Wong’s Nursing Care of Infants and Children, 10th Edition by Marilyn J. Hockenberry, David Wilson – Test Bank

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Wong’s Nursing Care of Infants and Children, 10th Edition by Marilyn J. Hockenberry, David Wilson – Test Bank

Chapter 02: Social, Cultural, Religious, and Family Influences on Child Health Promotion

 

MULTIPLE CHOICE

 

  1. Children are taught the values of their culture through observation and feedback relative to their own behavior. In teaching a class on cultural competence, the nurse should be aware that which factor may be culturally determined?
a. Ethnicity
b. Racial variation
c. Status
d. Geographic boundaries

 

 

ANS:  C

Status is culturally determined and varies according to each culture. Some cultures ascribe higher status to age or socioeconomic position. Social roles also are influenced by the culture. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. It is one component of culture. Race and culture are two distinct attributes. Whereas racial grouping describes transmissible traits, culture is determined by the pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. Cultural development may be limited by geographic boundaries, but the boundaries are not culturally determined.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 39

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is aware that if patients’ different cultures are implied to be inferior, the emotional attitude the nurse is displaying is what?
a. Acculturation
b. Ethnocentrism
c. Cultural shock
d. Cultural sensitivity

 

 

ANS:  B

Ethnocentrism is the belief that one’s way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of one’s ethnic group are superior to those of others. Acculturation is the gradual changes that are produced in a culture by the influence of another culture that cause one or both cultures to become more similar. The minority culture is forced to learn the majority culture to survive. Cultural shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. Cultural sensitivity, a component of culturally competent care, is an awareness of cultural similarities and differences.

 

DIF:    Cognitive Level: Understanding     REF:   p. 35              TOP:   Integrated Process: Caring

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which term best describes the sharing of common characteristics that differentiates one group from other groups in a society?
a. Race
b. Culture
c. Ethnicity
d. Superiority

 

 

ANS:  C

Ethnicity is a classification aimed at grouping individuals who consider themselves, or are considered by others, to share common characteristics that differentiate them from the other collectivities in a society, and from which they develop their distinctive cultural behavior. Race is a term that groups together people by their outward physical appearance. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perception and judgments. Superiority is the state or quality of being superior; it does not apply to ethnicity.

 

DIF:    Cognitive Level: Understanding     REF:   p. 39

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. After the family, which has the greatest influence on providing continuity between generations?
a. Race
b. School
c. Social class
d. Government

 

 

ANS:  B

Schools convey a tremendous amount of culture from the older members to the younger members of society. They prepare children to carry out the traditional social roles that will be expected of them as adults. Race is defined as a division of humankind possessing traits that are transmissible by descent and are sufficient to characterize race as a distinct human type; although race may have an influence on childrearing practices, its role is not as significant as that of schools. Social class refers to the family’s economic and educational levels. The social class of a family may change between generations. The government establishes parameters for children, including amount of schooling, but this is usually at a local level. The school culture has the most significant influence on continuity besides family.

 

DIF:    Cognitive Level: Remembering      REF:   p. 33

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is planning care for a patient with a different ethnic background. Which should be an appropriate goal?
a. Adapt, as necessary, ethnic practices to health needs.
b. Attempt, in a nonjudgmental way, to change ethnic beliefs.
c. Encourage continuation of ethnic practices in the hospital setting.
d. Strive to keep ethnic background from influencing health needs.

 

 

ANS:  A

Whenever possible, nurses should facilitate the integration of ethnic practices into health care provision. The ethnic background is part of the individual; it should be difficult to eliminate the influence of ethnic background. The ethnic practices need to be evaluated within the context of the health care setting to determine whether they are conflicting.

 

DIF:    Cognitive Level: Applying              REF:   p. 34              TOP:   Integrated Process: Caring

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse discovers welts on the back of a Vietnamese child during a home health visit. The child’s mother says she has rubbed the edge of a coin on her child’s oiled skin. The nurse should recognize this as what?
a. Child abuse
b. Cultural practice to rid the body of disease
c. Cultural practice to treat enuresis or temper tantrums
d. Child discipline measure common in the Vietnamese culture

 

 

ANS:  B

This is descriptive of coining. The welts are created by repeatedly rubbing a coin on the child’s oiled skin. The mother is attempting to rid the child’s body of disease. Coining is a cultural healing practice. Coining is not specific for enuresis or temper tantrums. This is not child abuse or discipline.

 

DIF:    Cognitive Level: Understanding     REF:   p. 41

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicles, and juices, are left. Which statement best explains this?
a. The parent is trying to feed the child only what the child likes most.
b. Hispanics believe the “evil eye” enters when a person gets cold.
c. The parent is trying to restore normal balance through appropriate “hot” remedies.
d. Hispanics believe an innate energy called chi is strengthened by eating soup.

 

 

ANS:  C

In several cultures, including Filipino, Chinese, Arabic, and Hispanic, hot and cold describe certain properties completely unrelated to temperature. Respiratory conditions such as pneumonia are “cold” conditions and are treated with “hot” foods. The child may like broth but is unlikely to always prefer it to Jell-O, Popsicles, and juice. The evil eye applies to a state of imbalance of health, not curative actions. Chinese individuals, not Hispanic individuals, believe in chi as an innate energy.

 

DIF:    Cognitive Level: Applying              REF:   p. 40

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. How is family systems theory best described?
a. The family is viewed as the sum of individual members.
b. A change in one family member cannot create a change in other members.
c. Individual family members are readily identified as the source of a problem.
d. When the family system is disrupted, change can occur at any point in the system.

 

 

ANS:  D

Family systems theory describes an interactional model. Any change in one member will create change in others. Although the family is the sum of the individual members, family systems theory focuses on the number of dyad interactions that can occur. The interactions, not the individual members, are considered to be the problem.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 18

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. Which family theory is described as a series of tasks for the family throughout its life span?
a. Exchange theory
b. Developmental theory
c. Structural-functional theory
d. Symbolic interactional theory

 

 

ANS:  B

In developmental systems theory, the family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. Exchange theory assumes that humans, families, and groups seek rewarding statuses so that rewards are maximized while costs are minimized. Structural-functional theory states that the family performs at least one societal function while also meeting family needs. Symbolic interactional theory describes the family as a unit of interacting persons with each occupying a position within the family.

 

DIF:    Cognitive Level: Remembering      REF:   p. 19

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events?
a. Interactional theory
b. Family stress theory
c. Erikson’s psychosocial theory
d. Developmental systems theory

 

 

ANS:  B

Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction. Interactional theory is not a family theory. Interactions are the basis of general systems theory. Erikson’s theory applies to individual growth and development, not families. Developmental systems theory is an outgrowth of Duvall’s theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others.

 

DIF:    Cognitive Level: Remembering      REF:   p. 19

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. Which type of family should the nurse recognize when the paternal grandmother, the parents, and two minor children live together?
a. Blended
b. Nuclear
c. Extended
d. Binuclear

 

 

ANS:  C

An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one stepparent, stepsibling, or half-sibling. A nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

 

DIF:    Cognitive Level: Remembering      REF:   pp. 20-21

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. Which type of family should the nurse recognize when a mother, her children, and a stepfather live together?
a. Traditional nuclear
b. Blended
c. Extended
d. Binuclear

 

 

ANS:  B

A blended family contains at least one stepparent, stepsibling, or half-sibling. A traditional nuclear family consists of a married couple and their biologic children. No other relatives or nonrelatives are present in the household. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

 

DIF:    Cognitive Level: Remembering      REF:   p. 20

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. Which is an accurate description of homosexual (or gay-lesbian) families?
a. A nurturing environment is lacking.
b. The children become homosexual like their parents.
c. The stability needed to raise healthy children is lacking.
d. The quality of parenting is equivalent to that of nongay parents.

 

 

ANS:  D

Although gay or lesbian families may be different from heterosexual families, the environment can be as healthy as any other. Lacking a nurturing environment and stability is reflective on the parents and family, not the type of family. There is little evidence to support that children become homosexual like their parents.

 

DIF:    Cognitive Level: Understanding     REF:   pp. 21-22

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is teaching a group of new nursing graduates about identifiable qualities of strong families that help them function effectively. Which quality should be included in the teaching?
a. Lack of congruence among family members
b. Clear set of family values, rules, and beliefs
c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events
d. Sense of commitment toward growth of individual family members as opposed to that of the family unit

 

 

ANS:  B

A clear set of family rules, values, and beliefs that establish expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Varied coping strategies are used by strong families. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit.

 

DIF:    Cognitive Level: Applying              REF:   p. 22

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. When assessing a family, the nurse determines that the parents exert little or no control over their children. This style of parenting is called which?
a. Permissive
b. Dictatorial
c. Democratic
d. Authoritarian

 

 

ANS:  A

Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their children’s actions. Dictatorial or authoritarian parents attempt to control their children’s behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their children’s behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect their children’s individual natures.

 

DIF:    Cognitive Level: Remembering      REF:   p. 24

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. When discussing discipline with the mother of a 4-year-old child, which should the nurse include?
a. Parental control should be consistent.
b. Withdrawal of love and approval is effective at this age.
c. Children as young as 4 years rarely need to be disciplined.
d. One should expect rules to be followed rigidly and unquestioningly.

 

 

ANS:  A

For effective discipline, parents must be consistent and must follow through with agreed-on actions. Withdrawal of love and approval is never appropriate or effective. The 4-year-old child will test limits and may misbehave. Children of this age do not respond to verbal reasoning. Realistic goals should be set for this age group. Discipline is necessary to reinforce these goals. Discipline strategies should be appropriate to the child’s age and temperament and the severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old child.

 

DIF:    Cognitive Level: Applying              REF:   p. 24

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which is a consequence of the physical punishment of children, such as spanking?
a. The psychologic impact is usually minimal.
b. The child’s development of reasoning increases.
c. Children rarely become accustomed to spanking.
d. Misbehavior is likely to occur when parents are not present.

 

 

ANS:  D

Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake but rather out of fear of punishment. Spanking can cause severe physical and psychologic injury and interfere with effective parent–child interaction. The use of corporal punishment may interfere with the child’s development of moral reasoning. Children do become accustomed to spanking, requiring more severe corporal punishment each time.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 26

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. The parents of a young child ask the nurse for suggestions about discipline. When discussing the use of time-outs, which should the nurse include?
a. Send the child to his or her room if the child has one.
b. A general rule for length of time is 1 hour per year of age.
c. Select an area that is safe and nonstimulating, such as a hallway.
d. If the child cries, refuses, or is more disruptive, try another approach.

 

 

ANS:  C

The area must be nonstimulating and safe. The child becomes bored in this environment and then changes behavior to rejoin activities. The child’s room may have toys and activities that negate the effect of being separated from the family. The general rule is 1 minute per year of age. An hour per year is excessive. When the child cries, refuses, or is more disruptive, the time-out does not start; the time-out begins when the child quiets.

 

DIF:    Cognitive Level: Remembering      REF:   p. 26

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. A 3-year-old child was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guideline concerning adoption should the nurse use in planning a response?
a. It is best to wait until the child asks about it.
b. The best time to tell the child is between the ages of 7 and 10 years.
c. It is not necessary to tell a child who was adopted so young.
d. Telling the child is an important aspect of their parental responsibilities.

 

 

ANS:  D

It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the child’s identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to prevent third parties from telling the children before the parents have had the opportunity.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 27

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. Children may believe that they are responsible for their parents’ divorce and interpret the separation as punishment. At which age is this most likely to occur?
a. 1 year
b. 4 years
c. 8 years
d. 13 years

 

 

ANS:  B

Preschool-age children are most likely to blame themselves for the divorce. A 4-year-old child will fear abandonment and express bewilderment regarding all human relationships. A 4-year-old child has magical thinking and believes his or her actions cause consequences, such as divorce. For infants, divorce may increase their irritability and interfere with the attachment process, but they are too young to feel responsibility. School-age children will have feelings of deprivation, including the loss of a parent, attention, money, and a secure future. Adolescents are able to disengage themselves from the parental conflict.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 29              TOP:   Nursing Process: Planning

MSC:  Client Needs: Psychosocial Integrity

 

  1. A parent of a school-age child tells the school nurse that the parents are going through a divorce. The child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as what?
a. Indicative of maladjustment
b. A common reaction to divorce
c. Suggestive of a lack of adequate parenting
d. An unusual response that indicates a need for referral

 

 

ANS:  B

Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. The child’s responses are common reactions of school-age children to parental divorce.

 

DIF:    Cognitive Level: Applying              REF:   p. 29

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, “I want to go back to work, but I don’t want Eric to suffer because I’ll have less time with him.” Which is the nurse’s most appropriate answer?
a. “I’m sure he’ll be fine if you get a good babysitter.”
b. “You will need to stay home until Eric starts school.”
c. “Let’s talk about the child care options that will be best for Eric.”
d. “You should go back to work so Eric will get used to being with others.”

 

 

ANS:  C

Asking the mother about child care options is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. The other three answers are directive; they do not address the effect that her working will have on Eric.

 

DIF:    Cognitive Level: Applying              REF:   p. 32

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. A foster parent is talking to the nurse about the health care needs for the child who has been placed in the parent’s care. Which statement best describes the health care needs of foster children?
a. Foster children always come from abusive households and are emotionally fragile.
b. Foster children tend to have a higher than normal incidence of acute and chronic health problems.
c. Foster children are usually born prematurely and require technologically advanced health care.
d. Foster children will not stay in the home for an extended period, so health care needs are not as important as emotional fulfillment.

 

 

ANS:  B

Children who are placed in foster care have a higher incidence of acute and chronic health problems and may experience feelings of isolation and confusion; therefore, they should be monitored closely. Foster children do not always come from abusive households and may or may not be emotionally fragile; not all foster children are born prematurely or require technically advanced health care; and foster children may stay in the home for extended periods, so their health care needs require attention.

 

DIF:    Cognitive Level: Applying              REF:   p. 32

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is planning to counsel family members as a group to assess the family’s group dynamics. Which theoretic family model is the nurse using as a framework?
a. Feminist theory
b. Family stress theory
c. Family systems theory
d. Developmental theory

 

 

ANS:  C

In family systems theory, the family is viewed as a system that continually interacts with its members and the environment. The emphasis is on the interaction between the members; a change in one family member creates a change in other members, which in turn results in a new change in the original member. Assessing the family’s group dynamics is an example of using this theory as a framework. Family stress theory explains how families react to stressful events and suggests factors that promote adaptation to stress. Developmental theory addresses family change over time using Duvall’s family life cycle stages based on the predictable changes in the family’s structure, function, and roles, with the age of the oldest child as the marker for stage transition. Feminist theories assume that privilege and power are inequitably distributed based upon gender, race, and class.

 

DIF:    Cognitive Level: Applying              REF:   p. 18              TOP:   Nursing Process: Planning

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is reviewing the importance of role learning for children. The nurse understands that children’s roles are primarily shaped by which members?
a. Peers
b. Parents
c. Siblings
d. Grandparents

 

 

ANS:  B

Children’s roles are shaped primarily by the parents, who apply direct or indirect pressures to induce or force children into the desired patterns of behavior or direct their efforts toward modification of the role responses of the child on a mutually acceptable basis.

 

DIF:    Cognitive Level: Analyzing            REF:   pp. 22-23

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is caring for an adolescent hospitalized for asthma. The adolescent belongs to a large family. The nurse recognizes that the adolescent is likely to relate to which group?
a. Peers
b. Parents
c. Siblings
d. Teachers

 

 

ANS:  A

Adolescents from a large family are more peer oriented than family oriented. Adolescents in small families identify more strongly with their parents and rely more on them for advice.

 

DIF:    Cognitive Level: Understanding     REF:   p. 23              TOP:   Integrated Process: Caring

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is explaining different parenting styles to a group of parents. The nurse explains that an authoritative parenting style can lead to which child behavior?
a. Shyness
b. Self-reliance
c. Submissiveness
d. Self-consciousness

 

 

ANS:  B

Children raised by parents with an authoritative parenting style tend to have high self-esteem and are self-reliant, assertive, inquisitive, content, and highly interactive with other children. Children raised by parents with an authoritarian parenting style tend to be sensitive, shy, self-conscious, retiring, and submissive.

 

DIF:    Cognitive Level: Applying              REF:   p. 24

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. Parents of a preschool child ask the nurse, “Should we set rules for our child as part of a discipline plan?” Which is an accurate response by the nurse?
a. “It is best to delay the punishment if a rule is broken.”
b. “The child is too young for rules. At this age, unrestricted freedom is best.”
c. “It is best to set the rules and reason with the child when the rules are broken.”
d. “Set clear and reasonable rules and expect the same behavior regardless of the circumstances.”

 

 

ANS:  D

Nurses can help parents establish realistic and concrete “rules.” The clearer the limits that are set and the more consistently they are enforced, the less need there is for disciplinary action. Delaying punishment weakens its intent. Children want and need limits. Unrestricted freedom is a threat to their security and safety. Reasoning involves explaining why an act is wrong and is usually appropriate for older children, especially when moral issues are involved. However, young children cannot be expected to “see the other side” because of their egocentrism.

 

DIF:    Cognitive Level: Applying              REF:   p. 25

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is discussing issues that are important with parents considering a cross-racial adoption. Which statement made by the parents indicates further teaching is needed?
a. “We will try to preserve the adopted child’s racial heritage.”
b. “We are glad we will be getting full medical information when we adopt our child.”
c. “We will make sure to have everyone realize this is our child and a member of the family.”
d. “We understand strangers may make thoughtless comments about our child being different from us.”

 

 

ANS:  B

In international adoptions, the medical information the parents receive may be incomplete or sketchy; weight, height, and head circumference are often the only objective information present in the child’s medical record. Further teaching is needed if the parents expect full medical information. It is advised that parents who adopt children with different ethnic backgrounds do everything to preserve the adopted children’s racial heritage. Strangers may make thoughtless comments and talk about the children as though they were not members of the family. It is vital that family members declare to others that this is their child and a cherished member of the family.

 

DIF:    Cognitive Level: Applying              REF:   pp. 27-28

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. The school nurse understands that children are impacted by divorce. Which has the most impact on the positive outcome of a divorce?
a. Age of the child
b. Gender of the child
c. Family characteristics
d. Ongoing family conflict

 

 

ANS:  C

Family characteristics are more crucial to the child’s well-being during a divorce than specific child characteristics, such as age or sex. High levels of ongoing family conflict are related to problems of social development, emotional stability, and cognitive skills for the child.

 

DIF:    Cognitive Level: Understanding     REF:   p. 29              TOP:   Integrated Process: Caring

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is discussing parenting in reconstituted families with a new stepparent. The nurse is aware that the new stepparent understands the teaching when which statement is made?
a. “I am glad there will be no disruption in my lifestyle.”
b. “I don’t think children really want to live in a two-parent home.”
c. “I realize there may be power conflicts bringing two households together.”
d. “I understand contact between grandparents should be kept to a minimum.”

 

 

ANS:  C

The entry of a stepparent into a ready-made family requires adjustments for all family members. Power conflicts are expected, and flexibility, mutual support, and open communication are critical in successful relationships. So the statement that power conflicts are possible means teaching was understood. Some obstacles to the role adjustments and family problem solving include disruption of previous lifestyles and interaction patterns, complexity in the formation of new ones, and lack of social supports. Most children from divorced families want to live in a two-parent home. There should be continued contact with grandparents.

 

DIF:    Cognitive Level: Applying              REF:   p. 31

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. The nurse is presenting a staff development program about understanding culture in the health care encounter. Which components should the nurse include in the program? (Select all that apply.)
a. Cultural humility
b. Cultural research
c. Cultural sensitivity
d. Cultural competency

 

 

ANS:  A, C, D

There are several different ways health care providers can best attend to all the different facets that make up an individual’s culture. Cultural competence tends to promote building information about a specific culture. Cultural sensitivity, a second way of understanding culture in the context of the clinical encounter, may be understood as a way of using one’s knowledge, consideration, understanding, respect, and tailoring after realizing awareness of self and others and encountering a diverse group or individual. Cultural humility, the third component, is a commitment and active engagement in a lifelong process that individuals enter into for an ongoing basis with patients, communities, colleagues, and themselves. Cultural research is not a component of understanding culture in the health care encounter.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 38

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. The parents of a 5-year-old child ask the nurse how they can minimize misbehavior. Which responses should the nurse give? (Select all that apply.)
a. Set clear and reasonable goals.
b. Praise your child for desirable behavior.
c. Don’t call attention to unacceptable behavior.
d. Teach desirable behavior through your own example.
e. Don’t provide an opportunity for your child to have any control.

 

 

ANS:  A, B, D

To minimize misbehavior, parents should (1) set clear and reasonable rules and expect the same behavior regardless of the circumstances, (2) praise children for desirable behavior with attention and verbal approval, and (3) teach desirable behavior through their own example. Parents should call attention to unacceptable behavior as soon as it begins and provide children with opportunities for power and control.

 

DIF:    Cognitive Level: Applying              REF:   p. 25

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which describe the feelings and behaviors of early preschool children related to divorce? (Select all that apply.)
a. Regressive behavior
b. Fear of abandonment
c. Fear regarding the future
d. Blame themselves for the divorce
e. Intense desire for reconciliation of parents

 

 

ANS:  A, B, D

Feelings and behaviors of early preschool children related to divorce include regressive behavior, fear of abandonment, and blaming themselves for the divorce. Fear regarding the future and intense desire for reconciliation of parents is a reaction later school-age children have to divorce.

 

DIF:    Cognitive Level: Understanding     REF:   p. 29              TOP:   Integrated Process: Caring

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which describe the feelings and behaviors of adolescents related to divorce? (Select all that apply.)
a. Disturbed concept of sexuality
b. May withdraw from family and friends
c. Worry about themselves, parents, or siblings
d. Expression of anger, sadness, shame, or embarrassment
e. Engage in fantasy to seek understanding of the divorce

 

 

ANS:  A, B, C, D

Feelings and behaviors of adolescents related to divorce include a disturbed concept of sexuality; withdrawing from family and friends; worrying about themselves, parents, and siblings; and expressions of anger, sadness, shame, and embarrassment. Engaging in fantasy to seek understanding of the divorce is a reaction by a child who has preconceptual cognitive processes, not the formal thinking processes adolescents have.

 

DIF:    Cognitive Level: Understanding     REF:   p. 29              TOP:   Integrated Process: Caring

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is teaching parents about the effects of media on childhood obesity. The nurse realizes the parents understand the teaching if they make which statements? (Select all that apply.)
a. “Advertising of unhealthy food can increase snacking.”
b. “Increased screen time may be related to unhealthy sleep.”
c. “There is a link between the amount of screen time and obesity.”
d. “Increased screen time can lead to better knowledge of nutrition.”
e. “Physical activity increases when children increase the amount of screen time.”

 

 

ANS:  A, B, C

A number of studies have demonstrated a link between the amount of screen time and obesity. Advertising of unhealthy food to children is a long-standing marketing practice, which may increase snacking in the face of decreased activity. In addition, both increased screen time and unhealthy eating may also be related to unhealthy sleep. Increased screen time does not lead to a better knowledge of nutrition or increased physical activity.

 

DIF:    Cognitive Level: Applying              REF:   p. 38

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

MATCHING

 

Culture characterizes a particular group with its values, beliefs, norms, patterns, and practices that are learned, shared, and transmitted from one generation to another. Match the terms used to describe groups with shared values, beliefs, norms, patterns, and practices.

a. Race
b. Gender
c. Ethnicity
d. Social class
e. Socialization

 

 

  1. Incorporates levels of education, occupation, income, and access to resources

 

  1. Distinguishes humans by physical traits

 

  1. Persons who have unique cultural, social, and linguistic heritage

 

  1. Process by which society communicates its competencies, values, and expectations

 

  1. An individual’s self-identification as man or woman

 

  1. ANS:  D                    DIF:    Cognitive Level: Understanding     REF:   p. 39

TOP:   Integrated Process: Caring              MSC:  Client Needs: Psychosocial Integrity

 

  1. ANS:  A                    DIF:    Cognitive Level: Understanding     REF:   p. 39

TOP:   Integrated Process: Caring              MSC:  Client Needs: Psychosocial Integrity

 

  1. ANS:  C                    DIF:    Cognitive Level: Understanding     REF:   p. 39

TOP:   Integrated Process: Caring              MSC:  Client Needs: Psychosocial Integrity

 

  1. ANS:  E                    DIF:    Cognitive Level: Understanding     REF:   p. 39

TOP:   Integrated Process: Caring              MSC:  Client Needs: Psychosocial Integrity

 

  1. ANS:  B                    DIF:    Cognitive Level: Understanding     REF:   p. 39

TOP:   Integrated Process: Caring              MSC:  Client Needs: Psychosocial Integrity

 

Chapter 16: Health Problems of the School-Age Child

 

MULTIPLE CHOICE

 

  1. Deficiency of which vitamin or mineral results in an inadequate inflammatory response?
a. A
b. B1
c. C
d. Zinc

 

 

ANS:  A

A deficiency of vitamin A results in an inadequate inflammatory response. Deficiencies of vitamins B1 and C result in decreased collagen formation. A deficiency of zinc leads to impaired epithelialization.

 

DIF:    Cognitive Level: Understanding     REF:   p. 613

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. An occlusive dressing is applied to a large abrasion. This is advantageous because the dressing will accomplish what?
a. Deliver vitamin C to the wound.
b. Provide an antiseptic for the wound.
c. Maintain a moist environment for healing.
d. Promote mechanical friction for healing.

 

 

ANS:  C

Occlusive dressings, such as Acuderm, are not adherent to the wound site. They provide a moist wound surface and insulate the wound. The dressing does not have vitamin C or antiseptic capabilities. Acuderm protects against friction.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 613

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. A toddler has a deep laceration contaminated with dirt and sand. Before closing the wound, the nurse should irrigate with what solution?
a. Alcohol
b. Normal saline
c. Povidone–iodine
d. Hydrogen peroxide

 

 

ANS:  B

Normal saline is the only acceptable fluid for irrigation listed. The nurse should cleanse the wound with a forced stream of normal saline or water. Alcohol is not used for wound irrigation. Povidone–iodine is contraindicated for cleansing fresh, open wounds. Hydrogen peroxide can cause formation of subcutaneous gas when applied under pressure.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 616

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. The nurse should know what about Lyme disease?
a. Very difficult to prevent
b. Easily treated with oral antibiotics in stages 1, 2, and 3
c. Caused by a spirochete that enters the skin through a tick bite
d. Common in geographic areas where the soil contains the mycotic spores that cause the disease

 

 

ANS:  C

Lyme disease is caused by Borrelia burgdorferi, a spirochete spread by ticks. The early characteristic rash is erythema migrans. Tick bites should be avoided by entering tick-infested areas with caution. Light-colored clothing should be worn to identify ticks easily. Long-sleeve shirts and long pants tucked into socks should be worn. Early treatment of the erythema migrans (stage 1) can prevent the development of Lyme disease. Lyme disease is caused by a spirochete, not mycotic spores.

 

DIF:    Cognitive Level: Understanding     REF:   p. 629

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. The school nurse is seeing a child who collected some poison ivy leaves during recess. He says only his hands touched it. What is the most appropriate nursing action?
a. Soak his hands in warm water.
b. Apply Burow’s solution compresses.
c. Rinse his hands in cold running water.
d. Scrub his hands thoroughly with antibacterial soap.

 

 

ANS:  C

The first recommended action is to rinse his hands in cold running water within 15 minutes of exposure. This will neutralize the urushiol not yet bonded to the skin. Soaking his hands in warm water is effective for soothing the skin lesions after the dermatitis has begun. Antibacterial soap removes protective skin oils and dilutes the urushiol, allowing it to spread.

 

DIF:    Cognitive Level: Applying              REF:   p. 620

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. A 6-year-old boy with very fair skin will be joining his family during a beach vacation. What should the nurse recommend?
a. Keep him off the beach during the daytime hours.
b. Use sunscreen with an SPF of at least 15 and reapply it every 2 to 3 hours.
c. Apply a topical sunscreen product with an SPF of 30 in the morning.
d. Dress him in long pants and long-sleeved shirt and keep him under a beach umbrella.

 

 

ANS:  B

A sunscreen with an SPF (sun protection factor) of at least 15 is recommended. The sunscreen should be reapplied every 2 to 3 hours and after the child is in the water or sweating excessively. During a beach vacation, avoiding the beach during daytime hours is impractical. The highest risk of sun exposure is from 10 AM to 3 PM. Sunlight exposure should be limited during this time. An SPF of 30 is good, but reapplying it is necessary every 2 to 3 hours and when the child gets wet. Long pants and a shirt are impractical. The beach umbrella can be used with the sunscreen to limit exposure to the sun.

 

DIF:    Cognitive Level: Applying              REF:   p. 621

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. The management of a child who has just been stung by a bee or wasp should include applying what?
a. Cool compresses
b. Antibiotic cream
c. Warm compresses
d. Corticosteroid cream

 

 

ANS:  A

Bee or wasp stings are initially treated by carefully removing the stinger, cleansing with soap and water, applying cool compresses, and using common household agents such as lemon juice or a paste made with aspirin and baking soda. Antibiotic cream is unnecessary unless a secondary infection occurs. Warm compresses are avoided. Corticosteroid cream is not part of the initial therapy. If a severe reaction occurs, systemic corticosteroids may be indicated.

 

DIF:    Cognitive Level: Applying              REF:   p. 627

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. A parent calls the clinic nurse because his 7-year-old child was bitten by a black widow spider. What action should the nurse advise the parent to take?
a. Apply warm compresses.
b. Carefully scrape off the stinger.
c. Take the child to the emergency department.
d. Apply a thin layer of corticosteroid cream.

 

 

ANS:  C

The venom of the black widow spider has a neurotoxic effect. The parent should take the child to the emergency department for treatment with antivenin and muscle relaxants as needed. Warm compresses increase the circulation to the area and facilitate the spread of the venom. The black widow spider does not have a stinger. Corticosteroid cream has no effect on the venom.

 

DIF:    Cognitive Level: Applying              REF:   p. 628

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. A school-age child has been bitten on the leg by a large snake that may be poisonous. During transport to an emergency facility, what should the care include?
a. Apply ice to the snakebite.
b. Immobilize the leg with a splint.
c. Place a loose tourniquet distal to the bite.
d. Apply warm compresses to the snakebite.

 

 

ANS:  B

The leg should be immobilized. Ice decreases blood flow to the area, which allows the venom to work more destruction and decreases the effect of antivenin on the natural immune mechanisms. A loose tourniquet is placed proximal, not distal, to the area of the bite to delay the flow of lymph. This can delay movement of the venom into the peripheral circulation. The tourniquet should be applied so that a pulse can be felt distal to the bite. Warmth increases circulation to the area and helps the toxin into the peripheral circulation.

 

DIF:    Cognitive Level: Applying              REF:   p. 631            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity

 

  1. Parents phone the nurse and say that their child just knocked out a permanent tooth. What should the nurse’s instructions to the parents include?
a. Place the tooth in dry container for transport.
b. Hold the tooth by the crown and not by the root area.
c. Transport the child and tooth to a dentist within 18 hours.
d. Take the child to hospital emergency department if his or her mouth is bleeding.

 

 

ANS:  B

It is important to avoid touching the root area of the tooth. The tooth should be held by the crown area; rinsed in milk, saline, or running water; and reimplanted as soon as possible. The tooth is kept moist during transport to maintain viability. Cold milk is the most desirable medium for transport. The child needs to be seen by a dentist as soon as possible. Tooth evulsion causes a large amount of bleeding. The child will need to be seen by a dentist because of the loss of a tooth, not the bleeding.

 

DIF:    Cognitive Level: Applying              REF:   p. 634

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. Parents are concerned that their 6-year-old son continues to occasionally wet the bed. What does the nurse explain?
a. This is likely because of increased stress at home.
b. Enuresis usually ceases between 6 and 8 years of age.
c. Drug therapy will be prescribed to treat the enuresis.
d. Testing will be necessary to determine what type of kidney problem exists.

 

 

ANS:  B

Further data must be gathered before the diagnosis of enuresis is made. Enuresis is the inappropriate voiding of urine at least twice a week. This child does meet the age criterion, but the parents need to be questioned about and keep a diary on the frequency of events. If the bedwetting is infrequent, parents can be encouraged that the child may grow out of this behavior. Drug therapy will not be prescribed until a more complete evaluation is done. Additional assessment information must be gathered, but at this time, there is no indication of renal disease.

 

DIF:    Cognitive Level: Applying              REF:   pp. 634-635

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The nurse is assisting the family of a child with a history of encopresis. What should be included in the nurse’s discussion with the family?
a. Instruct the parents to sit the child on the toilet at twice-daily routine intervals.
b. Instruct the parents that the child will probably need to have daily enemas.
c. Suggest the use of stimulant cathartics weekly.
d. Reassure the family that most problems are resolved successfully, with some relapses during periods of stress.

 

 

ANS:  D

Children may be unaware of a prior sensation and be unable to control the urge after it begins. They may be so accustomed to bowel accidents that they may be unable to smell or feel them. Family counseling is directed toward reassurance that most problems resolve successfully, although relapses during periods of stress are possible. Sitting the child on the toilet is not recommended because it may intensify the parent–child conflict. Enemas may be needed for impactions, but long-term use prevents the child from assuming responsibility for defecation. Stimulant cathartics may cause cramping that can frighten children.

 

DIF:    Cognitive Level: Applying              REF:   pp. 636-637

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. What is an important consideration in the diagnosis of attention deficit hyperactivity disorder (ADHD)?
a. Learning disabilities are apparent at an early age.
b. The child will always be distracted by external stimuli.
c. Parental observations of the child’s behavior are most relevant.
d. It must be determined whether the child’s behavior is age appropriate or problematic.

 

 

ANS:  D

The diagnosis of ADHD is complex. A multidisciplinary evaluation should be done to determine whether the child’s behavior is appropriate for the developmental age or whether it is problematic. Learning disabilities are usually not evident until the child enters school. Each child with ADHD responds differently to stimuli. Some children are distracted by internal stimuli and others by external stimuli. Parents can only provide one viewpoint of the child’s behavior. Many observers should be asked to provide input with structured tools to facilitate the diagnosis.

 

DIF:    Cognitive Level: Understanding     REF:   p. 639

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is facilitating a conference between the teachers and parents of a 7-year-old child newly diagnosed with attention deficit hyperactivity disorder (ADHD). What does the nurse stress?
a. Academic subjects should be taught in the afternoon.
b. Low-interest activities in the classroom should be minimized.
c. Visual references should accompany verbal instruction.
d. The child’s environment should be visually stimulating.

 

 

ANS:  C

Verbal instructions should always be accompanied by visual or written instructions. This provides the child with reinforcement and a reference to expectations. Academic subjects should be taught in the morning when the child is experiencing the effects of the morning dose of medication. Low-interest activities should be mixed with high-interest activities to maintain the child’s attention. Environmental stimulation should be minimized to help eliminate distractions that can overexcite the child.

 

DIF:    Cognitive Level: Applying              REF:   p. 641

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. What is characteristic of children with posttraumatic stress disorder (PTSD)?
a. Denial as a defense mechanism is unusual.
b. Traumatic effects cannot remain indefinitely.
c. Previous coping strategies and defense mechanisms are not useful.
d. Children often play out the situation over and over again.

 

 

ANS:  D

The third phase of adjustment to PTSD involves the children playing out the situation over and over to come to terms with their fears. Denial is frequently used as a defense mechanism during the second phase. For some children, traumatic effects can remain indefinitely. Coping is a learned response. During the third stage, the children can be helped to use their coping strategies to deal with their fears.

 

DIF:    Cognitive Level: Understanding     REF:   p. 643

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. A 9-year-old child has just been diagnosed with recurrent abdominal pain (RAP). In preparing for discharge, the nurse should include what in the home care instructions to the parents?
a. Following a high-fiber diet
b. Using stimulant laxatives
c. Using ice packs on the abdomen when pain occurs
d. Sitting on the toilet for 30 minutes after each meal

 

 

ANS:  A

A high-fiber diet with possible addition of bulk laxatives is beneficial for children with RAP. Bulk-forming laxatives such as psyllium are recommended. Stimulant laxatives may produce painful cramping for the child. Warm packs, such as a heating pad, may help ease the discomfort. Bowel training is recommended to assist the child in establishing regular bowel habits. Thirty minutes is too long for the child to sit on the toilet. The time should be limited to 15 minutes.

 

DIF:    Cognitive Level: Applying              REF:   p. 646

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. What is a characteristic of children with depression?
a. Increased range of affective response
b. Tendency to prefer play instead of schoolwork
c. Change in appetite resulting in weight loss or gain
d. Preoccupation with need to perform well in school

 

 

ANS:  C

Physiologic characteristics of children with depression include changes in appetite resulting in weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping patterns, insomnia or hypersomnia, and constipation. Children who are depressed have sad facial expressions with absent or diminished range of affective response. These children withdraw from previously enjoyed activities and engage in solitary play or work with a lack of interest in play. They are uninterested in doing homework or achieving in school, resulting in lower grades.

 

DIF:    Cognitive Level: Understanding     REF:   p. 647

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. The school nurse is reviewing the process of wound healing. What is the initial response at the site of injury?
a. Contraction
b. Maturation
c. Fibroplasia
d. Inflammation

 

 

ANS:  D

The initial response at the site of injury is inflammation, a vascular and cellular response that prepares the tissues for the subsequent repair process. Fibroplasia (granulation or proliferation), the second phase of healing, lasts from 5 days to 4 weeks. During contraction and maturation, the third and fourth phases of wound healing, collagen continues to be deposited and organized into layers, compressing the new blood vessels and gradually stopping blood flow across the wound.

 

DIF:    Cognitive Level: Understanding     REF:   p. 611

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. An older school-age child asks the nurse, “What is the reason for this topical corticosteroid cream?” What rationale should the nurse give?
a. The cream is used for an antifungal effect.
b. The cream is used for an analgesic effect.
c. The cream is used for an antibacterial effect.
d. The cream is used for an anti-inflammatory effect.

 

 

ANS:  D

The glucocorticoids are the therapeutic agents used most widely for skin disorders. Their local anti-inflammatory effects are merely palliative, so the medication must be applied until the disease state undergoes a remission or the causative agent is eliminated. It does not have an antifungal, analgesic, or antibacterial effect.

 

DIF:    Cognitive Level: Applying              REF:   p. 614

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is caring for a child with a decubiti on the buttocks. The nurse notes that the dressing covering the decubiti is loose. What action should the nurse implement?
a. Retape the dressing.
b. Remove the dressing.
c. Change the dressing.
d. Reinforce the dressing.

 

 

ANS:  C

Dressings should always be changed when they are loose or soiled. They should be changed more frequently in areas where contamination is likely (e.g., sacral area, buttocks, tracheal area). The dressing should not be retaped, removed, or reinforced.

 

DIF:    Cognitive Level: Applying              REF:   p. 613

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is explaining the purpose of using a vacuum-assisted closure (VAC) device to assist in the healing of a wound. What should the nurse explain as the purpose of using a VAC device?
a. The device will decrease capillary flow.
b. The device applies gentle continuous suction.
c. The device will allow the wound to remain open.
d. The device will prevent the formation of granulation tissue.

 

 

ANS:  B

A VAC device uses a technique that involves placing a foam dressing into the wound, covering it with an occlusive dressing, and applying gentle continuous suction. The negative pressure of the suction is applied from the foam dressing to the wound surfaces. The mechanical force removes excess fluids from the wound, stimulates formation of granulation tissue, restores capillary flow, and fosters closure of the wound.

 

DIF:    Cognitive Level: Applying              REF:   p. 617

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. A child has had contact with some poison ivy. The school nurse understands that the full-blown reaction should be evident after how many days?
a. 1 day
b. 2 days
c. 3 days
d. 4 days

 

 

ANS:  B

The full-blown reaction to poison ivy is evident after about 2 days, with linear patches or streaks of erythemic, raised, fluid-filled vesicles; swelling; and persistent itching at the site of contact.

 

DIF:    Cognitive Level: Understanding     REF:   p. 619

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The nurse is admitting a child with frostbite. What health care prescription should the nurse question and verify?
a. Massage the injured tissue.
b. Apply a loose dressing after rewarming.
c. Avoid any application of dry heat to the area.
d. Administer acetaminophen (Tylenol) for discomfort.

 

 

ANS:  A

A frostbite victim should not have injured tissue rubbed. It is contraindicated because it can cause damage by rupture of crystallized cells. After rewarming, a loose dressing is applied to the affected skin, and analgesia is administered if indicated. Dry heat is not applied.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 622

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The nurse understands that medications delivered by which route are more likely to cause a drug reaction?
a. Oral
b. Topical
c. Intravenous
d. Intramuscular

 

 

ANS:  C

Drugs administered by the intravenous route are more likely to cause a reaction than the oral, topical, or intramuscular route.

 

DIF:    Cognitive Level: Understanding     REF:   p. 623

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

 

MULTIPLE RESPONSE

 

  1. The nurse is caring for a child who has a temperature of 30° C (86° F). What physical effects of hypothermia should the nurse expect to observe in this child? (Select all that apply.)
a. Reduced urinary output
b. Injury to peripheral tissue
c. Increased blood pressure
d. Tachycardia
e. Irritability with loss of consciousness
f. Rigid extremities

 

 

ANS:  C, D, E

Hypothermia has varying physical effects depending on the child’s core temperature. At 30° C (86° F), a child would experience an increase in blood pressure, tachycardia, and irritability followed by a loss of consciousness. Reduced urinary output from a decrease of blood flow to the kidneys, injury to peripheral tissue, and rigid extremities are physical effects observed as the body temperature continues to decrease.

 

DIF:    Cognitive Level: Analyzing            REF:   pp. 622-623

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is teaching a school-age child about factors that can delay wound healing. What factors should the nurse include in the teaching session? (Select all that apply.)
a. Deficient vitamin C
b. Deficient vitamin D
c. Increased circulation
d. Dry wound environment
e. Increase in white blood cells

 

 

ANS:  A, B, D

Factors that delay wound healing are a dry wound environment (allows epithelial cells to dry), deficient vitamin C (inhibits formation of collagen fibers), and deficient vitamin D (regulates growth and differentiation of cell types). Decreased, not increased, circulation delays healing. An increase in the white blood cell count may occur but does not delay healing.

 

DIF:    Cognitive Level: Applying              REF:   p. 612

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The school nurse is assessing a child’s severely scraped knee for infection. What are signs of a wound infection? (Select all that apply.)
a. Odor
b. Edema
c. Dry scab
d. Purulent exudate
e. Decreased temperature

 

 

ANS:  A, B, D

Signs of wound infection are odor, edema, and purulent exudate. Increased, not decreased, temperature indicates infection. A dry scab over the wound is part of the healing process.

 

DIF:    Cognitive Level: Applying              REF:   p. 615

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is teaching parents of a school-age child how to cleanse small wounds. What should the nurse advise the parents to avoid using to cleanse a wound? (Select all that apply.)
a. Alcohol
b. Normal saline
c. Tepid water
d. Povidone–iodine
e. Hydrogen peroxide

 

 

ANS:  A, D, E

Caution caregivers to avoid cleansing the wound with povidone–iodine, alcohol, and hydrogen peroxide because these products disrupt wound healing. Normal saline and tepid water are safe to use when cleansing wounds.

 

DIF:    Cognitive Level: Applying              REF:   p. 616

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The emergency department nurse is admitting a child with a temperature of 35° C (95° F). What physical effects of hypothermia should the nurse expect to observe in this child? (Select all that apply.)
a. Bradycardia
b. Vigorous shivering
c. Decreased respiratory rate
d. Decreased intestinal motility
e. Task performance is impaired

 

 

ANS:  B, D, E

Hypothermia has varying physical effects depending on the child’s core temperature. At 35° C (95° F), a child would experience vigorous shivering, decreased intestinal motility, and task performance impairment. Bradycardia and decreased respiratory rate are physical effects observed as the body temperature continues to decrease.

 

DIF:    Cognitive Level: Analyzing            REF:   pp. 622-623

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is caring for a child with psoriasis. What local manifestations does the nurse expect to assess in this child? (Select all that apply.)
a. Development of wheals
b. First lesions appear in the scalp
c. Round, thick, dry reddish patches
d. Lesions appear in intergluteal folds
e. Patches are covered with coarse, silvery scales

 

 

ANS:  B, C, E

Local manifestations of psoriasis include lesions that appear in the scalp initially and round, thick dry patches covered with coarse, silvery scales. Development of wheals is seen in urticaria. Lesions in intergluteal folds are characteristic of intertrigo.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 626

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is caring for a child with erythema multiforme (Stevens-Johnson syndrome). What local manifestations does the nurse expect to assess in this child? (Select all that apply.)
a. Papular urticaria
b. Erythematous papular rash
c. Lesions absent in the scalp
d. Lesions enlarge by peripheral expansion
e. Firm papules that may be capped by vesicles

 

 

ANS:  B, C, D

Local manifestations of erythema multiforme include an erythematous popular rash, lesions involving most skin surfaces except the scalp and lesions that enlarge by peripheral expansion. Papular urticaria and firm papules capped by vesicles are characteristics of an insect bite.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 626

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is caring for a child with neurofibromatosis. What local manifestations does the nurse expect to assess in this child? (Select all that apply.)
a. Pigmented nevi
b. Axillary freckling
c. Café-au-lait spots
d. Slowly growing cutaneous neurofibromas
e. Wheals that spread irregularly and fade within a few hours

 

 

ANS:  A, B, C, D

Local manifestations of neurofibromatosis include pigmented nevi, axillary freckling, café-au-lait spots, and slowly growing cutaneous neurofibromas. Wheals that spread irregularly and fade within a few hours are characteristic of urticaria.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 626

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

COMPLETION

 

  1. A health care provider prescribes methylphenidate hydrochloride (Ritalin), PO, 20 mg, twice a day, for a child with attention deficit hyperactivity disorder. The medication label states: “Methylphenidate hydrochloride (Ritalin), 10 mg/1 tablet.” The nurse prepares to administer one dose. How many tab(s) should the nurse prepare to administer one dose? Fill in the blank. Record your answer as a whole number.

________________

 

ANS:

2

 

Follow the formula for dosage calculation.

Desired

———– ´ Quantity = Tablets per dose

Available

 

20 mg

———– ´ 1 = 2 tabs

10 mg

 

DIF:    Cognitive Level: Applying              REF:   p. 638

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. A health care provider prescribes clonidine hydrochloride (Kapvay), PO, 0.3 mg, daily for a child with attention deficit hyperactivity disorder. The medication label states: “Clonidine hydrochloride (Kapvay), 0.1 mg/1 tablet.” The nurse prepares to administer one dose. How many tablet(s) should the nurse prepare to administer one dose? Fill in the blank. Record your answer as a whole number.

________________

 

ANS:

3

 

Follow the formula for dosage calculation.

Multiply 1 mg ´ 10 kg to get the dose = 10 mg

 

Desired

———– ´ Quantity = Tablets per dose

Available

 

0.3 mg

———– ´ 1 tab = 3 tabs

0.1 mg

 

DIF:    Cognitive Level: Applying              REF:   p. 638

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. A health care provider prescribes sertraline (Zoloft) PO, 50 mg, daily, for a child with depression. The medication label states: “Sertraline (Zoloft) oral concentrate, 20 mg/1 ml.” The nurse prepares to administer one dose. How many milliliters should the nurse prepare to administer one dose? Fill in the blank. Record your answer to one decimal place.

________________

 

ANS:

2.5

 

Follow the formula for dosage calculation.

Desired

———– ´ Volume = ml per dose

Available

 

50 mg

———– ´ 1 ml = 2.5 ml

20 mg

 

DIF:    Cognitive Level: Applying              REF:   p. 643

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. A health care provider prescribes paroxetine (Paxil), 20 mg, PO, daily for a child with depression. The medication label states: “Paroxetine (Paxil) 10 mg/1 tablet.” The nurse prepares to administer one dose. How many tablet(s) should the nurse prepare to administer one dose? Fill in the blank. Record your answer as a whole number.

________________

 

ANS:

2

 

Follow the formula for dosage calculation.

 

Desired

———– ´ Quantity = Tablets per dose

Available

 

20 mg

———– ´ 1 = 2 tabs

10 mg

 

DIF:    Cognitive Level: Applying              REF:   p. 647

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. A health care provider prescribes haloperidol (Haldol), PO, 0.5 mg, twice a day, for a child with schizophrenia. The medication label states: “Haloperidol (Haldol) oral concentrate, 1 mg/1 ml.” The nurse prepares to administer one dose. How many milliliters should the nurse prepare to administer one dose? Fill in the blank. Record your answer to one decimal place.

________________

 

ANS:

0.5

 

Follow the formula for dosage calculation.

Desired

———– ´ Volume = ml per dose

Available

 

0.5 mg

———– ´ 1 ml = 0.5 ml

1 mg

 

DIF:    Cognitive Level: Applying              REF:   p. 648

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. A health care provider prescribes risperidone (Risperdal), PO, 2 mg, twice a day, for a child with schizophrenia. The medication label states: “Risperidone (Risperdal) oral concentrate, 1 mg/1 ml.” The nurse prepares to administer one dose. How many milliliters should the nurse prepare to administer one dose? Fill in the blank. Record your answer as a whole number.

________________

 

ANS:

2

 

Follow the formula for dosage calculation.

Desired

———– ´ Volume = ml per dose

Available

 

2 mg

———– ´ 1 ml = 2 ml

1 mg

 

DIF:    Cognitive Level: Applying              REF:   p. 648

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

MATCHING

 

Many cutaneous lesions are associated with local symptoms. Match the symptom with its definition.

a. Pruritus
b. Anesthesia
c. Hyperesthesia
d. Hypesthesia
e. Paresthesia

 

 

  1. Excessive sensitiveness

 

  1. Itching

 

  1. Diminished sensation

 

  1. Abnormal sensation

 

  1. Absence of sensation

 

  1. ANS:  C                    DIF:    Cognitive Level: Understanding     REF:   p. 610

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. ANS:  A                    DIF:    Cognitive Level: Understanding     REF:   p. 610

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. ANS:  D                    DIF:    Cognitive Level: Understanding     REF:   p. 610

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. ANS:  E                    DIF:    Cognitive Level: Understanding     REF:   p. 610

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. ANS:  B                    DIF:    Cognitive Level: Understanding     REF:   p. 610

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

Match the acute wound to its definition.

a. Abrasion
b. Avulsion
c. Laceration
d. Incision
e. Puncture

 

 

  1. Division of the skin made with a sharp object

 

  1. Forcible pulling out or extraction of tissue

 

  1. Removal of the superficial layers of skin by rubbing or scraping

 

  1. Wound with a relatively small opening compared with the depth

 

  1. Torn or jagged wound

 

  1. ANS:  D                    DIF:    Cognitive Level: Understanding     REF:   p. 610

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. ANS:  B                    DIF:    Cognitive Level: Understanding     REF:   p. 610

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. ANS:  A                    DIF:    Cognitive Level: Understanding     REF:   p. 610

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. ANS:  E                    DIF:    Cognitive Level: Understanding     REF:   p. 610

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. ANS:  C                    DIF:    Cognitive Level: Understanding     REF:   p. 610

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

Chapter 34: The Child with Musculoskeletal or Articular Dysfunction

 

MULTIPLE CHOICE

 

  1. An 8-year-old child is hit by a motor vehicle in the school parking lot. The school nurse notes that the child is responding to verbal stimulation but is not moving his extremities when requested. What is the first action the nurse should take?
a. Wait for the child’s parents to arrive.
b. Move the child out of the parking lot.
c. Have someone notify the emergency medical services (EMS) system.
d. Help the child stand to return to play.

 

 

ANS:  C

The child was involved in a motor vehicle collision and at this time is not able to move his extremities. The child needs immediate attention at a hospital for assessment of the possibility of a spinal cord injury. Because the child cannot move his extremities, the child should not be moved until his cervical and vertebral spines are stabilized. The EMS team can appropriately stabilize the spinal column for transport. Although it is important to notify the parents, the EMS system should be activated and transport arranged for serious injuries. The only indication to move the child is to prevent further trauma.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 1545

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. The nurse stops to assist an adolescent who has experienced severe trauma when hit by a motorcycle. The emergency medical system (EMS) has been activated. The first person who provided assistance applied a tourniquet to the child’s leg because of arterial bleeding. What should the nurse do related to the tourniquet?
a. Loosen the tourniquet.
b. Leave the tourniquet in place.
c. Remove the tourniquet and apply direct pressure if bleeding is still present.
d. Remove the tourniquet every 5 minutes, leaving it off for 30 seconds each time.

 

 

ANS:  B

A tourniquet is applied only as a last resort, and then it is left in place and not loosened until definitive treatment is available. After the tourniquet is applied, skin and tissue necrosis occur below the site. Loosening or removing the tourniquet allows toxins from the tissue necrosis to be released into the circulation. This can induce systemic, deadly tourniquet shock.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 1545

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. What is a physiologic effect of immobilization on children?
a. Metabolic rate increases.
b. Venous return improves because the child is in the supine position.
c. Circulatory stasis can lead to thrombus and embolus formation.
d. Bone calcium increases, releasing excess calcium into the body (hypercalcemia).

 

 

ANS:  C

The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with immobilization. With the loss of muscle contraction, there is a decreased venous return to the heart. Calcium leaves the bone during immobilization, leading to bone demineralization and increasing the calcium ion concentration in the blood.

 

DIF:    Cognitive Level: Understanding     REF:   p. 1549

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. What condition can result from the bone demineralization associated with immobility?
a. Osteoporosis
b. Pooling of blood
c. Urinary retention
d. Susceptibility to infection

 

 

ANS:  A

Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi. Pooling of blood is a result of the cardiovascular effects of immobilization. Urinary retention is secondary to the effect of immobilization on the urinary tract. Susceptibility to infection can result from the effects of immobilization on the respiratory and renal systems.

 

DIF:    Cognitive Level: Understanding     REF:   p. 1554

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. What measure is important in managing hypercalcemia in a child who is immobilized?
a. Provide adequate hydration.
b. Change position frequently.
c. Encourage a diet high in calcium.
d. Provide a diet high in calories for healing.

 

 

ANS:  A

Vigorous hydration is indicated to prevent problems with hypercalcemia. Suggested intake for an adolescent is 3000 to 4000 ml/day of fluids. Diuretics are used to promote the removal of calcium. Changing position is important for skin and respiratory concerns. Calcium in the diet is restricted when possible. A high-protein diet served as frequent snacks with favored foods is recommended. A high-calorie diet without adequate protein will not promote healing.

 

DIF:    Cognitive Level: Understanding     REF:   p. 1554

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is caring for an immobilized preschool child. What intervention is helpful during this period of immobilization?
a. Encourage wearing pajamas.
b. Let the child have few behavioral limitations.
c. Keep the child away from other immobilized children if possible.
d. Take the child for a “walk” by wagon outside the room.

 

 

ANS:  D

Transporting the child outside of the room by stretcher, wheelchair, or wagon increases environmental stimuli and provides social contact. Street clothes are preferred for hospitalized children. This decreases the sense of illness and disability. The child needs appropriate limits for both adherence to the medical regimen and developmental concerns. It is not necessary to keep the child away from other immobilized children.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 1563

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is teaching parents the proper use of a hip–knee–ankle–foot orthosis (HKAFO) for their 4-year-old child. The parents demonstrate basic essential knowledge by making what statement?
a. “Alcohol will be used twice a day to clean the skin around the brace.”
b. “Weekly visits to the orthotist are scheduled to check screws for tightness.”
c. “Initially, a burning sensation is expected and the brace should remain in place.”
d. “Condition of the skin in contact with the brace should be checked every 4 hours.”

 

 

ANS:  D

This type of brace has several contact points with the child’s skin. To minimize the risk of skin breakdown and facilitate use of the brace, vigilant skin monitoring is necessary. Alcohol should not be used on the skin. It is drying. Parents are capable of checking and tightening the screws when necessary. If a burning sensation occurs, the brace should be removed. If several complaints of burning occur, the orthotist should be contacted.

 

DIF:    Cognitive Level: Applying              REF:   p. 1565

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. Immobilization causes what effect on metabolism?
a. Hypocalcemia
b. Decreased metabolic rate
c. Positive nitrogen balance
d. Increased levels of stress hormones

 

 

ANS:  B

Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake. Immobilization leads to hypercalcemia and a negative nitrogen balance secondary to muscle atrophy. Decreased production of stress hormones occurs with decreased physical and emotional coping capacity.

 

DIF:    Cognitive Level: Understanding     REF:   p. 1554

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. What finding is characteristic of fractures in children?
a. Fractures rarely occur at the growth plate site because it absorbs shock well.
b. Rapidity of healing is inversely related to the child’s age.
c. Pliable bones of growing children are less porous than those of adults.
d. The periosteum of a child’s bone is thinner, is weaker, and has less osteogenic potential compared to that of an adult.

 

 

ANS:  B

Healing is more rapid in children. The younger the child, the more rapid the healing process. Nonunion of bone fragments is uncommon except in severe injuries. The epiphyseal plate is the weakest point of long bones and a frequent site of injury during trauma. Children’s bones are more pliable and porous than those of adults. This allows them to bend, buckle, and break. The greater porosity increases the flexibility of the bone and dissipates and absorbs a significant amount of the force on impact. The adult periosteum is thinner, is weaker, and has less osteogenic potential than that of a child.

 

DIF:    Cognitive Level: Understanding     REF:   p. 1568

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. A 14-year-old is admitted to the emergency department with a fracture of the right humerus epiphyseal plate through the joint surface. What information does the nurse know regarding this type of fracture?
a. It will create difficulty because the child is left handed.
b. It will heal slowly because this is the weakest part of the bone.
c. This type of fracture requires different management to prevent bone growth complications.
d. This type of fracture necessitates complete immobilization of the shoulder for 4 to 6 weeks.

 

 

ANS:  C

This type of fracture (Salter type III) can cause problems with growth in the affected limb. Early and complete assessment is essential to prevent angular deformities and longitudinal growth problems. The difficulty for the child does not depend on the location at the epiphyseal plate. Any fracture of the dominant arm presents obstacles for the individual. Healing is usually rapid in the epiphyseal plate area. Complete immobilization is not necessary. Often these injuries are surgically repaired with open reduction and internal fixation.

 

DIF:    Cognitive Level: Understanding     REF:   p. 1569

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. Parents bring a 7-year-old child to the clinic for evaluation of an injured wrist after a bicycle accident. The parents and child are upset, and the child will not allow an examination of the injured arm. What priority nursing intervention should occur at this time?
a. Send the child to radiology so radiography can be performed.
b. Initiate an intravenous line and administer morphine for the pain.
c. Calmly ask the child to point to where the pain is worst and to wiggle fingers.
d. Have the parents hold the child so that the nurse can examine the arm thoroughly.

 

 

ANS:  C

Initially, assessment is the priority. Because the child is alert but upset, the nurse should work to gain the child’s trust. Initial data are gained by observing the child’s ability to move the fingers and to point to the pain. Other important observations at this time are pallor and paresthesia. The child needs to be sent for radiography, but initial assessment data need to be obtained. Sending the child for radiography will increase the child’s anxiety, making the examination difficult. It is inappropriate to ask parents to restrain their child. These parents are upset about the injury. If restraint is indicated, the nurse should obtain assistance from other personnel.

 

DIF:    Cognitive Level: Applying              REF:   p. 1572

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. A 7-year-old child has just had a cast applied for a fractured arm with the wrist and elbow immobilized. What information should be included in the home care instructions?
a. No restrictions of activity are indicated.
b. Elevate casted arm when both upright and resting.
c. The shoulder should be kept as immobile as possible to avoid pain.
d. Swelling of the fingers is to be expected. Notify a health professional if it persists more than 48 hours.

 

 

ANS:  B

The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. The child should not engage in strenuous activity for the first few days. Rest with elevation of the extremity is encouraged. Joints above and below the cast on the affected extremity should be moved. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours.

 

DIF:    Cognitive Level: Applying              REF:   p. 1566

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse uses the five Ps to assess ischemia in a child with a fracture. What finding is considered a late and ominous sign?
a. Petaling
b. Posturing
c. Paresthesia
d. Positioning

 

 

ANS:  C

Paresthesia distal to the injury or cast is an ominous sign that requires immediate notification of the practitioner. Permanent muscle and tissue damage can occur within 6 hours. The other signs of ischemia that need to be reported are pain, pallor, pulselessness, and paralysis. Petaling is a method of placing protective or smooth edges on a cast. Posturing is not a sign of peripheral ischemia. Finding a position of comfort can be difficult with a fracture. It would not be an ominous sign unless pain was increasing or uncontrollable.

 

DIF:    Cognitive Level: Applying              REF:   p. 1573

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What technique should the nurse suggest to remove this material?
a. Soak in a bathtub.
b. Vigorously scrub the leg.
c. Carefully pick material off the leg.
d. Apply powder to absorb the material.

 

 

ANS:  A

Simply soaking in the bathtub is usually sufficient for removal of the desquamated skin and sebaceous secretions. Several days may be required to eliminate the accumulation completely. The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding. Oil or lotion, but not powder, may provide comfort for the child.

 

DIF:    Cognitive Level: Applying              REF:   p. 1557

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. A child with a hip spica cast is being prepared for discharge. Recognizing that caring for a child at home is complex, the nurse should include what instructions for the parents’ discharge teaching?
a. Turn every 8 hours.
b. Specially designed car restraints are necessary.
c. Diapers should be avoided to reduce soiling of the cast.
d. Use an abduction bar between the legs to aid in turning.

 

 

ANS:  B

Standard seat belts and car seats may not be readily adapted for use by children in some casts. Specially designed car seats and restraints meet safety requirements. The child must have position changes much more frequently than every 8 hours. During feeding and play activities, the child should be moved for both physiologic and psychosocial benefit. Diapers and other strategies are necessary to maintain cleanliness. The abduction bar is never used as an aid for turning. Putting pressure on the bar may damage the integrity of the cast.

 

DIF:    Cognitive Level: Applying              REF:   p. 1559

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. What is an appropriate nursing intervention when caring for a child in traction?
a. Removing adhesive traction straps daily to prevent skin breakdown
b. Assessing for tightness, weakness, or contractures in uninvolved joints and muscles
c. Providing active range of motion exercises to affected extremity three times a day
d. Keeping child prone to maintain good alignment

 

 

ANS:  B

Traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released or replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained.

 

DIF:    Cognitive Level: Applying              REF:   p. 1562

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is caring for a hospitalized adolescent whose femur was fractured 18 hours ago. The adolescent suddenly develops chest pain and dyspnea. The nurse should suspect what complication?
a. Sepsis
b. Osteomyelitis
c. Pulmonary embolism
d. Acute respiratory tract infection

 

 

ANS:  C

Fat emboli are of greatest concern in individuals with fractures of the long bones. Fat droplets from the marrow are transferred to the general circulation, where they are transported to the lung or brain. This type of embolism usually occurs within the second 12 hours after the injury. Sepsis would manifest with fever and lethargy. Osteomyelitis usually is seen with pain at the site of infection and fever. A child with an acute respiratory tract infection would have nasal congestion, not chest pain.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 1575

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. What statement is correct regarding sports injuries during adolescence?
a. Conditioning does not help prevent many sports injuries.
b. The increase in strength and vigor during adolescence helps prevent injuries related to fatigue.
c. More injuries occur during organized athletic competition than during recreational sports participation.
d. Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities.

 

 

ANS:  D

Injuries occur when the adolescent’s body is not suited to the sport or when he or she lacks the insight and judgment to recognize that an activity exceeds his or her physical abilities. More injuries occur when an adolescent’s muscles and body systems (respiratory and cardiovascular) are not conditioned to endure physical stress. Injuries do not occur from fatigue but rather from overuse. All sports have the potential for injury to the participant, whether the youngster engages in serious competition or in sports for recreation. More injuries occur during recreational sports than during organized athletic competition.

 

DIF:    Cognitive Level: Understanding     REF:   p. 1576          TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The middle school nurse is speaking to parents about prevention of injuries as a goal of the physical education program. How should the goal be achieved?
a. Use of protective equipment at the family’s discretion
b. Education of adults to recognize signs that indicate a risk for injury
c. Sports medicine program to help student athletes work through overuse injuries
d. Arrangements for multiple sports to use same athletic fields to accommodate more children

 

 

ANS:  B

Adults close to sports activities need to be aware of the early warning signs of fatigue, dehydration, and risk for injury. School policy should require mandatory use of protective equipment. Proper sports medicine therapy does not support “working through” overuse injuries. Too many students involved in different activities create distractions, which contribute to the child losing focus. This is a contributing factor to injury.

 

DIF:    Cognitive Level: Applying              REF:   p. 1584          TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A young girl has just injured her ankle at school. In addition to notifying the child’s parents, what is the most appropriate, immediate action by the school nurse?
a. Apply ice.
b. Observe for edema and discoloration.
c. Encourage child to assume a position of comfort.
d. Obtain parental permission for administration of acetaminophen or aspirin.

 

 

ANS:  A

Soft tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. The nurse observes for the edema while placing a cold pack. The applying of ice can reduce the severity of the injury. Maintaining the ankle at a position elevated above the heart is important. The nurse helps the child be comfortable with this requirement. The nurse obtains parental permission for administration of acetaminophen or aspirin after ice and rest are assured.

 

DIF:    Cognitive Level: Applying              REF:   p. 1601

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. A student athlete was injured during a basketball game. The nurse observes significant swelling. The player states he thought he “heard a pop,” that the pain is “pretty bad,” and that the ankle feels “as if it is coming apart.” Based on this description, the nurse suspects what injury?
a. Sprain
b. Fracture
c. Dislocation
d. Stress fracture

 

 

ANS:  A

Sprains account for approximately 75% of all ankle injuries in children. A sprain results when the trauma is so severe that a ligament is either stretched or partially or completely torn by the force created as a joint is twisted or wrenched. Joint laxity is the most valid indicator of the severity of a sprain. A fracture involves the cross-section of the bone. Dislocations occur when the force of stress on the ligaments disrupts the normal positioning of the bone ends. Stress fractures result from repeated muscular contraction and are seen most often in sports involving repetitive weight bearing such as running, gymnastics, and basketball.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 1578

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. An adolescent comes to the school nurse after experiencing shin splints during a track meet. What reassurance should the nurse offer?
a. Shin splints are expected in runners.
b. Ice, rest, and nonsteroidal antiinflammatory drugs (NSAIDs) usually relieve pain.
c. It is generally best to run around and “work the pain out.”
d. Moist heat and acetaminophen are indicated for this type of injury.

 

 

ANS:  B

Shin splints result when the ligaments tear away from the tibial shaft and cause pain. Actions that have an antiinflammatory effect are indicated for shin splints. Ice, rest, and NSAIDs are the usual treatment. Shin splints are rarely serious, but they are not expected, and preventive measures are taken. Rest is important to heal the shin splints. Continuing to place stress on the tibia can lead to further damage.

 

DIF:    Cognitive Level: Applying              REF:   p. 1579

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. The nurse at a summer camp recognizes the signs of heatstroke in an adolescent girl. Her temperature is 40° C (104° F). She is slightly confused but able to drink water. Nursing care while waiting for transport to the hospital should include what intervention?
a. Administer antipyretics.
b. Administer salt tablets.
c. Apply towels wet with cool water.
d. Sponge with solution of rubbing alcohol and water.

 

 

ANS:  C

Heatstroke is a failure of normal thermoregulatory mechanisms. The onset is rapid with initial symptoms of headache, weakness, and disorientation. Immediate care is relocation to a cool environment, removal of clothing, and applying of cool water (wet towels or immersion). Antipyretics are not used because they are metabolized by the liver, which is already not functioning. Salt tablets are not indicated and may be harmful by increasing dehydration. Rubbing alcohol is not used.

 

DIF:    Cognitive Level: Applying              REF:   p. 1580

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. What is the recommended drink for athletes during practice and competition?
a. Sports drinks to replace carbohydrates
b. Cold water for gastrointestinal tract rapid absorption
c. Carbonated beverages to help with acid–base balance
d. Enhanced performance carbohydrate–electrolyte drinks

 

 

ANS:  B

Water is recommended for most athletes, who should drink 4 to 8 oz every 15 to 20 minutes. Cold water facilitates rapid gastric emptying and intestinal absorption. Most carbohydrate sports drinks have 6% to 8% carbohydrate, which can cause gastrointestinal upset. Carbonated beverages are discouraged. There is no evidence that these drinks enhance function.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 1580

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is teaching the girls’ varsity sports teams about the “female athlete triad.” What is essential information to include?
a. They should take low to moderate calcium to avoid hypercalcemia.
b. They have strong bones because of the athletic training.
c. Pregnancy can occur in the absence of menstruation.
d. A diet high in carbohydrates accommodates increased training.

 

 

ANS:  C

Sexually active teenagers, regardless of menstrual status, need to consider contraceptive precautions. Increased calcium (1500 mg) is recommended for amenorrheic athletes. The decreased estrogen in girls with the female athlete triad, coupled with potentially inadequate diet, leads to osteoporosis. Diets high in protein and calories are necessary to avoid potentially long-term consequences of intensive, prolonged exercise programs in pubertal girls.

 

DIF:    Cognitive Level: Applying              REF:   p. 1604

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. Parents are considering treatment options for their 5-year-old child with Legg-Calvé-Perthes disease. Both surgical and conservative therapies are appropriate. They are able to verbalize the differences between the therapies when they make what statement?
a. “All therapies require extended periods of bed rest.”
b. “Conservative therapy will be required until puberty.”
c. “Our child cannot attend school during the treatment phase.”
d. “Surgical correction requires a 3- to 4-month recovery period.”

 

 

ANS:  D

Surgical correction involves additional risks of anesthesia, infection, and possibly blood transfusion. The recovery period is only 3 to 4 months rather than the 2 to 4 years of conservative therapies. The use of non–weight-bearing appliances and surgical intervention does not require prolonged bed rest. Conservative therapy is indicated for 2 to 4 years. The child is encouraged to attend school and engage in activities that can be adapted to therapeutic appliances.

 

DIF:    Cognitive Level: Applying              REF:   p. 1588

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. A 4-year-old child is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses the skin of his right foot and sees that it is pale with an absence of pulse. What should the nurse do first?
a. Reposition the child and notify the practitioner.
b. Notify the practitioner of the changes noted.
c. Give the child medication to relieve the pain.
d. Chart the observations and check the extremity again in 15 minutes.

 

 

ANS:  B

The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. This is an emergency condition. Pain medication should be given after the practitioner is notified. The findings should be documented with ongoing assessment.

 

DIF:    Cognitive Level: Applying              REF:   p. 1561

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. What term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine?
a. Scoliosis
b. Lordosis
c. Kyphosis
d. Ankylosis

 

 

ANS:  C

Kyphosis is an abnormally increased convex angulation in the curvature of the thoracic spine. Scoliosis is a complex spinal deformity usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis. Lordosis is an accentuation of the cervical or lumbar curvature beyond physiologic limits. Ankylosis is the immobility of a joint.

 

DIF:    Cognitive Level: Understanding     REF:   p. 1585

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. When does idiopathic scoliosis become most noticeable?
a. In the newborn period
b. When the child starts to walk
c. During the preadolescent growth spurt
d. During adolescence

 

 

ANS:  C

Idiopathic scoliosis is most noticeable during the preadolescent growth spurt. It is seldom apparent before age 10 years.

 

DIF:    Cognitive Level: Understanding     REF:   p. 1587

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic. The preadolescent asks how long she will have to wear the brace. What is the appropriate response by the nurse?
a. “For as long as you have been told.”
b. “Most preadolescents use the brace for 6 months.”
c. “Until your vertebral column has reached skeletal maturity.”
d. “It will be necessary to wear the brace for the rest of your life.”

 

 

ANS:  C

Bracing can halt or slow the progress of most curvatures. They must be used continuously until the child reaches skeletal maturity. Telling the child “for as long as you have been told” does not answer the child’s question and does not promote involvement in care. Six months is unrealistic because skeletal maturity is not reached until adolescence. When skeletal growth is complete, bracing is no longer effective.

 

DIF:    Cognitive Level: Applying              REF:   p. 1587

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. A 17-year-old patient is returning to the surgical unit after Luque instrumentation for scoliosis repair. In addition to the usual postoperative care, what additional intervention will be needed?
a. Position changes are made by log rolling.
b. Assistance is needed to use the bathroom.
c. The head of the bed is elevated to minimize spinal headache.
d. Passive range of motion is instituted to prevent neurologic injury.

 

 

ANS:  A

After scoliosis repair using a Luque procedure, the adolescent is turned by log rolling to prevent damage to the fusion and instrumentation. The patient is kept flat in bed for the first 12 hours and is not ambulatory until the second or third postoperative day. A urinary catheter is placed. The head of the bed is not elevated until the second postoperative day. Range of motion exercises are begun on the second postoperative day.

 

DIF:    Cognitive Level: Understanding     REF:   p. 1589

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. What is the primary method of treating osteomyelitis?
a. Joint replacement
b. Bracing and casting
c. Intravenous antibiotic therapy
d. Long-term corticosteroid therapy

 

 

ANS:  C

Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus infection. The treatment of choice is antibiotics. Joint replacement, bracing and casting, and long-term corticosteroid therapy are not indicated for infectious processes.

 

DIF:    Cognitive Level: Understanding     REF:   p. 1597

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. What nursing intervention is most appropriate when caring for the child with osteomyelitis?
a. Encourage frequent ambulation.
b. Administer antibiotics with meals.
c. Move and turn the child carefully and gently to minimize pain.
d. Provide active range of motion exercises for the affected extremity.

 

 

ANS:  C

During the acute phase, any movement of the affected limb causes discomfort to the child. Careful positioning with the affected limb supported is necessary. Weight bearing is not permitted until healing is well under way to avoid pathologic fractures. Intravenous antibiotics are used initially. Food is not necessary with parenteral therapy. Active range of motion would be painful for the child.

 

DIF:    Cognitive Level: Applying              REF:   p. 1599

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. What statement is true concerning osteogenesis imperfecta (OI)?
a. It is easily treated.
b. It is an inherited disorder.
c. Braces and exercises are of no therapeutic value.
d. Later onset disease usually runs a more difficult course.

 

 

ANS:  B

OI is a heterogeneous, autosomal dominant disorder characterized by fractures and bone deformity. Treatment is primarily supportive. Several investigational therapies are being evaluated. The primary goal of therapy is rehabilitation. Lightweight braces and splints help support limbs, prevent fractures, and aid in ambulation. The disease is present at birth. Prognosis is affected by the type of OI.

 

DIF:    Cognitive Level: Understanding     REF:   p. 1600

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. What is a major goal for the therapeutic management of juvenile idiopathic arthritis (JIA)?
a. Control pain and preserve joint function.
b. Minimize use of joint and achieve cure.
c. Prevent skin breakdown and relieve symptoms.
d. Reduce joint discomfort and regain proper alignment.

 

 

ANS:  A

The goals of therapy are to control pain, preserve joint range of motion and function, minimize the effects of inflammation, and promote normal growth and development. There is no cure for JIA at this time. Skin breakdown is not an issue for most children with JIA. Symptom relief and reduction in discomfort are important. When the joints are damaged, it is often irreversible.

 

DIF:    Cognitive Level: Understanding     REF:   p. 1602          TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity

 

  1. A child with juvenile idiopathic arthritis (JIA) is started on a nonsteroidal antiinflammatory drug (NSAID). What nursing consideration should be included?
a. Monitor heart rate.
b. Administer NSAIDs between meals.
c. Check for abdominal pain and bloody stools.
d. Expect inflammation to be gone in 3 or 4 days.

 

 

ANS:  C

NSAIDs are the first-line drugs used in JIA. Potential side effects include gastrointestinal (GI), renal, and hepatic side effects. The child is at risk for GI bleeding and elevated blood pressure. The heart rate is not affected by this drug class. NSAIDs should be given with meals to minimize gastrointestinal problems. The antiinflammatory response usually takes 3 weeks before effectiveness can be evaluated.

 

DIF:    Cognitive Level: Applying              REF:   p. 1605

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. What is an important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA)?
a. Apply ice packs to relieve acute swelling and pain.
b. Administer acetaminophen to reduce inflammation.
c. Teach the child and family correct administration of medications.
d. Encourage range of motion exercises during periods of inflammation.

 

 

ANS:  C

The management of JIA is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that nonsteroidal antiinflammatory drugs should not be given on an empty stomach and to be alert for signs of toxicity. Warm, moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range of motion exercises should not be done during periods of inflammation.

 

DIF:    Cognitive Level: Applying              REF:   p. 1605

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. What needs to be included as essential teaching for adolescents with systemic lupus erythematosus (SLE)?
a. High calorie diet because of increased metabolic needs
b. Home schooling to decrease the risk of infections
c. Protection from sun and fluorescent lights to minimize rash
d. Intensive exercise regimen to build up muscle strength and endurance

 

 

ANS:  C

The photosensitive rash is a major concern for individuals with SLE. Adolescents who spend time outdoors need to use sunscreens with a high SPF, hats, and clothing. Uncovered fluorescent lights can also cause a photosensitivity reaction. The diet should be sufficient in calories and nutrients for growth and development. The use of steroids can cause increased hunger, resulting in weight gain. This can present additional emotional issues for the adolescent. Normal functions should be maximized. The individual with SLE is encouraged to attend school and participate in peer activities. A balance of rest and exercise is important; excessive exercise is avoided.

 

DIF:    Cognitive Level: Applying              REF:   p. 1609

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is teaching the parent of a 4-year-old child with a cast on the arm about care at home. What statement by the parent indicates a correct understanding of the teaching?
a. “I should have the affected limb hang in a dependent position.”
b. “I will use an ice pack to relieve the itching.”
c. “I should avoid keeping the injured arm elevated.”
d. “I will expect the fingers to be swollen for the next 3 days.”

 

 

ANS:  B

Teaching the parent to use an ice pack to relieve the itching is an important aspect when planning discharge for a child with a cast. The affected limb should not be allowed to hang in a dependent position for more than 30 minutes. The affected arm should be kept elevated as much as possible. If there is swelling or redness of the fingers, the parent should notify the health care provider.

 

DIF:    Cognitive Level: Applying              REF:   p. 1559

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. What statement by the parent would indicate a correct understanding of the teaching?
a. “I should gently massage the skin under the straps once a day to stimulate circulation.”
b. “I will apply a lotion for sensitive skin under the straps after my baby has been given a bath to prevent skin irritation.”
c. “I should remove the harness several times a day to prevent contractures.”
d. “I will place the diaper over the harness, preferably using a superabsorbent disposable diaper that is relatively thin.”

 

 

ANS:  A

To prevent skin breakdown with an infant who has developmental dysplasia of the hip and is in a Pavlik harness, the parent should gently massage the skin under the straps once a day to stimulate circulation. The parent should not apply lotions or powder because this could irritate the skin. The parent should not remove the harness, except during a bath, and should place the diaper under the straps.

 

DIF:    Cognitive Level: Applying              REF:   p. 1591

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, what should the nurse explain?
a. Traction is tried first.
b. Surgical intervention is needed.
c. Frequent, serial casting is tried first.
d. Children outgrow this condition when they learn to walk.

 

 

ANS:  C

Serial casting is begun shortly after birth, before discharge from the nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Serial casting is the preferred treatment. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.

 

DIF:    Cognitive Level: Understanding     REF:   p. 1597

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a functional prosthetic device?
a. As soon as possible after birth
b. When the infant is developmentally ready to stand up
c. At about ages 12 to 15 months, when most children are walking
d. At about 4 years, when the healthy limb is not growing so rapidly

 

 

ANS:  B

An infant should be fitted with a functional prosthetic leg when the infant is developmentally ready to pull to a standing position. When the infant begins limb exploration, a soft prosthesis can be used. The child should begin using the prosthesis as part of his or her normal development. This will match the infant’s motor readiness.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 1552

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. The nurse knows that parents need further teaching with regard to the treatment of congenital clubfoot when they state what?
a. “We’ll keep the cast dry.”
b. “We’re happy this is the only cast our baby will need.”
c. “We’ll watch for any swelling of the foot while the cast is on.”
d. “We’re getting a special car seat to accommodate the cast.”

 

 

ANS:  B

The common approach to clubfoot management and treatment is the Ponseti method. Serial casting is begun shortly after birth. Weekly gentle manipulation and stretching of the foot along with placement of serial long-leg casts allow for gradual repositioning of the foot. The extremity or extremities are casted until maximum correction is achieved, usually within 6 to 10 weeks. If parents state that this is the only cast the infant will need, they need further teaching.

 

DIF:    Cognitive Level: Applying              REF:   p. 1597

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. A child has just returned from surgery for repair of a fractured femur. The child has a long-leg cast on. The toes on the leg with the cast are edematous, but they have color, sensitivity, and movement. What action should the nurse take?
a. Call the health care provider to report the edema.
b. Elevate the foot and leg on pillows.
c. Apply a warm moist pack to the foot.
d. Encourage movement of toes.

 

 

ANS:  B

During the first few hours after a cast is applied, the chief concern is that the extremity may continue to swell to the extent that the cast becomes a tourniquet, shutting off circulation and producing neurovascular complications (compartment syndrome). One measure to reduce the likelihood of this problem is to elevate the body part and thereby increase venous return. The health care provider does not need to be notified because edema is expected and warm moist packs will not decrease the edema. The child should move the toes, but that will not help reduce the edema.

 

DIF:    Cognitive Level: Applying              REF:   p. 1559

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. After spinal fusion surgery the nurse should check for signs of what?
a. Seizure activity
b. Increased intracranial pressure
c. Impaired color, sensitivity, and movement to the lower extremities
d. Impaired pupillary response during neurologic checks

 

 

ANS:  C

In addition to the usual postoperative assessments of wound, circulation, and vital signs, the neurologic status of the patient’s extremities requires special attention. Prompt recognition of any neurologic impairment is imperative because delayed paralysis may develop that requires surgical intervention.

 

DIF:    Cognitive Level: Applying              REF:   p. 1589

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. What should the nurse plan for an immobilized child in cervical traction to prevent deep vein thrombosis (DVT)?
a. Elevate the child’s legs.
b. Place a foot cradle on the bed.
c. Place a pillow under the child’s knees.
d. Assist the child to dorsiflex the feet and rotate the ankles.

 

 

ANS:  D

For a child who is immobilized, circulatory stasis and DVT development are prevented by instructing patients to change positions frequently, dorsiflex their feet and rotate the ankles, sit in a bedside chair periodically, or ambulate several times daily. Elevating the legs or placing a foot cradle on the bed will not prevent DVTs. A pillow under the knee would impair circulation, not improve it.

 

DIF:    Cognitive Level: Applying              REF:   p. 1551

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is teaching a child with a cast about cast removal. What should the nurse teach the child about cast removal?
a. “The cast cutter will be a quiet machine.”
b. “You will feel cold as the cast is removed.”
c. “You will feel a tickly sensation as the cast is removed.”
d. “The cast cutter cuts through the cast like a circular saw.”

 

 

ANS:  C

Cutting the cast to remove it or to relieve tightness is frequently a frightening experience for children. They fear the sound of the cast cutter and are terrified that their flesh, as well as the cast, will be cut. Because it works by vibration, a cast cutter cuts only the hard surface of the cast. The oscillating blade vibrates back and forth very rapidly and will not cut when placed lightly on the skin. Children have described it as producing a “tickly” sensation.

 

DIF:    Cognitive Level: Applying              REF:   p. 1557

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. A 3-year-old child has a femoral shaft fracture. The nurse recognizes that the approximate healing time for this child is how long?
a. 2 weeks
b. 4 weeks
c. 6 weeks
d. 8 weeks

 

 

ANS:  B

The approximate healing times for a femoral shaft fracture are as follows: neonatal period, 2 to 3 weeks; early childhood, 4 weeks; later childhood, 6 to 8 weeks; and adolescence, 8 to 12 weeks.

 

DIF:    Cognitive Level: Understanding     REF:   p. 1570

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is teaching infant care to parents with an infant who has been diagnosed with osteogenesis imperfecta (OI). What should the nurse include in the teaching session?
a. “Bisphosphonate therapy is not beneficial for OI.”
b. “Physical therapy should be avoided as it may cause damage to bones.”
c. “Lift the infant by the buttocks, not the ankles, when changing diapers.”
d. “The infant should meet expected gross motor development without assistive devices.”

 

 

ANS:  C

Infants and children with this disorder require careful handling to prevent fractures. They must be supported when they are being turned, positioned, moved, and held. Even changing a diaper may cause a fracture in severely affected infants. These children should never be held by the ankles when being diapered but should be gently lifted by the buttocks or supported with pillows. Bisphosphonate and physical therapy are beneficial for OI. Lightweight braces will be used when the child starts to ambulate.

 

DIF:    Cognitive Level: Applying              REF:   p. 1601

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

MULTIPLE RESPONSE

 

  1. In teaching a 16-year-old adolescent who was recently diagnosed with systemic lupus erythematosus (SLE), what statements should the nurse include? (Select all that apply.)
a. “You should use a moisturizer with a sun protection factor (SPF) of 30.”
b. “You should avoid pregnancy because this can cause a flare-up.”
c. “You should not receive any immunizations in the future.”
d. “You may need to be on a low-protein, high-carbohydrate diet.”
e. “You should expect to lose weight while taking steroids.”
f. “You may need to modify your daily recreational activities.”

 

 

ANS:  A, B, F

Teaching for an adolescent with SLE should foster adaptation and self-advocacy and include using a moisturizer with an SPF of 30, avoiding pregnancy because it can produce a flare-up, and modifying recreational activities but continuing with daily exercise as an essential part of the treatment plan. The adolescent should continue to receive immunizations as scheduled, should expect to gain weight while on steroid therapy, and would not have a specialized diet.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 1610

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is caring for a child immobilized because of Russel traction. What interventions should the nurse implement to prevent renal calculi? (Select all that apply.)
a. Monitor output.
b. Encourage the patient to drink apple juice.
c. Encourage milk intake.
d. Ensure adequate fluids.
e. Encourage the patient to drink cranberry juice.

 

 

ANS:  A, D, E

To prevent renal calculi in a child who is immobilized, a nurse should monitor output; ensure adequate fluids; and encourage cranberry juice, which acidifies urine. Apple juice and milk alkalize the urine, so they should not be encouraged.

 

DIF:    Cognitive Level: Applying              REF:   p. 1561

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is assisting with application of a synthetic cast on a child with a fractured humerus. What are the advantages of a synthetic cast over a plaster of Paris cast? (Select all that apply.)
a. Less bulky
b. Drying time is faster
c. Molds readily to body part
d. Permits regular clothing to be worn
e. Can be cleaned with small amount of soap and water

 

 

ANS:  A, B, D, E

The advantages of synthetic casts over plaster of Paris casts are that they are less bulky, dry faster, permit regular clothes to be worn, and can be cleaned. Plaster of Paris casts mold readily to a body part, but synthetic casts do not mold easily to body parts.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 1558          TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Physiological Integrity

 

  1. A child has had a short-arm synthetic cast applied. What should the nurse teach to the child and parents about cast care? (Select all that apply.)
a. Relieve itching with heat.
b. Elevate the arm when resting.
c. Observe the fingers for any evidence of discoloration.
d. Do not allow the child to put anything inside the cast.
e. Examine the skin at the cast edges for any breakdown.

 

 

ANS:  B, C, D, E

Cast care involves elevating the arm, observing the fingers for evidence of discoloration, not allowing the child to put anything inside the cast, and examining the skin at the edges of the cast for any breakdown. Ice, not heat, should be applied to relieve itching.

 

DIF:    Cognitive Level: Applying              REF:   p. 1559

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is conducting preoperative teaching to parents and their child about an external fixation device. What should the nurse include in the teaching session? (Select all that apply.)
a. Pin care
b. Crutch walking
c. Modifications in activity
d. Observing pin sites for infection
e. Full weight bearing will be allowed after 24 hours

 

 

ANS:  A, B, C, D

The device is attached surgically by securing a series of external full or half rings to the bone with wires. Children and parents should be instructed in pin care, including observation for infection and loosening of pins. Partial weight bearing is allowed, and the child needs to learn to walk with crutches. Alterations in activity include modifications at school and in physical education. Full weight bearing is not allowed until the distraction is completed and bone consolidation has occurred.

 

DIF:    Cognitive Level: Applying              REF:   p. 1562

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is caring for a 14-year-old child with systemic lupus erythematous (SLE). What clinical manifestations should the nurse expect to observe? (Select all that apply.)
a. Arthralgia
b. Weight gain
c. Polycythemia
d. Abdominal pain
e. Glomerulonephritis

 

 

ANS:  A, D, E

Clinical manifestations of SLE include arthralgia, abdominal pain, and glomerulonephritis. Weight loss, not gain, and anemia, not polycythemia, are manifestations of SLE.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 1608

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is caring for a 14-year-old child with juvenile idiopathic arthritis (JIA). What clinical manifestations should the nurse expect to observe? (Select all that apply.)
a. Erythema over joints
b. Soft tissue contractures
c. Swelling in multiple joints
d. Morning stiffness of the joints
e. Loss of motion in the affected joints

 

 

ANS:  B, C, D, E

Whether single or multiple joints are involved, stiffness, swelling, and loss of motion develop in the affected joints in JIA. The swelling results from soft tissue edema, joint effusion, and synovial thickening. The affected joints may be warm and tender to the touch, but it is not uncommon for pain not to be reported. The limited motion early in the disease is a result of muscle spasm and joint inflammation; later it is caused by ankylosis or soft tissue contracture. Morning stiffness of the joint(s) is characteristic and present on arising in the morning or after inactivity. Erythema is not typical, and a warm, painful, red joint is always suspect for infection.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 1602

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. The school nurse recognizes that the adverse effects of performance-enhancing substances can include what? (Select all that apply.)
a. Depression
b. Dehydration
c. Hypotension
d. Aggressiveness
e. Changes in libido

 

 

ANS:  A, D, E

Mood changes have been observed as adverse effects of using performance-enhancing substances, including aggressiveness, changes in libido, depression, anxiety, and psychosis. Fluid retention, not dehydration, and hypertension, not hypotension, are adverse effects of performance-enhancing substances.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 1582

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

COMPLETION

 

  1. The health care provider has prescribed sulfasalazine (Azulfidine) 5 mg/kg PO per dose twice a day for a child with juvenile arthritis. The child weighs 55 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.

________

 

ANS:

125

 

The correct calculation is:

 

55 lb/2.2 kg = 25 kg

 

Dose of Azulfidine is 5 mg/kg

 

5 mg ´ 25 = 125 mg

 

DIF:    Cognitive Level: Applying              REF:   p. 1604

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. The health care provider has prescribed cyclosporin (Sandimmune) 5 mg/kg/day PO divided twice daily for a child with juvenile arthritis. The child weighs 110 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer in a whole number.

_________

 

ANS:

125

 

The correct calculation is:

 

110 lb/2.2 kg = 50 kg

 

Dose of Sandimmune is 5 mg/kg/day divided bid

 

5 mg ´ 50 = 250 mg/day

 

250 mg/2 = 125 mg for one dose

 

DIF:    Cognitive Level: Applying              REF:   p. 1602

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. The health care provider has prescribed azathioprine (Imuran) 1 mg/kg/day PO for a child with juvenile arthritis. The child weighs 77 lb. The nurse is preparing to administer the daily dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.

_______

 

ANS:

35

 

The correct calculation is:

 

77 lb/2.2 kg = 35 kg

 

Dose of Imuran is 1 mg/kg/day

 

1 mg ´ 35 = 35 mg for the daily dose

 

DIF:    Cognitive Level: Applying              REF:   p. 1609

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

  1. The health care provider has prescribed hydroxychloroquine (Plaquenil) 5 mg/kg/day PO divided bid for a child with systemic lupus erythematosus. The child weighs 66 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.

_________

 

ANS:

75

 

The correct calculation is:

 

66 lb/2.2 kg = 30 kg

 

Dose of Plaquenil is 5 mg/kg/day divided bid

 

5 mg ´ 30 = 150 mg

 

150 mg/2 = 75 mg

 

DIF:    Cognitive Level: Applying              REF:   p. 1609

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiological Integrity

 

MATCHING

 

Match the type of fracture to its definition.

a. Transverse
b. Oblique
c. Spiral
d. Comminuted

 

 

  1. Slanting and circular, twisting around the bone shaft

 

  1. Small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue

 

  1. Crosswise at right angles to the long axis of the bone

 

  1. Slanting but straight between a horizontal and a perpendicular direction

 

  1. ANS:  C                    DIF:    Cognitive Level: Understanding     REF:   p. 1569

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. ANS:  D                    DIF:    Cognitive Level: Understanding     REF:   p. 1569

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. ANS:  A                    DIF:    Cognitive Level: Understanding     REF:   p. 1569

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

  1. ANS:  B                    DIF:    Cognitive Level: Understanding     REF:   p. 1569

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiological Integrity

 

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