FULL TEST BANK FOR
PEDIATRIC PHYSICAL EXAMINATION: AN ILLUSTRATED HANDBOOK 4TH EDITION
BY UDERSTADT,KEETON 100%VERIFIED ANSWERS
,TABLE OF CONTENTS
CHAPTER 1: APPROACH TO CARE AND ASSESSMENT OF CHILDREN AND ADOLESCENTS ............................ 3
CHAPTER 2. PHYSICAL ASSESSMENT PARAMETERS .................................................................................... 16
CHAPTER 3. DEVELOPMENTAL SURVEILLANCE AND SCREENING ............................................................... 28
CHAPTER 4. COMPREHENSIVE HEALTH GATHERING .................................................................................. 37
CHAPTER 5. ENVIRONMENTAL HEALTH HISTORY ....................................................................................... 45
CHAPTER 6 NEWBORN ASSESSMENT.......................................................................................................... 51
CHAPTER 7. SKIN ......................................................................................................................................... 68
CHAPTER 8. HEART AND VASCULAR SYSTEM.............................................................................................. 77
CHAPTER 9. CHEST AND RESPIRATORY SYSTEM ......................................................................................... 92
CHAPTER 10. HEAD AND NECK.................................................................................................................. 111
CHAPTER 11. LYMPHATIC SYSTEM ............................................................................................................ 117
CHAPTER 12. EYES ..................................................................................................................................... 127
CHAPTER 13. EARS .................................................................................................................................... 139
CHAPTER 14. NOSE, MOUTH, AND THROAT ............................................................................................. 144
CHAPTER 15. ABDOMEN AND RECTUM .................................................................................................... 147
CHAPTER 16. MALE GENITALIA ................................................................................................................. 168
CHAPTER 17. MALE AND FEMALE BREAST ................................................................................................ 170
CHAPTER 18. FEMALE GENITALIA ............................................................................................................. 184
CHAPTER 19. MUSCULOSKELETAL SYSTEM............................................................................................... 189
CHAPTER 20. NEUROLOGICAL SYSTEM ..................................................................................................... 206
,CHAPTER 1: APPROACH TO CARE AND ASSESSMENT OF CHILDREN AND
ADOLESCENTS
MULTIPLE CHOICE
1. A NURSE IS REVIEWING DEVELOPMENTAL CONCEPTS FOR INFANTS AND CHILDREN. WHICH
STATEMENT BEST DESCRIBES DEVELOPMENT IN INFANTS AND CHILDREN?
A. DEVELOPMENT, A PREDICTABLE AND ORDERLY PROCESS, OCCURS AT VARYING RATES WITHIN
NORMAL LIMITS.
B. DEVELOPMENT IS PRIMARILY RELATED TO THE GROWTH IN THE NUMBER AND SIZE OF CELLS.
C. DEVELOPMENT OCCURS IN A PROXIMODISTAL DIRECTION WITH FINE MUSCLE DEVELOPMENT
OCCURRING FIRST.
D. DEVELOPMENT IS MORE EASILY AND ACCURATELY MEASURED THAN GROWTH.
ANSWER: A
DEVELOPMENT, A CONTINUOUS ORDERLY PROCESS, PROVIDES THE BASIS FOR INCREASES IN THE
CHILDS FUNCTION AND COMPLEXITY OF BEHAVIOR. THE INCREASES IN RATE OF FUNCTION AND
COMPLEXITY CAN VARY NORMALLY WITHIN LIMITS FOR EACH CHILD. AN INCREASE IN THE NUMBER
AND SIZE OF CELLS IS A DEFINITION FOR GROWTH. DEVELOPMENT PROCEEDS IN A PROXIMODISTAL
DIRECTION WITH FINE MUSCLE ORGANIZATION OCCURRING AS A RESULT OF LARGE MUSCLE
ORGANIZATION. DEVELOPMENT IS A MORE COMPLEX PROCESS THAT IS AFFECTED BY MANY FACTORS;
THEREFORE, IT IS LESS EASILY AND ACCURATELY MEASURED. GROWTH IS A PREDICTABLE PROCESS
WITH STANDARD MEASUREMENT METHODS.
2. FREQUENT DEVELOPMENTAL ASSESSMENTS ARE IMPORTANT FOR WHICH REASON?
A. STABLE DEVELOPMENTAL PERIODS DURING INFANCY PROVIDE AN OPPORTUNITY TO IDENTIFY
ANY DELAYS OR DEFICITS.
B. INFANTS NEED STIMULATION SPECIFIC TO THE STAGE OF DEVELOPMENT.
C. CRITICAL PERIODS OF DEVELOPMENT OCCUR DURING CHILDHOOD.
D. CHILD DEVELOPMENT IS UNPREDICTABLE AND NEEDS MONITORING.
,ANSWER: C
CRITICAL PERIODS ARE BLOCKS OF TIME DURING WHICH CHILDREN ARE READY TO MASTER SPECIFIC
DEVELOPMENTAL TASKS. CHILDREN CAN MASTER THESE TASKS MORE EASILY DURING PARTICULAR
PERIODS OF TIME IN THEIR GROWTH AND DEVELOPMENTAL PROCESS. INFANCY IS A DYNAMIC TIME
OF DEVELOPMENT THAT REQUIRES FREQUENT EVALUATIONS TO ASSESS APPROPRIATE
DEVELOPMENTAL PROGRESS. INFANTS IN A NURTURING ENVIRONMENT WILL DEVELOP
APPROPRIATELY AND WILL NOT NECESSARILY NEED STIMULATION SPECIFIC TO THEIR
DEVELOPMENTAL STAGE. NORMAL GROWTH AND DEVELOPMENT ARE ORDERLY AND PROCEED IN A
PREDICTABLE PATTERN ON THE BASIS OF EACH INDIVIDUALS ABILITIES AND POTENTIALS.
3. WHICH FACTOR HAS THE GREATEST INFLUENCE ON CHILD GROWTH AND DEVELOPMENT?
A. CULTURE
B. ENVIRONMENT
C. GENETICS
D. NUTRITION
ANSWER: C
GENETIC FACTORS (HEREDITY) DETERMINE EACH INDIVIDUALS GROWTH AND DEVELOPMENTAL RATE.
ALTHOUGH FACTORS SUCH AS ENVIRONMENT, CULTURE, NUTRITION, AND FAMILY CAN INFLUENCE
GENETIC TRAITS, THEY DO NOT ELIMINATE THE EFFECT OF THE GENETIC ENDOWMENT, WHICH IS
PERMANENT. CULTURE IS A SIGNIFICANT FACTOR THAT INFLUENCES HOW CHILDREN GROW TOWARD
ADULTHOOD. CULTURE INFLUENCES BOTH GROWTH AND DEVELOPMENT BUT DOES NOT ELIMINATE
INBORN GENETIC INFLUENCES. ENVIRONMENT HAS A SIGNIFICANT ROLE IN DETERMINING GROWTH
AND DEVELOPMENT BOTH BEFORE AND AFTER BIRTH. THE ENVIRONMENT CAN INFLUENCE HOW AND
TO WHICH EXTENT GENETIC TRAITS ARE MANIFESTED, BUT ENVIRONMENTAL FACTORS CANNOT
ELIMINATE THE EFFECT OF GENETICS. NUTRITION IS CRITICAL FOR GROWTH AND PLAYS A SIGNIFICANT
ROLE THROUGHOUT CHILDHOOD.
,4. A NURSE IS PLANNING A TEACHING SESSION WITH A CHILD. ACCORDING TO PIAGETIAN THEORY, THE
PERIOD OF COGNITIVE DEVELOPMENT IN WHICH THE CHILD IS ABLE TO DISTINGUISH FACT FROM
FANTASY IS THE PERIOD OF COGNITIVE DEVELOPMENT.
A. SENSORIMOTOR
B. FORMAL OPERATIONS
C. CONCRETE OPERATIONS
D. PREOPERATIONAL
ANSWER: C
CONCRETE OPERATIONS IS THE PERIOD OF COGNITIVE DEVELOPMENT IN WHICH CHILDRENS THINKING
IS SHIFTED FROM EGOCENTRIC TO BEING ABLE TO SEE ANOTHERS POINT OF VIEW. THEY DEVELOP THE
ABILITY TO DISTINGUISH FACT FROM FANTASY. THE SENSORIMOTOR STAGE OCCURS IN INFANCY AND
IS A PERIOD OF REFLEXIVE BEHAVIOR. DURING THIS PERIOD, THE INFANTS WORLD BECOMES MORE
PERMANENT AND ORGANIZED. THE STAGE ENDS WITH THE INFANT DEMONSTRATING SOME
EVIDENCE OF REASONING. FORMAL OPERATIONS IS A PERIOD IN DEVELOPMENT IN WHICH NEW
IDEAS ARE CREATED THROUGH PREVIOUS THOUGHTS. ANALYTIC REASON AND ABSTRACT THOUGHT
EMERGE IN THIS PERIOD. THE PREOPERATIONAL STAGE IS A PERIOD OF EGOCENTRISM IN WHICH THE
CHILDS JUDGMENTS ARE ILLOGICAL AND DOMINATED BY MAGICAL THINKING AND ANIMISM.
5. THE THEORIST WHO VIEWED DEVELOPMENTAL PROGRESSION AS A LIFELONG SERIES OF CONFLICTS
THAT NEED RESOLUTION IS:
A. ERIKSON.
B. FREUD.
C. KOHLBERG.
D. PIAGET.
ANSWER: A
ERIK ERIKSON VIEWED DEVELOPMENT AS A SERIES OF CONFLICTS AFFECTED BY SOCIAL AND
CULTURAL FACTORS. EACH CONFLICT MUST BE RESOLVED FOR THE CHILD TO PROGRESS
EMOTIONALLY, WITH UNSUCCESSFUL RESOLUTION LEAVING THE CHILD EMOTIONALLY DISABLED.
SIGMUND FREUD PROPOSED A PSYCHOSEXUAL THEORY OF DEVELOPMENT IN WHICH CERTAIN PARTS
,OF THE BODY ASSUME PSYCHOLOGICAL SIGNIFICANCE AS FOCI OF SEXUAL ENERGY. THE FOCI SHIFT AS
THE INDIVIDUAL MOVES THROUGH THE DIFFERENT STAGES (ORAL, ANAL, PHALLIC, LATENCY, AND
GENITAL) OF DEVELOPMENT. LAWRENCE KOHLBERG DESCRIBED MORAL DEVELOPMENT AS HAVING
THREE LEVELS (PRECONVENTIONAL, CONVENTIONAL, AND POSTCONVENTIONAL). HIS
THEORY CLOSELY PARALLELS PIAGETS. JEAN PIAGETS COGNITIVE THEORY INTERPRETS HOW CHILDREN
LEARN AND THINK AND HOW THIS THINKING PROGRESSES AND DIFFERS FROM ADULT THINKING.
STAGES OF HIS THEORY INCLUDE SENSORIMOTOR, PREOPERATIONS, CONCRETE OPERATIONS, AND
FORMAL OPERATIONS.
6. WHAT DOES THE NURSE NEED TO KNOW WHEN OBSERVING CHRONICALLY ILL CHILDREN AT PLAY?
A. PLAY IS NOT IMPORTANT TO HOSPITALIZED CHILDREN.
B. CHILDREN NEED TO HAVE STRUCTURED PLAY PERIODS.
C. CHILDRENS PLAY IS AN INDICATION OF A CHILDS RESPONSE TO TREATMENT.
D. PLAY IS TO BE DISCOURAGED BECAUSE IT TIRES HOSPITALIZED CHILDREN.
ANSWER: C
PLAY FOR ALL CHILDREN IS AN ACTIVITY WOVEN WITH MEANING AND PURPOSE AND IS A
MECHANISM FOR MASTERING THEIR ENVIRONMENT. FOR CHRONICALLY ILL CHILDREN, PLAY CAN
INDICATE THEIR STATE OF WELLNESS AND RESPONSE TO TREATMENT. PLAY IS IMPORTANT TO ALL
CHILDREN IN ALL ENVIRONMENTS. ALTHOUGH CHILDRENS PLAY ACTIVITIES APPEAR UNORGANIZED
AND AT TIMES CHAOTIC, PLAY HAS PURPOSE AND MEANING. IMPOSING STRUCTURE ON PLAY
INTERFERES WITH THE TASKS BEING WORKED ON. CHILDREN WHO HAVE FEWER ENERGY RESERVES
STILL REQUIRE PLAY. FOR THESE CHILDREN, LESS-ACTIVE PLAY ACTIVITIES WILL BE IMPORTANT.
7. WHICH CHILD IS MOST LIKELY TO BE FRIGHTENED BY HOSPITALIZATION?
A. A 4-MONTH-OLD INFANT ADMITTED WITH A DIAGNOSIS OF BRONCHIOLITIS
B. A 2-YEAR-OLD TODDLER ADMITTED FOR CYSTIC FIBROSIS
C. A 9-YEAR-OLD CHILD HOSPITALIZED WITH A FRACTURED FEMUR
D. A 15-YEAR-OLD ADOLESCENT ADMITTED FOR ABDOMINAL PAIN
,ANSWER: B
TODDLERS ARE MOST LIKELY TO BE FRIGHTENED BY HOSPITALIZATION BECAUSE THEIR THOUGHT
PROCESSES ARE EGOCENTRIC, MAGICAL, AND ILLOGICAL. THEY FEEL VERY THREATENED BY
UNFAMILIAR PEOPLE AND STRANGE ENVIRONMENTS. YOUNG INFANTS ARE NOT AS LIKELY TO BE
FRIGHTENED AS TODDLERS BY HOSPITALIZATION BECAUSE THEY ARE NOT AS AWARE OF THE
ENVIRONMENT. THE 9-YEAR-OLD CHILDS COGNITIVE ABILITY IS SUFFICIENT ENOUGH FOR THE CHILD
TO UNDERSTAND THE REASON FOR THE HOSPITALIZATION. THE 15-YEAR-OLD ADOLESCENT HAS THE
COGNITIVE ABILITY TO INTERPRET THE REASON FOR THE HOSPITALIZATION.
8. WHICH STATEMENT MADE BY A 15-YEAR-OLD ADOLESCENT WITH A DIAGNOSIS OF
NEUROFIBROMATOSIS (AN AUTOSOMAL DOMINANT GENETIC DISORDER) BEST DEMONSTRATES AN
UNDERSTANDING OF THE MECHANISM OF INHERITANCE FOR THE DISEASE?
A. MY BABIES WILL PROBABLY NOT HAVE NEUROFIBROMATOSIS.
B. MY BABIES HAVE A 50% CHANCE OF HAVING NEUROFIBROMATOSIS.
C. WHETHER MY BABIES HAVE PROBLEMS DEPENDS ON THE FATHER.
D. MY BABIES HAVE A 25% CHANCE OF HAVING NEUROFIBROMATOSIS.
ANSWER: B
NEUROFIBROMATOSIS IS AN AUTOSOMAL DOMINANT GENETIC DISORDER THAT OCCURS WHEN THE
ABNORMAL GENE IS CARRIED ON THE AFFECTED CHROMOSOME WITH A NORMAL GENE. BECAUSE
THE ABNORMAL GENE IS DOMINANT, AN INDIVIDUAL WITH THE DEFECTIVE GENE HAS A 50% CHANCE
OF TRANSMITTING THE DEFECT TO AN INFANT WITH EACH PREGNANCY. NEUROFIBROMATOSIS IS NOT
A SEX-LINKED GENETIC DISEASE; THEREFORE, EITHER THE FATHER OR THE MOTHER GENETICALLY
TRANSFERS IT TO THE INFANT. A PARENT WITH THE DEFECTIVE GENE WILL GENETICALLY TRANSFER
EITHER A NORMAL OR ABNORMAL GENE TO AN INFANT. BECAUSE THE DEFECTIVE GENE IS
DOMINANT, THERE IS A 50% PROBABILITY OF THE CHILD INHERITING THE DISEASE.
9. DURING A ROUTINE HEALTHCARE VISIT, A PARENT ASKS THE NURSE WHY HER 9-MONTH-OLD INFANT
IS NOT WALKING AS HER OLDER CHILD DID AT THE SAME AGE. WHICH RESPONSE BY THE NURSE BEST
DEMONSTRATES AN UNDERSTANDING OF CHILD DEVELOPMENT?
A. SHES A LITTLE SLOW.
B. IF SHE IS PULLING UP, YOU CAN HELP HER BY HOLDING HER HAND.
,C. BABIES PROGRESS AT DIFFERENT RATES. YOUR INFANTS DEVELOPMENT IS WITHIN NORMAL
LIMITS.
D. MAYBE SHE NEEDS TO SEE A BEHAVIORAL SPECIALIST.
ANSWER: C
NINETY PERCENT OF INFANTS WALK BY 14 MONTHS OF AGE. THE INFANT IS WITHIN NORMAL
DEVELOPMENTAL LIMITS. IT IS INAPPROPRIATE FOR THE NURSE TO STATE THAT THE INFANT IS A
LITTLE SLOW. INFANTS WILL WALK WHEN THEY ARE DEVELOPMENTALLY READY. HURRYING AN
INFANT DOES NOT RESULT IN THE DEVELOPMENTAL TASK BEING ACHIEVED AT AN EARLIER TIME
PERIOD. CONSULTING A BEHAVIORAL SPECIALIST FOR DIAGNOSTIC EVALUATION IS INDICATED WHEN
A CHILD DEMONSTRATES DEVELOPMENTAL DELAYS. THE CHILD HAS NO EVIDENCE OF A DELAY.
10. WHICH EXPECTED OUTCOME WOULD BE DEVELOPMENTALLY APPROPRIATE FOR A HOSPITALIZED 4-
YEAR- OLD CHILD?
A. THE CHILD WILL BE DRESSED AND FED BY THE PARENTS.
B. THE CHILD WILL INDEPENDENTLY ASK FOR PLAY MATERIALS OR OTHER PERSONAL NEEDS.
C. THE CHILD WILL BE ABLE TO VERBALIZE AN UNDERSTANDING OF THE REASON FOR THE
HOSPITALIZATION.
D. THE CHILD WILL HAVE A PARENT STAY IN THE ROOM AT ALL TIMES.
ANSWER: B
ERIKSON IDENTIFIES INITIATIVE AS A DEVELOPMENTAL TASK FOR THE PRESCHOOL CHILD. INITIATING
PLAY ACTIVITIES AND ASKING FOR PLAY MATERIALS OR ASSISTANCE WITH PERSONAL NEEDS
DEMONSTRATE DEVELOPMENTAL APPROPRIATENESS. PARENTS NEED TO FOSTER APPROPRIATE
DEVELOPMENTAL BEHAVIOR IN THE 4-YEAR-OLD CHILD. DRESSING AND FEEDING THE CHILD DO NOT
ENCOURAGE INDEPENDENT BEHAVIOR. A 4- YEAR-OLD CHILD CANNOT BE EXPECTED TO COGNITIVELY
UNDERSTAND THE REASON FOR HIS OR HER HOSPITALIZATION. EXPECTING THE CHILD TO VERBALIZE
AN UNDERSTANDING FOR THE HOSPITALIZATION IS AN INAPPROPRIATE OUTCOME. PARENTS
STAYING WITH THE CHILD THROUGHOUT A HOSPITALIZATION IS AN INAPPROPRIATE OUTCOME.
ALTHOUGH CHILDREN BENEFIT FROM PARENTAL INVOLVEMENT, PARENTS MAY NOT HAVE THE
SUPPORT STRUCTURE TO STAY IN THE ROOM WITH THE CHILD AT ALL TIMES.
,11. A NURSE HAS COMPLETED A TEACHING SESSION WITH PARENTS OF PRESCHOOL AGED CHILDREN.
WHICH STATEMENT MADE BY THE PARENT IDENTIFIES AN APPROPRIATE LEVEL OF LANGUAGE
DEVELOPMENT FOR A 4- YEAR-OLD CHILD?
A. THE CHILD HAS A VOCABULARY OF 300 WORDS AND USES SIMPLE SENTENCES.
B. THE CHILD USES CORRECT GRAMMAR IN SENTENCES.
C. THE CHILD IS ABLE TO PRONOUNCE CONSONANTS CLEARLY.
D. THE CHILD USES LANGUAGE TO EXPRESS ABSTRACT THOUGHT.
ANSWER: B
THE 4-YEAR-OLD CHILD IS ABLE TO USE CORRECT GRAMMAR IN SENTENCE STRUCTURE AND TYPICALLY
HAS DIFFICULTY IN PRONOUNCING CONSONANTS. SIMPLE SENTENCES AND A 300-WORD
VOCABULARY ARE APPROPRIATE FOR A 2-YEAR-OLD CHILD. THE USE OF LANGUAGE TO EXPRESS
ABSTRACT THOUGHT IS DEVELOPMENTALLY APPROPRIATE FOR THE ADOLESCENT.
12. WHICH SHOULD THE NURSE EVALUATE BEFORE ADMINISTERING THE DENVER DEVELOPMENTAL
SCREENING TEST II (DDST-II)?
A. THE CHILDS HEIGHT AND WEIGHT
B. THE PARENTS ABILITY TO COMPREHEND THE RESULTS
C. THE CHILDS MOOD
D. THE PARENTCHILD INTERACTION
ANSWER: C
THE RESULTS OF THE SCREENING TEST ARE VALID IF THE CHILD ACTED IN A NORMAL AND EXPECTED
MANNER. THE CHILDS HEIGHT AND WEIGHT ARE NOT RELEVANT TO THE DDST-II SCREENING PROCESS.
THE PARENTS ABILITY TO UNDERSTAND THE RESULTS OF THE SCREENING IS NOT RELEVANT TO THE
VALIDITY OF THE TEST. THE PARENTCHILD INTERACTION IS NOT SIGNIFICANTLY RELEVANT TO THE
TEST RESULTS.
13. WHICH CHILDREN ARE AT GREATER RISK FOR NOT RECEIVING IMMUNIZATIONS?
, A. CHILDREN WHO ATTEND LICENSED DAY CARE PROGRAMS
B. CHILDREN ENTERING SCHOOL
C. CHILDREN WHO ARE HOME SCHOOLED
D. YOUNG ADULTS ENTERING COLLEGE
ANSWER: C
HOME SCHOOLED CHILDREN ARE AT RISK FOR BEING UNDERIMMUNIZED AND NEED TO BE
MONITORED. ALL STATES REQUIRE IMMUNIZATIONS FOR CHILDREN IN DAY CARE PROGRAMS AND
ENTERING SCHOOL. MOST COLLEGES REQUIRE A RECORD OF IMMUNIZATIONS AS PART OF A HEALTH
HISTORY.
14. WHICH DEVELOPMENTAL ASSESSMENT INSTRUMENT IS APPROPRIATE TO ASSESS A 5-YEAR-OLD
CHILD?
A. BRAZELTON BEHAVIORAL SCALE
B. DENVER DEVELOPMENTAL SCREENING TEST II (DDST-II)
C. DUBOWITZ SCALE
D. NEW BALLARD SCALE
ANSWER: B
THE DDST-II IS USED FOR INFANTS AND CHILDREN BETWEEN BIRTH AND 6 YEARS OF AGE.
BRAZELTONS BEHAVIORAL SCALE IS USED FOR NEWBORN ASSESSMENT. THE DUBOWITZ SCALE IS
USED FOR ESTIMATION OF GESTATIONAL AGE. THE NEW BALLARD SCALE IS USED FOR NEWBORN
SCREENING.
15. A 2-MONTH-OLD CHILD HAS NOT RECEIVED ANY IMMUNIZATIONS. WHICH IMMUNIZATIONS
SHOULD THE NURSE GIVE?
A. DTAP, HIB, HEPB, IPV, VARICELLA
B. DTAP, HIB, HEPB, MMR, IPV
C. DTAP, HIB, HEPB, PCV, IPV, ROTAVIRUS
PEDIATRIC PHYSICAL EXAMINATION: AN ILLUSTRATED HANDBOOK 4TH EDITION
BY UDERSTADT,KEETON 100%VERIFIED ANSWERS
,TABLE OF CONTENTS
CHAPTER 1: APPROACH TO CARE AND ASSESSMENT OF CHILDREN AND ADOLESCENTS ............................ 3
CHAPTER 2. PHYSICAL ASSESSMENT PARAMETERS .................................................................................... 16
CHAPTER 3. DEVELOPMENTAL SURVEILLANCE AND SCREENING ............................................................... 28
CHAPTER 4. COMPREHENSIVE HEALTH GATHERING .................................................................................. 37
CHAPTER 5. ENVIRONMENTAL HEALTH HISTORY ....................................................................................... 45
CHAPTER 6 NEWBORN ASSESSMENT.......................................................................................................... 51
CHAPTER 7. SKIN ......................................................................................................................................... 68
CHAPTER 8. HEART AND VASCULAR SYSTEM.............................................................................................. 77
CHAPTER 9. CHEST AND RESPIRATORY SYSTEM ......................................................................................... 92
CHAPTER 10. HEAD AND NECK.................................................................................................................. 111
CHAPTER 11. LYMPHATIC SYSTEM ............................................................................................................ 117
CHAPTER 12. EYES ..................................................................................................................................... 127
CHAPTER 13. EARS .................................................................................................................................... 139
CHAPTER 14. NOSE, MOUTH, AND THROAT ............................................................................................. 144
CHAPTER 15. ABDOMEN AND RECTUM .................................................................................................... 147
CHAPTER 16. MALE GENITALIA ................................................................................................................. 168
CHAPTER 17. MALE AND FEMALE BREAST ................................................................................................ 170
CHAPTER 18. FEMALE GENITALIA ............................................................................................................. 184
CHAPTER 19. MUSCULOSKELETAL SYSTEM............................................................................................... 189
CHAPTER 20. NEUROLOGICAL SYSTEM ..................................................................................................... 206
,CHAPTER 1: APPROACH TO CARE AND ASSESSMENT OF CHILDREN AND
ADOLESCENTS
MULTIPLE CHOICE
1. A NURSE IS REVIEWING DEVELOPMENTAL CONCEPTS FOR INFANTS AND CHILDREN. WHICH
STATEMENT BEST DESCRIBES DEVELOPMENT IN INFANTS AND CHILDREN?
A. DEVELOPMENT, A PREDICTABLE AND ORDERLY PROCESS, OCCURS AT VARYING RATES WITHIN
NORMAL LIMITS.
B. DEVELOPMENT IS PRIMARILY RELATED TO THE GROWTH IN THE NUMBER AND SIZE OF CELLS.
C. DEVELOPMENT OCCURS IN A PROXIMODISTAL DIRECTION WITH FINE MUSCLE DEVELOPMENT
OCCURRING FIRST.
D. DEVELOPMENT IS MORE EASILY AND ACCURATELY MEASURED THAN GROWTH.
ANSWER: A
DEVELOPMENT, A CONTINUOUS ORDERLY PROCESS, PROVIDES THE BASIS FOR INCREASES IN THE
CHILDS FUNCTION AND COMPLEXITY OF BEHAVIOR. THE INCREASES IN RATE OF FUNCTION AND
COMPLEXITY CAN VARY NORMALLY WITHIN LIMITS FOR EACH CHILD. AN INCREASE IN THE NUMBER
AND SIZE OF CELLS IS A DEFINITION FOR GROWTH. DEVELOPMENT PROCEEDS IN A PROXIMODISTAL
DIRECTION WITH FINE MUSCLE ORGANIZATION OCCURRING AS A RESULT OF LARGE MUSCLE
ORGANIZATION. DEVELOPMENT IS A MORE COMPLEX PROCESS THAT IS AFFECTED BY MANY FACTORS;
THEREFORE, IT IS LESS EASILY AND ACCURATELY MEASURED. GROWTH IS A PREDICTABLE PROCESS
WITH STANDARD MEASUREMENT METHODS.
2. FREQUENT DEVELOPMENTAL ASSESSMENTS ARE IMPORTANT FOR WHICH REASON?
A. STABLE DEVELOPMENTAL PERIODS DURING INFANCY PROVIDE AN OPPORTUNITY TO IDENTIFY
ANY DELAYS OR DEFICITS.
B. INFANTS NEED STIMULATION SPECIFIC TO THE STAGE OF DEVELOPMENT.
C. CRITICAL PERIODS OF DEVELOPMENT OCCUR DURING CHILDHOOD.
D. CHILD DEVELOPMENT IS UNPREDICTABLE AND NEEDS MONITORING.
,ANSWER: C
CRITICAL PERIODS ARE BLOCKS OF TIME DURING WHICH CHILDREN ARE READY TO MASTER SPECIFIC
DEVELOPMENTAL TASKS. CHILDREN CAN MASTER THESE TASKS MORE EASILY DURING PARTICULAR
PERIODS OF TIME IN THEIR GROWTH AND DEVELOPMENTAL PROCESS. INFANCY IS A DYNAMIC TIME
OF DEVELOPMENT THAT REQUIRES FREQUENT EVALUATIONS TO ASSESS APPROPRIATE
DEVELOPMENTAL PROGRESS. INFANTS IN A NURTURING ENVIRONMENT WILL DEVELOP
APPROPRIATELY AND WILL NOT NECESSARILY NEED STIMULATION SPECIFIC TO THEIR
DEVELOPMENTAL STAGE. NORMAL GROWTH AND DEVELOPMENT ARE ORDERLY AND PROCEED IN A
PREDICTABLE PATTERN ON THE BASIS OF EACH INDIVIDUALS ABILITIES AND POTENTIALS.
3. WHICH FACTOR HAS THE GREATEST INFLUENCE ON CHILD GROWTH AND DEVELOPMENT?
A. CULTURE
B. ENVIRONMENT
C. GENETICS
D. NUTRITION
ANSWER: C
GENETIC FACTORS (HEREDITY) DETERMINE EACH INDIVIDUALS GROWTH AND DEVELOPMENTAL RATE.
ALTHOUGH FACTORS SUCH AS ENVIRONMENT, CULTURE, NUTRITION, AND FAMILY CAN INFLUENCE
GENETIC TRAITS, THEY DO NOT ELIMINATE THE EFFECT OF THE GENETIC ENDOWMENT, WHICH IS
PERMANENT. CULTURE IS A SIGNIFICANT FACTOR THAT INFLUENCES HOW CHILDREN GROW TOWARD
ADULTHOOD. CULTURE INFLUENCES BOTH GROWTH AND DEVELOPMENT BUT DOES NOT ELIMINATE
INBORN GENETIC INFLUENCES. ENVIRONMENT HAS A SIGNIFICANT ROLE IN DETERMINING GROWTH
AND DEVELOPMENT BOTH BEFORE AND AFTER BIRTH. THE ENVIRONMENT CAN INFLUENCE HOW AND
TO WHICH EXTENT GENETIC TRAITS ARE MANIFESTED, BUT ENVIRONMENTAL FACTORS CANNOT
ELIMINATE THE EFFECT OF GENETICS. NUTRITION IS CRITICAL FOR GROWTH AND PLAYS A SIGNIFICANT
ROLE THROUGHOUT CHILDHOOD.
,4. A NURSE IS PLANNING A TEACHING SESSION WITH A CHILD. ACCORDING TO PIAGETIAN THEORY, THE
PERIOD OF COGNITIVE DEVELOPMENT IN WHICH THE CHILD IS ABLE TO DISTINGUISH FACT FROM
FANTASY IS THE PERIOD OF COGNITIVE DEVELOPMENT.
A. SENSORIMOTOR
B. FORMAL OPERATIONS
C. CONCRETE OPERATIONS
D. PREOPERATIONAL
ANSWER: C
CONCRETE OPERATIONS IS THE PERIOD OF COGNITIVE DEVELOPMENT IN WHICH CHILDRENS THINKING
IS SHIFTED FROM EGOCENTRIC TO BEING ABLE TO SEE ANOTHERS POINT OF VIEW. THEY DEVELOP THE
ABILITY TO DISTINGUISH FACT FROM FANTASY. THE SENSORIMOTOR STAGE OCCURS IN INFANCY AND
IS A PERIOD OF REFLEXIVE BEHAVIOR. DURING THIS PERIOD, THE INFANTS WORLD BECOMES MORE
PERMANENT AND ORGANIZED. THE STAGE ENDS WITH THE INFANT DEMONSTRATING SOME
EVIDENCE OF REASONING. FORMAL OPERATIONS IS A PERIOD IN DEVELOPMENT IN WHICH NEW
IDEAS ARE CREATED THROUGH PREVIOUS THOUGHTS. ANALYTIC REASON AND ABSTRACT THOUGHT
EMERGE IN THIS PERIOD. THE PREOPERATIONAL STAGE IS A PERIOD OF EGOCENTRISM IN WHICH THE
CHILDS JUDGMENTS ARE ILLOGICAL AND DOMINATED BY MAGICAL THINKING AND ANIMISM.
5. THE THEORIST WHO VIEWED DEVELOPMENTAL PROGRESSION AS A LIFELONG SERIES OF CONFLICTS
THAT NEED RESOLUTION IS:
A. ERIKSON.
B. FREUD.
C. KOHLBERG.
D. PIAGET.
ANSWER: A
ERIK ERIKSON VIEWED DEVELOPMENT AS A SERIES OF CONFLICTS AFFECTED BY SOCIAL AND
CULTURAL FACTORS. EACH CONFLICT MUST BE RESOLVED FOR THE CHILD TO PROGRESS
EMOTIONALLY, WITH UNSUCCESSFUL RESOLUTION LEAVING THE CHILD EMOTIONALLY DISABLED.
SIGMUND FREUD PROPOSED A PSYCHOSEXUAL THEORY OF DEVELOPMENT IN WHICH CERTAIN PARTS
,OF THE BODY ASSUME PSYCHOLOGICAL SIGNIFICANCE AS FOCI OF SEXUAL ENERGY. THE FOCI SHIFT AS
THE INDIVIDUAL MOVES THROUGH THE DIFFERENT STAGES (ORAL, ANAL, PHALLIC, LATENCY, AND
GENITAL) OF DEVELOPMENT. LAWRENCE KOHLBERG DESCRIBED MORAL DEVELOPMENT AS HAVING
THREE LEVELS (PRECONVENTIONAL, CONVENTIONAL, AND POSTCONVENTIONAL). HIS
THEORY CLOSELY PARALLELS PIAGETS. JEAN PIAGETS COGNITIVE THEORY INTERPRETS HOW CHILDREN
LEARN AND THINK AND HOW THIS THINKING PROGRESSES AND DIFFERS FROM ADULT THINKING.
STAGES OF HIS THEORY INCLUDE SENSORIMOTOR, PREOPERATIONS, CONCRETE OPERATIONS, AND
FORMAL OPERATIONS.
6. WHAT DOES THE NURSE NEED TO KNOW WHEN OBSERVING CHRONICALLY ILL CHILDREN AT PLAY?
A. PLAY IS NOT IMPORTANT TO HOSPITALIZED CHILDREN.
B. CHILDREN NEED TO HAVE STRUCTURED PLAY PERIODS.
C. CHILDRENS PLAY IS AN INDICATION OF A CHILDS RESPONSE TO TREATMENT.
D. PLAY IS TO BE DISCOURAGED BECAUSE IT TIRES HOSPITALIZED CHILDREN.
ANSWER: C
PLAY FOR ALL CHILDREN IS AN ACTIVITY WOVEN WITH MEANING AND PURPOSE AND IS A
MECHANISM FOR MASTERING THEIR ENVIRONMENT. FOR CHRONICALLY ILL CHILDREN, PLAY CAN
INDICATE THEIR STATE OF WELLNESS AND RESPONSE TO TREATMENT. PLAY IS IMPORTANT TO ALL
CHILDREN IN ALL ENVIRONMENTS. ALTHOUGH CHILDRENS PLAY ACTIVITIES APPEAR UNORGANIZED
AND AT TIMES CHAOTIC, PLAY HAS PURPOSE AND MEANING. IMPOSING STRUCTURE ON PLAY
INTERFERES WITH THE TASKS BEING WORKED ON. CHILDREN WHO HAVE FEWER ENERGY RESERVES
STILL REQUIRE PLAY. FOR THESE CHILDREN, LESS-ACTIVE PLAY ACTIVITIES WILL BE IMPORTANT.
7. WHICH CHILD IS MOST LIKELY TO BE FRIGHTENED BY HOSPITALIZATION?
A. A 4-MONTH-OLD INFANT ADMITTED WITH A DIAGNOSIS OF BRONCHIOLITIS
B. A 2-YEAR-OLD TODDLER ADMITTED FOR CYSTIC FIBROSIS
C. A 9-YEAR-OLD CHILD HOSPITALIZED WITH A FRACTURED FEMUR
D. A 15-YEAR-OLD ADOLESCENT ADMITTED FOR ABDOMINAL PAIN
,ANSWER: B
TODDLERS ARE MOST LIKELY TO BE FRIGHTENED BY HOSPITALIZATION BECAUSE THEIR THOUGHT
PROCESSES ARE EGOCENTRIC, MAGICAL, AND ILLOGICAL. THEY FEEL VERY THREATENED BY
UNFAMILIAR PEOPLE AND STRANGE ENVIRONMENTS. YOUNG INFANTS ARE NOT AS LIKELY TO BE
FRIGHTENED AS TODDLERS BY HOSPITALIZATION BECAUSE THEY ARE NOT AS AWARE OF THE
ENVIRONMENT. THE 9-YEAR-OLD CHILDS COGNITIVE ABILITY IS SUFFICIENT ENOUGH FOR THE CHILD
TO UNDERSTAND THE REASON FOR THE HOSPITALIZATION. THE 15-YEAR-OLD ADOLESCENT HAS THE
COGNITIVE ABILITY TO INTERPRET THE REASON FOR THE HOSPITALIZATION.
8. WHICH STATEMENT MADE BY A 15-YEAR-OLD ADOLESCENT WITH A DIAGNOSIS OF
NEUROFIBROMATOSIS (AN AUTOSOMAL DOMINANT GENETIC DISORDER) BEST DEMONSTRATES AN
UNDERSTANDING OF THE MECHANISM OF INHERITANCE FOR THE DISEASE?
A. MY BABIES WILL PROBABLY NOT HAVE NEUROFIBROMATOSIS.
B. MY BABIES HAVE A 50% CHANCE OF HAVING NEUROFIBROMATOSIS.
C. WHETHER MY BABIES HAVE PROBLEMS DEPENDS ON THE FATHER.
D. MY BABIES HAVE A 25% CHANCE OF HAVING NEUROFIBROMATOSIS.
ANSWER: B
NEUROFIBROMATOSIS IS AN AUTOSOMAL DOMINANT GENETIC DISORDER THAT OCCURS WHEN THE
ABNORMAL GENE IS CARRIED ON THE AFFECTED CHROMOSOME WITH A NORMAL GENE. BECAUSE
THE ABNORMAL GENE IS DOMINANT, AN INDIVIDUAL WITH THE DEFECTIVE GENE HAS A 50% CHANCE
OF TRANSMITTING THE DEFECT TO AN INFANT WITH EACH PREGNANCY. NEUROFIBROMATOSIS IS NOT
A SEX-LINKED GENETIC DISEASE; THEREFORE, EITHER THE FATHER OR THE MOTHER GENETICALLY
TRANSFERS IT TO THE INFANT. A PARENT WITH THE DEFECTIVE GENE WILL GENETICALLY TRANSFER
EITHER A NORMAL OR ABNORMAL GENE TO AN INFANT. BECAUSE THE DEFECTIVE GENE IS
DOMINANT, THERE IS A 50% PROBABILITY OF THE CHILD INHERITING THE DISEASE.
9. DURING A ROUTINE HEALTHCARE VISIT, A PARENT ASKS THE NURSE WHY HER 9-MONTH-OLD INFANT
IS NOT WALKING AS HER OLDER CHILD DID AT THE SAME AGE. WHICH RESPONSE BY THE NURSE BEST
DEMONSTRATES AN UNDERSTANDING OF CHILD DEVELOPMENT?
A. SHES A LITTLE SLOW.
B. IF SHE IS PULLING UP, YOU CAN HELP HER BY HOLDING HER HAND.
,C. BABIES PROGRESS AT DIFFERENT RATES. YOUR INFANTS DEVELOPMENT IS WITHIN NORMAL
LIMITS.
D. MAYBE SHE NEEDS TO SEE A BEHAVIORAL SPECIALIST.
ANSWER: C
NINETY PERCENT OF INFANTS WALK BY 14 MONTHS OF AGE. THE INFANT IS WITHIN NORMAL
DEVELOPMENTAL LIMITS. IT IS INAPPROPRIATE FOR THE NURSE TO STATE THAT THE INFANT IS A
LITTLE SLOW. INFANTS WILL WALK WHEN THEY ARE DEVELOPMENTALLY READY. HURRYING AN
INFANT DOES NOT RESULT IN THE DEVELOPMENTAL TASK BEING ACHIEVED AT AN EARLIER TIME
PERIOD. CONSULTING A BEHAVIORAL SPECIALIST FOR DIAGNOSTIC EVALUATION IS INDICATED WHEN
A CHILD DEMONSTRATES DEVELOPMENTAL DELAYS. THE CHILD HAS NO EVIDENCE OF A DELAY.
10. WHICH EXPECTED OUTCOME WOULD BE DEVELOPMENTALLY APPROPRIATE FOR A HOSPITALIZED 4-
YEAR- OLD CHILD?
A. THE CHILD WILL BE DRESSED AND FED BY THE PARENTS.
B. THE CHILD WILL INDEPENDENTLY ASK FOR PLAY MATERIALS OR OTHER PERSONAL NEEDS.
C. THE CHILD WILL BE ABLE TO VERBALIZE AN UNDERSTANDING OF THE REASON FOR THE
HOSPITALIZATION.
D. THE CHILD WILL HAVE A PARENT STAY IN THE ROOM AT ALL TIMES.
ANSWER: B
ERIKSON IDENTIFIES INITIATIVE AS A DEVELOPMENTAL TASK FOR THE PRESCHOOL CHILD. INITIATING
PLAY ACTIVITIES AND ASKING FOR PLAY MATERIALS OR ASSISTANCE WITH PERSONAL NEEDS
DEMONSTRATE DEVELOPMENTAL APPROPRIATENESS. PARENTS NEED TO FOSTER APPROPRIATE
DEVELOPMENTAL BEHAVIOR IN THE 4-YEAR-OLD CHILD. DRESSING AND FEEDING THE CHILD DO NOT
ENCOURAGE INDEPENDENT BEHAVIOR. A 4- YEAR-OLD CHILD CANNOT BE EXPECTED TO COGNITIVELY
UNDERSTAND THE REASON FOR HIS OR HER HOSPITALIZATION. EXPECTING THE CHILD TO VERBALIZE
AN UNDERSTANDING FOR THE HOSPITALIZATION IS AN INAPPROPRIATE OUTCOME. PARENTS
STAYING WITH THE CHILD THROUGHOUT A HOSPITALIZATION IS AN INAPPROPRIATE OUTCOME.
ALTHOUGH CHILDREN BENEFIT FROM PARENTAL INVOLVEMENT, PARENTS MAY NOT HAVE THE
SUPPORT STRUCTURE TO STAY IN THE ROOM WITH THE CHILD AT ALL TIMES.
,11. A NURSE HAS COMPLETED A TEACHING SESSION WITH PARENTS OF PRESCHOOL AGED CHILDREN.
WHICH STATEMENT MADE BY THE PARENT IDENTIFIES AN APPROPRIATE LEVEL OF LANGUAGE
DEVELOPMENT FOR A 4- YEAR-OLD CHILD?
A. THE CHILD HAS A VOCABULARY OF 300 WORDS AND USES SIMPLE SENTENCES.
B. THE CHILD USES CORRECT GRAMMAR IN SENTENCES.
C. THE CHILD IS ABLE TO PRONOUNCE CONSONANTS CLEARLY.
D. THE CHILD USES LANGUAGE TO EXPRESS ABSTRACT THOUGHT.
ANSWER: B
THE 4-YEAR-OLD CHILD IS ABLE TO USE CORRECT GRAMMAR IN SENTENCE STRUCTURE AND TYPICALLY
HAS DIFFICULTY IN PRONOUNCING CONSONANTS. SIMPLE SENTENCES AND A 300-WORD
VOCABULARY ARE APPROPRIATE FOR A 2-YEAR-OLD CHILD. THE USE OF LANGUAGE TO EXPRESS
ABSTRACT THOUGHT IS DEVELOPMENTALLY APPROPRIATE FOR THE ADOLESCENT.
12. WHICH SHOULD THE NURSE EVALUATE BEFORE ADMINISTERING THE DENVER DEVELOPMENTAL
SCREENING TEST II (DDST-II)?
A. THE CHILDS HEIGHT AND WEIGHT
B. THE PARENTS ABILITY TO COMPREHEND THE RESULTS
C. THE CHILDS MOOD
D. THE PARENTCHILD INTERACTION
ANSWER: C
THE RESULTS OF THE SCREENING TEST ARE VALID IF THE CHILD ACTED IN A NORMAL AND EXPECTED
MANNER. THE CHILDS HEIGHT AND WEIGHT ARE NOT RELEVANT TO THE DDST-II SCREENING PROCESS.
THE PARENTS ABILITY TO UNDERSTAND THE RESULTS OF THE SCREENING IS NOT RELEVANT TO THE
VALIDITY OF THE TEST. THE PARENTCHILD INTERACTION IS NOT SIGNIFICANTLY RELEVANT TO THE
TEST RESULTS.
13. WHICH CHILDREN ARE AT GREATER RISK FOR NOT RECEIVING IMMUNIZATIONS?
, A. CHILDREN WHO ATTEND LICENSED DAY CARE PROGRAMS
B. CHILDREN ENTERING SCHOOL
C. CHILDREN WHO ARE HOME SCHOOLED
D. YOUNG ADULTS ENTERING COLLEGE
ANSWER: C
HOME SCHOOLED CHILDREN ARE AT RISK FOR BEING UNDERIMMUNIZED AND NEED TO BE
MONITORED. ALL STATES REQUIRE IMMUNIZATIONS FOR CHILDREN IN DAY CARE PROGRAMS AND
ENTERING SCHOOL. MOST COLLEGES REQUIRE A RECORD OF IMMUNIZATIONS AS PART OF A HEALTH
HISTORY.
14. WHICH DEVELOPMENTAL ASSESSMENT INSTRUMENT IS APPROPRIATE TO ASSESS A 5-YEAR-OLD
CHILD?
A. BRAZELTON BEHAVIORAL SCALE
B. DENVER DEVELOPMENTAL SCREENING TEST II (DDST-II)
C. DUBOWITZ SCALE
D. NEW BALLARD SCALE
ANSWER: B
THE DDST-II IS USED FOR INFANTS AND CHILDREN BETWEEN BIRTH AND 6 YEARS OF AGE.
BRAZELTONS BEHAVIORAL SCALE IS USED FOR NEWBORN ASSESSMENT. THE DUBOWITZ SCALE IS
USED FOR ESTIMATION OF GESTATIONAL AGE. THE NEW BALLARD SCALE IS USED FOR NEWBORN
SCREENING.
15. A 2-MONTH-OLD CHILD HAS NOT RECEIVED ANY IMMUNIZATIONS. WHICH IMMUNIZATIONS
SHOULD THE NURSE GIVE?
A. DTAP, HIB, HEPB, IPV, VARICELLA
B. DTAP, HIB, HEPB, MMR, IPV
C. DTAP, HIB, HEPB, PCV, IPV, ROTAVIRUS
