Pediatric Nursing Caring For Children And Their Families 3rd Edition by Nicki L. Potts

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Pediatric Nursing Caring For Children And Their Families 3rd Edition by Nicki L. Potts

CHAPTER 2: LEGAL AND ETHICAL ISSUES

 

MULTIPLE CHOICE

 

  1. When the nurse is dealing with a specific and actual legal problem involving a child or adolescent, which of the following actions is most important for the nurse to take?
a. Consult with legal counsel who is familiar with the laws in the state where the problem occurred.
b. Select an attorney who appears to be sympathetic to pediatric clients, who has had success in similar cases, and who is willing to work with the nurse.
c. Contact the nursing school where he or she graduated to see if it has free legal counsel.
d. Wait to see if the problem will resolve itself without further action on the part of the nurse.

 

 

ANS:  A

 

  Feedback
A Correct: If a nurse needs a legal opioion about an issue or concern, a licensed attorney who is familiar with the specific area of law in the state where the problem occurred should be consulted.
B Incorrect: Although all of these attributes may be desirable in an attorney, the most important action for the nurse to take is consulting an attorney who is familiar with the specific area of law in that state. The answers to many legal questions vary from state to state, depending on the specific laws of the state and how the courts interpret those laws.
C Incorrect:  The most important action for the nurse to take is consulting an attorney who is familiar with the specific area of law in the state where the problem occurred. The nurse may have graduated from a nursing school in a state other than where the legal problem ocurred.
D Incorrect: Waiting to see if the problem will resolve itself does not change the fact that the problem involves the legal system. Often waiting will only exaccerbate the problem.

 

 

PTS:   1                    REF:   p. 30 – Legal Considerations

OBJ:   Cognitive Level: Comprehension

 

  1. Nurse Practice Acts, Mandatory Reporting Laws, and Good Samaritan Acts are examples of laws affecting nurses. Which of the following is the source for such laws and acts?
a. constitutional law c. state laws and regulations
b. federal law and regulations d. case law

 

 

ANS:  C

 

  Feedback
A Incorrect: Constitutional law upholds the constitution, Bill of Rights, and 16 Constitutional amendments. It is not a source for Nurse Practice Acts, Mandatory Reporting Laws, and Good Samaritan Acts.
B Incorrect: Federal laws and regulations uphold congressional laws and federal statutes.
C Correct: State laws and regulations are the source for Nurse Practice Acts, Mandatory Reporting Laws, and Good Samaritan Acts.
D Incorrect: Case laws are laws that result from judicial decisions.

 

 

PTS:   1                    REF:   p. 30 – Table 2-1                             OBJ:   Cognitive Level: Knowledge

 

  1. Which of the following factors is not necessary to review when obtaining informed consent?
a. risks of the procedure c. alternatives to the procedure
b. benefits of the procedure d. cost of the procedure

 

 

ANS:  D

 

  Feedback
A Incorrect: Informed consent must include the nature of the procedure, the risks and hazards of the procedure, the alternatives to the procedure, and the benefits of the procedure. Risks of the procedure is a factor that must be reviewed.
B Incorrect: The benefits of the procedure are one of the factors that must be reviewed when obtaining informed consent.
C Incorrect: Alternatives to the procedure are one of the factors that must be reviewed when obtaining informed consent.
D Correct: The cost of the procedure is not a necessary factor to review when obtaining informed consent.

 

 

PTS:   1                    REF:   p. 30 – Informed Consent and Assent for Health Care

OBJ:   Cognitive Level: Knowledge

 

  1. In the majority of cases, pediatric clients are asked to give their consent or permission before receiving a procedure or treatment. This process is referred to as which of the following terms?
a. inclusion c. consideration
b. assent d. co-permission

 

 

ANS:  B

 

  Feedback
A Incorrect: Inclusion is derived from the word include. Include means to involve as a subordinate part.
B Correct: While pediatric clients are entitled to informed consent, it is usually the role of the parent or legal guardain to give informed consent. A child is asked to give assent prior to a procedure or treatment. Assent means the child has been informed about what will happen during a treatment or procedure, and is willing to permit a health care provider to perform the care.
C Incorrect: Consideration refers to taking an individual’s opinion into account. However, this is not the correct legal term for giving consent or permission.
D Incorrect: Co-permission refers to jointly allowing, authorizing, or consenting such as a child with the parent or legal guardian. However, this is not the correct legal term for giving their consent or permission.

 

 

PTS:   1                    REF:   p. 30 – Informed Consent and Assent for Health Care

OBJ:   Cognitive Level: Knowledge

 

  1. The major benefit of getting assent from a child is which of the following?
a. having the assurance of not being sued
b. enhancing the self-esteem of the child
c. lessening the controlling nature of caregivers
d. obtaining the child’s cooperation and lessening the trauma

 

 

ANS:  D

 

  Feedback
A Incorrect: While getting assent from a child may prevent being sued, it is not the major benefit for obtaining assent.
B Incorrect: Getting assent from a child should have no effect on his/her self-esteem.
C Incorrect: Lessening the controlling nature of caregivers is not the major benefit for obtaining assent.
D Correct: While assent from a child is not legally required, it is always better to have the child’s cooperation prior to giving care. A child’s assent may minimize any trauma to the child.

 

 

PTS:   1                    REF:   p. 30 – Informed Consent and Assent for Health Care

OBJ:   Cognitive Level: Application

 

  1. If a health care facility or health care provider treats a client without proper consent, and legal action follows, the facility or provider would most likely be:
a. charged with failure to render optimum care to the client
b. charged with assault and held liable for any damages
c. fined severely for not following state regulations
d. denied Medicare- and Medicaid-approved status

 

 

ANS:  B

 

  Feedback
A Incorrect: A health care facility or health care provider my be charged with failure to render optimum care to a client without proper consent, but this is not a legal action.
B Correct: A health care facility or health care provider my be charged with assault and held liable for any damages if proper consent is not obtained before treating a client, and this is a legal action.
C Incorrect: A health care facility or health care provider my be fined severely for not following state regulations if proper consent was not obtained before treating a client, however, this is not a legal action.
D Incorrect: Failing to obtain proper consent from a client prior to treatment should not affect the Medicare- and Medicaid status of the health care facility or health care provider.

 

 

PTS:   1                    REF:   p. 31 – Informed Consent and Assent for Health Care

OBJ:   Cognitive Level: Comprehension

 

  1. A family is involved in an automobile accident. The father, who is unconscious, and his 14-year-old son, who has suffered life-threatening injuries, are transported by ambulance to the hospital. The hospital staff attempt to contact the mother; however, they learn from the housekeeper that the mother is out of the country and not reachable by phone. Which of the following actions would be most reasonable and prudent on the part of the hospital staff?
a. Obtain informed consent from the child, if possible, and with or without it, provide life-saving procedures.
b. Get a court order from a judge in case the family later has objections to some of the care, such as the use of blood products.
c. Have the housekeeper give informed consent.
d. Locate another relative and get informed consent.

 

 

ANS:  A

 

  Feedback
A Correct: Health care providers may provide emergency life-saving care to a child if they have made a reasonable attempt to contact the child’s parent or legal guardian to obtain prior informed consent.
B Incorrect: If a parent refuses to act in the best interest of a child, the state may step in and make legal decisions for the child. However, in this situation the father is unconscious and the mother cannot be reached, so it is not known if the parents would give consent.
C Incorrect: It is the role of the parents or legal guardian to give informed consent for the child. The housekeeper is not a parent or legal guardian.
D Incorrect: Locating another relative to obtain informed consent is not the most reasonable and prudent action for the hospital staff.

 

 

PTS:   1                    REF:   p. 31 – When Informed Consent is Not Required

OBJ:   Cognitive Level: Comprehension

 

  1. A nurse is working in the emergency room when a child is brought in with injuries and a history that suggests sexual abuse. The child is not cooperative. Which of the following reasons presents the best rationale for waiting until the child is cooperative, instead of restraining and forcing the child to submit to the examination?
a. The hospital staff would likely be charged with abuse.
b. One of the parents may object to restraint if both have not signed informed consent, especially if they are divorced.
c. Forcing participation may damage the child’s ability to give testimony in a criminal case.
d. Forced examination may not provide accurate results.

 

 

ANS:  C

 

  Feedback
A Incorrect. Restraint and forced cooperation is improper treatment at all times.
B Incorrect. Hopefully all adults involved will object to restraint and coercion.
C Correct. Forcing a child to participate in a forensic examination may damage the child’s ability to testify in a criminal case, especially if the child perceives the medical examination as abusive.
D Incorrect. Forced examination often provides inaccurate results.

 

 

PTS:   1                    REF:   p. 31 – When Informed Consent is Not Required

OBJ:   Cognitive Level: Comprehension | Cognitive Level: Application

 

  1. Although the age varies among states, the majority of states define a minor as being a person under the age of:
a. 16 c. 18
b. 17 d. 21

 

 

ANS:  C

 

  Feedback
A Incorrect. Sixteen is always a minor, and in most states, age of majority is 18, some 19 and one 21.
B Incorrect. Seventeen is always a minor, all 50 states.
C Correct. All but three states consider a minor to be a person under the age of 18. In Alabama and Wyoming, the age is 19, while in Mississippi it is 21.
D Incorrect. Only Mississippi considers 21 to be the age of majority.

 

 

PTS:   1                    REF:   p. 31 – When a Minor can Consent for Care

OBJ:   Cognitive Level: Knowledge

 

  1. Most states permit a child under age 18 to consent to certain types of care without parental or guardian notification or consent. The types of care that most often do not require the consent or notification of the parents or guardian include:
a. minor surgery c. contraception
b. liposuction d. psychiatric care

 

 

ANS:  C

 

  Feedback
A Incorrect. Generally, a child under age 18 will not be able to provide consent for minor surgery.
B Incorrect. Liposuction is an elective procedure, and cannot be performed based upon a minor’s consent.
C Correct. In many states a child under the age of 18 can consent to care involving pregnancy, contraception, or treatment of sexually transmitted diseases, without consent from or notification of a parent or guardian.
D Incorrect. A child under 18 cannot provide consent for psychiatric care.

 

 

PTS:   1                    REF:   p. 31 – When a Minor can Consent for Care

OBJ:   Cognitive Level: Knowledge

 

  1. Which of the following acts offers protection from liability when care is rendered voluntarily, such as at the scene of an accident?
a. Nurse Practice Act
b. Health Insurance Portability and Accountability Act (HIPAA)
c. Good Samaritan Act
d. Voluntary Assisting Act

 

 

ANS:  C

 

  Feedback
A Incorrect. The Nurse Practive Act is the state law which governs the practice of nursing.
B Incorrect. The Health Insurance Portability and Accountability Act provides for privacy.
C Correct. The Good Samaritan Act protects a nurse from liability when care is rendered voluntarily at the scene of an accident.
D Incorrect. The Voluntary Assisting Act is not the same as the Good Samaritan Act.

 

 

PTS:   1                    REF:   p. 38 – Legal Resources for Pediatric Nurses

OBJ:   Cognitive Level: Knowledge

 

  1. Emancipation is a legal recognition that a minor meets which of the following criteria?
a. has been freed from the caregivers’ rules and now makes his or her own rules
b. lives independently, is self-supporting, and makes his or her own decisions
c. is no longer required to go to school and can get a job
d. is no longer required to attend public school and is working on the general equivalency diploma (GED)

 

 

ANS:  B

 

  Feedback
A Incorrect. Following or not following rules of caregivers is note related to legal recognition.
B Correct. Emancipation is the legal recognition for a minor who lives independently and is legally responsible for his or her own support and decision making. Emancipation can occur through a formal court proceeding, during which a judge can establish whether a minor is living on his own and no longer requires financial support of parents. In some states, a minor is automatically granted emancipation in the event of marriage, joining the military, or becoming a parent prior to the age of majority.
C Incorrect. Many minors drop out of school and get jobs, but this does not qualify as emancipation.
D Incorrect. No longer attending public school or working on a GED do not achieve legal recognition required for emancipation.

 

 

PTS:   1                    REF:   p. 32 – When a Minor can Consent for Care

OBJ:   Cognitive Level: Knowledge

 

  1. Which of the following terms refers to the age determined by state law when an individual is said to have all the legal rights and responsibilities of an adult?
a. young adult c. age of majority
b. postteen d. legal adult

 

 

ANS:  C

 

  Feedback
A Incorrect. State laws are very specific about the age of majority, and it is always stated as age in years.
B Incorrect. State laws are very specific about the age of majority, and it is always stated as age in years.
C Correct. State laws define the age of majority as an age in years at which time the individual is said to have all the legal rights and responsibilities of an adult.
D Incorrect. State laws are very specific about the age of majority, and it is always stated as age in years.

 

 

PTS:   1                    REF:   p. 31 – When a Minor can Consent for Care

OBJ:   Cognitive Level: Knowledge

 

  1. In some states a minor can become emancipated without going through the courts by:
a. getting notarized signed permission by the caregivers
b. being thrown out of the parental home
c. making more money than the caregivers or having a full-time job
d. joining the military, marrying, or becoming a parent

 

 

ANS:  D

 

  Feedback
A  Incorrect. A notarized signed permission does not achieve legal recognition for emancipation required by state laws.
B Incorrect. Being thrown out of the parental home does not achieve legal recognition for emancipation required by state laws.
C Incorrect. Making more money than the caregivers or having a full-time job does not confer legal emancipation required by state laws.
D Correct. In some states, a minor may become automatically emancipated by marrying, joining the military, or becoming a parent before the age of majority

 

 

PTS:   1                    REF:   p. 32 – When a Minor can Consent for Care

OBJ:   Cognitive Level: Knowledge

 

  1. You are working in an adolescent residential treatment center. When admitting an adolescent to your unit, you need to get parental consent for care. You discover that the adolescent’s parents are divorced. One parent and a stepparent are caring for the adolescent. You would have the consent forms signed by:
a. the parent or parents who were granted legal custody by the divorce decree
b. either parent, as both parents are still the biological parents and have the right to sign forms
c. the parent and stepparent the adolescent is living with at this time
d. a court-appointed attorney-at-law who acts in the adolescent’s best interest

 

 

ANS:  A

 

  Feedback
A Correct. After divorce, the ability to consent for medical care rests with the parent or parents who has been granted legal custody by the divorce decree.
B Incorrect. The divorce decree may grant legal custody to both parents, but the consent forms are still to be signed by the parent or parents who were granted legal custody by the divorce decree, whether they are the biological parents or not.
C Incorrect. The stepparent is not recognized to exist in the divorce decree, hence the individual has no legal standing to provide or offer consent.
D Incorrect. Without the consent of the parent or parents who were granted legal custody by the divorce decree, a court order might be required to allow a court-appointed attorney-at-law to provide consent.

 

 

PTS:   1                    REF:   p. 32 – Parental Consent After Divorce

OBJ:   Cognitive Level: Knowledge

 

  1. The parents of a critically ill child are refusing medical treatment for the child. Which of the following terms identifies a legal rule that allows the state to make legal decisions in the best interest of the child?
a. parenti loci c. in lieu parental
b. parens patrie d. bon parentus

 

 

ANS:  B

.

  Feedback
A Incorrect. Parenti loci is not the same as parens patrie.
B Correct. Parens patrie provides the state with an overriding interest in the health and welfare of a child. Parens patrie is a legal rule that allows the state to make decisions in place of parents when they are unable or unwilling to provide for the best interests of the child.
C Incorrect. In lieu parental is not the same as parens patrie.
D Incorrect. Bon parentus is not the same as parens patrie.

 

 

PTS:   1                    REF:   p. 32 – Refusal of Health Care by Parent or Child

OBJ:   Cognitive Level: Knowledge

 

  1. A child is being considered as a donor for a kidney transplant. Which of the following areas must be evaluated before any genetic testing is ordered on a child?
a. the urgency of the need for the donated organ
b. the possibility the mother has withheld the fact that the children have different fathers
c. the parents’ religious beliefs and the doctrine of the church regarding organ donation
d. the best interests of the child who would undergo the testing

 

 

ANS:  D

 

  Feedback
A  Incorrect. Urgency is important, but before testing of any kind is ordered for a child, other issues have a higher priority.
B Incorrect. Genetic testing is not contraindicated because of questions of paternity.
C Incorrect. Sensitivity to the parents’ religious beliefs and church doctrine is required, but has no effect on a decision to pursue genetic testing.
D Correct. Always, the best interests of the child should be evaluated before any genetic testing is ordered. Counseling should be provided. Informed consent should be obtained when possible before proceeding.

 

 

PTS:   1                    REF:   p. 33 – Consent for Genetic Testing

OBJ:   Cognitive Level: Knowledge

 

  1. Research facilities receiving federal funds for research involving children as research subjects must require and make certain that all research protocols:
a. are tested first on animals
b. are tested in another country prior to being tested in this country
c. are reviewed by an institutional review board
d. provide for financial compensation for the child and the parents

 

 

ANS:  C

 

  Feedback
A  Incorrect. The research involves children, testing on animals is irrelevant.
B Incorrect. The involvement of federal funds does not require research involving children to be first performed in another country.
C Correct. All research facilities that receive federal funds must comply with federal regulations that require review of all experimental protocols by an Institutional Review Board.
D Incorrect. Research involving children is typically done only when the research will benefit the child, or pose little or no risk to the subject. Financial compensation is not required by federal regulation.

 

 

PTS:   1                    REF:   p. 33 – Children and Medical Experimentation

OBJ:   Cognitive Level: Knowledge

 

  1. When a nurse breaches the duty of confidentiality, he or she can be disciplined by both the employer and the state board of nursing. In addition to this discipline, he or she can:
a. immediately lose his or her nursing license
b. be held responsible for any damages that result
c. be fined by the federal government
d. be sentenced for up to 1 year in jail

 

 

ANS:  B

 

  Feedback
A Incorrect. Although the loss of license may occur, it is not immediate; breach of confidentiality is considered unprofessional conduct, and each state board of nursing has its own nurse practice act, administrative law, etc.
B Correct. A breach of confidentiality is serious, and the nurse is held responsible for any damages that result.
C Incorrect. The federal government is not involved.
D Incorrect. The penalty is enforced for the employer and the state board of nursing, not other governmental agencies.

 

 

PTS:   1                    REF:   p. 34 – Confidentiality                    OBJ:   Cognitive Level: Knowledge

 

  1. If a nurse fails to report suspected child abuse and a child later receives additional injuries at the hands of the suspected abuser, the nurse may face legal consequences in states with child abuse reporting laws. Which of the following consequences may be the harshest faced by the nurse?
a. to be held liable for civil damages to compensate the child and to be fined and imprisoned
b. to have the nursing license suspended for up to a year
c. to be assigned at least 1 year of community service
d. to be put on probation and have to meet periodically with the assigned probation officer

 

 

ANS:  A

 

  Feedback
A Correct. All 50 states allow breach of confidentiality when child abuse is involved, and all require mandatory reporting. If a health care provider fails to report suspected abuse, the individual may be liable for criminal charges. Most mandatory reporting laws carry the possibility of both fines and a term of imprisonment for failure to make a report. If a child receives additional injuries after the health care provider should have reported suspected abuse, the provider may be liable for civil damages to compensate the child.
B Incorrect. Suspension of nursing license is a result of action by the state board of nursing.
C  Incorrect. The penalties envisioned are criminal, involving fines and imprisonment, plus civil damages.
D Incorrect. The penalties provide terms of imprisonment, not probation.

 

 

PTS:   1                    REF:   p. 34 – When a Health Care Provider can Breach Confidentiality

OBJ:   Cognitive Level: Knowledge

 

  1. You are working in a health care practitioner’s office. A child is treated in the office for a stab wound to the arm. In your state, you would most likely be required to:
a. keep this confidential unless the child gives permission to report, according to confidentiality laws
b. report this information to law enforcement, based on mandatory injury reporting laws
c. ask the parents to provide the circumstances surrounding the incident and chart it
d. remind the health care practitioner that the incident should be reported

 

 

ANS:  B

 

  Feedback
A Incorrect. Injury reporting laws allow under this circumstance another breach of confidentiality.
B Correct. The mandatory injury reporting laws allow breach of confidentiality, and the laws may require reporting of all injuries by weapon (knife, gun) or criminal act to law enforcement.
C Incorrect. Although this determination is part of the injury, the nurse is required by law to report the incident to the authorities and let them pursue this information.
D Incorrect. The law specifically requires anyone involved in the incident to be responsible to make the report to the authorities, not simply remind someone else to do it.

 

 

PTS:   1                    REF:   p. 35 – When a Health Care Provider can Breach Confidentiality

OBJ:   Cognitive Level: Knowledge

 

  1. Based on case law (Safer v. Estate of Pack, 1996), the duty to warn persons of possible harm may extend to which of the following conditions?
a. risk of sexually transmitted diseases c. genetically inherited disease risk
b. risk of infectious diseases d. risk of physical harm

 

 

ANS:  C

 

  Feedback
A Incorrect. The case law in Safer v. Estate of Pack (1996) involves genetically inherited disease risk, not sexually transmitted diseases.
B Incorrect. The case law in Safer v. Estate of Pack (1996) involves genetically inherited disease risk, not risk of infectious diseases.
C Correct. In the case of Safer v. Estate of Pack (1996) a physician failed to warn the child of a client that she could have a higher risk of colon cancer and should receive early and frequent screening. When colon cancer developed in the daughter, the physician was sued for failure to warn.
D Incorrect. The case law in Safer v. Estate of Pack (1996) involves genetically inherited disease risk, not risk of physical harm.

 

 

PTS:   1                    REF:   p. 35 – When a Health Care Provider can Breach Confidentiality

OBJ:   Cognitive Level: Knowledge

 

  1. In the case of Tarosoff v. The Regents of the University of California (1976), the court said that health care providers have a duty to breach confidentiality when:
a. a mentally ill person has a history of violence
b. a client, with a psychiatric diagnosis that carries any risk of harm to others, returns to his or her family
c. a client tells the health care provider that he or she is going to harm anyone who mistreats him or her
d. a client makes a specific threat to an identifiable person

 

 

ANS:  D

 

  Feedback
A Incorrect. The case of Tarosoff v. The Regents of the University of California (1976) involved a patient, but the case does not require breach of confidentiality for a mentally ill person with a history of violence.
B Incorrect. The case of Tarosoff v. The Regents of the University of California (1976) involved a patient, but the case does not require breach of confidentiality for a client with a psychiatric diagnosis that carries any risk of harm to others.
C Incorrect. The case of Tarosoff v. The Regents of the University of California (1976) involved a patient, but the case does not require breach of confidentiality for a client with nonspecific claims to harm others who may mistreat them.
D Correct. The duty to breach confidentiality by warning a third party is required only when there is a specific threat to an identifiable person.

 

 

PTS:   1                    REF:   p. 35 – When a Health Care Provider can Breach Confidentiality

OBJ:   Cognitive Level: Comprehension

 

  1. You are the nurse working with an adolescent who has just been diagnosed with a sexually transmitted disease. In your state the provider of care has an obligation to report sexually transmitted diseases to the local health department. Your best action is which of the following?
a. Explain to the adolescent that the law requires reporting of this information, which will be handled in a sensitive and appropriate manner.
b. Report the information, and let the local health department deal with the adolescent, as they are trained in sensitive matters.
c. Ask the parents of the adolescent to notify the local health department.
d. Ask the hospital social worker to notify the local health department.

 

 

ANS:  A

 

  Feedback
A Correct. It is important to explain to the client that you have an obligation to report sexually transmitted diseases to the local health department. The obligation is to public health, but the report will be handled in a sensitive and appropriate manner; individual privacy will be protected.
B  Incorrect. The local health department is not trained in sensitive matters, it is primarily concerned with the public health of all citizens.
C Incorrect. The local health department does not accept reports from parents.
D Incorrect. The nurse’s responsibility is to report to the local health department, not the social worker.

 

 

PTS:   1                    REF:   p. 35 – Nursing Tip                         OBJ:   Cognitive Level: Knowledge

 

  1. For a nurse to be charged with malpractice in a malpractice lawsuit, four legal elements must be present. Three of these are the duty the nurse owes to the client, a breach of that duty, and the breach of duty being the cause of damage. The fourth element that must be present is:
a. The nurse caused more than 50% of the damage.
b. The hospital policies did not support the nurse’s actions.
c. There was actual damage to the client.
d. Damage in this case was permanent and irreversible.

 

 

ANS:  C

 

  Feedback
A Incorrect. Although others may have been involved, the percentage of the cause is not the standard.
B Incorrect. Negligence or malpractice does not involve hospital policies.
C Correct. There must be actual damage to the client.
D Incorrect. The threshold for damage does not require permanence or irreversability.

 

 

PTS:   1                    REF:   p. 36 – Malpractice in the Pediatric Setting

OBJ:   Cognitive Level: Knowledge

 

  1. When a claim of malpractice is made, the nurse being accused is referred to in legal terms as the:
a. defendant c. accused
b. plaintiff d. client

 

 

ANS:  A

 

  Feedback
A Correct. When a claim of malpractice is made, the person making the claim (client) is the plaintiff. The nurse who is being accused of causing the damage is the defendant.
B Incorrect. The plaintiff is the individual claiming damage.
C Incorrect. The accused may be the same as the defandant, but not the correct answer.
D Incorrect. The client or patient is the plaintiff, not the defendant.

 

 

PTS:   1                    REF:   p. 36 – Malpractice in the Pediatric Setting

OBJ:   Cognitive Level: Knowledge

 

  1. The special relationship that is created when the nurse takes an assignment of a client and agrees to provide care to that client is called in legal terms a(n):
a. obligation c. duty
b. special arrangement d. case

 

 

ANS:  C

 

  Feedback
A Incorrect. Obligation is a debt to be paid, but is not the legal term sought.
B Incorrect. Special arrangement may have additional terms and conditions, but is not the legal term sought.
C Correct. Duty is the special relationship when a person agrees to provide care to a client. The amount of time the duty is owed to the client will depend upon the setting in which the care is given.
D Incorrect. Case is not the legal term sought.

 

 

PTS:   1                    REF:   p. 36 – Duty   OBJ:   Cognitive Level: Knowledge

 

  1. You are the nurse working at a local hospital. When you accept an assignment of clients at the beginning of your shift, under the laws of negligence, you are considered to have a legal duty to:
a. provide care for each of these clients
b. ensure the satisfaction of clients and their families
c. act in a manner that won’t create legal difficulties for the hospital
d. perform in an ethical and moral manner

 

 

ANS:  A

 

  Feedback
A Correct. When a nurse accepts an assignment of clients at the beginning of the shift, under the laws of negligence, the nurse is considered to have a legal duty to provide care for those clients.
B Incorrect. Although the duty of providing care may provide satisfaction among clients and their families, it has nothing to do with the laws of negligence.
C Incorrect. The laws of negligence are designed first of all to protect the clients, and in so doing the hospital will avoid legal difficulties. But, the client must be considered first and always.
D Incorrect. The duty contemplates the nurse will always perform in an ethical and moral manner, but the laws of negligence recognize the duty of providing accepted standards of care.

 

 

PTS:   1                    REF:   p. 36 – Malpractice in the Pediatric Setting

OBJ:   Cognitive Level: Knowledge

 

  1. When the word causation is used in a lawsuit involving a client who received the wrong medication from a nurse and later died, it means that the plaintiff’s lawyer must prove that:
a. the nurse breached the standard of care
b. the injury (death) of the client was the result of receiving the wrong medication
c. the nurse intentionally tried to hurt the client
d. other health care providers were not at fault and only the nurse was at fault

 

 

ANS:  B

 

  Feedback
A Incorrect. The nurse may breach the standard of care, and this will result in injury, but is not the same as causation.
B Correct. Causation requires the legal system to assign blame, proving the death of the client was caused by the medical administration error.
C Incorrect. Medical negligence or malpractice does not require proof of an intent to harm or kill the client.
D Incorrect. Medical negligence or malpractice is the act of an individual, not the act of other health care providers.

 

 

PTS:   1                    REF:   p. 36 – Causation                            OBJ:   Cognitive Level: Knowledge

 

  1. When a medication error is made, malpractice has occurred only if:
a. an expert witness can convince a jury that it is malpractice
b. the medication is a prescription drug and not over the counter
c. there are damages such as pain and suffering
d. the client receiving the medication was a child

 

 

ANS:  C

 

  Feedback
A Incorrect. Medical negligence or malpractice may or may not require expert witnesses capable of convicing a jury that malpractive has occurred.
B Incorrect. Medical negligence or malpractice does not discriminate based upon a medication being prescription or over the counter.
C Correct. A medication error resulting in pain and suffering is medical malpractice, and a medication error not resulting in pain and suffering is not medical malpractice.
D Incorrect. Medical malpractice does not discriminate by the age of the client.

 

 

PTS:   1                    REF:   p. 36 – Malpractice in the Pediatric Setting

OBJ:   Cognitive Level: Knowledge

 

  1. In a malpractice case involving a nurse and a client, the most important document in court is usually which of the following documents?
a. the medication administration record c. incident reports
b. the nursing care plan d. the chart

 

 

ANS:  D

.

  Feedback
A Incorrect. The medication administration record is part of the medical chart.
B Incorrect. The nursing care plan may or may not be part of the medical chart.
C Incorrect. Incident reports are not always part of the medical chart.
D Correct. The client’s chart is usually the most important document in malpractice case.

 

 

PTS:   1                    REF:   p. 37 – Medical Records                 OBJ:   Cognitive Level: Knowledge

 

  1. At 9:00 AM you taught a client about the importance of voiding into a collection hat in the bathroom toilet. At 11:00 AM you find the client removed the hat and voided directly into the toilet. Which of the following statements would be best in charting this failure to follow your directions?
a. Uncooperative. Taught to void into collection hat and did not do so.
b. Voided directly into toilet. Did not use collection hat that was provided.
c. Exhibiting controlling behaviors. Refused to void in collection hat and voided into toilet; therefore, urine could not be measured.
d. Did not apparently understand instructions to void in collection hat. Voided into toilet.

 

 

ANS:  B

 

  Feedback
A Incorrect. Judgmental statement.
B Correct. A verbal description of what happened without stating a judgment.
C Incorrect. Labeling behavior, not proper for the medical chart.
D Incorrect. Attempt to explain what happened, not a simple description.

 

 

PTS:   1                    REF:   p. 37 – Medical Records                 OBJ:   Cognitive Level: Knowledge

 

  1. The nurse is caring for a small child who puts his arm through the side rail just as the nurse is lowering the side rail. The child gets a big bruise. The housekeeper asks the nurse what happened. The nurse should:
a. tell the housekeeper, since the housekeeper is part of the health care team
b. restrict information to general statements such as, “It was an accident.”
c. suggest the housekeeper ask the head nurse
d. avoid discussing the accident with the housekeeper

 

 

ANS:  D

 

  Feedback
A Incorrect. The incident is best left reported via the medical chart, and best not discussed with the housekeeper who can repeat or amplify or modify the statement.
B Incorrect. The incident is best left reported via the medical chart and not discussed in any way.
C Incorrect. Chart the incident, but do not refer the housekeeper to the head nurse.
D Correct. The incident is to be charted but not discussed with the housekeeper.

 

 

PTS:   1                    REF:   p. 37 – Nursing Tip                         OBJ:   Cognitive Level: Knowledge

 

  1. A person employed by the hospital to make certain the facility conforms to state and federal laws is usually called a:
a. risk manager c. legal nurse consultant
b. policy manager d. compliance officer

 

 

ANS:  A

 

  Feedback
A Correct. In many health care facilities, the risk manager is a nurse with specialized training or a nurse who is also an attorney. The risk manager is responsible for making sure the facility conforms to state and federal laws.
B Incorrect. The policy manager has other duties.
C Incorrect. The legal nurse consultant may or may not be employed by a hospital on a full-time basis, but could function as a risk manager if hired for the task.
D Incorrect. The compliance officer has other duties.

 

 

PTS:   1                    REF:   p. 38 – Legal Resources for Nurses OBJ:   Cognitive Level: Knowledge

 

  1. The nurse assigned to the pediatric unit of a hospital is caring for a child who cries for his mother when she is not with him. The mother works during the day. Which of the following actions on the part of the nurse most indicates the nurse is letting her own values get in the way of caring for this family?
a. encouraging the mother to discuss her feelings about leaving her son
b. being angry with the mother because she does not stay with the child
c. assessing the family for socioeconomic needs as well as other needs
d. offering to set up a meeting with social services and child protective services

 

 

ANS:  D

 

  Feedback
A Incorrect. Encouraging a mother to discuss her feelings about leaving her son is alway appropriate for a nurse.
B Incorrect. Expressing anger to a mother because she does not stay with her child is never appropriate for a nurse.
C Incorrect. Assessing the family’s socioeconomic needs is often appropriate for a nurse.
D Correct. When a nurse offers to set up a meeting with social services and child protective services, he or she has made a value judgment about the mother’s behavior and this is not appropriate.

 

 

PTS:   1                    REF:   p. 38 – Concepts of Ethics              OBJ:   Cognitive Level: Knowledge

 

  1. A specific type of ethical theory stresses rightness or wrongness of actions, regardless of consequences, as well as a duty to others. This ethical theory is often regarded as the key theory for use in health care ethical decision making. Which of the following is it?
a. deontologic c. virtue
b. teleologic d. care

 

 

ANS:  A

 

  Feedback
A Correct. Deontologic theory uses principles or rules to guide the decision-making process. Duty to others is emphasized. The rightness or wrongness of acts is clear-cut regardless of outcomes or consequences.
B Incorrect. Teleologic theory insists upon looking at the outcome or the consequences to decide what to do.
C Incorrect. Virtue theory looks at the intent of the moral agent. Development of traits of character such as excellence, truthfulness, gentleness, politeness, and trustworthiness lead to appreciation of a situation and the resulting appropriate decisions.
D  Incorrect. Care theory incorporates advocacy or acting on the client’s behalf based upon empathy and caring. It tends to use the individual’s needs or concerns as the framework for ethical decision making and essentially rejects objective-based rules or criteria for these decisions.

 

 

PTS:   1                    REF:   p. 39 – Ethical Theories                  OBJ:   Cognitive Level: Knowledge

 

  1. The use of moral reasoning to resolve problems raised by the health care field and life sciences is called:
a. scientific ethics c. bioethics
b. health care ethics d. cyroethics

 

 

ANS:  C

 

  Feedback
A Incorrect. Although based upon scientific method, it is not generally known as scientific ethics.
B Incorrect. Bioethics is the application of ethics into the lives of individuals by way of the health care system.
C Correct. Bioethics is the application of ethics into the lives of individuals by way of the health care system.
D Incorrect. Cyroethics is not bioethics.

 

 

PTS:   1                    REF:   p. 38 – Concepts of Ethics              OBJ:   Cognitive Level: Knowledge

 

  1. Nonmaleficence is an ethical principle that essentially means:
a. Don’t use bad language. c. Tell the truth at all times.
b. Don’t use bad judgment. d. Do no harm to the clients.

 

 

ANS:  D

 

  Feedback
A Incorrect. Bad language may be in bad taste, but it is not the same as nonmaleficence.
B Incorrect. Bad judgment is maljudgment, not nonmaleficence.
C Incorrect. Telling the truth at all times, or truthfulness, is not the same as nonmaleficence.
D Correct. Nonmaleficence is making sure that nothing harmful happens to the client.

 

 

PTS:   1                    REF:   p. 39 – Ethical Principles                 OBJ:   Cognitive Level: Knowledge

 

  1. Which of the following is the best example of the ethical principle of fidelity?
a. being a good friend to the client by sharing secrets
b. keeping a promise to return to the client’s room at a given time
c. doing whatever the client or the client’s physician asks of you
d. saving the client time and money by not wasting supplies

 

 

ANS:  B

 

  Feedback
A  Incorrect. Being a friend and sharing secrets with a client is not an expression of fidelity.
B Correct. Fidelity means to faithfully and always keep one’s promise or word.
C Incorrect. Doing whatever is asked is not the same as keeping one’s promise.
D Incorrect. Saving time and money by not wasting supplies may be admirable, but it is not the same as keeping one’s promises or word.

 

 

PTS:   1                    REF:   p. 39 – Ethical Principles                 OBJ:   Cognitive Level: Knowledge

 

  1. The five-step process for resolving ethical issues involves collecting information about the situation, stating the dilemma, listing all possible courses of action, and which of the following pairs of steps?
a. setting goals and working toward the goals
b. analyzing the advantages and disadvantages of each course of action and making the decision
c. implementing a variety of courses of action and evaluating which course of action is the best
d. surveying others on their opinions and making a choice of action based on the best rationale provided

 

 

ANS:  B

 

  Feedback
A Incorrect. Goals are not a part of the five-step ethical decision-making process.
B Correct. The next step in the five-step ethical decision-making process is to analyze the advantages and disadvantages of each available solution and from this arrive at a decision for action.
C Incorrect. A choice must be made among the various courses of action, and narrowed to a single choice for proceeding.
D Incorrect. Although analysis of the available solutions will involve collaboration, surveying others on their opinion is not analytic.

 

 

PTS:   1                    REF:   p. 40 – The Ethical Decision-Making Process

OBJ:   Cognitive Level: Knowledge

 

MULTIPLE RESPONSE

 

  1. The ethical principle of autonomy is applied in which of the following situations? Select all that apply.
a. allowing the child to select food items from the menu
b. permitting the child to wash in the evening rather than in the morning because this is the child’s typical routine
c. playing with a child whose family has gone home for the evening
d. calling the physician for pain medication for a child who has recently had surgery

 

 

ANS:  A, B

 

  Feedback
Correct Autonomy is allowing the health care client to make his or her own decisions. Allowing the child to select food items from the menu is an example of autonomy.

Permitting the child to wash according to the typical routine is an example of autonomy.

Incorrect Playing with a child whose parents have left for the evening is an example of beneficence.

Calling the physician for pain medication for a postoperative patient is an example of nonmaleficence.

 

 

PTS:   1                    REF:   p. 39 – Ethical Principles

OBJ:   Cognitive Level: Application

 

  1. A pregnant client informs the nurse that she has previously had an abortion. The client asks that her parents not be made aware of her past history. Which of the following ethical principles will be implemented by the health care team when maintaining the client’s desired confidentiality? Select all that apply.
a. autonomy c. fidelity
b. justice d. nonmaleficence

 

 

ANS:  A, C

 

  Feedback
Correct A nurse who maintains confidentiality is applying the ethical principle of autonomy. Autonomy involves allowing clients to make decisions. Thus, the nurse is allowing the client to make decisions.

A nurse who maintains confidentiality is applying the ethical principle of fidelity.

Incorrect Justice is not applicable in this situation.

Nonmaleficence is not applicable in this situation.

 

 

PTS:   1                    REF:   p. 39 – Ethical Principles

OBJ:   Cognitive Level: Application

 

 

CHAPTER 16: CARE OF CHILDREN WHO ARE HOSPITALIZED

 

MULTIPLE CHOICE

 

  1. Prior to the late 1950s governing parents visiting their hospitalized child were:
a. very liberal, allowing unlimited visitation and rooming-in
b. limited to the waking hours only
c. very restrictive and often limited to only weekly visits or visits of a few hours each day
d. limited to one parent only, allowing that parent unlimited visiting

 

 

ANS:  C

 

  Feedback
A Incorrect. Prior to the late 1950s, visitation was strictly limited, not very liberal.
B Incorrect. Prior to the late 1950s, the rules were restrictive, more concerned about the intense physical and emotional reactions to separation at the time of leave-taking than the time of day.
C Correct. Prior to the publication of the Platt report in England, 1959, hospital rules governing parents visiting their hospitalized child were very restrictive and often limited to only weekly visits or visits of a few hours each day.
D Incorrect. Prior to the late 1950s, the rules were restrictive, more concerned about the intense physical and emotional reactions to separation at the time of leave-taking than limiting the number of visitors.

 

 

PTS:   1                    REF:   p. 509 – History and Trends In Pediatrics and Pediatric Nursing

OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following documents described polices and practices in the care of hospitalized children and how detrimental were these to child development and recovery? (This document brought about change in visiting rules for parents visiting their hospitalized child.)
a. Platt Report of 1959 c. Lysaught report of 1970
b. Brown Report of 1948 d. Patient’s Bill of Rights

 

 

ANS:  A

 

  Feedback
A Correct. The issuance of the Platt Report in England in 1959 was historic in describing existing policies and practices in the care of hospitalized children, how these practices adversely affected child development and recovery, and the kinds of changes necessary for child-centered pediatric care and education.
B Incorrect. The Brown Report of 1948 has no connection with the policies and practices in the care of hospitalized children.
C Incorrect. The Lysaught report of 1970 has no connection with the policies and practices in the care of hospitalized children.
D Incorrect. The Patient’s Bill of Rights has no connection with the policies and practices in the care of hospitalized children.

 

 

PTS:   1                    REF:   p. 509 – History and Trends In Pediatrics and Pediatric Nursing

OBJ:   Cognitive Level: Knowledge

 

  1. Which of the following nurses was the first to systematically study how children and parents cope with hospitalization and to document the effectiveness of nursing in allaying and managing the fears and concerns of children?
a. Florence Erickson c. Gladys Sellew
b. Dorothy Marlow d. Florence G. Blake

 

 

ANS:  D

 

  Feedback
A Incorrect. Florence Erickson is remembered as an educator and researcher in the field of nursing and child development who emphasized the therapeutic use of play in the hospital (1914-2002).
B Incorrect. Dorothy Marlow is remembered for her Textbook in Pediatric Nursing which uniquely arranged the content of child care by age groups alongside concepts of growth and development (1921-1992).
C Incorrect. Gladys Sellew pioneered nursing work in the tenements, ghettos, and settlements of Cincinnati, Cleveland, Chicago and Washington, D.C. Her thesis was the first nursing research to be based upon an original investigation that used as its methodology participant observation (1887-1977).
D Correct. Florence G. Blake was the first nurse to systematically study how children and parents cope with hospitalization and to document the effectiveness of nursing in allaying and managing the fears and concerns of children (1907-1982).

 

 

PTS:   1                    REF:   p. 509 – History and Trends In Pediatrics and Pediatric Nursing

OBJ:   Cognitive Level: Knowledge

 

  1. Which of the following is the predominant goal of nurses caring for children?
a. Find out what is wrong with a child, and fix it as efficiently as is possible.
b. Identify the strengths of children, and enhance their growth in the midst of stress and intrusions.
c. Get the child and family well enough to go to the least-restrictive environment.
d. Spare the family as much trauma and psychological distress as is humanly possible.

 

 

ANS:  B

 

  Feedback
A Incorrect. Nursing care for children is more complex than repairing a car.
B Correct. The predominant goal of nurses caring for children is: to identify and preserve the strengths of children while trying to enhance their growth in the midst of stress and intrusions into their bodies, their space, and their very being.
C Incorrect. A goal of returning home is important, but not the most important.
D Incorrect. Reduction of trauma and psychological distress for the child is as important as it is for the family, maybe more so.

 

 

PTS:   1                    REF:   p. 543 – Home Care

OBJ:   Cognitive Level: Application

 

  1. Which of the following do nurses need to do first then preparing for nursing care of children in a clinical setting?
a. memorize Erikson’s life tasks
b. study Piaget’s theories of growth and development
c. examine their own thoughts and feelings about caring for children and families in the hospital and the roles and responsibilities of nurses in pediatric nursing
d. find out the physicians’ protocols, and familiarize themselves with these protocols as well as with the policy and procedure manuals of the hospital and unit

 

 

ANS:  C

 

  Feedback
A Incorrect. In the preparatory phase, after coming to terms with the beliefs that underlie practice, review and comprehend Erikson’s life tasks.
B Incorrect. In the preparatory phase, after coming to terms with the beliefs that underlie practice, study Piaget’s theories of growth and development.
C Correct. Articulating a personal philosophy about the care of children in hospitals provides a foundation of beliefs that underlie practice. First, examine your own thoughts and feelings about caring for children and families in the hospital and the roles and responsibilities of nurses in pediatric nursing
D Incorrect. After the more general reviews, the pediatric nurse would be well served to find out the physicians’ protocols, and familiarize themselves with these protocols as well as with the policy and procedure manuals of the hospital and unit.

 

 

PTS:   1                    REF:   p. 543 – Home Care

OBJ:   Cognitive Level: Application

 

  1. The nurse, working on a pediatric unit of a hospital, is assigned to care for several children with varying needs. One child was admitted solely for tests, another for management of diabetes, one for heart surgery, and one with a terminal illness. In planning time and attention to the children, the nurse makes it a priority to take into consideration which of the following factors?
a. severity of the reason for hospitalization
b. age and intelligence of the child
c. perceptions and interpretations of the experience by the child
d. parents’ emotional, physical, and financial needs

 

 

ANS:  C

 

  Feedback
A Incorrect. Severity of the reason for hospitalization is important in planning time and attention to the children, but after thinking about their developmental level.
B Incorrect. Looking at age and intelligence of the child establishes a notion of their developmental level, but is not as important as thinking about their perceptions and how they might interpret what is happening.
C Correct. The developmental level of children and their perceptions and interpretations of experiences are more important than the actual events.
D Incorrect. The parents’ emotional, physical, and financial needs can dramatically effect the child’s status, but first think about the perceptions and interpretations of the experience by the child.

 

 

PTS:   1                    REF:   p. 511 – Experiences of Children in Hospitals and Their Responses

OBJ:   Cognitive Level: Application

 

  1. Which of the following statements best describes stress-point nursing?
a. The nurse uses a chart and a pointer to go through the steps of the procedure.
b. All procedures and treatments are reduced to 10 steps or points to help explain them to the child undergoing them.
c. Each step of a procedure fits into a star-shaped diagram with the steps outlined on the points of the star.
d. The treatment or procedure is described in a sequential manner, exploring how it might feel, and the procedure or treatment is rehearsed.

 

 

ANS:  D

 

  Feedback
A Incorrect. Stress-point nursing is not best described by the nurse using a chart and pointer without providing sensory information also.
B Incorrect. Stress-point nursing is not best described by reducing all procedures and treatments into 10 steps.
C Incorrect. Stress-point nursing is not best described by fitting procedures into star-shaped diagrams.
D Correct. Stress-point nursing helps children cope by using both procedural information (description of the treatment and sequence of the steps) and sensory information (how might this feel).

 

 

PTS:   1                    REF:   p. 513 – Alleviating the Anxieties of Children

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse places a unique cartoon character on the outside and inside of a child’s door. The hospital has a picture of a different animal for each floor of the hospital, and these pictures are posted in the elevators. Each section of the pediatric unit has a different theme and walls of a different color. These actions on the part of the nurse and the hospital are designed to:
a. reduce anxiety and help children and others feel secure that they will not get lost and that they have a place of their own
b. remind everyone that this is a pediatric unit for children who have special needs and is not a unit for adults
c. cheer the children up and help them laugh to reduce tension in their lives
d. help establish a personality for the hospital, the floors, the unit, and the room of the child who is hospitalized

 

 

ANS:  A

 

  Feedback
A Correct. Children may fear situations that appear minor to an adult, may fear that they may become “lost” then being transported around the hospital. Anticipating this would prompt the nurse to put a sign on the door, so the child could be “found.”
B Incorrect. Placing a unique cartoon character on the outside and inside of a child’s door is not to remind everyone that this is a pediatric unit for children who have special needs and is not a unit for adults.
C Incorrect. Placing a unique cartoon character on the outside and inside of a child’s door is not to cheer the children up and help them laugh to reduce tension in their lives.
D Incorrect. Placing a unique cartoon character on the outside and inside of a child’s door is not to help establish a personality for the hospital, the floors, the unit, and the room of the child who is hospitalized.

 

 

PTS:   1                    REF:   p. 513 – Alleviating the Anxieties of Children

OBJ:   Cognitive Level: Application

 

  1. Nurses caring for a pediatric client can most strengthen a child’s sense of security by:
a. providing a unit and hospital handbook of rules and posting the dos and don’ts on the walls there children can see them
b. letting the children know then they will be leaving, who will be caring for them, and then they will be back, and saying good-bye then they leave
c. giving the children enough toys, games, and stuffed animals to play with
d. telling the children then meals will be and what the menu will be for each meal as well as then they will have nothing by mouth (NPO) and for how long

 

 

ANS:  B

 

  Feedback
A Incorrect. Nurses caring for a pediatric client will not most strengthen a child’s sense of security by providing a unit and hospital handbook of rules and posting the dos and don’ts on the walls there children can see them.
B Correct. To strengthen children’s sense of feeling secure, it is important for nurses to let them know then they will be leaving, who will be caring for them, and then they will be back, and saying good-bye then they leave.
C Incorrect. Nurses caring for a pediatric client will not most strengthen a child’s sense of security by giving the children enough toys, games, and stuffed animals to play with.
D Incorrect. Nurses caring for a pediatric client will not most strengthen a child’s sense of security by telling the children then meals will be and what the menu will be for each meal as well as then they will have nothing by mouth (NPO) and for how long.

 

 

PTS:   1                    REF:   p. 513 – Alleviating the Anxieties of Children

OBJ:   Cognitive Level: Application

 

  1. The pediatric nurse in the hospital finds one of her clients crying because “Daddy just left.” Which of the following actions by the nurse would most help the child to feel more secure?
a. holding the child, talking about then Dad will return, and looking at Dad’s picture
b. looking at the clock, talking about the amount of time before Dad returns, and drawing a clock with that time
c. distracting the child by playing a game that requires a lot of concentration
d. giving the child a cuddly blanket and a cuddly stuffed animal to hold until Dad returns

 

 

ANS:  A

 

  Feedback
A Correct. Finding one of her clients crying because “Daddy just left,” the pediatric nurse would most help the child to feel more secure by holding the child, talking about then Dad will return, and looking at Dad’s picture.
B Incorrect. Finding one of her clients crying because “Daddy just left,” the pediatric nurse would not most help the child to feel more secure by looking at the clock, talking about the amount of time before Dad returns, and drawing a clock with that time.
C Incorrect. Finding one of her clients crying because “Daddy just left,” the pediatric nurse would not most help the child to feel more secure by distracting the child by playing a game that requires a lot of concentration.
D Incorrect. Finding one of her clients crying because “Daddy just left,” the pediatric nurse would not most help the child to feel more secure by giving the child a cuddly blanket and a cuddly stuffed animal to hold until Dad returns.

 

 

PTS:   1                    REF:   p. 513 – Alleviating the Anxieties of Children

OBJ:   Cognitive Level: Application

 

  1. The nurse notices that a hospitalized, seriously ill child has a talent for drawing and writing poetry. The nurse will encourage this talent mainly for the purpose of getting the child to
a. express and deal with feelings and thoughts in coping with the illness and hospitalization
b. earn money to help the parents pay the hospital bill and for college tuition later
c. entertain himself and stay distracted from pain and discouragement
d. interact with other people on the unit who may have the same interests or hobbies

 

 

ANS:  A

 

  Feedback
A Correct. Children’s talents also help in coping. For example, through drawing, writing prose or poetry, and other creative activities, children not only express their thoughts and feelings, but also use these media to cope.
B Incorrect. The nurse will not encourage the seriously ill child who has a talent for drawing and writing poetry to earn money to help the parents pay the hospital bill and for college tuition later.
C Incorrect. The nurse will not encourage this talent for drawing and writing poetry mainly for the purpose of getting the child to entertain himself and stay distracted from pain and discouragement.
D Incorrect. The nurse will not encourage this talent for drawing and writing poetry mainly for the purpose of getting the child to interact with other people on the unit who may have the same interests or hobbies.

 

 

PTS:   1                    REF:   p. 513 – Alleviating the Anxieties of Children

OBJ:   Cognitive Level: Application

 

  1. Which of the following is most critical to the nurse in identifying and meeting the needs of acutely ill children?
a. what was learned in class about pediatrics
b. all the nurse’s physiological and psychological senses
c. journal articles with up-to-date information
d. the verbal communication of the child

 

 

ANS:  B

 

  Feedback
A Incorrect. What was learned in class about pediatrics is not the most critical to the identification and to meeting the needs of acutely ill children.
B Correct. All the nurse’s physiological and psychological senses are critical in identifying and meeting the needs of acutely ill children.
C Incorrect. Journal articles with up-to-date information are not the most critical to the identification and to meeting the needs of acutely ill children.
D Incorrect. The verbal communication of the child is not the most critical to the identification and to meeting the needs of acutely ill children.

 

 

PTS:   1

REF:   p. 515 – Major Factors in Support of Coping During Illness and Hospitalization

OBJ:   Cognitive Level: Comprehension

 

  1. The most skilled pediatric nurse will be committed to attending to each child and family in:
a. exactly the same way
b. a manner similar to one in the textbook
c. unique ways designed for that child and family
d. the same way as every other nurse on the unit

 

 

ANS:  C

 

  Feedback
A Incorrect. The most skilled pediatric nurse will not be committed to attending to each child and family in exactly the same way, everyone is different.
B Incorrect. The most skilled pediatric nurse will not be committed to attending to each child and family in a manner similar to one in the textbook.
C Correct. The most skilled pediatric nurse will be committed to attending to each child and family in unique ways designed for that child and family. The experienced nurse may also be described as a nurse-artist because of the sensitivity exemplified in grasping the meaning of behavior in light of past and evolving events and the creative, skillful actions that reflect depth of understanding, and commitment to attending to each child and family in unique ways.
D Incorrect. The most skilled pediatric nurse will not be committed to attending to each child and family in the same way as every other nurse on the unit, as every nurse is unique.

 

 

PTS:   1

REF:   p. 515 – Major Factors in Support of Coping During Illness and Hospitalization

OBJ:   Cognitive Level: Application

 

  1. You are the nurse admitting a 5-year-old child to the pediatric unit. The mother says that she feels certain the child will be all right with the parents taking turns being at the hospital in the evenings only. The mother mentions that the child has been attending day care for several years. Which of the following is the nurse’s best response?
a. “Hospitalization can be very stressful to a child without a familiar person. If you can arrange to be here more, it will help your child.”
b. “Some children who have been in day care do fine with just the nurse.”
c. “I will personally take care of your child whenever I am here, so you won’t have to worry about the care at all.”
d. “Perhaps you could hire a private duty nurse’s aide or a nurse for part of the day.”

 

 

ANS:  A

 

  Feedback
A Correct. The critical importance of caregiver presence in the hospital may need to be explained to families because young children are often cared for by others during the day, and the impact of separation in a strange environment may not be fully understood.
B Incorrect. Upon hearing a mother of an admitted 5-year-old child say that she feels certain the child will be all right with the parents taking turns being at the hospital in the evenings only, the nurse’s best response will not be: “Some children who have been in day care do fine with just the nurse.”
C Incorrect. Upon hearing a mother of an admitted 5-year-old child say that she feels certain the child will be all right with the parents taking turns being at the hospital in the evenings only, the nurse’s best response will not be: “I will personally take care of your child whenever I am here, so you won’t have to worry about the care at all.”
D Incorrect. Upon hearing a mother of an admitted 5-year-old child say that she feels certain the child will be all right with the parents taking turns being at the hospital in the evenings only, the nurse’s best response will not be: “Perhaps you could hire a private duty nurse’s aide or a nurse for part of the day.”

 

 

PTS:   1

REF:   p. 515 – Major Factors in Support of Coping During Illness and Hospitalization

OBJ:   Cognitive Level: Application

 

  1. Which of the following arrangements is generally considered to be best for the parents of a hospitalized infant or young child?
a. day visits and sleeping at home
b. rooming-in
c. separate caregiver sleeping room on the unit
d. staying at a nearby hotel or motel

 

 

ANS:  B

 

  Feedback
A Incorrect. Day visits and sleeping at home is not generally considered to be the best arrangements for the parents of a hospitalized infant or young child.
B Correct. The selection of arrangements is complex, but, whenever possible, rooming-in by the parents is of the highest priority for infants and young children.
C Incorrect. Separate caregiver sleeping room on the unit is not generally considered to be the best arrangements for the parents of a hospitalized infant or young child.
D Incorrect. Staying at a nearby hotel or motel is not generally considered to be the best arrangements for the parents of a hospitalized infant or young child.

 

 

PTS:   1

REF:   p. 516 – Major Factors in Support of Coping During Illness and Hospitalization

OBJ:   Cognitive Level: Comprehension

 

  1. In the nursing mutual participation model of care (NMPMC), the nurse believes that:
a. caregivers can and will be helpful at times if the nurse provides adequate teaching and training
b. caregivers can participate in the simple day-to-day care of the child
c. with enough supervision, caregivers can be good partners with nurses in caring for ill children and can help allay the children’s fears
d. the presence and support of families is essential for optimal healing, recovery, and prevention of additional trauma to a child

 

 

ANS:  D

 

  Feedback
A Incorrect. In the nursing mutual participation model of care (NMPMC), the nurse does believe that caregivers can and will be helpful at all times with or without adequate teaching and training.
B Incorrect. In the nursing mutual participation model of care (NMPMC), the nurse does believe that caregivers can participate in the simple day-to-day care of the child, and much, much more.
C Incorrect. In the nursing mutual participation model of care (NMPMC), the nurse does not believe that supervision of caregivers makes them good partners with nurses in caring for ill children and can help allay the children’s fears.
D Correct. In the nursing mutual participation model of care (NMPMC), the nurse believes that the presence and support of families is essential for optimal healing, recovery, and prevention of additional trauma to a child.

 

 

PTS:   1

REF:   p. 517 – Major Factors in Support of Coping During Illness and Hospitalization

OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following questions by the nurse would best fit the philosophy of the nursing mutual participation model of care (NMPMC)?
a. “Where have you been all morning?”
b. “Have you brushed your child’s teeth today?”
c. “How does your child look to you today?”
d. “Do you think your child’s color is worse?”

 

 

ANS:  C

 

  Feedback
A Incorrect. The following question by the nurse would not best fit the philosophy of the nursing mutual participation model of care (NMPMC): “Where have you been all morning?” The question is like an interrogation.
B Incorrect. The following question by the nurse would not best fit the philosophy of the nursing mutual participation model of care (NMPMC): “Have you brushed your child’s teeth today?” The question suggests there is a partition of responsibilities.
C Correct. The following question by the nurse would best fit the philosophy of the nursing mutual participation model of care (NMPMC): “How does your child look to you today?” The question indicates equality of the partnership.
D Incorrect. The following question by the nurse would not best fit the philosophy of the nursing mutual participation model of care (NMPMC): “Do you think your child’s color is worse?”

 

 

PTS:   1

REF:   p. 517 – Major Factors in Support of Coping During Illness and Hospitalization

OBJ:   Cognitive Level: Application

 

  1. The environment of the pediatric unit most needs to:
a. be conducive to feelings of safety and security
b. reflect the latest technology and up-to-date care
c. reflect a warm working relationship among the staff
d. be aesthetically pleasing to children and families

 

 

ANS:  A

 

  Feedback
A Correct. As a place of healing, the environment of the pediatric unit should be conducive to feelings of safety and security.
B Incorrect. The latest technology and up-to-date care are not as important as an environment conducive to feelings of safety and security.
C Incorrect. The environment of the pediatric unit needs to reflect a warm working relationship among the staff, but this is at best secondary, as it contributes to an environment conducive to feelings of safety and security.
D Incorrect. The environment of the pediatric unit may need to be aesthetically pleasing to children and families, but most important is an environment conducive to feelings of safety and security.

 

 

PTS:   1

REF:   p. 519 – Major Factors in Support of Coping During Illness and Hospitalization

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse is helping admit a child to the pediatric unit of the hospital. The nurse will help the child:
a. put her clothing and shoes in the closet or send them home in a bag
b. store worn blankets and stuffed animals out of sight
c. place the shoes in plain sight there the child can see them
d. make the bed up the way the child likes it at home

 

 

ANS:  C

 

  Feedback
A Incorrect. While admitting a child to the pediatric unit of the hospital, the nurse will not best help the child by putting her clothing and shoes in the closet or sending them home.
B Incorrect. While admitting a child to the pediatric unit of the hospital, the nurse will not best help the child by putting away their personal and most prized possessions.
C Correct. While admitting a child to the pediatric unit of the hospital, the nurse will help the child place her shoes in plain sight there the child can see them. Shoes are symbols of mobility and reminders of going home, i.e., a symbol of life outside the hospital.
D Incorrect. While admitting a child to the pediatric unit of the hospital, the nurse will not best help the child by making the bed up the way the child likes it at home.

 

 

PTS:   1

REF:   p. 519 – Major Factors in Support of Coping During Illness and Hospitalization

OBJ:   Cognitive Level: Application

 

  1. Which of the following areas is most important for a pediatric unit to have for its hospitalized children to use?
a. a library c. computer room
b. television room d. playroom

 

 

ANS:  D

 

  Feedback
A Incorrect. A library is not most important for a pediatric unit.
B Incorrect. A television room is not most important for a pediatric unit.
C Incorrect. A computer room is not most important for a pediatric unit.
D Correct. Every pediatric unit needs a playroom as a safe haven there no painful treatments or scenes are encountered; a place there children are empowered to cope with stressful events on a day-to-day basis.

 

 

PTS:   1

REF:   p. 519 – Major Factors in Support of Coping During Illness and Hospitalization

OBJ:   Cognitive Level: Comprehension

 

  1. The parents ask if blood work can be drawn from their daughter while she is in the playroom and distracted from this procedure. The best answer by the nurse is:
a. “No, definitely not, because it is against hospital rules to draw blood there.”
b. “Yes, if you prefer the blood to be drawn there, we will abide by your wishes.”
c. “The playroom is a safe haven there no painful treatments or scenes are encountered.”
d. “If your child agrees to have the blood drawn in the playroom and other parents don’t object.”

 

 

ANS:  C

 

  Feedback
A Incorrect. Answering a parent’s question about why you would never draw blood then the child is in the playroom, the best answer by the nurse is not: “No, definitely not, because it is against hospital rules to draw blood there.”
B Incorrect. Answering a parent’s question about why you would never draw blood then the child is in the playroom, the best answer by the nurse is never: “Yes, if you prefer the blood to be drawn there, we will abide by your wishes.”
C Correct. Answering a parent’s question about why you would never draw blood then the child is in the playroom, the best answer by the nurse is: “The playroom is a safe haven there no painful treatments or scenes are encountered.”
D Incorrect. Answering a parent’s question about why you would never draw blood then the child is in the playroom, the best answer by the nurse is never: “If your child agrees to have the blood drawn in the playroom and other parents don’t object.”

 

 

PTS:   1

REF:   p. 519 – Major Factors in Support of Coping During Illness and Hospitalization

OBJ:   Cognitive Level: Application

 

  1. Which of the following therapies is most often used by psychiatrists, psychologists, and psychiatric nurse clinicians to assess and treat young children who are experiencing anxiety or who have mental health problems?
a. reality therapy c. play therapy
b. rational emotive therapy d. short-term therapy

 

 

ANS:  C

 

  Feedback
A Incorrect. Reality therapy would never be used by psychiatrists, psychologists, and psychiatric nurse clinicians to assess and treat young children who are experiencing anxiety or who have mental health problems.
B Incorrect. Rational emotive therapy would never be used by psychiatrists, psychologists, and psychiatric nurse clinicians to assess and treat young children who are experiencing anxiety or who have mental health problems.
C Correct. Therapeutic play, or play therapy, is a highly effective, nondirective way of assisting children to use hospital equipment and toys to express reactions to stressful events in the hospital.
D Incorrect. Short-term therapy is not most often used by psychiatrists, psychologists, and psychiatric nurse clinicians to assess and treat young children who are experiencing anxiety or who have mental health problem.

 

 

PTS:   1

REF:   p. 520 – Major Factors in Support of Coping During Illness and Hospitalization

OBJ:   Cognitive Level: Comprehension

 

  1. Pediatric nurses realize that allowing a sibling to visit a hospitalized child:
a. presents a great risk of infection and should not be allowed
b. will probably tire out the ill child and make him feel worse
c. will probably be very disruptive to the nursing staff and to the rest of the unit
d. often is very helpful to not only the hospitalized child but the sibling as well

 

 

ANS:  D

 

  Feedback
A Incorrect. Pediatric nurses realize that allowing a sibling to visit a hospitalized child does not present a great risk of infection and should be allowed.
B Incorrect. Pediatric nurses realize that allowing a sibling to visit a hospitalized child will not probably tire out the ill child and make him feel worse, in fact, both will feel better.
C Incorrect. Pediatric nurses realize that allowing a sibling to visit a hospitalized child may be disruptive to the nursing staff and to the rest of the unit, but the visit will help both the siblings.
D Correct. Sibling visitation has become a well-established practice in pediatric units. There are considerable benefits to the child, sibling, and family with minimal risks such as infections. Siblings have fears and fantasies about what is happening as well, and seeing them helps alleviates concerns.

 

 

PTS:   1

REF:   p. 518 – Major Factors in Support of Coping During Illness and Hospitalization

OBJ:   Cognitive Level: Comprehension

 

  1. You are working as a pediatric nurse on the pediatric unit and assigned to work with a school-aged child who is on bed rest. This child cannot go to the playroom. What is the most helpful thing you can do to reduce stress and anxiety for this child?
a. Offer extra ice cream and special desserts if allowed on the child’s diet.
b. Get two puppets and have a conversation with the child holding one and you holding the other puppet.
c. Talk to the child several times during the shift, assuring him that he has nothing to be anxious about.
d. Give the child a book to read about what it is like for a child to be in the hospital.

 

 

ANS:  B

 

  Feedback
A Incorrect. For the school-aged child who is on bed rest and unable to go to the playroom, offering extra ice cream and special desserts will not be the most helpful thing you can do to reduce stress and anxiety for this child.
B Correct. It is difficult for children to resist play, but if they cannot go to the playroom, observing the play of other children, puppet shows or play at the bedside is appropriate.
C Incorrect. For the school-aged child who is on bed rest and unable to go to the playroom, talking to the child several times during the shift, assuring him that he has nothing to be anxious about will not be the most helpful thing you can do to reduce stress and anxiety for this child.
D Incorrect. For the school-aged child who is on bed rest and unable to go to the playroom, giving the child a book to read about what it is like for a child to be in the hospital will not be the most helpful thing you can do to reduce stress and anxiety for this child.

 

 

PTS:   1

REF:   p. 519 – Major Factors in Support of Coping During Illness and Hospitalization

OBJ:   Cognitive Level: Application

 

  1. A mother asks the pediatric nurse then preparation for her 5-year-old child’s upcoming hospital experience should begin. Which of the following is the nurse’s best response?
a. a few days before admission
b. during the admission process on the day of admission
c. on arrival at the hospital unit
d. no preparation is needed because it will just create anxiety

 

 

ANS:  A

 

  Feedback
A Correct. For planned admissions, the age of the child should be a guide to timing for preparation for hospitalization or surgery. For children aged 4-to-7-year-olds, 4 to 7 days.
B Incorrect. Answering a mother’s question about then she should begin preparation for her 5-year-old child’s upcoming hospital experience, the best response would not be during the admission process on the day of admission.
C Incorrect. Answering a mother’s question about then she should begin preparation for her 5-year-old child’s upcoming hospital experience, the best response would not be upon arrival at the hospital unit.
D Incorrect. Answering a mother’s question about then she should begin preparation for her 5-year-old child’s upcoming hospital experience, the best response would not be none needed because it will just create anxiety.

 

 

PTS:   1

REF:   p. 522 – Major Factors in Support of Coping During Illness and Hospitalization

OBJ:   Cognitive Level: Application

 

  1. An infant is going to be admitted to the hospital in a few days. What is the best approach to prepare the infant for hospitalization?
a. Have the parents take the infant to the hospital for an hour or so to familiarize the infant with the hospital environment.
b. Put the infant on a routine that is similar to the routines the infant will encounter in the hospital.
c. It is better to prepare the caregivers so that they will convey a sense of calmness to the infant.
d. Have the parents go by the hospital to have the nurses meet the baby ahead of time.

 

 

ANS:  C

 

  Feedback
A Incorrect. When preparing for the infant for upcoming hospitalization, the best approach is not to have the parents take the infant to the hospital for an hour or so to familiarize the infant with the hospital environment.
B Incorrect. When preparing for the infant for upcoming hospitalization, the best approach is not to put the infant on a routine that is similar to the routines the infant will encounter in the hospital.
C Correct. For infants, the best approach is to prepare the caregivers. By allaying their fears and concerns they will be better able to communicate a sense of calmness and well-being to their infants.
D Incorrect. When preparing for the infant for upcoming hospitalization, the best approach is not to have the parents go by the hospital to have the nurses meet the baby ahead of time.

 

 

PTS:   1

REF:   p. 522 – Major Factors in Support of Coping During Illness and Hospitalization

OBJ:   Cognitive Level: Application

 

  1. You are working with the family of a school-aged child who will be admitted in 2 weeks to the pediatric unit for surgery. Which of the following activities would be most helpful to the child?
a. Have the child spend time with a child or other children who have been clients in this hospital.
b. Allow the child to tour the hospital, engage in medical play, and handle equipment such as an IV fluid bag, tubing, and blood pressure equipment.
c. Show the child a movie about the hospital.
d. Have the child draw pictures of the upcoming hospitalization.

 

 

ANS:  B

 

  Feedback
A Incorrect. Having the child spend time with a child or other children who have been clients in this hospital would not be the most helpful activity for the school-aged child.
B Correct. For planned admissions for children over age 7 years, a few weeks before hospitalization or surgery is fine. Through tours, use of puppets, medical play, children’s literature, and audiovisual media, children learn about the experience and their role in the recovery process. Whenever possible, you will let them handle equipment such as an IV fluid bag, tubing, and blood pressure equipment.
C Incorrect. Showing the child a movie about the hospital would not be the most helpful activity for the school-aged child.
D Incorrect. Having the child draw pictures of the upcoming hospitalization would not be the most helpful activity for the school-aged child.

 

 

PTS:   1                    REF:   p. 523 – Preparation of Children and Families for Hospitalization

OBJ:   Cognitive Level: Application

 

  1. When young children are admitted to the hospital, the nurse should first establish a relationship with the:
a. child c. mother
b. caregivers d. father

 

 

ANS:  B

 

  Feedback
A Incorrect. When young children are admitted to the hospital, the nurse should first establish a relationship with the caregivers, not the child
B Correct. When young children are admitted to the hospital, the nurse should first establish a relationship with the caregivers. As children see their caregivers trust the nurse, it is easier for them to engage in a relationship with the nurse.
C Incorrect. When young children are admitted to the hospital, the nurse should first establish a relationship with the caregivers, not exclusively the mother.
D Incorrect. When young children are admitted to the hospital, the nurse should first establish a relationship with the caregivers, not exclusively the father.

 

 

PTS:   1                    REF:   p. 523 – Preparation of Children and Families for Hospitalization

OBJ:   Cognitive Level: Application

 

  1. Which of the following actions on the part of the nurse would best facilitate positive responses then talking with a hospitalized child?
a. using terms of endearment such as “honey” or “sugar”
b. promising a special treat such as ice cream or a ride in the wheelchair
c. getting positioned at eye level and having eye contact with the child
d. having the child hold some piece of hospital or personal equipment

 

 

ANS:  C

 

  Feedback
A Incorrect. Using terms of endearment such as “honey” or “sugar” will not best facilitate positive responses then talking with a hospitalized child.
B Incorrect. Promising a special treat such as ice cream or a ride in the wheelchair will not best facilitate positive responses then talking with a hospitalized child.
C Correct. Being at eye level and having eye contact while talking to children facilitates positive responses.
D Incorrect. Having the child hold some piece of hospital or personal equipment will not best facilitate positive responses then talking with a hospitalized child.

 

 

PTS:   1                    REF:   p. 523 – Preparation of Children and Families for Hospitalization

OBJ:   Cognitive Level: Application

 

  1. Which of the following actions by the nurse would usually be most productive in gaining an understanding of an adolescent’s or a child’s perceptions related to their illness and hospitalization?
a. Conduct interviews with extended family members.
b. Interview the child or adolescent alone one-on-one.
c. Read the child’s diary if the parents will provide it.
d. Have the child write a report for the nurse to read.

 

 

ANS:  B

 

  Feedback
A Incorrect. Conducting interviews with extended family members would never be most productive in gaining an understanding of an adolescent’s or a child’s perceptions related to their illness and hospitalization.
B Correct. It is always helpful to have a separate interview with the child or adolescent in order to understand their perceptions related to illness and hospitalization.
C Incorrect. Reading the child’s diary if the parents will provide it is an invasion of privacy that will never be appropriate, and if discovered by the adolescent, will destroy professional boundaries beyond repair.
D Incorrect. Having the child write a report for the nurse to read is not the equal for a two-way conversation of an interview one-on-one.

 

 

PTS:   1                    REF:   p. 524 – Care of Children During Admission to a Hospital

OBJ:   Cognitive Level: Application

 

  1. When children are in an uncomplicated preoperative situation, the need for heavy sedation decreases then
a. the anesthetist or anesthesiologist is friendly
b. a nurse gives pain medication liberally the day before surgery
c. the doctor stops by before surgery to talk to the client
d. the parents are present during the preoperative situation

 

 

ANS:  D

 

  Feedback
A Incorrect. Although having a friendly anesthetist or anesthesiologist may decrease the child’s stress, the presence of the parents during the preoperative situation is the most important factor in decreasing the need for heavy sedation.
B Incorrect. A nurse giving pain medication liberally the day before surgery is not a factor in decreasing the need for heavy sedation for the child
C Incorrect. Although having the doctor stops by before surgery to talk to the client may provide and reinforce information for children and parents and encourage expression of any fears they may have about surgery, is not the most important factor in decreasing the need for heavy sedation.
D Correct. When children are in an uncomplicated preoperative situation, the need for heavy sedation decreases then the parents are present during the preoperative situation.Their presence during induction of anesthesia is reassuring to children and minimizes the stress of separation.

 

 

PTS:   1                    REF:   p. 524 – Care of Children During Admission to a Hospital

OBJ:   Cognitive Level: Comprehension

 

  1. When anesthesia is explained to children, which of the following statements would usually be less frightening?
a. “This medicine will put you to sleep.”
b. “We are going to put you down under the anesthesia now.”
c. “This will give you a special kind of sleep and you will awake.”
d. “You will have a heavenly feeling.”

 

 

ANS:  C

 

  Feedback
A Incorrect. The statement “this medicine will put you to sleep” may be frightening for children especially if it has been used in reference to euthanizing a pet.
B Incorrect. The statement “we are going to put you down under the anesthesia now” may also be frightening for children. Preschoolers interpret what is said literally and may think they will be put underneath something.
C Correct. When anesthesia is explained to children, the least frightening statement would be: “This will give you a special kind of sleep and you will be awakened then it’s over and come back here there (person in family) will be waiting for you”.
D Incorrect. Saying “you will have a heavenly feeling” to a child as a way to explain anesthesia may also frightening. Sometimes words are confusing and cause distress. This statement may evoke fantasies of doom. The child might think he or she could die during surgery and will be going to heaven.

 

 

PTS:   1                    REF:   p. 524 – Care of Children During Admission to a Hospital

OBJ:   Cognitive Level: Application

 

  1. When having a child role-play a procedure, the nurse would
a. ask the child to choose the “subject” of the procedure
b. select one of the child’s dolls or stuffed animals for the procedure
c. invite the mother to be the subject
d. volunteer to be the subject on which the procedure is being done

 

 

ANS:  A

 

  Feedback
A Correct. When having a child role-play a procedure, the nurse would ask the child to choose the “subject” of the procedure.
B Incorrect. Many children do not like to use their favorite doll or stuffed animal then role-playing a procedure.
C Incorrect. Inviting the mother to be the subject is not appropriate because the child may be afraid that she might be hurt or feel pain.
D Incorrect. The nurse should allow the child to choose who will be the subject of the procedure. It is not appropriate for the nurse to volunteer to be the subject.

 

 

PTS:   1                    REF:   p. 526 – Preparation of Children and Their Families for Surgery

OBJ:   Cognitive Level: Application

 

  1. When explaining to a child that you are going to do a dressing change, the best explanation would include which of the following statements?
a. “I am going to rip the bandage off real quick, and it will be all gone.”
b. “I will try not to pull all your hair out then I pull this bandage off.”
c. “I am going to take off your bandage.”
d. “I am going to fix your bandage and make it better.”

 

 

ANS:  D

 

  Feedback
A Incorrect. This statement is not the best explanation. “I am going to rip the bandage off real quick…” can be threatening to a child.
B Incorrect. This statement should always be avoided because it is aggressive language and can cause anxiety and distress for the child.
C Incorrect. This statement is not the best explanation because it uses aggressive language.
D Correct. When explaining to a child that you are going to do a dressing change, the best explanation would be “I am going to fix your bandage and make it better.” When preparing children for procedures, use the least aggressive language. This statement is the least aggressive of all the choices.

 

 

PTS:   1                    REF:   p. 526 – Preparation of Children and Their Families for Surgery

OBJ:   Cognitive Level: Application

 

  1. Which of the following statements by the nurse would be most helpful to a child during a procedure or a treatment?
a. “It is hard to be quiet and lie still during this, but you are doing very well.”
b. “You’re a good girl (or a good boy).”
c. “This will only hurt for another 10 minutes.”
d. “If you are good, I will give you some of your favorite ice cream or a Popsicle.”

 

 

ANS:  A

 

  Feedback
A Correct. The statement by the nurse “It is hard to be quiet and lie still during this, but you are doing very well” would be most helpful to a child during a procedure or a treatment. During procedures, the nurse should guide and coach the child using soft, reassuring words and giving praise intermittently for cooperation and following directions
B Incorrect. It is inadvisable to use phrases like “You’re a good girl (or a good boy).” Young children may associate the procedure with punishment.
C Incorrect. This statement is not helpful because it is not possible to know how long a treatment will hurt. At the conclusion of the procedure, offer a simple apology if the child experienced pain, such as “I’m sorry if I hurt you.”
D Incorrect. This statement is not helpful to a child during a procedure or treatment. If the child cries during the procedure, he or she may feel like a failure. Also, follow up to a procedure should include fun activities or comfort measures agreed on in advance.

 

 

PTS:   1                    REF:   p. 526 – Preparation of Children and Their Families for Surgery

OBJ:   Cognitive Level: Application

 

  1. Which of the following terms is preferred then referring to a child who has diabetes?
a. that kid c. the child with diabetes
b. the diabetic kid d. the cute diabetic child

 

 

ANS:  C

 

  Feedback
A Incorrect. The term “that kid” should not be used because it minimizes the dignity of children.
B Incorrect. The term “the diabetic kid” should not be used. This term identifies the child by the disease, diabetes. As stated in “A” the term “kid” is inappropriate.
C Correct. The term “the child with diabetes” is preferred then referring to a child who has diabetes. This term emphasizes that he is a child with a health problem. Any other term labels or stereotypes the child and can have detrimental effects.
D Incorrect. “The cute diabetic child” is inappropriate because it identifies the child by the disease.

 

 

PTS:   1                    REF:   p. 528 – Communicating with Children and Families

OBJ:   Cognitive Level: Application

 

  1. The nurse is tube-feeding an infant. In order to reduce future difficulty with the infant accepting oral feedings, which of the following actions will the nurse carry out?
a. Keep the infant in an upright position and never lose hand contact with the infant.
b. Have the infant suck on the nurse’s fingers.
c. Hold the infant in an en face position, give eye contact, and carry out verbal interaction.
d. Give the baby a pacifier to use at each feeding.

 

 

ANS:  C

 

  Feedback
A Incorrect. Eye contact is key, not touch.
B Incorrect. Eye contact is key, not touch.
C Correct. The nurse is tube-feeding an infant. In order to reduce future difficulty with the infant accepting oral feedings, which of the following actions will the nurse carry out
D Incorrect. Eye contact is key, not an inanimate object such as a pacifier.

 

 

PTS:   1                    REF:   p. 529 – Nursing Care and Guidance of Infants

OBJ:   Cognitive Level: Application

 

  1. The nurse gives an infant a pacifier to suck on during a tube feeding. The reason for the pacifier is to:
a. distract the infant so she will not try to pull the feeding tube out in a reflex action
b. help the infant know the relationship between oral pleasure and a full satiated feeling
c. keep the child from sucking on her fingers during this time
d. keep the infant focused so she will not remember the procedure

 

 

ANS:  B

 

  Feedback
A Incorrect. The reason for the pacifier is not to distract the infant so she will not try to pull the feeding tube out in a reflex action. The basic source of infant satisfaction is through satiation of oral needs. Tube feeding interferes with the gratification of these needs.
B Correct. The nurse gives an infant a pacifier to suck on during a tube feeding. The reason for the pacifier is to help the infant know the relationship between oral pleasure and a full satiated feeling.
C Incorrect. The nurse does not give an infant a pacifier to suck on during a tube feeding to keep the child from sucking on her fingers.
D Incorrect. The nurse does not give an infant a pacifier to suck on during a tube feeding to keep the infant focused so she will not remember the procedure.

 

 

PTS:   1                    REF:   p. 529 – Nursing Care and Guidance of Infants

OBJ:   Cognitive Level: Application

 

  1. When an infant undergoes surgery, is vomiting, or has to take medications that taste terrible, these experiences will most often make it difficult for the infant to:
a. experience pleasure in sucking, swallowing, digesting, and eliminating
b. relate to the nursing staff and the other members of the health care team
c. accept cuddling and comforting from the caregivers
d. communicate basic human needs

 

 

ANS:  A

 

  Feedback
A Correct. Nurses should be particularly aware of the effects of situations that interfere with the gratification of oral needs (e.g., oral surgery, vomiting, distasteful medications, withholding food and fluids as well as periods of nonoral feeding). These experiences will most often make it difficult for the infant to experience pleasure in sucking, swallowing, digesting, and eliminating.
B Incorrect. The infant is sufficiently self-centered that they are never going to be concerned about how they relate to the nursing staff and the other members of the health care team.
C Incorrect. When oral satisfaction is threatened, the infant will not be satisfied with cuddling and comforting from the caregivers until the more basic need is fulfilled.
D Incorrect. When oral satisfaction is threatened, the infant has adequate means to communicate their needs without difficulty.

 

 

PTS:   1                    REF:   p. 529 – Nursing Care and Guidance of Infants

OBJ:   Cognitive Level: Application

 

  1. The nurse is teaching a new mother how to reduce tension in the newborn and infant. Which of the following activities will the nurse recommend?
a. giving the breast or bottle so that the baby falls asleep with warm milk
b. talking softly, singing, and gentle stroking
c. swinging the baby in the air, holding the neck secure
d. bouncing the child on the knee

 

 

ANS:  B

 

  Feedback
A Incorrect. Giving the breast or bottle so that the baby falls asleep with warm milk will lead to caries, and is not the activity the nurse will recommend.
B Correct. Talking to infants slowly, singing lullabies, moving them gently and carefully, and rocking and cuddling are ways to help infants reduce tension.
C Incorrect. Swinging the baby in the air, holding the neck secure will not reduce tension, but will induce fear in the newborn and infant; this is definitely not the activity the nurse will recommend.
D Incorrect. Bouncing the child on the knee if done gently and carefully is not the activity the nurse will recommend, as holding the infant closely and cuddling is preferred.

 

 

PTS:   1                    REF:   p. 529 – Nursing Care and Guidance of Infants

OBJ:   Cognitive Level: Application

 

  1. Which of the following practices is used by a large number of cultural groups to provide comfort and security to a child?
a. burying a rock near a large shade tree
b. taping a coin to the umbilical cord
c. wrapping the infant snugly in a soft blanket
d. boiling an egg and keeping it close to the child

 

 

ANS:  C

 

  Feedback
A Incorrect. Burying a rock near a large shade tree is not a practice used by a large number of cultural groups to provide comfort and security to a child.
B Incorrect. Taping a coin to the umbilical cord is not a practice used by a large number of cultural groups to provide comfort and security to a child.
C Correct. Swaddling, by wrapping the infant snugly in a soft blanket, is a practice used by many cultural groups to promote infant comfort and security.
D Incorrect. Boiling an egg and keeping it close to the child is not a practice used by a large number of cultural groups to provide comfort and security to an infant.

 

 

PTS:   1                    REF:   p. 529 – Nursing Care and Guidance of Infants

OBJ:   Cognitive Level: Application

 

  1. The nurse is teaching new mothers about safety in caring for infants. Which of the following actions will the nurse insist the new mothers adhere to in the day-to-day care of the infant?
a. Put a blanket on the floor around and under the crib.
b. Have the crib sides at least halfway up at all times.
c. Have at least one hand on the infant then the crib sides are down.
d. Leave little toys in the crib so the infant will be entertained.

 

 

ANS:  C

 

  Feedback
A Incorrect. In teaching new mothers about safety in caring for infants, the nurse will never insist the new mothers put a blanket on the floor around and under the crib.
B Incorrect. In teaching new mothers about safety in caring for infants, the nurse will not insist the new mothers have the crib sides at least halfway up at all times, as this will engender a false sense of security.
C Correct. In teaching new mothers about safety in caring for infants, the nurse will insist the new mothers always have at least one hand on the infant then the crib sides are down.
D Incorrect. In teaching new mothers about safety in caring for infants, the nurse will never insist the new mothers leave little toys in the crib. In fact, the nurse will insist harmful objects or objects small enough to be swallowed never be left in or near the crib to avoid that danger.

 

 

PTS:   1                    REF:   p. 530 – Nursing Care and Guidance of Infants

OBJ:   Cognitive Level: Application

 

  1. Which of the following is necessary for the nurse working with hospitalized toddlers to know?
a. what the individual toddler has mastered and how to maintain mastery
b. how far behind or ahead this child seems to be compared to the average same-age child
c. which parent has been present most of the time then skills have been mastered
d. how many times the child has had to try something before mastering it

 

 

ANS:  A

 

  Feedback
A Correct. To preserve developing autonomy and minimize shame and doubt in themselves, it is important to know the accomplishments of individual toddlers and maintain mastery insofar as possible.
B Incorrect. The nurse working with the hospitalized toddler is focused upon the individual and their accomplishments, and is not concerned with comparison to the average same-age child.
C Incorrect. The nurse working with the hospitalized toddler is focused upon the individual and their accomplishments, and is not concerned with which parent has been present most of the time then skills have been mastered.
D Incorrect. The nurse working with the hospitalized toddler is focused upon the individual and their accomplishments, and is not concerned with how many times the child has had to try something before mastering it.

 

 

PTS:   1                    REF:   p. 530 – Nursing Care and Guidance of Infants

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse working with hospitalized toddlers can best preserve the toddlers’ sense of autonomy by:
a. telling the parents to let them have their own way once in a while
b. letting them throw a tantrum as long as they want without stopping it
c. finding ways to give them some choices of actions and things
d. writing their preferences on a bedside list or on a wall chart

 

 

ANS:  C

 

  Feedback
A Incorrect. The nurse working with hospitalized toddlers will not best preserve the toddlers’ sense of autonomy by telling the parents to let them have their own way once in a while, ut by teaching the parents to find ways to give them some choices of actions and things.
B Incorrect. The nurse working with hospitalized toddlers will not best preserve the toddlers’ sense of autonomy by letting them throw a tantrum as long as they want without stopping it, but by teaching the parents to find ways to give them some choices of actions and things.
C Correct. Understanding autonomy in toddlers and the negativism that is part of this task is evident with choices for a toddler. The choices must be age-appropriate and simple.
D Incorrect. The nurse working with hospitalized toddlers will not best preserve the toddlers’ sense of autonomy by writing their preferences on a bedside list or on a wall chart.

 

 

PTS:   1                    REF:   p. 530 – Nursing Care and Guidance of Infants

OBJ:   Cognitive Level: Application

 

  1. When toddlers are separated from parents or caregivers for a long time, they may look away or focus on something else then caregivers return. This behavior is most accurately interpreted as which of the following behaviors?
a. settling in and accepting that the caregivers have more important things to do
b. development of some lifelong coping skills to deal with stressful situations
c. revenge for being abandoned then they needed their parents’ or caregivers’ attention
d. detachment from losing hope for permanent reunion with parents or caregivers

 

 

ANS:  D

 

  Feedback
A Incorrect. Due to extended separation from home, the toddler may look away or focus on something else then caregivers return. This does not indicate that the toddler is settling in and accepting that the caregivers have more important things to do, but this behavior is most accurately interpreted as denial.
B Incorrect. Due to extended separation from home, the toddler may look away or focus on something else then caregivers return. This does not indicate that the toddler is developing some lifelong coping skills to deal with stressful situations.
C Incorrect. Due to extended separation from home, the toddler may look away or focus on something else then caregivers return. This does not indicate that the toddler is taking revenge for being abandoned then they needed their parents’ or caregivers’ attention.
D Correct. Due to extended separation from home, the toddler may look away or focus on something else then caregivers return. This behavior is most accurately interpreted as denial or detachment, indicating the toddler has lost hope for permanent reunion.

 

 

PTS:   1                    REF:   p. 531 – Nursing Care and Guidance of Toddlers

OBJ:   Cognitive Level: Application

 

  1. The nurse working with a toddler in the hospital wants the toddler to eat lunch. Which of the following statements by the nurse will likely result in the toddler eating lunch?
a. “Do you want your lunch?”
b. “You must eat your lunch now because you have to be done in 30 minutes!”
c. “It’s time to eat now. Do you want Pooh Bear to eat with you?”
d. “Are you hungry?”

 

 

ANS:  C

 

  Feedback
A Incorrect. Wanting a toddler in the hospital to eat lunch, the nurse will not entice the toddler to eat by offering a choice that is not age-appropriate such as, “Do you want your lunch?” Such a choice often results in a negative response by the toddler.
B Incorrect. Wanting a toddler in the hospital to eat lunch, the nurse will not entice the toddler to eat by challenging their autonomy by giving an order with a time limit. Such a statement will result in a negative response by the toddler.
C Correct. Wanting a toddler in the hospital to eat lunch, the nurse offers an age-appropriate choice, such as: “It’s time to eat now. Do you want Pooh Bear to eat with you?”
D Incorrect. Wanting a toddler in the hospital to eat lunch, the nurse knows not to ask: “Are you hungry?” What if the toddler answers, “No”?

 

 

PTS:   1                    REF:   p. 532 – Nursing Care and Guidance of Toddlers

OBJ:   Cognitive Level: Application

 

  1. Preschool children have special needs including:
a. being curious and wanting to know why
b. wanting someone to do everything for them
c. fear of failure and needing reassurance
d. wanting to be bigger and better than others

 

 

ANS:  A

 

  Feedback
A Correct. Preschool children are naturally curious, wanting to know why, they have facility with language and other skills and enjoy the beginning of independence, yet are acutely aware of their need for the presence and support of adults in their lives.
B Incorrect. Preschool children are beginning to establish independence and do not want someone to do everything for them.
C Incorrect. Preschool children are not best described as fearing failure and needing reassurance.
D Incorrect. Preschool children are not best described as wanting to be bigger and better than others.

 

 

PTS:   1                    REF:   p. 532 – Nursing Care and Guidance of Toddlers

OBJ:   Cognitive Level: Comprehension

 

  1. Preschoolers learn best through which of the following methods?
a. observations and manipulation of objects
b. abstractions presented by their caregivers
c. looking at simple picture instructions in a book
d. being told how to do something by caregivers

 

 

ANS:  A

 

  Feedback
A Correct. Preschoolers learn best through observation and manipulation of objects. Abstractions or things not seen are difficult to understand for this age group.
B Incorrect. Preschoolers do not learn best through abstractions presented by their caregivers, as they are very concrete.
C Incorrect. Preschoolers do not learn best through looking at simple picture instructions in a book, as these are abstractions.
D Incorrect. Preschoolers do not learn best through being told how to do something by caregivers, but instead by using objects and observing.

 

 

PTS:   1                    REF:   p. 532 – Nursing Care and Guidance of Toddlers

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse working with pediatric clients will keep in mind that the meaning of red to children is:
a. happiness c. hurting
b. life d. joy

 

 

ANS:  C

 

  Feedback
A Incorrect. The nurse working with pediatric clients knows that the meaning of red to children is not happiness.
B Incorrect. The nurse working with pediatric clients knows that the meaning of red to children is not life.
C Correct. Seeing blood or “taking blood” is frightening because of its symbolic nature. To many children, “Red is the color of hurting.” Their falls and scrapes and scratches and cuts are present in their minds, blood, red, injury, even the pain of the care after the fall.
D Incorrect. The nurse working with pediatric clients knows that the meaning of red to children is not joy.

 

 

PTS:   1                    REF:   p. 532 – Nursing Care and Guidance of Toddlers

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse working with a preschooler finds on assessment early in the shift that this child is not taking adequate fluids. Which of the following actions by the nurse will most likely result in the child taking more fluids?
a. telling the child he will not get better unless he drinks more
b. offering the child a reward if he drinks a certain amount each hour
c. having the doctor talk to the child and the parents
d. setting up a tea party or playing restaurant

 

 

ANS:  D

 

  Feedback
A Incorrect. Sometimes then children are having difficulty taking fluids, the nurse will not most likely tell the child he will not get better unless he drinks more. Threats are rarely effective intervention.
B Incorrect. Sometimes then children are having difficulty taking fluids, the nurse will not most likely offer the child a reward if he drinks a certain amount each hour. Bribes are not always an effective technique.
C Incorrect. Sometimes then children are having difficulty taking fluids, the nurse will never most likely have the doctor talk to the child and the parents, as this is the responsibility of the nurse and the nursing staff.
D Correct. Preschoolers are usually sociable, and group play and activities are often successful. Sometimes then children are having difficulty taking fluids, a tea party, or playing restaurant then “drinks” are ordered, is more helpful than frequent encouragement to take fluids.

 

 

PTS:   1                    REF:   p. 535 – Nursing Care and Guidance of Preschool Children

OBJ:   Cognitive Level: Application

 

  1. The nurse assigned to work with school-aged children who have been hospitalized knows that from a developmental viewpoint their special needs include:
a. opportunities to do and learn well c. an adult to debate life’s issues with
b. someone to supervise their activities d. opportunities to regress without fear

 

 

ANS:  A

 

  Feedback
A Correct. During hospitalization of school-aged children, every effort needs to be put forth to help those whose primary focus is school-related to continue to learn and maintain their individual strengths.
B Incorrect. The nurse assigned to work with school-aged children who have been hospitalized knows that from a developmental viewpoint their special needs does not include someone to supervise their activities.
C Incorrect. The nurse assigned to work with school-aged children who have been hospitalized knows that from a developmental viewpoint their special needs does not include an adult to debate life’s issues with.
D Incorrect. The nurse assigned to work with school-aged children who have been hospitalized knows that from a developmental viewpoint their special needs does not include opportunities to regress without fear. Instead, they need to maintain their skills and to continue learning.

 

 

PTS:   1                    REF:   p. 535 – Nursing Care and Guidance of Preschool Children

OBJ:   Cognitive Level: Comprehension

 

MULTIPLE RESPONSE

 

  1. Hospitalized adolescents do best then which of the following conditions exist? Select all that apply.
a. then other adolescents are present on the same unit
b. in a room with another adolescent but on a ward of mixed adolescents and adults there they can view how adults respond to their hospitalizations
c. mixed with younger children so they can be role models for the younger children
d. then offered the opportunity to participate in the governance of their space

 

 

ANS:  A, D

 

  Feedback
Correct For the hospitalized adolescent, adaptation is facilitated then other adolescents are present on the same unit.

For the hospitalized adolescent, adaptation is facilitated then the adolescent is offered the opportunity to participate in the governance of their space.

Incorrect Adaptation is not facilitated by being in a mixed unit with adolescents and adults.

Mixing the unit with younger children is also not an indication for adaptation for the hospitalized adolescent.

 

 

PTS:   1                    REF:   p. 530 – Nursing Care and Guidance of Infants

OBJ:   Cognitive Level: Application

 

 

 

CHAPTER 36: CHILD ABUSE AND NEGLECT

 

MULTIPLE CHOICE

 

  1. Which of the following statements best defines the term child maltreatment?
a. intentional injury of a child c. failure to provide what a child needs
b. not giving a child what he or she wants d. accidental harm to a child by someone

 

 

ANS:  A

 

  Feedback
A Correct: Child maltreatment is the intentional injury of a child.
B Incorrect: Child maltreatment is not considered failure to give a child what the child wants.
C Incorrect: Child maltreatment is not considered the failure to provide what a child needs.
D Incorrect: Child maltreatment is not considered accidental harm to a child by someone else. The harm or injury is intentional, not accidental.

 

 

PTS:   1                    REF:   p. 1380 – Child Abuse and Neglect

OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following statements best defines the term physical abuse?
a. bodily injury to a person that seems to have been inflicted by other than accidental means
b. purposefully beating a child so that there are highly visible marks on the child’s body
c. use of the hands applied to a child in an excessively forceful manner
d. any damage to a child that involves the use of muscle-applied force

 

 

ANS:  A

 

  Feedback
A Correct: Physical abuse is defined as bodily injury to a person that seems to have been inflicted by other than accidental means. Such injuries may include damage to the skin, including bruise, burns, bite marks, and lacerations; damage to the head; or shaken baby syndrome.
B Incorrect: In physical abuse, marks may not be visible on the child’s body. For example, with shaken baby syndrome, there may not be any visible signs of injury.
C Incorrect: Physical abuse may include more than the use of the hands applied to a child in an excessively forceful manner.
D Incorrect: Muscle-applied force may not be the etiology of physical abuse in the child.

 

 

PTS:   1                    REF:   p. 1380 – Child Abuse and Neglect

OBJ:   Cognitive Level: Comprehension

 

  1. The school nurse observes parents interacting with a school-aged child and notices that they do not show any affection toward the child and there is no evidence of emotional support or supervision. Later the nurse learns from the child that he must take care of all his own hygiene tasks, has to find something to eat on his own, and his parents never say anything nice about him. The nurse at this point believes that the parents are engaging in:
a. physical abuse c. poor parenting
b. psychological abuse d. withholding of love

 

 

ANS:  B

 

  Feedback
A Incorrect: These characteristics are not specific for physical abuse.
B Correct: Psychological abuse results from the recurrent lack of attention to the child’s needs, and includes lack of affection, emotional support, or supervision.
C Incorrect: These characteristics are not specific for poor parenting.
D Incorrect: These characteristics are not specific for withholding of love.

 

 

PTS:   1                    REF:   p. 1380 – Child Abuse and Neglect

OBJ:   Cognitive Level: Comprehension

 

  1. The majority of perpetrators of abuse to children reported to state Child Protective Service agencies as suspected victims of abuse and neglect are:
a. neighbors within one block c. parents
b. strangers d. relatives other than parents

 

 

ANS:  C

 

  Feedback
A Incorrect: Neighbors within one block are not the majority of perpetrators.
B Incorrect: Strangers are not the majority of perpetrators.
C Correct: Three-fourths of all perpetrators of abuse to children reported to the Child Protective Service agencies are caregivers.
D Incorrect: Relatives other than parents are not the majority of perpetrators.

 

 

PTS:   1                    REF:   p. 1386 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. The majority of child abuse victims fall into which of the following age ranges?
a. over 10 years c. 6 to 8 years
b. 8 to 10 years d. under 6 years

 

 

ANS:  D

 

  Feedback
A Incorrect: The majority of child abuse victims are under 6 years, not over 10 years.
B Incorrect: The majority of child abuse victims are under 6 years, not 8 to 10 years.
C Incorrect: The majority of child abuse victims are under 6 years, not 6 to 8 years.
D Correct: The majority of child abuse victims are under 6 years.

 

 

PTS:   1                    REF:   p. 1380 – Child Abuse and Neglect

OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following is the most common type of mistreatment of children?
a. physical abuse c. sexual abuse
b. neglect d. emotional maltreatment

 

 

ANS:  B

 

  Feedback
A Incorrect: The most common type of mistreatment of children is not physical abuse. Twenty-five percent of child victims are physically abused.
B Correct: The most common type of mistreatment of children is neglect. Fifty-five percent of child victims suffer from neglect.
C Incorrect: The most common type of mistreatment of children is not sexual abuse. Twelve percent of victims are sexually abused.
D Incorrect: The most common type of mistreatment of children is not emotional maltreatment. Six percent of victims are emotionally abused.

 

 

PTS:   1                    REF:   p. 1380 – Child Abuse and Neglect

OBJ:   Cognitive Level: Comprehension

 

  1. In the sociological model of family violence, family violence is viewed as:
a. a pattern of behavior that is passed from generation to generation
b. a pattern of harm within the nuclear family with no outside persons involved
c. any harmful action(s) between related persons no matter how distant the relationship is
d. harmful activities within a group designated as family no matter what the relationship

 

 

ANS:  A

 

  Feedback
A Correct: In the sociological model of family violence, family violence is viewed as a pattern of behavior that is passed from generation to generation. Although the form of abuse may change, the pattern continues. In one generation the abuse may be physical, but may change to sexual abuse in the next generation. Caregivers will construct similar abusive relationships with their own children based on their experiences of having violent caregivers.
B Incorrect: In the sociological model of family violence, family violence is not viewed as a pattern of harm within the nuclear family with no outside persons involved.
C Incorrect: In the sociological model of family violence, family violence is not viewed as any harmful action(s) between related persons no matter how distant the relationship is.
D Incorrect: In the sociological model of family violence, family violence is not viewed as harmful activities within a group designated as family no matter what the relationship.

 

 

PTS:   1                    REF:   p. 1381 – Child Abuse and Neglect

OBJ:   Cognitive Level: Comprehension

 

  1. When family violence is passed from generation to generation, this type of abuse has which of the following characteristics?
a. It continues without changing to another type.
b. The form of abuse may change.
c. It usually gets more violent.
d. It is more detrimental to the child from generation to generation.

 

 

ANS:  B

 

  Feedback
A Incorrect: Intergenerational patterns of violence do not necessarily continue without changing to another type of abuse.
B Correct: When family violence is passed from generation to generation, the form of abuse may change.
C Incorrect: When family violence is passed from generation to generation, it does not necessarily get more violent.
D Incorrect: This type of abuse is not more detrimental to the child from generation to generation.

 

 

PTS:   1                    REF:   p. 1381 – Child Abuse and Neglect

OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following children is in a high-risk family for less nurturing and more hurtful behavior?
a. a child being raised by grandparents
b. a child who is forbidden from playing with other children
c. a child being raised by two men
d. a child in a nuclear family there both parents have full-time jobs

 

 

ANS:  B

 

  Feedback
A Incorrect: A child being raised by grandparents is not necessarily in a high-risk family for abuse. The characteristics of the grandparents would have to be known.
B Correct: Children at high risk for less nurturing and more hurtful behavior live in a family system that has little contact with community groups such as school or church. These children are not involved in after-school activities and are not allowed to play with other neighborhood children.
C Incorrect: A child being raised by two men is not necessarily in a high-risk situation for abuse.
D Incorrect: A child in a nuclear family there both parents have full-time jobs is probably not in a high-risk family for abuse. One of the risk factors for abuse is stress. Families who spend increased time together under stressful conditions may not have appropriate social supports. Examples of this type of stress are poverty and unemployment.

 

 

PTS:   1                    REF:   p. 1381 – Child Abuse and Neglect

OBJ:   Cognitive Level: Application

 

  1. The social-interactional systemic perspective of child abuse and neglect says that the legitimization of violence in the family is due to which of the following factors?
a. family pathology of a genetic nature
b. increased availability of pornography
c. emphasis on hiding sexuality and not being open
d. society’s attitudes, beliefs, and values

 

 

ANS:  D

 

  Feedback
A Incorrect: According to the social-interactional systemic perspective of child abuse, the legitimization of violence in the family is not due to family pathology of a genetic nature.
B Incorrect: The legitimization of violence in the family is not due to increased availability of pornography.
C Incorrect: The legitimization of violence in the family is not due to emphasis on hiding sexuality and not being open.
D Correct: The social-interactional systemic perspective suggests society contains the attitudes, values, and beliefs that legitimize violence in families. For example, violent acts, interactions, and roles are part of society, and television, movies and videos demonstrate and illustrate the value society places on violence. Our society tends to accept violence as a matter of course, treating it casually or exploiting it to gain an audience.

 

 

PTS:   1                    REF:   p. 1381 – Child Abuse and Neglect

OBJ:   Cognitive Level: Comprehension

 

  1. According to the social-interactional systemic perspective of child abuse and neglect, four factors place the family members at risk for abuse. These risk factors are the family itself, the caregiver, the child, and:
a. chronic poverty c. the presence of a family crisis
b. genetics d. the national emphasis on sex

 

 

ANS:  C

 

  Feedback
A Incorrect: These four factors are the family itself, the caregiver, the child, but not chronic poverty.
B Incorrect: These four factors are the family itself, the caregiver, the child, but not genetics.
C Correct: These four factors are the family itself, the caregiver, the child, and the presence of a family crisis.
D Incorrect: These four factors are the family itself, the caregiver, the child, but not the national emphasis on sex.

 

 

PTS:   1                    REF:   p. 1381 – Child Abuse and Neglect

OBJ:   Cognitive Level: Comprehension

 

  1. When caregivers lack knowledge about parenting, lack parenting skills, and are emotionally immature, the child often assumes which of the following roles?
a. victim
b. caregiver role toward the caregiver
c. regressed child of regressed caregivers
d. scapegoat

 

 

ANS:  B

 

  Feedback
A Incorrect: The child does not assume the role of victim in this situation.
B Correct: When caregivers lack knowledge about parenting, lack parenting skills, and are emotionally immature, the child often assumes a caregiver role toward the caregiver. An example of this is then a 5-year old consoles an unemployed parent.
C Incorrect: The child does not assume the role of regressed child of regressed caregivers.
D Incorrect: The child does not assume the role of scapegoat.

 

 

PTS:   1                    REF:   p. 1381 – Child Abuse and Neglect

OBJ:   Cognitive Level: Application

 

  1. Which of the following examples best defines the term role reversal?
a. The child assumes a caregiver role toward the caregiver.
b. The good child takes on a bad child role.
c. A person who has been a good provider quits his or her job.
d. A lazy person becomes very productive in the family.

 

 

ANS:  A

 

  Feedback
A Correct: Role reversal occurs then the child assumes a caregiver role toward the caregiver.
B Incorrect: Role reversal is not exemplified by the good child taking on a bad child role.
C Incorrect: Role reversal is not defined as a person who has been a good provider quitting his or her job.
D Incorrect: Role reversal is not defined as a lazy person becoming very productive in the family.

 

 

PTS:   1                    REF:   p. 1383 – Theoretical Approaches to Child Abuse and Neglect

OBJ:   Cognitive Level: Comprehension

 

  1. When there is a depressed parent in the family, it is most likely that the depression will have which of the following effects?
a. will not affect the person’s ability or performance in parenting
b. will cause the parent who is depressed to try harder to be a good parent
c. places the parent at risk for physically or emotionally abusing the children
d. will be seen in the child during the growing-up years

 

 

ANS:  C

 

  Feedback
A Incorrect: Depression will affect the person’s ability or performance in parenting.
B Incorrect: Depression will not cause the parent who is depressed to try harder to be a good parent.
C Correct: A depressed parent is at risk for physically or emotionally abusing the children. Such an individual may be irritable or withdrawn from family members, not have the emotional energy to manage the demanding needs of a child, or become provoked and use harsher punishment than is necessary or appropriate.
D Incorrect: The most likely effect of depression in a parent is not that depression will be seen in the child during the growing-up years.

 

 

PTS:   1                    REF:   p. 1383 – Theoretical Approaches to Child Abuse and Neglect

OBJ:   Cognitive Level: Application

 

  1. The nurse working in the pediatric clinic notices that a newborn seems particularly fussy. The mother verifies that this is a very “fussy baby and that it is impossible to soothe the baby.” In thinking through what to further assess and what to teach the mother, the nurse will keep in mind that fussy babies are:
a. often in some kind of pain c. often victims of the mother’s drug use
b. somewhat neurologically unstable d. at greater risk for abuse

 

 

ANS:  D

 

  Feedback
A Incorrect: Fussy babies are not necessarily in some kind of pain. Some infants are born with a fussy temperament.
B Incorrect: Fussy babies are not somewhat neurologically unstable.
C Incorrect: Fussy babies are not necessarily the victim of the mother’s drug use.
D Correct: Infants with a fussy, unsoothable, difficult temperament are most likely to resist a caregiver’s attempt at comforting, placing them at greater risk for abuse.

 

 

PTS:   1                    REF:   p. 1383 – Theoretical Approaches to Child Abuse and Neglect

OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following children are at greatest risk of abuse or neglect by the parents?
a. postmaturity babies
b. 13-year-old children
c. children with high intelligent quotient (IQ)
d. premature infants

 

 

ANS:  D

 

  Feedback
A Incorrect: Postmature babies are not at greatest risk of abuse or neglect by the parents.
B Incorrect: 13-year-old children are not at greatest risk of abuse or neglect by the parents. Instead young children (particularly those younger than 3 years) are at high risk for abuse or neglect.
C Incorrect: Children with high intelligent quotient (IQ) are not at greatest risk of abuse or neglect by the parents.
D Correct: Premature infants are at greatest risk of abuse or neglect by the parents because they place great demands on the parents.

 

 

PTS:   1                    REF:   p. 1383 – Theoretical Approaches to Child Abuse and Neglect

OBJ:   Cognitive Level: Application

 

  1. An infant is separated from his parents for a few minutes while the nurse weighs him. The infant seems distressed and looks around for the mother. The mother soothes the infant then the nurse is through weighing him. This type of attachment between mother and baby is most likely which of the following types of attachment?
a. avoidant c. secure
b. disorganized d. strange

 

 

ANS:  C

 

  Feedback
A Incorrect: This type of attachment between mother and baby is not likely an avoidant attachment. In avoidant attachment the infant realizes the caregiver will not always be available to provide comfort. The infant exhibits “independent” behavior without acknowledging the caregiver prior to separation, exhibits minimal distress during separation, and avoids emotional support offered by the caregiver upon reunion.
B Incorrect: This type of attachment is not disorganized attachment. In this situation the infant is confused and cannot understand how to get physiological and psychological needs met by the caregiver. This infant may be rejected or comforted by the caregiver.
C Correct: This type of attachment between mother and baby is most likely a secure attachment.
D Incorrect: This type of attachment is not strange attachment. Strange is not a type of attachment.

 

 

PTS:   1                    REF:   p. 1384 – Theoretical Approaches to Child Abuse and Neglect

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse is caring for an infant who shows no distress then her parents leave, and then they return the infant ignores her parents. There was no evidence of distress while the parents were gone. This type of attachment between the infant and parents is most likely which of the following types of attachment?
a. secure c. ambivalent
b. avoidant d. detached

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not a secure attachment.
B Correct: This is a description of avoidant attachment.
C Incorrect: This is not an ambivalent attachment. In this type of attachment the infant understands the caregiver is not reliable in meeting physiological and psychological needs and remains close before separation, is distressed during separation, demonstrates a combination of contact-seeking behaviors with temper tantrums during reunion, and may display indifference then comforted by the caregiver.
D Incorrect: This is not a detached attachment. Detached is not a type of attachment.

 

 

PTS:   1                    REF:   p. 1384 – Theoretical Approaches to Child Abuse and Neglect

OBJ:   Cognitive Level: Application

 

  1. Asian parents bring their child to the hospital with what appears to be burns or abrasions on the neck, spines, and ribs. The parents use the words cao gao. The nurse is aware that these physical findings and the term cao gao refers to:
a. an Asian practice of burning and inflicting pain on children who won’t obey
b. parents rubbing a pumice stone over a child’s body to sand off evil spirits
c. rubbing a coin or a spoon heated in oil on an ill child’s neck, spine, and ribs
d. burning incense on a rice paper on a child’s upper body to bring good luck

 

 

ANS:  C

 

  Feedback
A Incorrect: The term cao gao does not refer to an Asian practice of burning and inflicting pain on children who won’t obey.
B Incorrect: The term cao gao does not refer to parents rubbing a pumice stone over a child’s body to sand off evil spirits.
C Correct: The term cao gao or coining refers to a practice of Southeast Asians to treat minor ailments and involves rubbing a coin or a spoon heated in oil on an ill child’s neck, spine, and ribs. It may create a burn or abrasions.
D Incorrect: The term cao gao does not refer to burning incense on a rice paper on a child’s upper body to bring good luck.

 

 

PTS:   1                    REF:   p. 1384 – Theoretical Approaches to Child Abuse and Neglect

OBJ:   Cognitive Level: Comprehension

 

  1. A child of Russian parentage is brought to the hospital with what appears to be second-degree burns. The nurse is aware of a Russian practice of treating headaches and abdominal pain by creating a vacuum under a cup or glass then a small amount of burning material is placed on the skin. This practice is called:
a. tassos c. ventosos
b. mal de vaso d. veritas

 

 

ANS:  C

 

  Feedback
A Incorrect: This practice is not called tassos.
B Incorrect: This practice is not called mal de vaso.
C Correct: Ventosos or cupping involves creating a vacuum under a cup or glass then a small amount of burning material is placed on the skin.
D Incorrect: This practice is not called veritas.

 

 

PTS:   1                    REF:   p. 1384 – Theoretical Approaches to Child Abuse and Neglect

OBJ:   Cognitive Level: Comprehension

 

  1. A child is brought to the pediatric clinic for immunizations for school. The parent wants the immunizations to be given in the arm. The nurse explains that at least one of the injections has to be given in the buttocks. When the nurse pulls the diaper down, the nurse sees bite marks around the genital and buttock area. Which of the following explanations is most likely?
a. A neighborhood toddler is in a biting stage.
b. This child is in a biting stage, and the parents bit him back to get him to stop biting.
c. The child is a victim of sexual or physical abuse.
d. This must have happened then the dog slept with the child.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not a credible explanation. Children tend to bite other children on areas other than the genitals or buttocks.
B Incorrect: This is not a likely explanation of the bite marks.
C Correct: Bite marks around the genital and buttock area are indicators of physical or sexual abuse. Lesions from bites are oval or semicircular. If the diameter across the lesion is greater than 3 cm, it was probably inflicted by an adult.
D Incorrect: A bite from an animal such as a dog has sharp, puncture, slash or tear marks. This is not a likely explanation.

 

 

PTS:   1                    REF:   p. 1385 – Theoretical Approaches to Child Abuse and Neglect

OBJ:   Cognitive Level: Application

 

  1. A parent brings a toddler to the pediatric clinic. The nurse observes a number of bruises on the child in various stages of healing. The parent claims the toddler bruises easily. The best action on the part of the pediatrician and the nurse would be to:
a. believe the parents and schedule an appointment in 2 weeks
b. report this to child and family services and order a screening battery of bleeding and clotting blood work
c. check with the other parent or another caregiver to see what he or she might be able to add to this history
d. tell the parent that it is clear that he or she is lying and to tell the truth

 

 

ANS:  B

 

  Feedback
A Incorrect: A number of bruises in various stages of healing is a “red flag” indicator for abuse. So the best action to be suspicious of the parent’s explanation.
B Correct: Physical abuse indicators include bruises in various stages of healing. The color of the bruises helps determine if the injury occurred as a single episode or over a period of time. Bruises resulting from physical abuse will be various colors, from reddish blue or purple to yellow, brown and fading. To avoid errors in diagnosis, children who present with multiple bruises that do not reflect the use of an object should be reported to child and family services. Screening tests of bleeding and clotting should be ordered to evaluate for a bleeding disorder.
C Incorrect: A number of bruises in various stages of healing is a “red flag” indicator for abuse. So checking with the other parent or another caregiver to see what he or she might be able to add to this history is not the best action.
D Incorrect: This is an inappropriate action. It is important to establish a trusting relationship with the parent so a supportive, nonblaming approach is best.

 

 

PTS:   1                    REF:   p. 1385 – Theoretical Approaches to Child Abuse and Neglect

OBJ:   Cognitive Level: Application

 

  1. When the nurse sees a child who has burns on the backs of the legs and the top of the buttocks, and an area that is not burned in the center of the buttocks, the nurse will:
a. tend to believe the parents who say the child got into the tub accidentally before it cooled off
b. suspect that the child’s buttocks were held forcibly against the bottom of the tub
c. suspect that the parents poured hot liquids on some areas of the legs and buttocks
d. think that the child backed up against a heater or was held there by the parents

 

 

ANS:  B

 

  Feedback
A Incorrect: An accidental burn as a result of a child getting into a bathtub before the water cooled off will occur on the child’s feet. So the nurse should be suspicious because the explanation of burn doesn’t seem consistent with the injury.
B Correct: The description of this burn indicates an immersion burn often used as a form of punishment for problem behaviors in toilet training. It is caused by purposefully placing the child’s buttocks in hot water and holding her or him against the bottom of the tub.
C Incorrect: When a parent pours hot liquids on a child, it usually involves the back, lateral side of the face, or shoulder, not the legs and buttocks.
D Incorrect: The description of this burn is inconsistent with this explanation of how it occurred.

 

 

PTS:   1                    REF:   p. 1386 – Types of Child Abuse

OBJ:   Cognitive Level: Application

 

  1. A child comes to the clinic with bruises that are yellow-brown and fading. Based on the characteristics of these bruises, how old is the injury?
a. 3 days c. 6 days
b. 4 days d. over 1 week

 

 

ANS:  D

 

  Feedback
A Incorrect: A bruise that occurred 3 to 5 days ago will be yellowish-green to brown.
B Incorrect: A bruise that occurred 3 to 5 days ago will be yellowish-green to brown.
C Incorrect: A bruise that occurred 6 days ago will be yellow-fading.
D Correct: A bruise that is yellow-brown and fading indicates an injury over 1 week old.

 

 

PTS:   1                    REF:   p. 1388 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse notices that a child has reddish blue to purple bruises that have margins. How old are these bruises?
a. 5 days c. more than 10 days
b. 7 days d. less than 1 day

 

 

ANS:  D

 

  Feedback
A Incorrect: Bruises that are 5 days old are yellowish-green to brown.
B Incorrect: Bruises that are 7 days old are yellow-fading in color.
C Incorrect: Bruises that are more than 10 days old are yellow-brown-fading in color.
D Correct: Reddish blue to purple bruises are less than 1 day old.

 

 

PTS:   1                    REF:   p. 1388 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following explains why children between the ages of 1 and 5 are more at risk than older children for getting serious burn injuries?
a. They tend to aggravate and make their parents angry more than older children do.
b. Children this age are small and cannot fight back then parents are abusive.
c. The skin of a child is thinner and much more sensitive than an adult’s skin.
d. Children this age are more curious and tend to get into things very quickly.

 

 

ANS:  C

 

  Feedback
A Incorrect: This is not a factor explaining why children between the ages of 1 and 5 are more at risk for getting serious burn injuries.
B Incorrect: This is not a factor explaining why children between the ages of 1 and 5 are more at risk for getting serious burn injuries.
C Correct: Children between the ages of 1 and 5 are more at risk than older children for getting serious burn injuries because their skin is thinner and much more sensitive than an older child or adult’s skin.
D Incorrect: Children this age may have a number of bruises, not burns, as a result of being more curious and getting into things very quickly.

 

 

PTS:   1                    REF:   p. 1388 – Types of Child Abuse

OBJ:   Cognitive Level: Application

 

  1. Which of the following statements best describes the term stocking or glove type burn?
a. The burn has the look of a stocking or glove because the child tried to protect him- or herself from being immersed in hot scalding water.
b. The parents have dipped the child into hot liquid while he or she was asleep.
c. The child was wearing a stocking or a glove then immersed in hot liquid.
d. The parent was wearing heavy gloves or stockings on his or her hands while immersing the child in hot liquids or hot scalding water.

 

 

ANS:  A

 

  Feedback
A Correct: A stocking or glove type burn has the look of a stocking or glove because the child tried to protect him- or herself from being immersed in hot scalding water.
B Incorrect: If the parents dipped a child into hot liquid while he or she was asleep, the burns would depend on what part of the body came in contact with the water.
C Incorrect: A stocking or glove type burn has the look of a stocking or glove because the child tried to protect him- or herself from being immersed in hot scalding water.
D Incorrect: This statement does not accurately describe how a stocking or glove type burn occurred.

 

 

PTS:   1                    REF:   p. 1388 – Types of Child Abuse

OBJ:   Cognitive Level: Application

 

  1. What is meant by the term flexion burns?
a. a burn caused by a cigarette or other hot object applied to the elbow of a bent arm
b. the body part immersed in hot liquids is held in a flexed position
c. the burn is so serious the child cannot flex his or her extremity
d. the parent flexed his or her own arms to avoid being burned while burning the child

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not an accurate description of a flexion burn.
B Correct: A flexion burn occurs then a caregiver purposefully immerses a child in hot water and the body part immersed is held in a flexed position.
C Incorrect: This is not an accurate description of a flexion burn.
D Incorrect: This is not an accurate description of a flexion burn.

 

 

PTS:   1                    REF:   p. 1388 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. What is the characteristic pattern of the burn in a flexion burn?
a. tiger pattern c. concentric circles
b. zigzag d. zebra pattern

 

 

ANS:  D

 

  Feedback
A Incorrect: A tiger pattern is not the characteristic pattern of the burn in a flexion burn.
B Incorrect: A zigzag pattern is not the characteristic pattern of the burn in a flexion burn.
C Incorrect: Concentric circles are not the characteristic pattern of the burn in a flexion burn.
D Correct: A zebra pattern is the characteristic pattern of the burn in a flexion burn. For example, a child who has hot coffee thrown on his arm may flex the arm so that only the top parts of the forearm and upper arm are burned, and the inside of the arm is protected by flexion in response to oncoming hot liquid.

 

 

PTS:   1                    REF:   p. 1388 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. Most child abuse deaths occur for which of the following reasons?
a. neurological injuries, with most of these being head injuries
b. bleeding from cuts
c. smothering or serious lack of oxygen for any number of reasons
d. abdominal injuries

 

 

ANS:  A

 

  Feedback
A Correct: Most child abuse deaths occur from neurological injuries, with most of these being head injuries, involving skull fractures and intracranial hemorrhage.
B Incorrect: Most child abuse deaths do not occur from bleeding from cuts.
C Incorrect: Most child abuse deaths do not occur from smothering or serious lack of oxygen for any number of reasons.
D Incorrect: Most child abuse deaths do not occur from abdominal injuries. Abdominal injuries rank second to neurological injuries as the major cause of abuse-related deaths.

 

 

PTS:   1                    REF:   p. 1388 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following is a classic sign of shaken baby syndrome?
a. chills and fever
b. fear and withdrawal
c. edema of the extremities and bloated appearance to the abdominal area of the body
d. retinal hemorrhage, usually bilaterally with subdural or subarachnoid hemorrhages

 

 

ANS:  D

 

  Feedback
A Incorrect: These symptoms are not a classic sign of shaken baby syndrome.
B Incorrect: These symptoms are not a classic sign of shaken baby syndrome.
C Incorrect: These symptoms are not a classic sign of shaken baby syndrome.
D Correct: A classic sign of shaken baby syndrome is retinal hemorrhage, usually bilaterally with subdural or subarachnoid hemorrhages.

 

 

PTS:   1                    REF:   p. 1388 – Types of Child Abuse

OBJ:   Cognitive Level: Application

 

  1. A father calls emergency medical services (EMS) for his 1-year-old infant who was vomiting and then experienced a series of seizures. Upon admission to the hospital, the infant was listless and irritable, had bradycardia, and had periods of apnea. The infant has now lapsed into a coma. Which of the following conditions will the nurse and the health care team members suspect and most want to rule out?
a. spinal meningitis c. fever-induced seizures
b. encephalitis d. shaken baby syndrome (SBS)

 

 

ANS:  D

 

  Feedback
A Incorrect: These manifestations are similar to those seen in spinal meningitis, but the health care team members would be most concerned and want to rule out SBS. The infant is at risk for additional injuries (death) from shaking if abuse has occurred. One-third of children with SBS die from their injuries; and one-third experience permanent injury.
B Incorrect: Some of these manifestations also occur in encephalitis. However, health care team members would be most concerned and want to rule out SBS. The infant is at risk for additional injuries (death) from shaking if abuse has occurred.
C Incorrect: Fever-induced seizures are brief, clonic, or tonic, clonic in nature. The other manifestations in this situation would not be evident with fever-induced seizures.
D Correct: Infants should be suspected of SBS with any signs of head injury, including poor feeding or vomiting, irritability, listlessness, lethargy, bradycardia, apnea, seizures coma, bulging fontanels, large head circumference, hypothermia, or failure to thrive. The classic triad of SBS is hematoma, brain edema and retinal hemorrhages, usually bilateral.

 

 

PTS:   1                    REF:   p. 1388 – Types of Child Abuse

OBJ:   Cognitive Level: Application

 

  1. Risk factors for shaken baby syndrome include:
a. stressful life events
b. gender with women mostly responsible
c. multiple births within a family
d. age of parents, especially elder parents

 

 

ANS:  A

 

  Feedback
A Correct: Risk factors for shaken baby syndrome include stressful life events such as social, physical or financial problems.
B Incorrect: Men are mostly responsible for SBS and deaths attributed to SBS.
C Incorrect: Multiple births within a family are not risk factors for SBS.
D Incorrect: Elder parents are not a risk factor for any type of abuse. Instead caregivers who abuse their children tend to be young.

 

 

PTS:   1                    REF:   p. 1388 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following is the second major cause of abuse-related deaths?
a. burns c. falls due to pushing or dropping
b. abdominal injuries d. poisoning

 

 

ANS:  B

 

  Feedback
A Incorrect: Burns are not the second major cause of abuse-related deaths.
B Correct: The second major cause of abuse-related deaths is abdominal injuries.
C Incorrect: Falls due to pushing or dropping are not the second major cause of abuse-related deaths.
D Incorrect: Poisoning is not the second major cause of abuse-related deaths.

 

 

PTS:   1                    REF:   p. 1388 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. The school nurse notices a child who has a frightened look then adults approach, appears sad, hangs around after school, and seems reluctant to go home. This child seemed very distressed then a classmate was crying after falling on the playground. The nurse tried to console this child while consoling the injured child. The school nurse realizes that this child has some of the classic symptoms of:
a. a physically abused child c. mental retardation
b. autism d. early mental illness

 

 

ANS:  A

 

  Feedback
A Correct: The child who has been physically abused may exhibit passive behaviors such as withdrawal, depression or a sad mood. Other behaviors can include anger, hostility, or being frightened then approached by an adult. The child has a fear or reluctance to go home and displays anxiety and distress when hearing other children cry. This child has some of the classic symptoms of a physically abused child.
B Incorrect: This child does not have the classic symptoms of autism.
C Incorrect: This child does not have the classic symptoms of mental retardation.
D Incorrect: This child does not have the classic symptoms of early mental illness.

 

 

PTS:   1                    REF:   p. 1389 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse assessing a child who is suspected of being a victim of abuse will interview the child privately and will:
a. find out what the child was doing before the injuries occurred
b. reassure the child that he or she is not “in trouble” and that the child has not done anything wrong
c. tell the child that he or she has nothing to fear from the parents or the legal system
d. see what the child has done in response to any abusive behavior from the parents

 

 

ANS:  B

 

  Feedback
A Incorrect: This is an inappropriate intervention and assumes the child did something wrong and deserved the abuse.
B Correct: When interviewing a child suspected of being abused, it is important to reassure the child that he or she is not “in trouble” and that the child has not done anything wrong. Children often assume they are to blame for the caregiver’s actions; therefore, it is important to remind them the injuries are not their fault.
C Incorrect: Telling the child that he or she has nothing to fear from the parents is not an appropriate intervention. Some parents may become angry that the child talked with the nurse and react by injuring the child again.
D Incorrect: Seeing what the child has done in response to any abusive behavior from the parents is not significant information to obtain.

 

 

PTS:   1                    REF:   p. 1391 – Types of Child Abuse

OBJ:   Cognitive Level: Application

 

  1. The nurse is developing a care plan for the parents of a toddler who was born prematurely and was in the neonatal intensive care unit for 2 months. The mother has been using a belt to discipline the child. The father is not very attentive to the needs of the mother or the baby. Which of the following nursing diagnoses would best fit this situation?
a. interrupted family processes due to disrupted attachment
b. deficient knowledge related to lack of parenting instructions
c. high risk for injury to others related to mood disturbance
d. marital discord in need of therapy related to lack of information

 

 

ANS:  A

 

  Feedback
A Correct: The nursing diagnosis that would best fit this situation is interrupted family processes due to disrupted attachment. An infant who was separated from his parents for the first 2 months of life due to prematurity and hospitalization has not established a nurturing bond or appropriate attachment. Weak attachment bonds can result in caregivers viewing the child as an “imperfect child” and place him at risk for abuse.
B Incorrect: This nursing diagnosis does not best fit this situation.
C Incorrect: This nursing diagnosis does not best fit this situation.
D Incorrect: This nursing diagnosis does not best fit this situation.

 

 

PTS:   1                    REF:   p. 1393 – Types of Child Abuse

OBJ:   Cognitive Level: Application

 

  1. Which of the following outcomes is most important in the nursing care plan for a family engaging in physical abuse of the children?
a. The child will remain safe with no evidence of physical abuse or neglect.
b. The parents will demonstrate at least one nurturing behavior.
c. The parents will discuss normal growth and development for the age of the child.
d. The child will report all instances of threatened or actual abuse and neglect.

 

 

ANS:  A

 

  Feedback
A Correct: The most important outcome is that the child will remain safe with no evidence of further physical abuse or neglect.
B Incorrect: This is not the most important outcome. The child’s safety is paramount.
C Incorrect: This is not the most important outcome. The child’s safety is paramount.
D Incorrect: This is not the most important outcome. The child’s safety is paramount.

 

 

PTS:   1                    REF:   p. 1394 – Types of Child Abuse

OBJ:   Cognitive Level: Application

 

  1. Which of the following statements best describes Munchausen syndrome by proxy?
a. The child has uncontrollable facial and vocal tics as a result of emotional abuse by caregivers.
b. Caregivers make up signs and symptoms of disease or unnecessarily expose their child to harmful medical interventions and painful invasive procedures.
c. The parents give the children no attention unless they are exhibiting signs and symptoms of illness.
d. Relatives of a child get all the attention in the family and the child is forced to fake illness to get any attention at all.

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not a description of Munchausen syndrome by proxy.
B Correct: Munchausen syndrome by proxy refers to caregivers who fabricate signs and symptoms of disease or unnecessarily expose their child to harmful medical interventions and painful invasive procedures. The perpetrator uses the disease to escape from marital, physical, or emotional problems, or poor self-esteem. By attending to the supposed needs of the child, the caregiver escapes the reality of her problems.
C Incorrect: This is not a description of Munchausen syndrome by proxy.
D Incorrect: This is not a description of Munchausen syndrome by proxy.

 

 

PTS:   1                    REF:   p. 1391 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. The adult abuser who receives a diagnosis of Munchausen syndrome by proxy:
a. is the victim of unnecessary medical treatment at the hands of another adult
b. was the victim of unnecessary treatment in the past and now carries this pattern on
c. uses this disease to escape from poor self-esteem, marital, physical, or mental problems
d. is an uncaring and cunning individual who has psychological problems similar to antisocial behavior

 

 

ANS:  C

 

  Feedback
A Incorrect: The adult abuser is not the victim of unnecessary medical treatment at the hands of another adult.
B Incorrect: The adult abuser was not the victim of unnecessary treatment in the past and now carries this pattern on.
C Correct: The adult abuser who receives a diagnosis of Munchausen syndrome by proxy uses this disease to escape from poor self-esteem, marital, physical, or mental problems. This disorder includes the intentional production or feigning of psychological or physical symptoms in the child for the purpose of indirectly assuming the sick role.
D Incorrect: The adult abuser is not an uncaring and cunning individual who has psychological problems similar to antisocial behavior. Many abusers fulfill the diagnostic criteria for borderline personality disorder with a rigid defensive structure and a poor identity formation.

 

 

PTS:   1                    REF:   p. 1391 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse will establish which of the following kinds of relationships with the family and the person suspected of having Munchausen syndrome by proxy?
a. distant c. uninvolved
b. trusting d. opponent

 

 

ANS:  B

 

  Feedback
A Incorrect: The nurse will not establish distant relationships with the family and the person suspected of having Munchausen syndrome by proxy.
B Correct: The nurse will establish trusting relationships with the family and the person suspected of having Munchausen syndrome by proxy. A trusting, therapeutic relationship is vital to the success of treatment, given the client’s resistance to the concept that no physical cause for the symptoms exist. Therapeutic interventions must address ways to assist the client to get needs met without fabricating signs and symptoms in their child.
C Incorrect: The nurse will not establish uninvolved relationships with the family and the person suspected of having Munchausen syndrome by proxy.
D Incorrect: The nurse will not establish opponent relationships with the family and the person suspected of having Munchausen syndrome by proxy.

 

 

PTS:   1                    REF:   p. 1391 – Types of Child Abuse

OBJ:   Cognitive Level: Application

 

  1. The school nurse is working with a child who seems angry and hits or hurts other children. Children who hurt other children are most often:
a. victims of abuse themselves
b. victims of manic depressive illness
c. individuals who are neurologically impaired
d. persons with brain damage

 

 

ANS:  A

 

  Feedback
A Correct: Children who hurt their siblings, peers, pets, or neighborhood animals are most often victims of abuse themselves.
B Incorrect: Children who hurt other children are not most often victims of manic depressive illness.
C Incorrect: Children who hurt other children are not most often individuals who are neurologically impaired.
D Incorrect: Children who hurt other children are not most often persons with brain damage.

 

 

PTS:   1                    REF:   p. 1392 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following statements best describes child abandonment?
a. leaving town quickly and never looking back
b. failure to pick up children promptly then others are caring for them or failure to let the children know there you are
c. desertion of a child without arranging for reasonable care and providing no communication about caregiver’s location
d. caregivers intentionally withholding, without cause or excuse, care, presence, love, protection, maintenance, and affection

 

 

ANS:  C

 

  Feedback
A Incorrect: Child abandonment is not defined as leaving town quickly and never looking back.
B Incorrect: Child abandonment is not defined as failure to pick up children promptly then others are caring for them or failure to let the children know there you are.
C Correct: Child abandonment is defined as desertion of a child without arranging for reasonable care and providing no communication about caregiver’s location.
D Incorrect: Child abandonment is not defined as caregivers intentionally withholding, without cause or excuse, care, presence, love, protection, maintenance, and affection.

 

 

PTS:   1                    REF:   p. 1392 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following statements best describes child neglect?
a. not giving one’s child all the toys and advantages that other parents provide
b. not sending a brilliant child to college or otherwise providing for the child’s future
c. not providing special dance lessons or music lessons then the child asks for these lessons
d. then a child experiences predictable injury or impairment because of caregiver inattention

 

 

ANS:  D

 

  Feedback
A Incorrect: Child neglect is not described as failure to give one’s child all the toys and advantages that other parents provide.
B Incorrect: Child neglect is not described as failure to send a brilliant child to college or otherwise providing for the child’s future.
C Incorrect: Child neglect is not described as failure to provide special dance lessons or music lessons then the child asks for these lessons.
D Correct: Child neglect occurs then a child experiences predictable injury or impairment because of caregiver inattention. Neglect is often suspected in children who are not of normal height and weight for age.

 

 

PTS:   1                    REF:   p. 1392 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. The school nurse notices a child who is wearing old, dirty, poor-fitting clothes; is always hungry; has no lunch money; and is always tired. When the nurse asks the boy about his tiredness, he talks of playing outside until midnight. The nurse will suspect that this child is:
a. a victim of child neglect
b. the victim of poverty
c. an orphan
d. being raised by a parent of low intelligence quotient (IQ)

 

 

ANS:  A

 

  Feedback
A Correct: The nurse will suspect that this child is a victim of child neglect.
B Incorrect:The nurse not will suspect that this child is a victim of poverty.
C Incorrect: The nurse not will suspect that this child is an orphan.
D Incorrect: The nurse not will suspect that this child is being raised by a parent of low intelligence quotient (IQ).

 

 

PTS:   1                    REF:   p. 1392 – Types of Child Abuse

OBJ:   Cognitive Level: Application

 

  1. Which of the following is the best example of psychological abuse that is an act of commission?
a. not attending parents’ night at the school
b. telling a child that he or she is dumb and will not amount to anything
c. forgetting to give a child money or food for lunch
d. not getting a child his or her vaccinations for school and having problems from this

 

 

ANS:  B

 

  Feedback
A Incorrect: This is not an example of commission, but of omission.
B Correct: Psychological abuse is defined as acts of omission or commission. It also involves the presence of hostile behavior as well as the absence of positive parenting behaviors. The best example of commission is telling a child that he or she is dumb and will not amount to anything.
C Incorrect: This is not an example of commission, but of omission.
D Incorrect: This is not an example of commission, but of omission.

 

 

PTS:   1                    REF:   p. 1392 – Types of Child Abuse

OBJ:   Cognitive Level: Application

 

  1. Theorists believe that the behavior of caregivers who psychologically abuse their children stem from:
a. not having experienced warm, caring parenting as children, not having their emotional needs met, and getting low levels of support
b. criminal minds who are cunning and calculate how to be mean to children and punish them
c. biochemical changes in the brain causing some people to have increased and even insatiable sexual urges toward children
d. a childish mind that relates better to children than to adults who engage in problem solving and more adult behaviors

 

 

ANS:  A

 

  Feedback
A Correct: Theorists believe that the behavior of caregivers who psychologically abuse their children stem from not having experienced warm, caring parenting as children, not having their emotional needs met, and getting low levels of support. The caregivers’ behavior may represent a re-creation of patterns of psychological abuse experienced as a child.
B Incorrect: The behavior of caregivers who psychologically abuse their children does not stem from criminal minds that are cunning and calculate how to be mean to children and punish them.
C Incorrect: The behavior of caregivers who psychologically abuse their children does not stem from biochemical changes in the brain causing some people to have increased and even insatiable sexual urges toward children.
D Incorrect: The behavior of caregivers who psychologically abuse their children does not stem from a childish mind that relates better to children than to adults who engage in problem solving and more adult behaviors.

 

 

PTS:   1                    REF:   p. 1392 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. Which of the following signs or symptoms would most lead the nurse to believe a child is being psychologically abused?
a. working hard to get along well with other children
b. high self-esteem and good academic performance
c. a close peer group since preschool
d. self-defeating and self-mutilating behaviors

 

 

ANS:  D

 

  Feedback
A Incorrect: Working hard to get along well with other children are not indicators suggesting psychological abuse.
B Incorrect: High self-esteem and good academic performance are not indicators suggesting psychological abuse. Instead, low self-esteem and poor academic performance are indicators of psychological abuse.
C Incorrect: A close peer group since preschool is not an indicator suggesting psychological abuse. Rather, a child who has been psychologically abused lacks friends or a peer group.
D Correct: Self-defeating and self-mutilating behaviors in a child are indicators suggesting psychological abuse.

 

 

PTS:   1                    REF:   p. 1397 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. The nurse is working with a teenage girl who has been having sex with an adult male. The nurse is aware that this constitutes
a. statutory rape c. sex with permission
b. permissive sex d. an offense

 

 

ANS:  A

 

  Feedback
A Correct: A teenage girl who has been having sex with an adult male constitutes statutory rape which is defined as consensual sexual relations between a minor and an adult.
B Incorrect: A teenage girl who has been having sex with an adult male does not constitute permissive sex.
C Incorrect: A teenage girl who has been having sex with an adult male does not constitute sex with permission.
D Incorrect: A teenage girl who has been having sex with an adult male is not an offense but is a legal matter.

 

 

PTS:   1                    REF:   p. 1397 – Types of Child Abuse

OBJ:   Cognitive Level: Application

 

  1. Which of the following statements best describes acquaintance rape or date rape?
a. then two people don’t love each other and engage in sexual activities
b. sexual intercourse committed with force or the threat of force without a person’s consent
c. then someone on a date tricks the other person into having sexual intercourse
d. sexual intercourse then one person engaging in the activity is unsure about wanting to do so

 

 

ANS:  B

 

  Feedback
A Incorrect: Acquaintance rape or date rape is not described as then two people don’t love each other and engage in sexual activities.
B Correct: Acquaintance rape or date rape is best described as sexual intercourse committed with force or the threat of force without a person’s consent. The victim and perpetrator know one another either socially or professionally.
C Incorrect: Acquaintance rape or date rape is not described as then someone on a date tricks the other person into having sexual intercourse.
D Incorrect: Acquaintance rape or date rape is not described as sexual intercourse then one person engaging in the activity is unsure about wanting to do so.

 

 

PTS:   1                    REF:   p. 1397 – Types of Child Abuse

OBJ:   Cognitive Level: Application

 

  1. Incest is most likely to occur between:
a. family members in a household of poverty
b. parents and children
c. high achievers
d. siblings

 

 

ANS:  D

 

  Feedback
A Incorrect: Incest is not most likely to occur between family members in a household of poverty.
B Incorrect: Incest is not most likely to occur between parents and children.
C Incorrect: Incest is not most likely to occur between high achievers.
D Correct: Incest is most likely to occur between siblings. Incest is defined as sexual intercourse between closely related persons. Sibling incest has been estimated to be at least five times more common than parent-child incest.

 

 

PTS:   1                    REF:   p. 1398 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

  1. Nudity, disrobing, and genital exposure by an adult in front of a child, as well as observing a child undressed, sexual touching, and contact for prostitution or child pornography, are said to be:
a. traumatization c. exploitation
b. familiarization d. fraternization

 

 

ANS:  C

 

  Feedback
A Incorrect: These behaviors are not said to be traumatization.
B Incorrect: These behaviors are not said to be familiarization.
C Correct: Nudity, disrobing, and genital exposure by an adult in front of a child, as well as observing a child undressed, sexual touching, and contact for prostitution or child pornography, are said to be exploitation. The child’s emotional development is affected by this type of abuse, resulting in shame, guilt, depression, anxiety, psychosomatic disorders, substance abuse, ADHD, and conduct or oppositional disorders.
D Incorrect: These behaviors are not said to be fraternization.

 

 

PTS:   1                    REF:   p. 1398 – Types of Child Abuse

OBJ:   Cognitive Level: Comprehension

 

MULTIPLE RESPONSE

 

  1. Nurses have an integral role in preventing child abuse and family violence through which of the following interventions? Select all that apply.
a. educating the public c. becoming involved in health policy
b. supporting mental health initiatives d. supporting family health initiatives

 

 

ANS:  A, B, C, D

 

  Feedback
Correct Nurses have an integral role in the prevention of child abuse and family violence through educating the public.

Nurses have an integral role in the prevention of child abuse and family violence through supporting mental health initiatives.

Nurses have an integral role in the prevention of child abuse and family violence through becoming involved in health policy.

Nurses have an integral role in the prevention of child abuse and family violence through supporting family health initiatives.

Incorrect All options are correct.

 

 

PTS:   1                    REF:   p. 1380 – Child Abuse and Neglect

OBJ:   Cognitive Level: Application

 

  1. A nurse is asked to describe the concept of attachment between a young child and the caregiver to a group of families planning to adopt internationally. Which of the following statements made by the nurse describes the qualities involved in attachment of the parent and child? Select all that apply.
a. being emotionally available
b. allowing the child to grieve independently for the loss of his or her familiar surroundings
c. offer protection and warmth to the child despite attachment challenges
d. set firm parameters and allow the child to deal with disappointment

 

 

ANS:  A, C

 

  Feedback
Correct To promote attachment between a child and the caregiver, it is necessary for the caregiver to be emotionally available for the child.

To promote attachment between a child and the caregiver, the caregiver should offer protection and warmth to the child despite attachment challenges.

Incorrect Allowing the child to grieve independently would not offer comfort and a sense of security, both important components for facilitating attachment.

Setting parameters and allowing the child to deal with disappointment would not likely facilitate attachment, as such actions would not facilitate the development of security and trust.

 

 

PTS:   1                    REF:   p. 1384 – Theoretical Approaches to Child Abuse and Neglect

OBJ:   Cognitive Level: Application

 

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