TEST BANK FOR NURSING CARE OF CHILDREN PRINCIPLES AND PRACTICE, (JAMES, NURSING CARE OF CHILDREN) 4TH EDITION

TEST BANK FOR NURSING CARE OF CHILDREN PRINCIPLES AND PRACTICE, (JAMES, NURSING CARE OF CHILDREN) 4TH EDITION Table of Contents Chapter 01: Introduction to Nursing Care of Children ........................................................................................................... 2 Chapter 02: Family-Centered Nursing Care ......................................................................................................................... 5 Chapter 03: Communicating with Children ........................................................................................................................... 9 Chapter 04: Health Promotion for the Developing Child ..................................................................................................... 12 Chapter 05: Health Promotion for the Infant ....................................................................................................................... 17 Chapter 06: Health Promotion During Early Childhood ...................................................................................................... 21 Chapter 07: Health Promotion for the School-Age Child ..................................................................................................... 25 Chapter 08: Health Promotion for the Adolescent ............................................................................................................... 29 Chapter 09: Physical Assessment of Children ................................................................................................................... 33 Chapter 10: Emergency Care of Children ........................................................................................................................... 38 Chapter 11: The Ill Child in the Hospital and Other Care Settings ....................................................................................... 40 Chapter 12: The Child with a Chronic Condition or Terminal Illness .................................................................................... 46 Chapter 13: Principles and Procedures for Nursing Care of Children .................................................................................. 50 Chapter 14: Medication and Administration Safety of Infants and Children ........................................................................ 54 Chapter 15: Pain Management for Children ....................................................................................................................... 59 Chapter 16: The Child with a Fluid and Electrolyte Alteration ............................................................................................. 62 Chapter 17: The Child with an Infectious Disease .............................................................................................................. 66 Chapter 18: The Child with an Immunologic Alteration ....................................................................................................... 71 Chapter 19: The Child with a Gastrointestinal Alteration ..................................................................................................... 75 Chapter 20: The Child with a Genitourinary Alteration ........................................................................................................ 86 Chapter 21: The Child with a Respiratory Alteration ........................................................................................................... 90 Chapter 22: The Child with a Cardiovascular Alteration ................................................................................................... 100 Chapter 23: The Child with a Hematological Alteration ..................................................................................................... 107 Chapter 24: The Child with Cancer .................................................................................................................................. 111 Chapter 25: The Child with an Integumentary Alteration ................................................................................................... 117 Chapter 26: The Child with a Musculoskeletal Alteration .................................................................................................. 121 Chapter 27: The Child with an Endocrine or Metabolic Alteration ..................................................................................... 131 Chapter 28: The Child with a Neurological Alteration ........................................................................................................ 136 Chapter 29: Psychosocial Problems in Children and Families .......................................................................................... 142 Chapter 30: The Child with a Developmental Disability .................................................................................................... 147 Chapter 31: The Child with a Sensory Alteration .............................................................................................................. 153Chapter 01: Introduction to Nursing Care of Children MULTIPLE CHOICE 1. A nurse is reviewing changes in healthcare delivery and funding for pediatric populations. Which current trend in the pediatric setting should the nurse expect to find? • Increased hospitalization of children • Decreased number of uninsured children • An increase in ambulatory care • Decreased use of managed care 2. A nurse is referring a low-income family with three children under the age of 5 years to a program that assists with supplemental food supplies. Which program should the nurse refer this family to? • Medicaid • • • Medicare Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program Women, Infants, and Children (WIC) program 3. In most states, adolescents who are not emancipated minors must have parental permission before: • treatment for drug abuse. • • • treatment for sexually transmitted diseases (STDs). obtaining birth control. surgery. 4. A nurse is completing a clinical pathway for a child admitted to the hospital with pneumonia. Which characteristic of a clinical pathway is correct? • Developed and implemented by nurses • Used primarily in the pediatric setting • Specific time lines for sequencing interventions • One of the steps in the nursing process5. When planning a parenting class, the nurse should explain that the leading cause of death in children 1 to 4 years of age in the United States is: • premature birth. • congenital anomalies. • accidental death. • respiratory tract illness. 6. Which statement is true regarding the “quality assurance” or “incident” report? • The report assures the legal department that there is no problem. • Reports are a permanent part of the client’s chart. • The nurse’s notes should contain the following: “Incident report filed and copy placed in chart.” • This report is a form of documentation of an event that may result in legal action. 7. Which client situation fails to meet the first requirement of informed consent? • The parent does not understand the physician’s explanations. • • • The physician gives the parent only a partial list of possible side effects and complications. No parent is available and the physician asks the adolescent to sign the consent form. The infant’s teenage mother signs a consent form because her parent tells her to. 8. A nurse assigned to a child does not know how to perform a treatment that has been prescribed for the child. What should the nurse’s first action be? 4 Delay the treatment until another nurse can do it. 5 6 7 Make the child’s parents aware of the situation. Inform the nursing supervisor of the problem. Arrange to have the child transferred to another unit. 9. A nurse is completing a care plan for a child and is finishing the assessment phase. Which activity is not part of a nursing assessment? 4 Writing nursing diagnoses 5 6 7 Reviewing diagnostic reports Collecting data Setting priorities10. Which patient outcome is stated correctly? 4 The child will administer his insulin injection before breakfast on 10/31. 4 5 6 The child will accept the diagnosis of type 1 diabetes mellitus before discharge. The parents will understand how to determine the child’s daily insulin dosage. The nurse will monitor blood glucose levels before meals and at bedtime. MULTIPLE RESPONSE 1. A nurse is reviewing the nursing care plan for a hospitalized child. Which statements are collaborative problems? Select all that apply. 4 Risk for injury 5 6 7 8 Potential complication of seizure disorder Altered nutrition: Less than body requirements Fluid volume deficit Potential complication of respiratory acidosis 2. Which nursing activities do not meet the standard of care? Select all that apply. 4 Failure to notify a physician about a child’s worsening condition 5 6 7 Calling the supervisor about staffing concerns Delegating assessment of a new admit to the Unlicensed Assistive Personnel (UAP) Asking the Unlicensed Assistive Personnel (UAP) to take vital signs4 Documenting that a physician was unavailable and the nursing supervisor was notified Chapter 02: Family-Centered Nursing Care MULTIPLE CHOICE 1. A nurse is teaching parents how to apply “time-out” as a disciplinary method for their 4 year old. Parents have understood the teaching if they state which formula correctly guides the use of “time-out”? 4 5 6 7 Use the guideline of 1 minute per each year of the child’s age. Relate the length of the time-out to the severity of the behavior. Never use time-out for a child younger than age 4 years. Follow the time-out with a treat. 2. What is the nurse’s best approach when an 8-year-old boy frequently causes a disruption in the playroom by taking toys from other children? 4 Exclude the child from the playroom. 5 6 7 Explain to the children in the playroom that he is very ill and should be allowed to have the toys. Approach the child in his room and ask, “Would you like it if the other children took your toys from y Approach the child in his room and state, “I am concerned that you are taking the other children’s toy me.” 3. Families that deal most effectively with stress have which behavior patterns? 4 Focus on family problems. 5 6 7 Feel weakened by stress. Expect that some stress is normal. Feel guilty when stress exists. 4. Which family will most likely have the greatest difficulty in coping with an ill child? 4 A single-parent mother who has the support of her parents and siblings 5 6 7 Parents who have just moved to the area and are living in an apartment while they look for a house The family of a child who has had multiple hospitalizations related to asthma and has adequate relatio nursing staff A family in which there is a young child and four older married children who live in the area5. Which is the priority nursing intervention for the family of a child who has been admitted to the hospital? 4 Begin discharge teaching. 5 6 7 Identify and mobilize internal and external strengths. Identify ways in which the family could have prevented their child’s hospitalization. Instruct the parents on normal growth and development. 6. A nurse is planning culturally competent care for a child of Hispanic descent. Which characteristic found in a Hispanic family should the nurse include in the plan of care? 4 Stoicism 5 6 7 Close extended family Docile children are considered weak Very interested in health-promoting lifestyles 7. While reviewing nursing documentation on dietary intake for a 7-year-old child of Asian descent, the nurse notes that he consistently refuses to eat the food on his tray. Which assumption is most likely accurate? 4 He is a picky eater. 5 6 7 He needs less food because he is on bed rest. He may have culturally related food preferences. He is probably eating between meals and spoiling his appetite. 8. To resolve family conflict, it is necessary to have open communication, accurate perception of the problem, and a(n): 4 5 6 7 intact family structure. arbitrator. willingness to consider the view of others. balance in personality types.9. A nurse is planning a parenting class for expectant parents. Which statement is true about the characteristics of a healthy family? 4 5 The parents and children have rigid assignments for all the family tasks. Young families assume total responsibility for the parenting tasks, refusing any assistance. 6 7 The family is overwhelmed by the significant changes that occur as a result of childbirth. Adults agree on the majority of basic parenting principles. 10. A nurse determines that a child consistently displays predictable behavior and is regular in performing daily habits. Which temperament is the child displaying? 4 5 6 7 Easy Slow-to-warm-up Difficult Shy 11. The parent of a child who has had numerous hospitalizations asks the nurse for advice because her child has been having behavior problems at home and in school. In discussing effective discipline, which is an essential component? 4 5 All children display some degree of acting out and this behavior is normal. The child is manipulative and should have firmer limits set on her behavior. 6 7 Use positive reinforcement and encouragement to promote cooperation and the desired behaviors. Underlying reasons for rules should be given and the child should be allowed to decide on which rule followed. 12. A nurse assesses that parents discuss rules with their children when the children do not agree with the rules. Which style of parenting is being displayed? 4 Authoritarian 5 6 7 Authoritative Permissive Disciplinarian13. Which should the nurse expect to be problematic for a family whose religious affiliation is Jehovah’s Witness? 4 5 6 7 Immunizations Autopsy Organ donation Blood transfusion MULTIPLE RESPONSE 1. The nurse is caring for a child from a Middle Eastern family. Which interventions should the nurse include in planning care? Select all that apply. 4 Include the father in the decision making. 5 6 7 Ask for a dietary consult to maintain religious dietary practices. Plan for a male nurse to care for a female patient. Ask the housekeeping staff to interpret if needed. 2. A nurse is caring for a child with the religion of Christian Science. What interventions should the nurse include in the care plan for this child? Select all that apply. 4 5 6 Offer iced tea to the child who is experiencing fluid volume deficit. Inform the Christian Science practitioner that the child has been admitted to the hospital. Allow parents to sign a form opting out of routine immunizations.4 Ask parents if the child has been baptized and if parents want a pastor to visit. Chapter 03: Communicating with Children MULTIPLE CHOICE 1. Which information should the nurse include when preparing a 5-year-old child for a cardiac catheterization? 4 5 6 7 A detailed explanation of the procedure A description of what the child will feel and see during the procedure An explanation about the dye that will go directly into his vein An assurance to the child that he and the nurse can talk about the procedure when it is over 2. Who are the “experts” in planning for the care of a 9-year-old child with a profound sensory impairment who is hospitalized for surgery? 4 The child’s parents 5 6 7 The child’s teacher The case manager The primary nurse 3. Which is an effective technique for communicating with toddlers? 4 Have the toddler make up a story from a picture. 5 6 7 Involve the toddler in dramatic play with dress-up clothing. Repeatedly read familiar stories to the child. Ask the toddler to draw pictures of his fears. 4. What is the most important consideration for effectively communicating with a child? 4 The child’s chronological age 5 6 7 The parent–child interaction The child’s receptiveness The child’s developmental level5. Which behavior is most likely to encourage open communication? 4 Avoiding eye contact 5 6 7 Folding arms across the chest Standing with head bowed Soft stance with arms loose at the side 6. Which strategy is most likely to encourage a child to express feelings about the hospital experience? 4 Asking close-ended questions 5 6 7 Asking direct questions Sharing personal experiences Actively listening 7. Which is the most appropriate question to ask to encourage conversation when interviewing an adolescent? 4 “Are you in school?” 5 6 7 “Are you doing well in school?” “How is school going for you?” “How do your parents feel about your grades?” 8. What is the most appropriate response for the nurse to make to the parent of a 3- year- old child found in a bed with the side rails down? 4 “You must never leave the child in the room alone with the side rails down.” “I am very concerned about your child’s safety when you leave the side rails down. The hospital 5 6 7 has g that side rails need to be up if the child is in the bed.” “It is hospital policy that side rails need to be up if the child is in bed.” “When parents leave side rails down, they might be considered as uncaring.” 9. Which is an appropriate preoperative teaching plan for a school-age child? 4 Begin preoperative teaching the morning of surgery. 5 6 7 Schedule a tour of the hospital a few weeks before surgery. Show the child books and pictures 4 days before surgery. Limit teaching to 5 minutes and use simple terminology. 10. A primary nurse bought a hospitalized child a new toy to replace a broken one. What is the best interpretation of the nurse’s behavior?4 5 6 7 The nurse is displaying signs of overinvolvement. The nurse is a kind and generous person. The nurse feels a special closeness to the child. The nurse wants to make the child happy. 11. When meeting a toddler for the first time, the nurse initiates contact by: 4 calling the toddler by name and picking the toddler up. 5 6 7 asking the toddler for her first name. kneeling in front of the toddler and speaking softly to the child. telling the toddler that you are her nurse. MULTIPLE RESPONSE 1. A nurse is admitting a school-age child with a visual impairment to the hospital. To effectively communicate the nurse should plan which interventions? Select all that apply. 4 5 4 5 6 Orient the child to his or her surroundings. Enter quietly and touch the child before speaking. Put the nurse call bell close to the parent. Allow the child to handle equipment. Explain sounds the child may hear frequently. 2. A preschool age child is being admitted for some diagnostic tests and possible surgery. The nurse planning care should use which statements when explaining procedures to the child? Select all that apply. 4 “Fluids will be given through tubing connected to a small tiny tube inserted into your arm.” 5 6 7 8 “After surgery, we will be doing dressing changes.” “You will get a shot before surgery.” “The doctor will give you medicine that will help you go into a deep sleep.” “We will take you to surgery on a bed on wheels.”Chapter 04: Health Promotion for the Developing Child MULTIPLE CHOICE 1. A nurse is reviewing developmental concepts for infants and children. Which statement best describes development in infants and children? 4 Development, a predictable and orderly process, occurs at varying rates within normal limits. 5 6 7 Development is primarily related to the growth in the number and size of cells. Development occurs in a proximodistal direction with fine muscle development occurring first. Development is more easily and accurately measured than growth. 2. Frequent developmental assessments are important for which reason? 4 Stable developmental periods during infancy provide an opportunity to identify any delays or deficits. 5 6 7 Infants need stimulation specific to the stage of development. Critical periods of development occur during childhood. Child development is unpredictable and needs monitoring. 3. Which factor has the greatest influence on child growth and development? 4 Culture 5 6 7 Environment Genetics Nutrition 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. 4 sensorimotor 5 6 formal operations concrete operations7 preoperational 5. The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is: 4 5 6 7 Erikson. Freud. Kohlberg. Piaget. 6.What does the nurse need to know when observing chronically ill children at play? 4 Play is not important to hospitalized children. 5 6 7 Children need to have structured play periods. Children’s play is an indication of a child’s response to treatment. Play is to be discouraged because it tires hospitalized children. 7. Which child is most likely to be frightened by hospitalization? 4 A 4-month-old infant admitted with a diagnosis of bronchiolitis 5 6 7 A 2-year-old toddler admitted for cystic fibrosis A 9-year-old child hospitalized with a fractured femur A 15-year-old adolescent admitted for abdominal pain 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? 4 5 6 7 “My babies will probably not have neurofibromatosis.” “My babies have a 50% chance of having neurofibromatosis.” “Whether my babies have problems depends on the father.” “My babies have a 25% chance of having neurofibromatosis.” 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? 4 5 “She’s a little slow.” “If she is pulling up, you can help her by holding her hand.”6 7 “Babies progress at different rates. Your infant’s development is within normal limits.” “Maybe she needs to see a behavioral specialist.” 10. Which “expected outcome” would be developmentally appropriate for a hospitalized 4-year-old child? 4 5 6 7 The child will be dressed and fed by the parents. The child will independently ask for play materials or other personal needs. The child will be able to verbalize an understanding of the reason for the hospitalization. The child will have a parent stay in the room 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? 4 5 6 7 The child has a vocabulary of 300 words and uses simple sentences. The child uses correct grammar in sentences. The child is able to pronounce consonants clearly. The child uses language to express abstract thought. 12. Which should the nurse evaluate before administering the Denver Developmental Screening Test II (DDST-II)? 4 The child’s height and weight 5 6 7 The parent’s ability to comprehend the results The child’s mood The parent–child interaction 13. Which children are at greater risk for not receiving immunizations? 4 Children who attend licensed day care programs 5 6 7 Children entering school Children who are home schooled Young adults entering college 14. Which developmental assessment instrument is appropriate to assess a 5-year-old child? 4 Brazelton Behavioral Scale5 6 7 Denver Developmental Screening Test II (DDST-II) Dubowitz Scale New Ballard Scale 15. A 2-month-old child has not received any immunizations. Which immunizations should the nurse give? 4 DTaP, Hib, HepB, IPV, varicella 5 6 7 DTaP, Hib, HepB, MMR, IPV DTaP, Hib, HepB, PCV, IPV, rotavirus DTaP, Hib, HepB, PCV, IPV, HepA 16. You are preparing immunizations for a 12-month-old child who is immunocompromised. Which immunization cannot be given? 4 DTaP 5 6 7 HepA IPV Varicella 17. Which immunization can cause fever and rash to occur 1 to 2 weeks after administration? 4 HepB 5 6 7 DTaP Hib MMRMULTIPLE RESPONSE 1. The nurse is preparing immunizations for a healthy 11-year-old boy who has received all his primary immunizations. Which immunizations will the nurse consider? Select all that apply. 4 5 6 7 Meningococcal DTaP OPV Smallpox 2. Parents of a 4-month-old child ask the nurse what they can do to help relieve the discomfort of teething. The nurse should include which suggestions for the parents? Select all that apply. 4 Provide warm liquids. 5 6 7 8 Rub the gums with aspirin. Over-the-counter topical medications for gum pain relief can be used as directed. Administer acetaminophen (Tylenol) as directed. Provide a hard food such as a frozen bagel for chewing. OTHER 1. Place in order the gross motor developmental milestones a nurse expects to assess in an infant. Begin with the earliest gross motor milestone expected and progress to the last gross motor milestone attained. 4 Turns from abdomen to back 5 Lifts head off of bed when in a prone position 6 Walks holding on to furniture 7 Turns from back to abdomen 8 Sits unsupportedChapter 05: Health Promotion for the Infant MULTIPLE CHOICE 1. Which milestone is developmentally appropriate for a 2-month-old infant when the nurse pulls the infant to a sitting position? 4 Head lag is present when the infant’s trunk is lifted. 5 6 7 The infant is able to support the head when the trunk is lifted. The infant is briefly able to hold the head erect. The infant is fully able to support and hold the head in a straight line. 2. Approximately what should a newborn weigh at 1 year of age if the newborn’s birth weight was 7 pounds 6 ounces? 4 14 3/4 pounds 5 6 7 22 1/8 pounds 29 1/2 pounds Unable to estimate weight at 1 year ANS: B An infant triples the birth weight by 1 year of age. An infant doubles the birth weight by 6 months of age. An infant quadruples the birth weight by 2 years of age. Weight at 6 months, 1 year, and 2 years of age can be estimated from the birth weight. DIF: Cognitive Level: Application REF: p. 78 OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance 3. Which statement made by a parent would be consistent with a developmental delay? 4 “I have noticed that my 9-month-old infant responds consistently to the sound of his name.” 5 “I have noticed that my 12-month-old child does not get herself to a sitting position or pull to stand.”6 7 “I am so happy when my 1 1/2-month-old infant smiles at me.” “My 5-month-old infant is not rolling over in both directions yet.” 4. At a healthy 2-month-old infant’s well-child clinic visit, the nurse should give which immunizations? 4 DTaP, IPV, HepB, Hib, PCV, rotavirus 5 6 7 MMR, DTaP, PVC, and IPV Hib, DTaP, rotavirus, and OPV Hib and MMR, IPV, and rotavirus 5. The nurse advises the mother of a 3-month-old infant, exclusively breast-fed, to: 4 start giving the infant a vitamin D supplement. 5 6 7 6. At start using an infant feeder and add rice cereal to the formula. start feeding the infant rice cereal with a spoon at the evening feeding. continue breast-feeding without any supplements. months of age, an infant should first be expected to locate an object hidden from view. 4 4 5 6 7 6 9 20 7. The parents of a newborn infant state, “We will probably not have our baby immunized because we are concerned about the risk of our child being injured.” Which is the best response for the nurse to make? 4 5 6 7 “It is your decision.” “Have you talked with your parents about this? They can probably help you think about this decision. “The risks of not immunizing your baby are greater than the risks from the immunizations.” “You are making a mistake.” 8. The mother of a 9-month-old infant is concerned because the infant cries when she leaves him. Which is the best response for the nurse to make to the mother? 4 5 6 7 “You could consider leaving the infant more often so he can adjust.” “You might consider taking him to the doctor because he may be ill.” “Have you noticed whether the baby is teething?” “This can be a healthy sign of attachment.”9. Which statement concerning physiological factors of infancy is true? 4 The infant has a slower metabolic rate than an adult. 5 6 7 An infant is not able to digest protein and lactase. Infants have a slower circulatory response than adults. The kidneys of an infant are less efficient in concentrating urine than an adult’s kidneys. 10. Which is a priority in counseling parents of a 6-month-old infant? 4 Increased appetite from secondary growth spurt 5 6 7 Allowing the infant to self-feed Securing a developmentally safe environment for the infant Strategies to teach infants to sit up 11. A mother of a 2-month-old infant tells the nurse, “My child doesn’t sleep as much as his older brother did at the same age.” What is the best response for the nurse? 4 5 6 7 “Have you tried to feed the baby more often?” “Infant sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time.” “It is helpful to keep a record of your baby’s eating, waking, sleeping, and elimination patterns and to week to discuss them.” “This infant is difficult. It is important for you to identify what is bothering the baby.” 12. The mother of a 10-month-old infant tells the nurse that her infant “really likes cow’s milk.” Which is the best response to this mother? 4 “Milk is good for him.”