. Children are taught the values of their culture through observation and feedback relative to their own behavior. In teaching a class on cultural competence, the nurse should be aware that which factor may be culturally determined? a. Ethnicity b. c. d. Racial variation Status Geographic boundaries ANS: C Status is culturally determined and varies according to each culture. Some cultures ascribe higher status to age or socioeconomic position. Social roles also are influenced by the culture. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. It is one component of culture. Race and culture are two distinct attributes. Whereas racial 8 | P a g elOMoARcPSD|9221363 grouping describes transmissible traits, culture is determined by the pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. Cultural development may be limited by geographic boundaries, but the boundaries are not culturally determined. DIF: Cognitive Level: Analyzing REF: dl. 39 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. The nurse is aware that if patients different cultures are implied to be inferior, the emotional attitude the nurse is displaying is what? a. Acculturation b. c. d. Ethnocentrism Cultural shock Cultural sensitivity ANS: B Ethnocentrism is the belief that ones way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of ones ethnic group are superior to those of others. Acculturation is the gradual changes that are produced in a culture by the influence of another culture that cause one or both cultures to become more similar. The minority culture is forced to learn the majority culture to survive. Cultural shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. Cultural sensitivity, a component of culturally competent care, is an awareness of cultural similarities and differences. DIF: Cognitive Level: Understanding REF: dl. 35 TOP: Integrated Process: Caring MSC: Client Needs: Psychosocial Integrity 3. Which term best describes the sharing of common characteristics that differentiates one group from other groups in a society? a. Race b. c. d. Culture Ethnicity Superiorit y ANS: C Ethnicity is a classification aimed at grouping individuals who consider themselves, or are considered by others, to share common characteristics that differentiate them from the other collectivities in a society, and from which they develop their distinctive cultural behavior. Race is a term that groups together people by their outward physical appearance. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perception and judgments. Superiority is the state or quality of being superior; it does not apply to ethnicity. DIF: Cognitive Level: Understanding REF: dl. 39 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 4. After the family, which has the greatest influence on providing continuity between generations? a. Race 9 | P a g elOMoARcPSD|9221363 b. c. d. School Social class Governmen t ANS: B Schools convey a tremendous amount of culture from the older members to the younger members of society. They prepare children to carry out the traditional social roles that will be expected of them as adults. Race is defined as a division of humankind possessing traits that are transmissible by descent and are sufficient to characterize race as a distinct human type; although race may have an influence on childrearing practices, its role is not as significant as that of schools. Social class refers to the familys economic and educational levels. The social class of a family may change between generations. The government establishes parameters for children, including amount of schooling, but this is usually at a local level. The school culture has the most significant influence on continuity besides family. DIF: Cognitive Level: Remembering REF: dl. 33 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 5. The nurse is planning care for a patient with a different ethnic background. Which should be an appropriate goal? a. Adapt, as necessary, ethnic practices to health needs. b. c. d. Attempt, in a nonjudgmental way, to change ethnic beliefs. Encourage continuation of ethnic practices in the hospital setting. Strive to keep ethnic background from influencing health needs. ANS: A Whenever possible, nurses should facilitate the integration of ethnic practices into health care provision. The ethnic background is part of the individual; it should be difficult to eliminate the influence of ethnic background. The ethnic practices need to be evaluated within the context of the health care setting to determine whether they are conflicting. DIF: Cognitive Level: Applying REF: dl. 34 TOP: Integrated Process: Caring MSC: Client Needs: Psychosocial Integrity 6. The nurse discovers welts on the back of a Vietnamese child during a home health visit. The childs mother says she has rubbed the edge of a coin on her childs oiled skin. The nurse should recognize this as what? a. Child abuse b. c. d. Cultural practice to rid the body of disease Cultural practice to treat enuresis or temper tantrums Child discipline measure common in the Vietnamese culture ANS: B This is descriptive of coining. The welts are created by repeatedly rubbing a coin on the childs oiled skin. The mother is attempting to rid the childs body of disease. Coining is a cultural healing practice. Coining is not specific for enuresis or temper tantrums. This is not child abuse or discipline. DIF: Cognitive Level: Understanding REF: dl. 41 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 7. A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicles, and juices, are left. Which statement best explains this? a. The parent is trying to feed the child only what the child likes most. b. c. 10 | P a g e Hispanics believe the evil eye enters when a person gets cold. The parent is trying to restore normal balance through appropriate hot remedies.lOMoARcPSD|9221363 d. Hispanics believe an innate energy called chi is strengthened by eating soup. ANS: C In several cultures, including Filipino, Chinese, Arabic, and Hispanic, hot and cold describe certain properties completely unrelated to temperature. Respiratory conditions such as pneumonia are cold conditions and are treated with hot foods. The child may like broth but is unlikely to always prefer it to Jell-O, Popsicles, and juice. The evil eye applies to a state of imbalance of health, not curative actions. Chinese individuals, not Hispanic individuals, believe in chi as an innate energy. DIF: Cognitive Level: Applying REF: dl. 40 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 8. How is family systems theory best described? a. The family is viewed as the sum of individual members. b. c. d. A change in one family member cannot create a change in other members. Individual family members are readily identified as the source of a problem. When the family system is disrupted, change can occur at any point in the system. ANS: D Family systems theory describes an interactional model. Any change in one member will create change in others. Although the family is the sum of the individual members, family systems theory focuses on the number of dyad interactions that can occur. The interactions, not the individual members, are considered to be the problem. DIF: Cognitive Level: Analyzing REF: dl. 18 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 9. Which family theory is described as a series of tasks for the family throughout its life span? a. Exchange theory b. c. d. Developmental theory Structural-functional theory Symbolic interactional theory ANS: B In developmental systems 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. Exchange theory assumes that humans, families, and groups seek rewarding statuses so that rewards are maximized while costs are minimized. Structural-functional theory states that the family performs at least one societal function while also meeting family needs. Symbolic interactional theory describes the family as a unit of interacting persons with each occupying a position within the family. DIF: Cognitive Level: Remembering REF: dl. 19 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 10. Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Interactional theory b. c. d. Family stress theory Eriksons psychosocial theory Developmental systems theory ANS: B 11 | P a g elOMoARcPSD|9221363 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. Eriksons theory applies to individual growth and development, not families. Developmental systems theory is an outgrowth of Duvalls 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. DIF: Cognitive Level: Remembering REF: dl. 19 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 11. Which type of family should the nurse recognize when the paternal grandmother, the parents, and two minor children live together? a. Blended b. c. d. Nuclear Extended Binuclear ANS: C 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 stepparent, stepsibling, or half-sibling. A 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. DIF: Cognitive Level: Remembering REF: pp. 20-21 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 12. Which type of family should the nurse recognize when a mother, her children, and a stepfather live together? a. Traditional nuclear b. c. d. Blended Extended Binuclear ANS: B A blended family contains at least one stepparent, stepsibling, or half-sibling. A traditional nuclear family consists of a married couple and their biologic children. No other relatives or nonrelatives are present in the household. 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. 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. DIF: Cognitive Level: Remembering REF: dl. 20 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 13. Which is an accurate description of homosexual (or gay-lesbian) families? a. A nurturing environment is lacking. b. c. d. The children become homosexual like their parents. The stability needed to raise healthy children is lacking. The quality of parenting is equivalent to that of nongay parents. ANS: D 12 | P a g elOMoARcPSD|9221363 Although gay or lesbian families may be different from heterosexual families, the environment can be as healthy as any other. Lacking a nurturing environment and stability is reflective on the parents and family, not the type of family. There is little evidence to support that children become homosexual like their parents. DIF: Cognitive Level: Understanding REF: pp. 21-22 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 14. The nurse is teaching a group of new nursing graduates about identifiable qualities of strong families that help them function effectively. Which quality should be included in the teaching? a. Lack of congruence among family members b. Clear set of family values, rules, and beliefs Adoption of one coping strategy that always promotes positive functioning in dealing with life c. d. ANS: B events Sense of commitment toward growth of individual family members as opposed to that of the family unit A clear set of family rules, values, and beliefs that establish expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Varied coping strategies are used by strong families. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit. DIF: Cognitive Level: Applying REF: dl. 22 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 15. When assessing a family, the nurse determines that the parents exert little or no control over their children. This style of parenting is called which? a. Permissive b. c. d. Dictatorial Democratic Authoritaria n 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 childrens actions. Dictatorial or authoritarian parents attempt to control their childrens 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 childrens behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect their childrens individual natures. DIF: Cognitive Level: Remembering REF: dl. 24 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 16. When discussing discipline with the mother of a 4-year-old child, which should the 13 | P a g elOMoARcPSD|9221363 nurse include? a. Parental control should be consistent. b. c. d. Withdrawal of love and approval is effective at this age. Children as young as 4 years rarely need to be disciplined. One should expect rules to be followed rigidly and unquestioningly. ANS: A For effective discipline, parents must be consistent and must follow through with agreed-on actions. Withdrawal of love and approval is never appropriate or effective. The 4-year-old child will test limits and may misbehave. Children of this age do not respond to verbal reasoning. Realistic goals should be set for this age group. Discipline is necessary to reinforce these goals. Discipline strategies should be appropriate to the childs age and temperament and the severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old child. DIF: Cognitive Level: Applying REF: dl. 24 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 17. Which is a consequence of the physical punishment of children, such as spanking? a. The psychologic impact is usually minimal. b. c. d. The childs development of reasoning increases. Children rarely become accustomed to spanking. 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 psychologic injury and interfere with effective parentchild interaction. The use of corporal punishment may interfere with the childs development of moral reasoning. Children do become accustomed to spanking, requiring more severe corporal punishment each time. DIF: Cognitive Level: Analyzing REF: dl. 26 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 18. The parents of a young child ask the nurse for suggestions about discipline. When discussing the use of time-outs, which should the nurse include? a. Send the child to his or her room if the child has one. b. c. d. A general rule for length of time is 1 hour per year of age. Select an area that is safe and nonstimulating, such as a hallway. If the child cries, refuses, or is more disruptive, try another approach. ANS: C The area must be nonstimulating and safe. The child becomes bored in this environment and then changes behavior to rejoin activities. The childs room may have toys and activities that negate the effect of being separated from the family. The general rule is 1 minute per year of age. An hour per year is excessive. When the child cries, refuses, or is more disruptive, the time-out does not start; the time-out begins when the child quiets. DIF: Cognitive Level: Remembering REF: dl. 26 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 14 | P a g elOMoARcPSD|9221363 19. A 3-year-old child was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guideline concerning adoption should the nurse use in planning a response? a. It is best to wait until the child asks about it. b. c. d. The best time to tell the child is between the ages of 7 and 10 years. It is not necessary to tell a child who was adopted so young. Telling the child is an important aspect of their parental responsibilities. ANS: D It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the childs 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 prevent third parties from telling the children before the parents have had the opportunity. DIF: Cognitive Level: Analyzing REF: dl. 27 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 20. Children may believe that they are responsible for their parents divorce and interpret the separation as punishment. At which age is this most likely to occur? a. 1 year b. c. d. 4 years 8 years 13 years ANS: B Preschool-age children are most likely to blame themselves for the divorce. A 4-year-old child will fear abandonment and express bewilderment regarding all human relationships. A 4-year- old child has magical thinking and believes his or her actions cause consequences, such as divorce. For infants, divorce may increase their irritability and interfere with the attachment process, but they are too young to feel responsibility. School-age children will have feelings of deprivation, including the loss of a parent, attention, money, and a secure future. Adolescents are able to disengage themselves from the parental conflict. Chapter 3. Developmental and Genetic Influences on Child Health Promotion MULTIPLE CHOICE 1. Which genetic term refers to a person who possesses one copy of an affected gene and one copy of an unaffected gene and is clinically unaffected? a. Allele b. c. d. ANS: B An individual who is a carrier is asymptomatic but possesses a genetic alteration, either in the form of a gene or chromosome change. Alleles are alternative expressions of genes at a different 15 | P a g e Carrier Pedigree MultifactoriallOMoARcPSD|9221363 locus. A pedigree is a diagram that describes family relationships, gender, disease, status, or other relevant information about a family. Multifactorial describes a complex interaction of both genetic and environmental factors that produce an effect on the individual. DIF: Cognitive Level: Understanding REF: dl. 46 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 2. Which genetic term refers to the transfer of all or part of a chromosome to a different chromosome after chromosome breakage? a. Trisomy b. c. d. Monosomy Translocation Nondisjunctio n ANS: C Translocation is the transfer of all or part of a chromosome to a different chromosome after chromosome breakage. It can be balanced, producing no phenotypic effects, or unbalanced, producing severe or lethal effects. Trisomy is an abnormal number of chromosomes caused by the presence of an extra chromosome, which is added to a given chromosome pair and results in a total of 47 chromosomes per cell. Monosomy is an abnormal number of chromosomes whereby the chromosome is represented by a single copy in a somatic cell. Nondisjunction is the failure of homologous chromosomes or chromatids to separate during mitosis or meiosis. DIF: Cognitive Level: Understanding REF: dl. 48 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 3. Which is a birth defect or disorder that occurs as a new case in a family and is not inherited? a. Sporadic b. c. d. Polygenic Monosomy Association ANS: A Sporadic describes a birth defect previously unidentified in a family. It is not inherited. Polygenic inheritance involves the inheritance of many genes at separate loci whose combined effects produce a given phenotype. Monosomy is an abnormal number of chromosomes whereby the chromosome is represented by a single copy in a somatic cell. A nonrandom cluster of malformations without a specific cause is an association. DIF: Cognitive Level: Understanding REF: dl. 48 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 4. The nurse is assessing a neonate who was born 1 hour ago to healthy white parents in their early forties. Which finding should be most suggestive of Down syndrome? a. Hypertonia b. c. d. Low-set ears Micrognathia Long, thin fingers and toes ANS: B Children with Down syndrome have low-set ears. Infants with Down syndrome have hypotonia, not hypertonia. Micrognathia is common in trisomy 16, not Down syndrome. Children with Down syndrome have short hands with broad fingers. 16 | P a g elOMoARcPSD|9221363 DIF: Cognitive Level: Understanding REF: dl. 82 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 5. Which abnormality is a common sex chromosome defect? a. Down syndrome b. c. d. Turner syndrome Marfan syndrome Hemophili a 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. DIF: Cognitive Level: Understanding REF: dl. 53 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 6. Turner syndrome is suspected in an adolescent girl with short stature. What causes this? a. Absence of one of the X chromosomes b. c. d. Presence of an incomplete Y chromosome Precocious puberty in an otherwise healthy child 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. These young women have 45 rather than 46 chromosomes. DIF: Cognitive Level: Understanding REF: dl. 53 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 7. Which is a sex chromosome abnormality that is caused by the presence of one or more additional X chromosomes in a male? a. b. c. d. Turner Triple X Klinefelter Trisomy 13 ANS: C Klinefelter syndrome is characterized by one or more additional X chromosomes. These individuals are tall with male secondary sexual characteristics that may be deficient, and they may be learning disabled. An absence of an X chromosome results in Turner syndrome. Triple X and trisomy 13 are not abnormalities that involve one or more additional X chromosomes in a male (Klinefelter syndrome). DIF: Cognitive Level: Understanding REF: dl. 53 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 8. Parents ask the nurse about the characteristics of autosomal dominant inheritance. Which statement is characteristic of autosomal dominant inheritance? a. Females are affected with greater frequency than males. b. c. d. ANS: C 17 | P a g e Unaffected children of affected individuals will have affected children. Each child of a heterozygous affected parent has a 50% chance of being affected. Any child of two unaffected heterozygous parents has a 25% chance of being affected.lOMoARcPSD|9221363 In autosomal dominant inheritance, only one copy of the mutant gene is necessary to cause the disorder. When a parent is affected, there is a 50% chance that the chromosome with the gene for the disorder will be contributed to each pregnancy. Males and females are equally affected. The disorder does not skip a generation. If the child is not affected, then most likely he or she is not a carrier of the gene for the disorder. In autosomal recessive inheritance, any child of two unaffected heterozygous parents has a 25% chance of being affected. DIF: Cognitive Level: Applying REF: dl. 57 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 9. Parents ask the nurse about the characteristics of autosomal recessive inheritance. Which is characteristic of autosomal recessive inheritance? a. b. c. d. Affected individuals have unaffected parents. Affected individuals have one affected parent. Affected parents have a 50% chance of having an affected child. Affected parents will have unaffected children. ANS: A Parents who are carriers of a recessive gene are asymptomatic. For a child to be affected, both parents must have a copy of the gene, which is passed to the child. Both parents are asymptomatic but can have affected children. In autosomal recessive inheritance, there is a 25% chance that each pregnancy will result in an affected child. In autosomal dominant inheritance, affected parents can have unaffected children. DIF: Cognitive Level: Applying REF: dl. 62 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 10. Which is characteristic of X-linked recessive inheritance? a. b. c. d. There are no carriers. Affected individuals are principally males. Affected individuals are principally females. Affected individuals will always have affected parents. ANS: B In X-linked recessive disorders, the affected individuals are usually male. With recessive traits, usually two copies of the gene are needed to produce the effect. Because the male only has one X chromosome, the effect is visible with only one copy of the gene. Females are usually only carriers of X-linked recessive disorders. The X chromosome that does not have the recessive gene will produce the normal protein, so the woman will not show evidence of the disorder. The transmission is from mother to son. Usually the mother and father are unaffected. DIF: Cognitive Level: Understanding REF: dl. 64 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 11. A father with an X-linked recessive disorder asks the nurse what the probability is that his sons will have the disorder. Which response should the nurse make? a. Male children will be carriers. b. c. 18 | P a g e All male children will be affected. None of the sons will have the disorder.lOMoARcPSD|9221363 d. It cannot be determined without more data. ANS: C When a male has an X-linked recessive disorder, he has one copy of the allele on his X chromosome. The father passes only his Y chromosome (not the X chromosome) to his sons. Therefore, none of his sons will have the X-linked recessive gene. They will not be carriers or be affected by the disorder. No additional data are needed to answer this question. DIF: Cognitive Level: Applying REF: dl. 64 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 12. The inheritance of which is X-linked recessive? a. b. c. d. Hemophilia A Marfan syndrome Neurofibromatosis Fragile X syndrome ANS: A Hemophilia A is inherited as an X-linked recessive trait. Marfan syndrome and neurofibromatosis are inherited as autosomal dominant disorders. Fragile X is inherited as an X- linked trait. DIF: Cognitive Level: Understanding REF: dl. 64 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 13. Chromosome analysis of the fetus is usually accomplished through the testing of which? a. Fetal serum b. c. d. Maternal urine Amniotic fluid Maternal serum ANS: C Amniocentesis is the most common method to retrieve fetal cells for chromosome analysis. Viable fetal cells are sloughed off into the amniotic fluid, and when a sample is taken, they can be cultured and analyzed. It is difficult to obtain a sample of the fetal blood. It is a high-risk situation for the fetus. Fetal cells are not present in the maternal urine or blood. DIF: Cognitive Level: Analyzing REF: dl. 46 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 14. A couple asks the nurse about the optimal time for genetic counseling. They do not plan to have children for several years. When should the nurse recommend they begin genetic counseling? a. As soon as the woman suspects that she may be pregnant b. c. d. Whenever they are ready to start their family Now, if one of them has a family history of congenital heart disease Now, if they are members of a population at risk for certain diseases ANS: D Persons who seek genetic evaluation and counseling must first be aware if there is a genetic or potential problem in their families. Genetic testing should be done now if the couple is part of a population at risk. It is not feasible at this time to test for all genetic diseases. The optimal time for genetic counseling is before pregnancy occurs. During the pregnancy, genetic counseling may be indicated if a genetic disorder is suspected. Congenital heart disease is not a single-gene disorder. DIF: Cognitive Level: Applying REF: dl. 62 19 | P a g elOMoARcPSD|9221363 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 15. A woman, age 43 years, is 6 weeks pregnant. It is important that she be informed of which? a. The need for a therapeutic abortion b. c. d. Increased risk for Down syndrome Increased risk for Turner syndrome The need for an immediate amniocentesis ANS: B Women who are older than age 35 years at the birth of a single child or 31 years at the birth of twins are advised to have prenatal diagnosis. The risk of having a child with Down syndrome increases with maternal age. There is no indication of a need for a therapeutic abortion at this stage. Turner syndrome is not associated with advanced maternal age. Amniocentesis cannot be done at a gestational age of 6 weeks. DIF: Cognitive Level: Applying REF: dl. 51 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 16. A couple has given birth to their first child, a boy with a recessive disorder. The genetic counselor tells them that the risk of recurrence is one in four. Which statement is a correct interpretation of this information? a. The risk factor remains the same for each pregnancy. b. c. The risk factor will change when they have a second child. Because the parents have one affected child, the next three children should be unaffected. Because the parents have one affected child, the next child is four times more likely to be d. ANS: A affected. Each pregnancy has the same risks for an affected child. Because an odds ratio reflects the risk, this does not change over time. The statement by the genetic counselor refers to a probability. This does not change over time. The statement Because the parents have one affected child, the next child is four times more likely to be affected does not reflect autosomal recessive inheritance. DIF: Cognitive Level: Analyzing REF: dl. 57 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 17. A couple expecting their first child has a positive family history for several congenital defects and disorders. The couple tells the nurse that they are opposed to abortion for religious reasons. Which should the nurse consider when counseling the couple? a. The couple should be encouraged to have recommended diagnostic testing. b. c. d. 20 | P a g e The couple needs counseling regarding advantages and disadvantages of pregnancy termination. Diagnostic testing is required by law in this situation. Diagnostic testing is of limited value if termination of pregnancy is not anlOMoARcPSD|9221363 option. ANS: A The benefits of prenatal diagnostic testing extend beyond decisions concerning abortion. If the child has congenital disorders, decisions can be made about fetal surgery if indicated. In addition, if the child is expected to require neonatal intensive care at birth, the mother is encouraged to deliver at a level III neonatal center. The couple is counseled about the advantages and disadvantages of prenatal diagnosis, not pregnancy termination, although the family cannot be forced to have prenatal testing. The information gives the parents time to grieve and plan for their child if congenital disorders are present. If the child is free of defects, then the parents are relieved of a major worry. DIF: Cognitive Level: Applying REF: dl. 71 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 18. Parents ask the nurse if there was something that should have been done during the pregnancy to prevent their childs cleft lip. Which statement should the nurse give as a response? a. This is a type of deformation and can sometimes be prevented. b. c. ANS: D prevent this. Cleft lip, an example of a malformation, occurs at approximately 5 weeks of gestation when the developing embryo naturally has two clefts in the area. There is no known way to prevent this defect. Deformations are often caused by extrinsic mechanical forces on normally developing tissue. Club foot is an example of a deformation often caused by uterine constraint. Cleft lip is not a genetic disorder; the reasons for this occurring are still unknown. Taking folic acid during pregnancy can help to prevent neural tube disorders but not cleft lip defects. DIF: Cognitive Level: Applying REF: dl. 49 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 19. The nurse is teaching parents of a child with cri du chat syndrome about this disorder. The nurse understands parents understand the teaching if they make which statement? a. This disorder is very common. b. c. d. This is an autosomal recessive disorder. The crying pattern is abnormal and catlike. The child will always have a moon-shaped face. ANS: C Typical of this disease is a crying pattern that is abnormal and catlike. Cri du chat, or cats cry, syndrome is a rare (one in 50,000 live births) chromosome deletion syndrome, not autosomal recessive, resulting from loss of the small arm of chromosome 5. In early infancy this syndrome manifests with a typical but nondistinctive facial appearance, often a moon-shaped face with wide-spaced eyes (hypertelorism). As the child grows, this feature is progressively diluted, and by age 2 years, the child is indistinguishable from age-matched control participants. DIF: Cognitive Level: Applying REF: pp. 54-55 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 20. The nurse is reviewing a clients prenatal history. Which prescribed medication does the 21 | P a g e Studies show that taking folic acid during pregnancy can prevent this defect. This is a genetic disorder and has a 25% chance of happening with each pregnancy. The malformation occurs at approximately 5 weeks of gestation; there is no known way to d.lOMoARcPSD|9221363 nurse understand is not considered a teratogen and prescribed during pregnancy? a. Phenytoin (Dilantin) b. c. d. Warfarin (Coumadin) Isotretinoin (Accutane) Heparin sodium (Heparin) ANS: D Teratogens, agents that cause birth defects when present in the prenatal environment, account for the majority of adverse intrauterine effects not attributable to genetic factors. Types of teratogens include drugs (phenytoin [Dilantin], warfarin [Coumadin], isotretinoin [Accutane]). Heparin is the anticoagulant used during pregnancy and is not a teratogen. It does not cross the placenta. Chapter 4. Communication and Physical Assessment of the Child and Family MULTIPLE CHOICE 1. The nurse is seeing an adolescent and the parents in the clinic for the first time. Which should the nurse do first? a. Introduce him- or herself. b. c. d. Make the family comfortable. Give assurance of privacy. Explain the purpose of the interview. ANS: A The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. Clarification of the purpose of the interview and the nurses role is the second thing that should be done. During the initial part of the interview, the nurse should include general conversation to help make the family feel at ease. The interview also should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality. DIF: Cognitive Level: Applying REF: dl. 91 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance 2. Which is considered a block to effective communication? a. b. c. d. Using silence Using clichs Directing the focus Defining the problem ANS: B Using stereotyped comments or clichs can block effective communication. After the nurse uses such trite phrases, parents often do not respond. Silence can be an effective interviewing tool. Silence permits the interviewee to sort out thoughts and feelings and search for responses to 22 | P a g elOMoARcPSD|9221363 questions. To be effective, the nurse must be able to direct the focus of the interview while allowing maximum freedom of expression. By using open-ended questions and guiding questions, the nurse can obtain the necessary information and maintain a relationship with the family. The nurse and parent must collaborate and define the problem that will be the focus of the nursing intervention. DIF: Cognitive Level: Applying REF: dl. 94 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance 3. Which is the single most important factor to consider when communicating with children? a. Presence of the childs parent b. c. d. Childs physical condition Childs developmental level Childs nonverbal behaviors ANS: C The nurse must be aware of the childs developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Nonverbal behaviors vary in importance based on the childs developmental level and physical condition. Although the childs physical condition is a consideration, developmental level is much more important. The presence of parents is important when communicating with young children but may be detrimental when speaking with adolescents. DIF: Cognitive Level: Understanding REF: dl. 147 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance 4. Because children younger than 5 years are egocentric, the nurse should do which when communicating with them? a. Focus communication on the child. b. c. d. Use easy analogies when possible. Explain experiences of others to the child. Assure the child that communication is private. ANS: A Because children of this age are able to see things only in terms of themselves, the best approach is to focus communication directly on them. Children should be provided with information about what they can do and how they will feel. With children who are egocentric, analogies, experiences, and assurances that communication is private will not be effective because the child is not capable of understanding. DIF: Cognitive Level: Understanding REF: dl. 96 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance 5. The nurses approach when introducing hospital equipment to a preschooler who seems afraid should be based on which principle? a. The child may think the equipment is alive. b. c. d. Explaining the equipment will only increase