NR 328 Exam #1
Which topics should the nurse discuss with the parents of a young child to promote health in their child?
a. Dental care needs to be started by age 7.
b. Immunization schedule and the importance of immunizations.
c. Human milk or iron fortified formula for the first 4 months of life.
d. Positioning the car seat in the front passenger seat. ANS: B
Rationale: Immunizations have made a major impact in the prevention of disease in children. The nurse
should review individual immunization records at every clinic visit, avoid missing opportunities to
vaccinate, and encourage parents to keep immunizations current. Dental caries is the single most
common chronic disease of childhood and may begin before the first birthday. Human milk or iron
fortified formula for should be given for the first year of life to prevent Iron Deficiency anemia. Children
younger than 1 year of age have the highest rate of death from motor vehicle accidents, primarily from a
failure to properly use car restraints.
What is the leading cause of death in children older than the age of 1 year?
a. Drowning
b. Burns
c. Motor vehicle accidents
d. Cancer ANS:Answer(s): C
Rationale: a. Drowning is the second leading cause of death in children older than the age of 1 year. b.
Burns cause fewer deaths than motor vehicle accidents in children older than the age of 1 year. c. Motor
vehicle accidents are the leading cause of death in children older than the age of 1 year. d. Cancer
causes fewer deaths than motor vehicle accidents in children older than the age of 1 year.
The nurse makes sure that a toddler has a teddy bear and that a nightlight is on in the hospital room at
bedtime. What concept would these nursing actions demonstrate?
a. Atraumatic care
b. Nonmaleficence
c. Justice
,d. Advocacy ANS:Answer(s): A
Rationale: A. Atraumatic care is the provision of therapeutic care in settings, by personnel, and through
the use of interventions that eliminate or minimize the psychological and physical distress experienced
by children and their families in the health care system. In this case, it is making sure that the toddler
has a teddy bear and that a night light is on to prevent a dark environment. B. Nonmaleficence is the
obligation to minimize or prevent harm; there is no situation present that would require this. C. Justice
is the concept of fairness and is not applicable to this situation. D. Advocacy involves ensuring that
families are aware of all available health services, adequately informed of treatments and procedures,
involved in the child's care, and encouraged to change or support existing health care practices.
True or False: Open ended questions are most likely to encourage parents to talk about their feelings r/t
their child's illness. ANS:True
When the nurse interviews an adolescent, what is important to help establish a relationship?
a. Use the same type of language as the adolescent.
b. Emphasize that confidentiality will always be maintained.
c. Focus the discussion on the peer group.
d. Display a genuine interest in the adolescent. ANS: D.
Rationale: Display a genuine interest in the adolescent.Adolescents accept anyone who shows a genuine
interest in them. Although peers are important to this age-group, the focus of the interview should be
on the adolescent. The nurse should clarify which information will be shared with other members of the
health care team and any limits to confidentiality. The nurse should maintain a professional relationship
with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the
nurse should clarify terms frequently.
What approach is the most appropriate when performing a physical assessment on a toddler?
a. Demonstrate use of equipment.
b. Perform traumatic procedures first.
c. Use minimum physical contact initially.
d. Always proceed in a head-to-toe direction. ANS: C.
,Rationale: Parents can remove clothing, and the child can remain on the parent's lap. The nurse should
use minimum physical contact initially to gain the cooperation of the child. The nurse should introduce
the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex
for this age-group. Traumatic procedures should always be performed last. These will most likely upset
the child and inhibit cooperation. The head-to-toe assessment can be done in older children but usually
must be adapted in younger children.
What is the most consistent and commonly used indicator of pain in infants?
a. Thrashing of arms and legs.
b. Increased heart rate.
c. Increased respirations.
d. Facial expression of discomfort. ANS: D.
Rationale: Facial expression of discomfort. Facial expression has consistently been validated as an
indicator of pain in infants. Behavioral pain measures are most reliable for sharp procedural pain in
infants. Increased heart rate and respirations are indicative of a generalized and complex response to
stress. They are not specific for pain in infants. Thrashing of arms and legs is a reliable indicator in young
children, not infants.
True or False: At age 1 month is the normal age for binocularity-ability to fixate on one visual field with
both eyes simultaneously. ANS: False.
Rationale: Binocularity is usually achieved by age 3 to 4 months. One month is too young for
binocularity. If binocularity is not achieved by 6 to 12 months, the child must be observed for
strabismus.
What self-report pain rating scales can be used in children as young as 3 years of age?
a. FACES Pain Rating Scale
b. Visual Analog Scale
c. Word-Graphic Rating Scale
d. Who Cares? ANS: A.
, Rationale: The FACES Pain Rating Scale is for children as young as 3 years of age. The Visual Analog Scale
can be used for children older than 4 years of age but is most appropriate for ages 7 and older. The
Word-Graphic Rating Scale uses descriptive words and is recommended for children 4 to 17 years of age.
An intravenous line is needed in a school-age child. What medication is appropriate analgesic for use
with this patient?
a. LMX (4% liposomal lidocaine cream) 30 minutes before the procedure.
b. EMLA (eutectic mixture of local anesthetics) immediately before.
c. A transdermal fentanyl (Duragesic) patch at the site of venipuncture.
d. TAC (tetracaine, epinephrine [Adrenalin], cocaine) 15 minutes before. ANS: A.
Rationale: LMX is an effective analgesic agent when applied to the skin 30 minutes before a procedure.
It eliminates or reduces the pain from most procedures involving skin puncture. TAC provides skin
anesthesia about 15 minutes after application to nonintact skin. The gel can be placed on the wound for
suturing. It is not useful for intact skin. Transdermal fentanyl patches are useful for continuous pain
control, not rapid pain control. For maximum effectiveness, EMLA must be applied approximately 60
minutes in advance. A transdermal fentanyl (Duragesic) patch at the site of venipuncture.
At what age does Erickson consider the infancy stage? ANS:0 - 18 months
What is the basic conflict and important events of Erickson's infancy stage? ANS:Trust vs. Mistrust
Feeding/Comfort
At what age does Erickson consider the Early Childhood stage? ANS:2 - 3 years
What is the basic comfort and important events of Erickson's early childhood stage? ANS:Autonomy vs.
Shame and Doubt
Toilet training/Dressing
At what age does Erickson consider the preschool stage? ANS:3 - 5 years
Which topics should the nurse discuss with the parents of a young child to promote health in their child?
a. Dental care needs to be started by age 7.
b. Immunization schedule and the importance of immunizations.
c. Human milk or iron fortified formula for the first 4 months of life.
d. Positioning the car seat in the front passenger seat. ANS: B
Rationale: Immunizations have made a major impact in the prevention of disease in children. The nurse
should review individual immunization records at every clinic visit, avoid missing opportunities to
vaccinate, and encourage parents to keep immunizations current. Dental caries is the single most
common chronic disease of childhood and may begin before the first birthday. Human milk or iron
fortified formula for should be given for the first year of life to prevent Iron Deficiency anemia. Children
younger than 1 year of age have the highest rate of death from motor vehicle accidents, primarily from a
failure to properly use car restraints.
What is the leading cause of death in children older than the age of 1 year?
a. Drowning
b. Burns
c. Motor vehicle accidents
d. Cancer ANS:Answer(s): C
Rationale: a. Drowning is the second leading cause of death in children older than the age of 1 year. b.
Burns cause fewer deaths than motor vehicle accidents in children older than the age of 1 year. c. Motor
vehicle accidents are the leading cause of death in children older than the age of 1 year. d. Cancer
causes fewer deaths than motor vehicle accidents in children older than the age of 1 year.
The nurse makes sure that a toddler has a teddy bear and that a nightlight is on in the hospital room at
bedtime. What concept would these nursing actions demonstrate?
a. Atraumatic care
b. Nonmaleficence
c. Justice
,d. Advocacy ANS:Answer(s): A
Rationale: A. Atraumatic care is the provision of therapeutic care in settings, by personnel, and through
the use of interventions that eliminate or minimize the psychological and physical distress experienced
by children and their families in the health care system. In this case, it is making sure that the toddler
has a teddy bear and that a night light is on to prevent a dark environment. B. Nonmaleficence is the
obligation to minimize or prevent harm; there is no situation present that would require this. C. Justice
is the concept of fairness and is not applicable to this situation. D. Advocacy involves ensuring that
families are aware of all available health services, adequately informed of treatments and procedures,
involved in the child's care, and encouraged to change or support existing health care practices.
True or False: Open ended questions are most likely to encourage parents to talk about their feelings r/t
their child's illness. ANS:True
When the nurse interviews an adolescent, what is important to help establish a relationship?
a. Use the same type of language as the adolescent.
b. Emphasize that confidentiality will always be maintained.
c. Focus the discussion on the peer group.
d. Display a genuine interest in the adolescent. ANS: D.
Rationale: Display a genuine interest in the adolescent.Adolescents accept anyone who shows a genuine
interest in them. Although peers are important to this age-group, the focus of the interview should be
on the adolescent. The nurse should clarify which information will be shared with other members of the
health care team and any limits to confidentiality. The nurse should maintain a professional relationship
with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the
nurse should clarify terms frequently.
What approach is the most appropriate when performing a physical assessment on a toddler?
a. Demonstrate use of equipment.
b. Perform traumatic procedures first.
c. Use minimum physical contact initially.
d. Always proceed in a head-to-toe direction. ANS: C.
,Rationale: Parents can remove clothing, and the child can remain on the parent's lap. The nurse should
use minimum physical contact initially to gain the cooperation of the child. The nurse should introduce
the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex
for this age-group. Traumatic procedures should always be performed last. These will most likely upset
the child and inhibit cooperation. The head-to-toe assessment can be done in older children but usually
must be adapted in younger children.
What is the most consistent and commonly used indicator of pain in infants?
a. Thrashing of arms and legs.
b. Increased heart rate.
c. Increased respirations.
d. Facial expression of discomfort. ANS: D.
Rationale: Facial expression of discomfort. Facial expression has consistently been validated as an
indicator of pain in infants. Behavioral pain measures are most reliable for sharp procedural pain in
infants. Increased heart rate and respirations are indicative of a generalized and complex response to
stress. They are not specific for pain in infants. Thrashing of arms and legs is a reliable indicator in young
children, not infants.
True or False: At age 1 month is the normal age for binocularity-ability to fixate on one visual field with
both eyes simultaneously. ANS: False.
Rationale: Binocularity is usually achieved by age 3 to 4 months. One month is too young for
binocularity. If binocularity is not achieved by 6 to 12 months, the child must be observed for
strabismus.
What self-report pain rating scales can be used in children as young as 3 years of age?
a. FACES Pain Rating Scale
b. Visual Analog Scale
c. Word-Graphic Rating Scale
d. Who Cares? ANS: A.
, Rationale: The FACES Pain Rating Scale is for children as young as 3 years of age. The Visual Analog Scale
can be used for children older than 4 years of age but is most appropriate for ages 7 and older. The
Word-Graphic Rating Scale uses descriptive words and is recommended for children 4 to 17 years of age.
An intravenous line is needed in a school-age child. What medication is appropriate analgesic for use
with this patient?
a. LMX (4% liposomal lidocaine cream) 30 minutes before the procedure.
b. EMLA (eutectic mixture of local anesthetics) immediately before.
c. A transdermal fentanyl (Duragesic) patch at the site of venipuncture.
d. TAC (tetracaine, epinephrine [Adrenalin], cocaine) 15 minutes before. ANS: A.
Rationale: LMX is an effective analgesic agent when applied to the skin 30 minutes before a procedure.
It eliminates or reduces the pain from most procedures involving skin puncture. TAC provides skin
anesthesia about 15 minutes after application to nonintact skin. The gel can be placed on the wound for
suturing. It is not useful for intact skin. Transdermal fentanyl patches are useful for continuous pain
control, not rapid pain control. For maximum effectiveness, EMLA must be applied approximately 60
minutes in advance. A transdermal fentanyl (Duragesic) patch at the site of venipuncture.
At what age does Erickson consider the infancy stage? ANS:0 - 18 months
What is the basic conflict and important events of Erickson's infancy stage? ANS:Trust vs. Mistrust
Feeding/Comfort
At what age does Erickson consider the Early Childhood stage? ANS:2 - 3 years
What is the basic comfort and important events of Erickson's early childhood stage? ANS:Autonomy vs.
Shame and Doubt
Toilet training/Dressing
At what age does Erickson consider the preschool stage? ANS:3 - 5 years
