NSG6435 Final Exam 2
The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the
nurse do first? - ANS introduce self
What action is most likely to encourage parents to talk about their feelings related to their child's
illness? - ANS Use open-ended questions.
What is the single most important factor to consider when communicating with children? - ANS The
child's developmental level
What is an important consideration for the nurse who is communicating with a very young child? - ANS
Use transition objects such as a doll.
When introducing hospital equipment to a preschooler who seems afraid, the nurse's approach should
be based on which principle? - ANS The child may think the equipment is alive.
Which age group is most concerned with body integrity? - ANS School-age child
An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing
action is to: - ANS Explain in simple terms how it works.
When the nurse interviews an adolescent, it is especially important to: - ANS Allow an opportunity to
express feelings.
The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique might
be most helpful? - ANS Ask the child to draw a picture.
The nurse is taking a health history on an adolescent. What best describes how the chief complaint
should be determined? - ANS Ask adolescent, "Why did you come here today?"
,Where in the health history should the nurse describe all details related to the chief complaint? - ANS
Present illness
The nurse is interviewing the mother of an infant. She reports, "I had a difficult delivery, and my baby
was born prematurely." This information should be recorded under which heading? - ANS Birth history
When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones
such as the age of walking without assistance. This should be considered because these milestones are: -
ANS An important part of the child's past growth and development
The nurse is taking a sexual history on an adolescent girl. The best way to determine whether she is
sexually active is to: - ANS Ask her, "Are you having sex with anyone?"
When doing a nutritional assessment on an Hispanic family, the nurse learns that their diet consists
mainly of vegetables, legumes, and starches. The nurse should recognize that this diet: - ANS May
provide sufficient amino acids.
Which parameter correlates best with measurements of the body's total protein stores? - ANS Upper
arm circumference
An appropriate approach to performing a physical assessment on a toddler is to: - ANS Use minimal
physical contact initially.
With the National Center for Health Statistics (NCHS) criteria, which body mass index (BMI)-for-age
percentile indicates a risk for being overweight? - ANS 85th percentile
The nurse is using the NCHS growth chart for an African-American child. The nurse should consider that:
- ANS The NCHS charts are accurate for U.S. African-American children.
, Which tool measures body fat most accurately? - ANS Calipers
By what age do the head and chest circumferences generally become equal? - ANS 1 to 2 years
The earliest age at which a satisfactory radial pulse can be taken in children is: - ANS 2 years
Where is the best place to observe for the presence of petechiae in dark-skinned individuals? - ANS Oral
mucosa
When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and
warm. The best explanation for this is: - ANS Infection or inflammation close to the site.
The nurse has just started assessing a young child who is febrile and appears very ill. There is
hyperextension of the child's head (opisthotonos) with pain on flexion. The most appropriate action is
to: - ANS Refer for immediate medical evaluation.
The nurse should expect the anterior fontanel to close at age: - ANS 12 to 18 months
During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in
both eyes. The nurse should recognize that this is: - ANS A normal finding.
Binocularity, the ability to fixate on one visual field with both eyes simultaneously, is normally present
by what age? - ANS 3 to 4 months
The most frequently used test for measuring visual acuity is the: - ANS Snellen letter chart.
The nurse is testing an infant's visual acuity. By what age should the infant be able to fix on and follow a
target? - ANS 3 to 4 months
The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the
nurse do first? - ANS introduce self
What action is most likely to encourage parents to talk about their feelings related to their child's
illness? - ANS Use open-ended questions.
What is the single most important factor to consider when communicating with children? - ANS The
child's developmental level
What is an important consideration for the nurse who is communicating with a very young child? - ANS
Use transition objects such as a doll.
When introducing hospital equipment to a preschooler who seems afraid, the nurse's approach should
be based on which principle? - ANS The child may think the equipment is alive.
Which age group is most concerned with body integrity? - ANS School-age child
An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing
action is to: - ANS Explain in simple terms how it works.
When the nurse interviews an adolescent, it is especially important to: - ANS Allow an opportunity to
express feelings.
The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique might
be most helpful? - ANS Ask the child to draw a picture.
The nurse is taking a health history on an adolescent. What best describes how the chief complaint
should be determined? - ANS Ask adolescent, "Why did you come here today?"
,Where in the health history should the nurse describe all details related to the chief complaint? - ANS
Present illness
The nurse is interviewing the mother of an infant. She reports, "I had a difficult delivery, and my baby
was born prematurely." This information should be recorded under which heading? - ANS Birth history
When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones
such as the age of walking without assistance. This should be considered because these milestones are: -
ANS An important part of the child's past growth and development
The nurse is taking a sexual history on an adolescent girl. The best way to determine whether she is
sexually active is to: - ANS Ask her, "Are you having sex with anyone?"
When doing a nutritional assessment on an Hispanic family, the nurse learns that their diet consists
mainly of vegetables, legumes, and starches. The nurse should recognize that this diet: - ANS May
provide sufficient amino acids.
Which parameter correlates best with measurements of the body's total protein stores? - ANS Upper
arm circumference
An appropriate approach to performing a physical assessment on a toddler is to: - ANS Use minimal
physical contact initially.
With the National Center for Health Statistics (NCHS) criteria, which body mass index (BMI)-for-age
percentile indicates a risk for being overweight? - ANS 85th percentile
The nurse is using the NCHS growth chart for an African-American child. The nurse should consider that:
- ANS The NCHS charts are accurate for U.S. African-American children.
, Which tool measures body fat most accurately? - ANS Calipers
By what age do the head and chest circumferences generally become equal? - ANS 1 to 2 years
The earliest age at which a satisfactory radial pulse can be taken in children is: - ANS 2 years
Where is the best place to observe for the presence of petechiae in dark-skinned individuals? - ANS Oral
mucosa
When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and
warm. The best explanation for this is: - ANS Infection or inflammation close to the site.
The nurse has just started assessing a young child who is febrile and appears very ill. There is
hyperextension of the child's head (opisthotonos) with pain on flexion. The most appropriate action is
to: - ANS Refer for immediate medical evaluation.
The nurse should expect the anterior fontanel to close at age: - ANS 12 to 18 months
During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in
both eyes. The nurse should recognize that this is: - ANS A normal finding.
Binocularity, the ability to fixate on one visual field with both eyes simultaneously, is normally present
by what age? - ANS 3 to 4 months
The most frequently used test for measuring visual acuity is the: - ANS Snellen letter chart.
The nurse is testing an infant's visual acuity. By what age should the infant be able to fix on and follow a
target? - ANS 3 to 4 months
