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 12: Health Promotion of the Toddler and Family

 

MULTIPLE CHOICE

 

  1. What factor is most important in predisposing toddlers to frequent infections?
a. Respirations are abdominal.
b. Pulse and respiratory rates in toddlers are slower than those in infants.
c. Defense mechanisms are less efficient than those during infancy.
d. Toddlers have short, straight internal ear canals and large lymph tissue.

 

 

ANS:  D

Toddlers continue to have the short, straight internal ear canals of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose toddlers to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 490

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

 

  1. What do the psychosocial developmental tasks of toddlerhood include?
a. Development of a conscience
b. Recognition of sex differences
c. Ability to get along with age mates
d. Ability to delay gratification

 

 

ANS:  D

If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that toddlers are concerned with is the ability to delay gratification. Development of a conscience and recognition of sex differences occur during the preschool years. The ability to get along with age mates develops during the preschool and school-age years.

 

DIF:    Cognitive Level: Understanding     REF:   p. 490

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

 

  1. The developmental task with which the child of 15 to 30 months is likely to be struggling is a sense of which?
a. Trust
b. Initiative
c. Intimacy
d. Autonomy

 

 

ANS:  D

Autonomy versus shame and doubt is the developmental task of toddlers. Trust versus mistrust is the developmental stage of infancy. Initiative versus guilt is the developmental stage of early childhood. Intimacy and solidarity versus isolation is the developmental stage of early adulthood.

 

DIF:    Cognitive Level: Remembering      REF:   p. 490

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

 

  1. Parents of an 18-month-old boy tells the nurse that he says “no” to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. What is the nurse’s best interpretation of this behavior?
a. This is normal behavior for his age.
b. This is unusual behavior for his age.
c. He is not effectively coping with stress.
d. He is showing he needs more attention.

 

 

ANS:  A

Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and use of the word “no.” Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old.

 

DIF:    Cognitive Level: Understanding     REF:   p. 491

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A 17-month-old child should be expected to be in which stage, according to Piaget?
a. Preoperations
b. Concrete operations
c. Tertiary circular reactions
d. Secondary circular reactions

 

 

ANS:  C

A 17-month-old is in the fifth stage of the sensorimotor phase, tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. Concrete operations is the cognitive stage associated with school-age children. The secondary circular reaction stage lasts from about ages 4 to 8 months.

 

DIF:    Cognitive Level: Understanding     REF:   p. 491

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

 

  1. Although a 14-month-old girl received a shock from an electrical outlet recently, her parent finds her about to place a paper clip in another outlet. Which is the best interpretation of this behavior?
a. Her cognitive development is delayed.
b. This is typical behavior because toddlers are not very developed.
c. This is typical behavior because of toddlers’ inability to transfer remembering to new situations.
d. This is not typical behavior because toddlers should know better than to repeat an act that caused pain.

 

 

ANS:  C

During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. This is typical behavior for a toddler, who is only somewhat aware of a causal relation between events. Her cognitive development is appropriate for her age.

 

DIF:    Cognitive Level: Understanding     REF:   p. 491

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

 

  1. A toddler, age 16 months, falls down a few stairs. He gets up and “scolds” the stairs as if they caused him to fall. What is this an example of?
a. Animism
b. Ritualism
c. Irreversibility
d. Delayed cognitive development

 

 

ANS:  A

Animism is the attribution of lifelike qualities to inanimate objects. By scolding the stairs, the toddler is attributing human characteristics to them. Ritualism is the need to maintain sameness and reliability. It provides a sense of comfort to toddlers. Irreversibility is the inability to reverse or undo actions initiated physically. The toddler is acting in an age-appropriate manner.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 493

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

 

  1. What is a characteristic of a toddler’s language development at age 18 months?
a. Vocabulary of 25 words
b. Use of holophrases
c. Increasing level of understanding
d. Approximately one third of speech understandable

 

 

ANS:  C

During the second year of life, the understanding and understanding of speech increase to a level far greater than the child’s vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages. An 18-month-old child has a vocabulary of approximately 10 words. At this age, the child does not use the one-word sentences that are characteristic of 1-year-old children. The child has a very limited vocabulary of single words that are comprehensible.

 

DIF:    Cognitive Level: Understanding     REF:   p. 493

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

 

  1. Which characteristic best describes the gross motor skills of a 24-month-old child?
a. Skips
b. Broad jumps
c. Rides tricycle
d. Walks up and down stairs

 

 

ANS:  D

A 24-month-old child can go up and down stairs alone with two feet on each step. Skipping and broad jumping are skills acquired at age 3 years. Tricycle riding is achieved at age 4 years.

 

DIF:    Cognitive Level: Understanding     REF:   p. 514

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

 

  1. What developmental characteristic does not occur until a child reaches age 2 1/2 years?
a. Birth weight has doubled.
b. Anterior fontanel is still open.
c. Primary dentition is complete.
d. Binocularity may be established.

 

 

ANS:  C

Usually by age 30 months, the primary dentition of 20 teeth is complete. Birth weight doubles at approximately ages 5 to 6 months. The anterior fontanel closes at ages 12 to 18 months. Binocularity is established by age 15 months.

 

DIF:    Cognitive Level: Understanding     REF:   p. 499

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

 

  1. Which statement is correct about toilet training?
a. Bladder training is usually accomplished before bowel training.
b. Wanting to please the parent helps motivate the child to use the toilet.
c. Watching older siblings use the toilet confuses the child.
d. Children must be forced to sit on the toilet when first learning.

 

 

ANS:  B

Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please the parent by holding on rather than pleasing him- or herself by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

 

DIF:    Cognitive Level: Understanding     REF:   p. 500

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

 

  1. The parents of a newborn say that their toddler “hates the baby. . . . He suggested that we put him in the trash can so the trash truck could take him away.” What is the nurse’s best reply?
a. “Let’s see if we can figure out why he hates the new baby.”
b. “That’s a strong statement to come from such a small boy.”
c. “Let’s refer him to counseling to work this hatred out. It’s not a normal response.”
d. “That is a normal response to the birth of a sibling. Let’s look at ways to deal with this.”

 

 

ANS:  D

The arrival of a new infant represents a crisis for even the best prepared toddler. Toddlers have their entire schedules and routines disrupted because of the new family member. The nurse should work with the parents on ways to involve the toddler in the newborn’s care and to help focus attention on the toddler. The toddler does not hate the infant. This is an expected, normal response to the changes in routines and attention that affect the toddler. The toddler can be provided with a doll to imitate parents’ behaviors. The child can care for the doll’s needs at the same time the parent is performing similar care for the newborn.

 

DIF:    Cognitive Level: Understanding     REF:   p. 502

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. A toddler’s parent asks the nurse for suggestions on dealing with temper tantrums. What is the most appropriate recommendation?
a. Punish the child.
b. Explain to child that this is wrong.
c. Leave the child alone until the tantrum is over.
d. Remain close by the child but without eye contact.

 

 

ANS:  D

The best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common during this age group as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The presence of the parent is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

 

DIF:    Cognitive Level: Understanding     REF:   p. 503

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A parent asks the nurse about negativism in toddlers. What is the most appropriate recommendation?
a. Punish the child.
b. Provide more attention.
c. Ask child not to always say “no.”
d. Reduce the opportunities for a “no” answer.

 

 

ANS:  D

The nurse should suggest to the parent that questions should be phrased with realistic choices rather than yes or no answers. This provides a sense of control for the toddler and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young to comply with requests not to say “no.”

 

DIF:    Cognitive Level: Analyzing            REF:   p. 503

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The parents of a 2-year-old child tell the nurse they are concerned because the toddler has started to use “baby talk” since the arrival of their new baby. What should the nurse recommend?
a. Ignore the baby talk.
b. Tell the toddler frequently, “You are a big kid now.”
c. Explain to the toddler that baby talk is for babies.
d. Encourage the toddler to practice more advanced patterns of speech.

 

 

ANS:  A

Baby talk is a sign of regression in the toddler. Often toddlers attempt to cope with a stressful situation by reverting to patterns of behavior that were successful in earlier stages of development. It should be ignored while the parents praise the child for developmentally appropriate behaviors. Regression is children’s way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism.

 

DIF:    Cognitive Level: Applying              REF:   p. 504

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Parents tell the nurse that their toddler eats little at mealtime, only sits at the table with the family briefly, and wants snacks “all the time.” What should the nurse recommend?
a. Give her nutritious snacks.
b. Offer rewards for eating at mealtimes.
c. Avoid snacks so she is hungry at mealtimes.
d. Explain to her in a firm manner what is expected of her.

 

 

ANS:  A

Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirements associated with the slower growth rate. Parents should assist the child in developing healthy eating habits. Toddlers are often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should be not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat non-nutritious foods in response. A toddler is not able to understand explanations of what is expected of her and comply with the expectations.

 

DIF:    Cognitive Level: Applying              REF:   p. 505

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is what?
a. A sign the child is spoiled
b. An attempt to exert unhealthy control
c. Regression, which is common at this age
d. Ritualism, an expected behavior at this age

 

 

ANS:  D

The child is exhibiting the ritualism, which is characteristic at this age. Ritualism is the need to maintain sameness and reliability. It provides a sense of structure and comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. This does not indicate the child has unreasonable expectations but rather is part of normal development. Ritualism is not regression, which is a retreat from a present pattern of functioning.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 491

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The nurse is discussing with a parent group the importance of fluoride for healthy teeth. What should the nurse recommend?
a. Determine whether the water supply is fluoridated.
b. Use fluoridated mouth rinses in children older than 1 year.
c. Give fluoride supplements to infants beginning at age 2 months.
d. Brush teeth with fluoridated toothpaste unless the fluoride content of water supply is adequate.

 

 

ANS:  A

The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount. It is difficult to teach toddlers to spit out mouthwash. Swallowing fluoridated mouthwashes can contribute to fluorosis. Fluoride supplementation is not recommended until after age 6 months and then only if the water is not fluoridated. Fluoridated toothpaste is still indicated if the fluoride content of the water supply is adequate, but very small amounts are used.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 510

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which is an appropriate recommendation in preventing tooth decay in young children?
a. Substitute raisins for candy.
b. Substitute sugarless gum for regular gum.
c. Use honey or molasses instead of refined sugar.
d. When sweets are to be eaten, select a time not during meals.

 

 

ANS:  B

Regular gum has high sugar content. When the child chews gum, the sugar is in prolonged contact with the teeth. Sugarless gum is less cariogenic than regular gum. Raisins, honey, and molasses are highly cariogenic and should be avoided. Sweets should be consumed with meals so that the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 511

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. What is the leading cause of death during the toddler period?
a. Injuries
b. Infectious diseases
c. Childhood diseases
d. Congenital disorders

 

 

ANS:  A

Injuries are the most common cause of death in children ages 1 through 4 years. It is the highest rate of death from injuries of any childhood age group except adolescence. Congenital disorders are the second leading cause of death in this age group. Infectious and childhood diseases are less common causes of death in this age group.

 

DIF:    Cognitive Level: Understanding     REF:   p. 512            TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The parent of 16-month-old child asks, “What is the best way to keep my child from getting into our medicines at home?” What should the nurse advise?
a. “All medicines should be locked securely away.”
b. “The medicines should be placed in high cabinets.”
c. “Your child just needs to be taught not to touch medicines.”
d. “Medicines should not be kept in the homes of small children.”

 

 

ANS:  A

The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. Toddlers can climb using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize that all the different forms of medications in the home may be dangerous. Keeping medicines out of the homes of small children is not feasible because many parents require medications for chronic or acute illnesses. Parents must be taught safe storage for their home and when they visit other homes.

 

DIF:    Cognitive Level: Applying              REF:   p. 512

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Parents are switching their toddler, who has met the weight requirement, from a rear-facing car seat to a forward-facing seat. The nurse should recommend the parents place the seat where in the car?
a. In the front passenger seat
b. In the middle of the rear seat
c. In the rear seat behind the driver
d. In the rear seat behind the passenger

 

 

ANS:  B

Children 0 to 3 years of age riding properly restrained in the middle of the backseat have a 43% lower risk of injury than children riding in the outboard (window) seat during a crash.

 

DIF:    Cognitive Level: Applying              REF:   p. 514

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. What is the most common type of burn in the toddler age group?
a. Electric burn from electrical outlets
b. Flame burn from playing with matches
c. Hot object burn from cigarettes or irons
d. Scald burn from high-temperature tap water

 

 

ANS:  D

Scald burns are the most common type of thermal injury in children, especially 1- and 2-year-old children. Temperature should be reduced on the hot water in the house and hot liquids placed out of the child’s reach. Electric burns from electrical outlets and hot object burns from cigarettes or irons are both significant causes of burn injury. The child should be protected by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electrical outlets when not in use. Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age group but not one of the most common types of burn.

 

DIF:    Cognitive Level: Understanding     REF:   p. 515            TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The nurse is assessing a 20-month-old toddler during a well-child visit and notices tooth decay. The nurse should understand that early childhood caries are caused by what?
a. Allowing the child to eat citrus foods at bedtime
b. A hereditary factor that cannot be prevented
c. Poor fluoride supply in the drinking water
d. Giving the child a bottle of juice or milk at naptime

 

 

ANS:  D

One cause of early childhood caries is allowing the child to go to sleep with a bottle of milk or juice; as the sweet liquid pools in the mouth, the teeth are bathed for several hours in this cariogenic environment. Eating citrus fruit at bedtime and poor fluoride supply in drinking water do not cause early childhood caries. The problem is not hereditary and can be prevented with proper education.

 

DIF:    Cognitive Level: Understanding     REF:   p. 511

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

 

  1. The nurse is providing guidance strategies to a group of parents with toddlers at a community outreach program. Which statement by a parent indicates a correct understanding of the teaching?
a. “I should expect my 24-month-old child to express some signs of readiness for toilet training.”
b. “I should be firm and structured when disciplining my 18-month-old child.”
c. “I should expect my 12-month-old child to start to develop a fear of darkness and to need a security blanket.”
d. “I should expect my 36-month-old child to understand time and proximity of events.”

 

 

ANS:  A

A 24-month-old toddler starts to show readiness for toilet training; it is important for the parent to be aware of this and be ready to start the process. At 18 months of age, a child needs consistent but gentle discipline because the child cannot yet understand firmness and structure with discipline. Development of fears and need for security items usually occurs at the end of the 18- to 24-month stage. A 36-month-old child does not yet understand time and proximity of events, so the parent needs to understand that the toddler cannot “hurry up or we will be late.”

 

DIF:    Cognitive Level: Applying              REF:   p. 518

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The nurse is assessing a toddler’s visual acuity. Which visual acuity is considered acceptable during the toddler years?
a. 20/20
b. 20/40
c. 20/50
d. 20/60

 

 

ANS:  B

Visual acuity of 20/40 is considered acceptable during the toddler years.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 488

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

 

  1. The nurse is teaching parents about toilet training. What should the nurse include in the teaching session?
a. Bladder training is accomplished before bowel training.
b. The mastery of skills required for toilet training is present at 18 months.
c. By 12 months, the child is able to retain urine for up to 2 hours or longer.
d. The physiologic ability to control the sphincters occurs between 18 and 24 months.

 

 

ANS:  D

The physiologic ability to control the sphincters occurs somewhere between ages 18 and 24 months. Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The mastery of skills required for training are not present before 24 months of age. By 14 to 18 months of age, the child is able to retain urine for up to 2 hours or longer.

 

DIF:    Cognitive Level: Applying              REF:   p. 489

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The nurse is planning care for a hospitalized toddler. What is the rationale for planning to continue the toddler’s rituals while hospitalized?
a. To provide security
b. To prevent regression
c. To prevent dependency
d. To decrease negativism

 

 

ANS:  A

Ritualism, the need to maintain sameness and reliability, provides a sense of security and comfort. It will not prevent regression or dependency or decrease negativism.

 

DIF:    Cognitive Level: Applying              REF:   p. 491            TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A nurse is observing children playing in the playroom. What describes parallel play?
a. A child playing a video game
b. Two children playing a card game
c. Two children watching a movie on a television
d. A child playing with blocks next to a child playing with trucks

 

 

ANS:  D

Parallel play is when a toddler plays alongside, not with, other children. A child playing with blocks next to a child playing with trucks is descriptive of parallel play. The child playing a video game is descriptive of solitary play. Two children playing cards is descriptive of cooperative play. Two children watching a television is descriptive of associative play.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 497

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

 

  1. Parents ask the nurse for strategies to help their toddler adjust to a new baby. What should the nurse suggest?
a. Start talking about the baby very early in the pregnancy.
b. Move the toddler to a new bed after the baby comes home.
c. Tell the toddler that a new playmate will be coming home soon.
d. Alert visitors to the new baby to include the toddler in the visit.

 

 

ANS:  D

Parents can minimize sibling rivalry by alerting visitors to the toddler’s needs, having small presents on hand for the toddler, and including the child in the visits as much as possible. Time is a vague concept for toddlers. A good time to start talking about the new baby is when the toddler becomes aware of the pregnancy and the changes occurring in the home in anticipation of the new member. To avoid additional stresses when the newborn arrives, parents should perform anticipated changes, such as moving the toddler to a different room or bed, well in advance of the birth. Telling the toddler that a new playmate will come home soon sets up unrealistic expectations.

 

DIF:    Cognitive Level: Applying              REF:   p. 502

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Parents ask the nurse, “How should we deal with our toddler’s regression since our new baby has come home?” The nurse should give the parents which response?
a. “Introduce new areas of learning.”
b. “Use time-out as punishment when regression occurs.”
c. “Ignore the behavior and praise appropriate behavior.”
d. “Explain to the toddler that the behavior is not acceptable.”

 

 

ANS:  C

When regression does occur, the best approach is to ignore it while praising existing patterns of appropriate behavior. It is advisable not to introduce new areas of learning when an additional crisis is present or expected, such as beginning toilet training shortly before a sibling is born or during a brief hospitalization. Time-out should not be used as a punishment, and the toddler does not have the cognitive ability to understand an explanation that the behavior is not acceptable.

 

DIF:    Cognitive Level: Applying              REF:   p. 504

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The nurse understands that which guideline should be followed to determine serving sizes for toddlers?
a. 1/2 tbsp of solid food per year of age
b. 1 tbsp of solid food per year of age
c. 2 tbsp of solid food per year of age
d. 2 1/2 tbsp of solid food per year of age

 

 

ANS:  B

To determine serving sizes for young children, the guideline to follow is 1 tbsp of solid food per year of age. One-half tbsp per year of age would not be adequate. Two or 2 1/2 tbsp per year of age would be excessive.

 

DIF:    Cognitive Level: Understanding     REF:   p. 505

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

 

  1. The nurse is teaching parents about avoiding accidental burns with their toddler. What water heater setting should the nurse recommend to the parents?
a. 120° F
b. 130° F
c. 140° F
d. 150° F

 

 

ANS:  A

The water heater should be set to limit household water temperatures to less than 49° C (120° F). At this temperature, it takes 10 minutes for exposure to the water to cause a full-thickness burn. Conversely, water temperatures of 54° C (130° F), the usual setting of most water heaters, expose household members to the risk of full-thickness burns within 30 seconds.

 

DIF:    Cognitive Level: Applying              REF:   p. 516

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. To avoid a fall from a crib, the nurse recommends to parents that their toddler should sleep in a bed rather than a crib when reaching what height?
a. 30 in
b. 35 in
c. 40 in
d. 45 in

 

 

ANS:  B

When children reach a height of 89 cm (35 in), they should sleep in a bed rather than a crib.

 

DIF:    Cognitive Level: Applying              REF:   p. 517

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

MULTIPLE RESPONSE

 

  1. The nurse is preparing a staff education program about growth and development of an 18-month-old toddler. Which characteristics should the nurse include in the staff education program? (Select all that apply.)
a. Eats well with a spoon and cup
b. Runs clumsily and can walk up stairs
c. Points to common objects
d. Builds a tower of three or four blocks
e. Has a vocabulary of 300 words
f. Dresses self in simple clothes

 

 

ANS:  A, B, C, D

Tasks accomplished by an 18-month-old toddler include eating well with a spoon and cup, running clumsily, walking up stairs, pointing to common objects such as shoes, and building a tower with three or four blocks. An 18-month-old toddler has a vocabulary of only 10 words, not 300. Toddlers cannot dress themselves in simple clothing until 24 months of age.

 

DIF:    Cognitive Level: Applying              REF:   p. 490

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

 

  1. A parent asks the nurse, “When will I know my child is ready for toilet training?” The nurse should include what in the response? (Select all that apply.)
a. The child should be able to stay dry for 1 hour.
b. The child should be able to sit, walk, and squat.
c. The child should have regular bowel movements.
d. The child should express a willingness to please.

 

 

ANS:  B, C, D

Signs of toilet training readiness include physical and psychological readiness. The ability to sit, walk, and squat and having regular bowel movements are physical readiness signs. Expressing a willingness to please is a sign of psychological readiness. The child should be able to stay dry for 2 hours, not 1.

 

DIF:    Cognitive Level: Applying              REF:   p. 500

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The nurse is teaching parents of a toddler how to handle temper tantrums. What should the nurse include in the teaching? (Select all that apply.)
a. Provide realistic expectations.
b. Avoid using rewards for good behavior.
c. Ensure consistency among all caregivers in expectations.
d. During tantrums, ignore the behavior and continue to be present.
e. Use time-outs for managing temper tantrums, starting at 12 months.

 

 

ANS:  A, C, D

The best approach toward tapering temper tantrums requires consistency and developmentally appropriate expectations and rewards. Ensuring consistency among all caregivers in expectations, prioritizing what rules are important, and developing consequences that are reasonable for the child’s level of development help manage the behavior. During tantrums, ignore the behavior, provided the behavior is not injurious to the child, such as violently banging the head on the floor. Continue to be present to provide a feeling of control and security to the child after the tantrum has subsided. Starting at 18 months, time-outs work well for managing temper tantrums, but not at 12 months.

 

DIF:    Cognitive Level: Applying              REF:   p. 503

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. What preventive measures should the nurse teach parents of toddlers to prevent early childhood caries? (Select all that apply.)
a. Avoid using a bottle as a pacifier.
b. Eliminate bedtime bottles completely.
c. Place juice in a bottle for the child to drink.
d. Wean from the bottle by 18 months of age.
e. Avoid coating pacifiers in a sweet substance.

 

 

ANS:  A, B, E

Prevention of dental caries involves eliminating the bedtime bottle completely, feeding the last bottle before bedtime, substituting a bottle of water for milk or juice, not using the bottle as a pacifier, and never coating pacifiers in sweet substances. Juice in bottles, especially commercially available ready-to-use bottles, is discouraged; these beverages are especially damaging because the sugar is more readily converted to acid. Juice should always be offered in a cup to avoid prolonging the bottle-feeding habit. Toddlers should be encouraged to drink from a cup at the first birthday and weaned from a bottle by 14 months of age, not 18 months.

 

DIF:    Cognitive Level: Applying              REF:   p. 512

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A toddler is in the sensorimotor, tertiary circular reactions stage of cognitive development. What behavior should the nurse expect to assess? (Select all that apply.)
a. Refers to self by pronoun
b. Gestures “up” and “down”
c. Able to insert round object into a hole
d. Can find hidden objects but only in the first location
e. Uses future-oriented words, such as “tomorrow”

 

 

ANS:  B, C, D

Children in the sensorimotor, tertiary circular reactions stage of cognitive development show the behaviors of gesturing “up” and “down,” have the ability to insert round objects into a hole, and can find hidden objects but only in the first location. The behaviors of referring to oneself by pronoun and using future-oriented words such as “tomorrow” are seen in the preoperational stage of cognitive development.

 

DIF:    Cognitive Level: Applying              REF:   p. 492

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

 

  1. The nurse is teaching a parent of an 18-month-old about developmental milestones associated with feeding. What should the nurse include in the teaching? (Select all that apply.)
a. The child will begin to use a fork.
b. The child will be able use a straw and cup.
c. The child will be able to hold a cup with both hands.
d. The child will be able to drink from a cup with a lid.
e. The child will begin to use a spoon but may turn it before reaching the mouth.

 

 

ANS:  C, D, E

An 18-month-old child can hold a cup with both hands, is able to drink from a cup with a lid, and begins to use a spoon but may turn it before reaching the mouth. Using a fork is a developmental milestone of a 36-month-old child. Using a straw and cup is a milestone seen at 24 months.

 

DIF:    Cognitive Level: Applying              REF:   p. 505

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The nurse is preparing to administer some iron drops to a toddler. Which factor can increase iron absorption? (Select all that apply.)
a. Vitamin A
b. Acidity (low pH)
c. Phosphates (milk)
d. Malabsorptive disorders
e. Ascorbic acid (Vitamin C)

 

 

ANS:  A, B, E

Factors that increase iron absorption are vitamin A, acidity (low pH), and ascorbic acid (vitamin C). Phosphates (milk) and malabsorptive disorders decrease absorption of iron.

 

DIF:    Cognitive Level: Applying              REF:   p. 508

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

 

  1. A parent tells the nurse, “My toddler tries to undo the car seat harness and climb out of the seat.” What strategies should the nurse recommend to the parent to encourage the child to stay in the seat? (Select all that apply.)
a. Allow your child to hold a favorite toy.
b. Allow your child out of the seat occasionally.
c. Avoid using rewards to encourage cooperative behavior.
d. When child tries to unbuckle the seat harness, firmly say, “No.”
e. It may be necessary to stop the car to reinforce the expected behavior.

 

 

ANS:  A, D, E

Strategies to encourage a child to stay in a car seat include allowing the child to hold favorite toy, firmly saying “No” if the child begins to undo the harness, and stopping the car to reinforce the expected behavior. Rewards, such as stars or stickers, can be used to encourage cooperative behavior. The child should stay in the car seat at all times, even for short trips.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 512

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

 

  1. What child behavior indicates to the nurse that temper tantrums have become a problem? (Select all that apply.)
a. The child is 2 to 3 years old
b. Tantrums occur at bedtime
c. Tantrums occur past 5 years of age
d. Tantrums last longer than 15 minutes
e. Tantrums occur more than five times a day

 

 

ANS:  C, D, E

Temper tantrums are common during the toddler years and essentially represent normal developmental behaviors. However, temper tantrums can be signs of serious problems. Temper tantrums that occur past 5 years of age, last longer than 15 minutes, or occur more than five times a day are considered abnormal and may indicate a serious problem. A popular time for a tantrum is before bedtime.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 503

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

 

COMPLETION

 

  1. A health care provider prescribes sodium fluoride drops, 0.25 mg PO daily. The medication label states: “Sodium fluoride drops 0.5 mg/1 ml.” The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using one decimal place.

________________

 

ANS:

0.5

 

Follow the formula for dosage calculation.

Desired

———– ´ Volume = ml per dose

Available

 

0.25 mg

———– ´ 1 ml = 0.5 ml

0.5 mg

 

DIF:    Cognitive Level: Applying              REF:   p. 510

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

 

MATCHING

 

Match the type of vegetarianism to its description.

a. Lacto-ovo vegetarians
b. Lactovegetarians
c. Pure vegetarians (vegans)
d. Macrobiotics
e. Semi-vegetarians

 

 

  1. Eliminate all foods of animal origin, including milk and eggs, allowing only a few types of fruits, vegetables, and legumes

 

  1. Eliminate all foods of animal origin, including milk and eggs

 

  1. Exclude meat from their diet but consume dairy products and rarely fish

 

  1. Exclude meat and eggs but drink milk

 

  1. Exclude meat from their diet but consumes dairy products with some fish and poultry

 

  1. ANS:  D                    DIF:    Cognitive Level: Understanding     REF:   p. 507

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

 

  1. ANS:  C                    DIF:    Cognitive Level: Understanding     REF:   p. 507

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

 

  1. ANS:  A                    DIF:    Cognitive Level: Understanding     REF:   p. 507

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

 

  1. ANS:  B                    DIF:    Cognitive Level: Understanding     REF:   p. 507

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

 

  1. ANS:  E                    DIF:    Cognitive Level: Understanding     REF:   p. 507

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

 

Chapter 24: The Child with Fluid and Electrolyte Imbalance

 

MULTIPLE CHOICE

 

  1. What substance is released from the posterior pituitary gland and promotes water retention in the renal system?
a. Renin
b. Aldosterone
c. Angiotensin
d. Antidiuretic hormone (ADH)

 

 

ANS:  D

ADH is released in response to increased osmolality and decreased volume of intravascular fluid; it promotes water retention in the renal system by increasing the permeability of renal tubules to water. Renin release is stimulated by diminished blood flow to the kidneys. Aldosterone is secreted by the adrenal cortex. It enhances sodium reabsorption in renal tubules, promoting osmotic reabsorption of water. Renin reacts with a plasma globulin to generate angiotensin, which is a powerful vasoconstrictor. Angiotensin also stimulates the release of aldosterone.

 

DIF:    Cognitive Level: Understanding     REF:   p. 947

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

 

  1. Nurses should be alert for increased fluid requirements in which circumstance?
a. Fever
b. Mechanical ventilation
c. Congestive heart failure
d. Increased intracranial pressure

 

 

ANS:  A

Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. The mechanically ventilated child has decreased fluid requirements. Congestive heart failure is a case of fluid overload in children. Increased intracranial pressure does not lead to increased fluid requirements in children.

 

DIF:    Cognitive Level: Understanding     REF:   p. 948

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

 

  1. What factor predisposes an infant to fluid imbalances?
a. Decreased surface area
b. Lower metabolic rate
c. Immature kidney functioning
d. Decreased daily exchange of extracellular fluid

 

 

ANS:  C

The infant’s kidneys are functionally immature at birth and are inefficient in excreting waste products of metabolism. Infants have a relatively high body surface area (BSA) compared with adults. This allows a higher loss of fluid to the environment. A higher metabolic rate is present as a result of the higher BSA in relation to active metabolic tissue. The higher metabolic rate increases heat production, which results in greater insensible water loss. Infants have a greater exchange of extracellular fluid, leaving them with a reduced fluid reserve in conditions of dehydration.

 

DIF:    Cognitive Level: Understanding     REF:   p. 948

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

 

  1. What is the required number of milliliters of fluid needed per day for a 14-kg child?
a. 800
b. 1000
c. 1200
d. 1400

 

 

ANS:  C

For the first 10 kg of body weight, a child requires 100 ml/kg. For each additional kilogram of body weight, an extra 50 ml is needed.

10 kg ´ 100 ml/kg/day = 1000 ml

4 kg ´ 50 ml/kg/day = 200 ml

1000 ml + 200 ml = 1200 ml/day

Eight hundred to 1000 ml is too little; 1400 ml is too much.

 

DIF:    Cognitive Level: Applying              REF:   p. 952

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

 

  1. An infant is brought to the emergency department with the following clinical manifestations: poor skin turgor, weight loss, lethargy, tachycardia, and tachypnea. This is suggestive of which situation?
a. Water excess
b. Sodium excess
c. Water depletion
d. Potassium excess

 

 

ANS:  C

These clinical manifestations indicate water depletion or dehydration. Edema and weight gain occur with water excess or overhydration. Sodium or potassium excess would not cause these symptoms.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 949

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

 

  1. Clinical manifestations of sodium excess (hypernatremia) include which signs or symptoms?
a. Hyperreflexia
b. Abdominal cramps
c. Cardiac dysrhythmias
d. Dry, sticky mucous membranes

 

 

ANS:  D

Dry, sticky mucous membranes are associated with hypernatremia. Hyperreflexia is associated with hyperkalemia. Abdominal cramps, weakness, dizziness, nausea, and apprehension are associated hyponatremia. Cardiac dysrhythmias are associated with hypokalemia.

 

DIF:    Cognitive Level: Understanding     REF:   p. 950

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

 

  1. What laboratory finding should the nurse expect in a child with an excess of water?
a. Decreased hematocrit
b. High serum osmolality
c. High urine specific gravity
d. Increased blood urea nitrogen

 

 

ANS:  A

The excess water in the circulatory system results in hemodilution. The laboratory results show a falsely decreased hematocrit. Laboratory analysis of blood that is hemodiluted reveals decreased serum osmolality and blood urea nitrogen. The urine specific gravity is variable relative to the child’s ability to correct the fluid imbalance.

 

DIF:    Cognitive Level: Understanding     REF:   p. 949

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

 

  1. What clinical manifestation(s) is associated with calcium depletion (hypocalcemia)?
a. Nausea, vomiting
b. Weakness, fatigue
c. Muscle hypotonicity
d. Neuromuscular irritability

 

 

ANS:  D

Neuromuscular irritability is a clinical manifestation of hypocalcemia. Nausea and vomiting occur with hypercalcemia and hypernatremia. Weakness, fatigue, and muscle hypotonicity are clinical manifestations of hypercalcemia.

 

DIF:    Cognitive Level: Understanding     REF:   p. 951

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

 

  1. What type of dehydration occurs when the electrolyte deficit exceeds the water deficit?
a. Isotonic dehydration
b. Hypotonic dehydration
c. Hypertonic dehydration
d. Hyperosmotic dehydration

 

 

ANS:  B

Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. Isotonic dehydration occurs in conditions in which electrolyte and water deficits are present in balanced proportion. Hypertonic dehydration results from water loss in excess of electrolyte loss. This is the most dangerous type of dehydration. It is caused by feeding children fluids with high amounts of solute. Hyperosmotic dehydration is another term for hypertonic dehydration.

 

DIF:    Cognitive Level: Understanding     REF:   p. 952

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

 

  1. What amount of fluid loss occurs with moderate dehydration?
a. <50 ml/kg
b. 50 to 90 ml/kg
c. <5% total body weight
d. >15% total body weight

 

 

ANS:  B

Moderate dehydration is defined as a fluid loss of between 50 and 90 ml/kg. Mild dehydration is defined as a fluid loss of less than 50 ml/kg. Weight loss up to 5% is considered mild dehydration. Weight loss over 15% is severe dehydration.

 

DIF:    Cognitive Level: Understanding     REF:   p. 952

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

 

  1. Physiologically, the child compensates for fluid volume losses by which mechanism?
a. Inhibition of aldosterone secretion
b. Hemoconcentration to reduce cardiac workload
c. Fluid shift from interstitial space to intravascular space
d. Vasodilation of peripheral arterioles to increase perfusion

 

 

ANS:  C

Compensatory mechanisms attempt to maintain fluid volume. Initially, interstitial fluid moves into the intravascular compartment to maintain blood volume. Aldosterone is released to promote sodium retention and conserve water in the kidneys. Hemoconcentration results from the fluid volume loss. With less circulating volume, tachycardia results. Vasoconstriction of peripheral arterioles occurs to help maintain blood pressure.

 

DIF:    Cognitive Level: Understanding     REF:   p. 952

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

 

  1. Ongoing fluid losses can overwhelm the child’s ability to compensate, resulting in shock. What early clinical sign precedes shock?
a. Tachycardia
b. Slow respirations
c. Warm, flushed skin
d. Decreased blood pressure

 

 

ANS:  A

Shock is preceded by tachycardia and signs of poor tissue perfusion and decreased pulse oximetry values. Respirations are increased as the child attempts to compensate. As a result of the poor peripheral circulation, the child has skin that is cool and mottled with decreased capillary refilling after blanching. In children, lowered blood pressure is a late sign and may accompany the onset of cardiovascular collapse.

 

DIF:    Cognitive Level: Understanding     REF:   p. 952

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

 

  1. The presence of which pair of factors is a good predictor of a fluid deficit of at least 5% in an infant?
a. Weight loss and decreased heart rate
b. Capillary refill of less than 2 seconds and no tears
c. Increased skin elasticity and sunken anterior fontanel
d. Dry mucous membranes and generally ill appearance

 

 

ANS:  D

A good predictor of a fluid deficit of at least 5% is any two four factors: capillary refill of more than 2 seconds, absent tears, dry mucous membranes, and ill general appearance. Weight loss is associated with fluid deficit, but the degree needs to be quantified. Heart rate is usually elevated. Skin elasticity is decreased, not increased. The anterior fontanel is depressed.

 

DIF:    Cognitive Level: Applying              REF:   p. 957

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

 

  1. The nurse suspects fluid overload in an infant receiving intravenous fluids. What clinical manifestation is suggestive of water intoxication?
a. Oliguria
b. Weight loss
c. Irritability and seizures
d. Muscle weakness and cardiac dysrhythmias

 

 

ANS:  C

Irritability, somnolence, headache, vomiting, diarrhea, and generalized seizures are manifestations of water intoxication. Urinary output is increased as the child attempts to maintain fluid balance. Weight gain is usually associated with water intoxication. Muscle weakness and cardiac dysrhythmias are not associated with water intoxication.

 

DIF:    Cognitive Level: Understanding     REF:   p. 985

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

 

  1. What physiologic state(s) produces the clinical manifestations of nervous system stimulation and excitement, such as overexcitability, nervousness, and tetany?
a. Metabolic acidosis
b. Respiratory alkalosis
c. Metabolic and respiratory acidosis
d. Metabolic and respiratory alkalosis

 

 

ANS:  D

The major symptoms and signs of alkalosis include nervous system stimulation and excitement, including overexcitability, nervousness, tingling sensations, and tetany that may progress to seizures. Acidosis (both metabolic and respiratory) has clinical signs of depression of the central nervous system, such as lethargy, diminished mental capacity, delirium, stupor, and coma. Respiratory alkalosis has the same symptoms and signs as metabolic alkalosis.

 

DIF:    Cognitive Level: Analysis               REF:   p. 962            TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Physiological Integrity

 

  1. What is an approximate method of estimating output for a child who is not toilet trained?
a. Have parents estimate output.
b. Weigh diapers after each void.
c. Place a urine collection device on the child.
d. Have the child sit on a potty chair 30 minutes after eating.

 

 

ANS:  B

Weighing diapers will provide an estimate of urinary output. Each 1 g of weight is equivalent to 1 ml of urine. Having parents estimate output would be inaccurate. It is difficult to estimate how much fluid is in a diaper. The urine collection device would irritate the child’s skin. It would be difficult for a toddler who is not toilet trained to sit on a potty chair 30 minutes after eating.

 

DIF:    Cognitive Level: Applying              REF:   p. 957

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

 

  1. The nurse is selecting a site to begin an intravenous infusion on a 2-year-old child. The superficial veins on his hand and arm are not readily visible. What intervention should increase the visibility of these veins?
a. Gently tap over the site.
b. Apply a cold compress to the site.
c. Raise the extremity above the level of the body.
d. Use a rubber band as a tourniquet for 5 minutes.

 

 

ANS:  A

Gently tapping the site can sometimes cause the veins to be more visible. This is done before the skin is prepared. Warm compresses (not cold) may be useful. The extremity is held in a dependent position. A tourniquet may be helpful, but if too tight, it could cause the vein to burst when punctured. Five minutes is too long.

 

DIF:    Cognitive Level: Applying              REF:   p. 961

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

 

  1. When caring for a child with an intravenous (IV) infusion, what is an appropriate nursing action?
a. Change the insertion site every 24 hours.
b. Check the insertion site frequently for signs of infiltration.
c. Use a macrodropper to facilitate reaching the prescribed flow rate.
d. Avoid restraining the child to prevent undue emotional stress.

 

 

ANS:  B

The nursing responsibility for IV therapy is to calculate the amount to be infused in a given length of time; set the infusion rate; and monitor the apparatus frequently, at least every 1 to 2 hours, to make certain that the desired rate is maintained, the integrity of the system remains intact, the site remains intact (free of redness, edema, infiltration, or irritation), and the infusion does not stop. Insertion sites do not need to be changed every 24 hours unless a problem is found with the site. This exposes the child to significant trauma. A minidropper (60 drops/ml) is the recommended IV tubing in pediatric patients. Intravenous sites should be protected. This may require soft restraints on the child.

 

DIF:    Cognitive Level: Applying              REF:   p. 961

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

 

  1. The nurse determines that a child’s intravenous infusion has infiltrated. The infused solution is a vesicant. What is the most appropriate nursing action?
a. Stop the infusion and apply ice.
b. End the infusion and notify the practitioner.
c. Slow the infusion rate and notify the practitioner.
d. Discontinue the infusion and apply warm compresses.

 

 

ANS:  B

A vesicant causes cellular damage when even minute amounts escape into the tissue. The intravenous infusion is immediately stopped, the extremity is elevated, the practitioner is notified, and the treatment protocol is initiated. The applying of heat or ice depends on the fluid that has extravasated. The catheter is left in place until it is no longer needed.

 

DIF:    Cognitive Level: Applying              REF:   p. 972

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

 

  1. Several types of long-term central venous access devices are used. What is a benefit of using an implanted port (e.g., Port-a-Cath)?
a. You do not need to pierce the skin for access.
b. It is easy to use for self-administered infusions.
c. The patient does not need to limit regular physical activity, including swimming.
d. The catheter cannot dislodge from the port even if the child “plays” with the port site.

 

 

ANS:  C

No limitations on physical activity are needed. The child is able to participate in all regular physical activities, including bathing, showering, and swimming. The skin over the device is pierced with a Huber needle to access. Long-term central venous access devices are difficult to use for self-administration. The port is placed under the skin. If the child manipulates the device and plays with the actual port, the catheter can be dislodged.

 

DIF:    Cognitive Level: Applying              REF:   p. 979            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is teaching the family of a child with a long-term central venous access device about signs and symptoms of bacteremia. What finding indicates the presence of bacteremia?
a. Hypertension
b. Pain at the entry site
c. Fever and general malaise
d. Redness and swelling at the entry site

 

 

ANS:  C

Fever, chills, general malaise, and an ill appearance can be signs of bacteremia and require immediate intervention. Hypotension would be indicative of sepsis and possible impending cardiovascular collapse. Pain, redness, and swelling at the entry site indicate local infection.

 

DIF:    Cognitive Level: Applying              REF:   p. 979

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. What flush solution is recommended for intravenous catheters larger than 24 gauge?
a. Saline
b. Heparin
c. Alteplase
d. Heparin and saline combination

 

 

ANS:  A

The recommended solution for flushing venous access devices is saline. The turbulent flow flush with saline is effective for catheters larger than 24 gauge. The use of heparin does not increase the longevity of the venous access device. In 24-gauge catheters, heparin may offer an advantage. Alteplase is used for treating catheter-related occlusions in children. The heparin and saline combination does not offer any advantage over saline or heparin individually.

 

DIF:    Cognitive Level: Applying              REF:   p. 977

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

 

  1. The nurse is teaching a parent of a 10-year-old child who will be discharged with a venous access device (VAD). What statement by the parent indicates a correct understanding of the teaching?
a. “I should have my child wear a protective vest when my child wants to participate in contact sports.”
b. “I should apply pressure to the entry site to the vein, not the exit site, if the VAD is accidentally removed.”
c. “I can expect my child to have feelings of general malaise for 1 week after the VAD is inserted.”
d. “I should give my child a sponge bath for the first 2 weeks after the VAD is inserted; then I can allow my child to take a bath.”

 

 

ANS:  B

The parents of a child with a VAD should be taught to apply pressure to the entry site to the vein, not the exit site, if the VAD is accidentally removed. The child should not participate in contact sports, even with a protective vest, to prevent the VAD from becoming dislodged. General malaise is a sign of an infection, not an expected finding after insertion of the VAD. The child can shower or take a bath after insertion of the VAD; the child does not need a sponge bath for any length of time.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 979

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. What type of diarrhea is associated with an inflammation of the mucosa and submucosa in the ileum and colon caused by infectious agents?
a. Osmotic
b. Secretory
c. Cytotoxic
d. Dysenteric

 

 

ANS:  D

Dysenteric diarrhea is associated with an inflammation of the mucosa and submucosa in the ileum and colon caused by infectious agents such as Campylobacter, Salmonella, or Shigella organisms. Edema, mucosal bleeding, and leukocyte infiltration occur. Osmotic diarrhea occurs when the intestine cannot absorb nutrients or electrolytes. It is commonly seen in malabsorption syndromes such as lactose intolerance. Secretory diarrhea is usually a result of bacterial enterotoxins that stimulate fluid and electrolyte secretion from the mucosal crypt cells, the principal secretory cells of the small intestine. Cytotoxic diarrhea is characterized by the viral destruction of the villi of the small intestine. This results in a smaller intestinal surface area, with a decreased capacity for fluid and electrolyte absorption.

 

DIF:    Cognitive Level: Understanding     REF:   p. 952

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

 

  1. What condition is often associated with severe diarrhea?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis

 

 

ANS:  A

Metabolic acidosis results from the increased absorption of short-chain fatty acids produced in the colon. There is an increase in lactic acid from tissue hypoxia secondary to hypovolemia. Bicarbonate is lost through the stool. Ketosis results from fat metabolism when glycogen stores are depleted. Metabolic alkalosis and respiratory alkalosis do not occur from severe diarrhea.

 

DIF:    Cognitive Level: Understanding     REF:   p. 952

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

 

  1. What organism is a parasite that causes acute diarrhea?
a. Shigella organisms
b. Salmonella organisms
c. Giardia lamblia
d. Escherichia coli

 

 

ANS:  C

  1. lamblia is a parasite that represents 10% of nondysenteric illness in the United States. Shigella, Salmonella, and E. coli are bacterial pathogens.

 

DIF:    Cognitive Level: Understanding     REF:   p. 948

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

 

  1. A school-age child with diarrhea has been rehydrated. The nurse is discussing the child’s diet with the family. What food or beverage should be tolerated best?
a. Clear fluids
b. Carbonated drinks
c. Applesauce and milk
d. Easily digested foods

 

 

ANS:  D

Easily digested foods such as cereals, cooked vegetables, and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness. Clear fluids (e.g., fruit juices and gelatin) and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. In some children, lactose intolerance will develop with diarrhea, and cow’s milk should be avoided in the recovery stage.

 

DIF:    Cognitive Level: Applying              REF:   p. 988

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solutions (ORS). The child’s mother calls the clinic nurse because he is also occasionally vomiting. The nurse should recommend which intervention?
a. Bring the child to the hospital for intravenous fluids.
b. Alternate giving ORS and carbonated drinks.
c. Continue to give ORS frequently in small amounts.
d. Keep child NPO (nothing by mouth) for 8 hours and resume ORS if vomiting has subsided.

 

 

ANS:  C

Children who are vomiting should be given ORS at frequent intervals and in small amounts. Intravenous fluids are not indicated for mild dehydration. Carbonated beverages are high in carbohydrates and are not recommended for the treatment of diarrhea and vomiting. The child is not kept NPO because this would cause additional fluid losses.

 

DIF:    Cognitive Level: Implementation    REF:   p. 954

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

 

  1. A 7-year-old child with acute diarrhea has been rehydrated with oral rehydration solution (ORS). The nurse should recommend that the child’s diet be advanced to what kind of diet?
a. Regular diet
b. Clear liquids
c. High carbohydrate diet
d. BRAT (bananas, rice, applesauce, and toast or tea) diet

 

 

ANS:  A

It is appropriate to advance to a regular diet after ORS has been used to rehydrate the child. Clear liquids are not appropriate for hydration or afterward. A high carbohydrate diet may contribute to loose stools because of the low electrolyte content and high osmolality. The BRAT diet has little nutritional value and is high in carbohydrates.

 

DIF:    Cognitive Level: Implementation    REF:   p. 954            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity

 

  1. What is the most frequent cause of hypovolemic shock in children?
a. Sepsis
b. Blood loss
c. Anaphylaxis
d. Heart failure

 

 

ANS:  B

Blood loss is the most frequent cause of hypovolemic shock in children. Sepsis causes septic shock, which is overwhelming sepsis and circulating bacterial toxins. Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance. Heart failure contributes to hypervolemia, not hypovolemia.

 

DIF:    Cognitive Level: Understanding     REF:   p. 959

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

 

  1. What type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy?
a. Neurogenic shock
b. Cardiogenic shock
c. Hypovolemic shock
d. Anaphylactic shock

 

 

ANS:  D

Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance. Neurogenic shock results from loss of neuronal control, such as the interruption of neuronal transmission after a spinal cord injury. Cardiogenic shock is decreased cardiac output. Hypovolemic shock is a reduction in the size of the vascular compartment, decreasing blood pressure, and low central venous pressure.

 

DIF:    Cognitive Level: Understanding     REF:   p. 959

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

 

  1. What clinical manifestation(s) should the nurse expect to see as shock progresses in a child and becomes decompensated shock?
a. Thirst
b. Irritability
c. Apprehension
d. Confusion and somnolence

 

 

ANS:  D

Confusion and somnolence are beginning signs of decompensated shock. Thirst, irritability, and apprehension are signs of compensated shock.

 

DIF:    Cognitive Level: Understanding     REF:   p. 960

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

 

  1. The nurse suspects shock in a child 1 day after surgery. What should be the initial nursing action?
a. Place the child on a cardiac monitor.
b. Obtain arterial blood gases.
c. Provide supplemental oxygen.
d. Put the child in the Trendelenburg position.

 

 

ANS:  C

The initial nursing action for a patient in shock is to establish ventilatory support. Oxygen is provided, and the nurse carefully observes for signs of respiratory failure, which indicates a need for intubation. Cardiac monitoring would be indicated to assess the child’s status further, but ventilatory support comes first. Oxygen saturation monitoring should be begun. Arterial blood gases would be indicated if alternative methods of monitoring oxygen therapy were not available. The Trendelenburg position is not indicated and is detrimental to the child. The head-down position increases intracranial pressure and decreases diaphragmatic excursion and lung volume.

 

DIF:    Cognitive Level: Understanding     REF:   p. 961

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

 

  1. What explains physiologically the edema formation that occurs with burns?
a. Vasoconstriction
b. Reduced capillary permeability
c. Increased capillary permeability
d. Diminished hydrostatic pressure within capillaries

 

 

ANS:  C

With a major burn, capillary permeability increases, allowing plasma proteins, fluids, and electrolytes to be lost into the interstitial space, causing edema. Maximum edema in a small wound occurs about 8 to 12 hours after injury. In larger injuries, the maximum edema may not occur until 18 to 24 hours later. Vasodilation occurs, causing an increase in hydrostatic pressure.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 963

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

 

  1. What is a systemic response to severe burns in a child?
a. Metabolic alkalosis
b. Decreased metabolic rate
c. Increased renal plasma flow
d. Abrupt drop in cardiac output

 

 

ANS:  D

The initial physiologic response to a burn injury is a dramatic change in circulation. A precipitous drop in cardiac output precedes any change in circulating blood or plasma volumes. A circulating myocardial depressant factor associated with severe burn injury is thought to be the cause. Metabolic acidosis usually occurs secondary to the disruption of the body’s buffering action resulting from fluid shifting to extravascular space. There is a greatly accelerated metabolic rate in burn patients, supported by protein and lipid breakdown. With the loss of circulating volume, there is decreased renal blood flow and depressed glomerular filtration.

 

DIF:    Cognitive Level: Understanding     REF:   p. 975

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

 

  1. A child is admitted with extensive burns. The nurse notes burns on the child’s lips and singed nasal hairs. The nurse should suspect what condition in the child?
a. A chemical burn
b. A hot-water scald
c. An electrical burn
d. An inhalation injury

 

 

ANS:  D

Evidence of an inhalation injury includes burns of the face and lips, singed nasal hairs, and laryngeal edema. Clinical manifestations may be delayed for up to 24 hours. Chemical burns, electrical burns, and burns associated with hot-water scalds would not produce singed nasal hair.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 993

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

 

  1. What is the most immediate threat to life in children with thermal injuries?
a. Shock
b. Anemia
c. Local infection
d. Systemic sepsis

 

 

ANS:  A

The immediate threat to life in children with thermal injuries is airway compromise and profound shock. Anemia is not of immediate concern. During the healing phase, local infection or sepsis is the primary complication.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 972

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

 

  1. After the acute stage and during the healing process, what is the primary complication from burn injury?
a. Shock
b. Asphyxia
c. Infection
d. Renal shutdown

 

 

ANS:  C

During the healing phase, local infection or sepsis is the primary complication. Respiratory problems, primarily airway compromise, and shock are the primary complications during the acute stage of burn injury. Renal shutdown is not a complication of the burn injury but may be a result of the profound shock.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 975

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

 

  1. What sign is one of the first to indicate overwhelming sepsis in a child with burn injuries?
a. Seizures
b. Bradycardia
c. Disorientation
d. Decreased blood pressure

 

 

ANS:  C

Disorientation in the burn patient is one of the first signs of overwhelming sepsis and may indicate inadequate hydration. Seizures, bradycardia, and decreased blood pressure are not initial manifestations of overwhelming sepsis.

 

DIF:    Cognitive Level: Understanding     REF:   p. 976

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

 

  1. A toddler sustains a minor burn on the hand from hot coffee. What is the first action in treating this burn?
a. Apply burn ointment.
b. Put ice on the burned area.
c. Cover the hand with gauze dressing.
d. Hold the hand under cool running water.

 

 

ANS:  D

In minor burns, the best method to stop the burning process is to hold the burned area under cool running water. Ointments are not applied to a new burn; the ointment will contribute to the burning. Ice is not recommended. Gauze dressings do not stop the burning process.

 

DIF:    Cognitive Level: Applying              REF:   p. 977

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

 

  1. What finding is the most reliable guide to the adequacy of fluid replacement for a small child with burns?
a. Absence of thirst
b. Falling hematocrit
c. Increased seepage from burn wound
d. Urinary output of 1 to 2 ml/kg of body weight/hr

 

 

ANS:  D

Replacement fluid therapy is delivered to provide a urinary output of 30 ml/hr in older children or 1 to 2 ml/kg of body weight/hr for children weighing less than 30 kg (66 lb). Thirst is the result of a complex set of interactions and is not a reliable indicator of hydration. Thirst occurs late in dehydration. A falling hematocrit would be indicative of hemodilution. This may reflect fluid shifts and may not accurately represent fluid replacement therapy. Increased seepage from a burn wound would be indicative of increased output, not adequate hydration.

 

DIF:    Cognitive Level: Applying              REF:   p. 978            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity

 

  1. What is the purpose of a high-protein diet for a child with major burns?
a. Promote growth
b. Improve appetite
c. Minimize protein breakdown
d. Diminish risk of stress-induced hyperglycemia

 

 

ANS:  C

Initially after major burns, there is a hypometabolic phase, which lasts for 2 or 3 days. A hypermetabolic phase follows, characterized by increased body temperature, oxygen and glucose consumption, carbon dioxide production, glycogenolysis, proteolysis, and lipolysis. This response continues for up to 9 months. A diet high in protein and calories is necessary. Healing, not growth, is the primary consideration. Many children have poor appetites, and supplementation is necessary. Hypoglycemia, not hyperglycemia, can occur from the stress of burn injury because the liver glycogen stores are rapidly depleted.

 

DIF:    Cognitive Level: Applying              REF:   p. 979            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity

 

  1. Fentanyl and midazolam (Versed) are given before débridement of a child’s burn wounds. What is the purpose of using these medications?
a. Facilitate healing
b. Provide pain relief
c. Minimize risk of infection
d. Decrease amount of débridement needed

 

 

ANS:  B

Partial-thickness burns require débridement of devitalized tissue to promote healing. The procedure is painful and requires analgesia and sedation before the procedure. Fentanyl and midazolam provide excellent intravenous sedation and analgesia to control procedural pain in children with burns.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 980

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

 

  1. Hydrotherapy is required to treat a child with extensive partial-thickness burn wounds. What is the purpose of hydrotherapy?
a. Provide pain relief
b. Débride the wounds
c. Destroy bacteria on the skin
d. Increase peripheral blood flow

 

 

ANS:  B

Soaking in a tub or showering once or twice a day acts to loosen and remove sloughing tissue, exudate, and topical medications. The hydrotherapy cleanses the wound and the entire body and helps maintain range of motion. Appropriate pain medications are necessary. Dressing changes are extremely painful. The total bacterial count of the skin is reduced by the hydrotherapy, but this is not the primary goal. There may be an increase in peripheral blood flow, but the primary purpose is for wound débridement.

 

DIF:    Cognitive Level: Applying              REF:   p. 980

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

 

  1. What is the nursing action related to the applying of biologic or synthetic skin coverings for a child with partial-thickness burns of both legs?
a. Splint the legs to prevent movement.
b. Observe wounds for signs of infection.
c. Monitor closely for manifestations of shock.
d. Examine dressings for indications of bleeding.

 

 

ANS:  B

When applied early to a superficial partial-thickness injury, biologic dressings stimulate epithelial growth and faster wound healing. If the dressing covers areas of heavy microbial contamination, infection occurs beneath the dressing. In the case of partial-thickness burns, such infection may convert the wound to a full-thickness injury. Infection is the primary concern when biologic dressings are used.

 

DIF:    Cognitive Level: Applying              REF:   p. 982

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

 

  1. What is an effective strategy to reduce the stress of burn dressing procedures?
a. Involve the child and give choices as feasible.
b. Explain to the child why analgesics cannot be used.
c. Reassure the child that dressing changes are not painful.
d. Encourage the child to master stress with controlled passivity.

 

 

ANS:  A

Children who have an understanding of the procedure and some perceived control demonstrate less maladaptive behavior. They respond well to participating in decisions and should be given as many choices as possible. Analgesia and sedation can and should be used. The dressing change procedure is very painful and stressful. Misinformation should not be given to the child. Encouraging the child to master stress with controlled passivity is not a positive coping strategy.

 

DIF:    Cognitive Level: Applying              REF:   p. 988            TOP:   Nursing Process: Planning

MSC:  Client Needs: Psychosocial Integrity

 

  1. What consideration is important for the nurse when changing dressings and applying topical medication to a child’s abdomen and leg burns?
a. Apply topical medication with clean hands.
b. Wash hands and forearms before and after dressing change.
c. If dressings have adhered to the wound, soak in hot water before removal.
d. Apply dressing so that movement is limited during the healing process.

 

 

ANS:  B

Frequent hand and forearm washing is the single most important element of the infection-control program. Topical medications should be applied with a tongue blade or gloved hand. Dressings that have adhered to the wound can be removed with tepid water or normal saline. Dressings are applied with sufficient tension to remain in place but not so tightly as to impair circulation or limit motion.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 988

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

 

  1. What is a strategy used to minimize scarring with burn injury in a child?
a. Applying of drying agents on skin
b. Use of loose-fitting garments over healing areas
c. Limitation of period without pressure to areas of scarring
d. Immobilization of extremities while healing is occurring

 

 

ANS:  C

Uniform pressure to the scar decreases the blood supply and forces the collagen into a more normal alignment. When pressure is removed, blood supply to the scar is immediately increased; therefore, periods without pressure should be brief to avoid nourishment of the hypertrophic tissue. Moisturizing agents are used with massage to help stretch tissue and prevent contractures. Compression garments, not loose-fitting garments, are indicated. Range of motion exercises are done to minimize contractures.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 989

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

 

  1. Prevention of burn injury is important anticipatory guidance. In the infant and toddler period, which mode is the most common cause of burn?
a. Matches
b. Electrical cords
c. Hot liquids in the kitchen
d. Microwave-heated foods

 

 

ANS:  C

Infants and toddlers are most commonly injured by hot liquids in the kitchen and bathroom. This often occurs as a result of inadequate supervision of this curious and energetic age group. Matches and lighters are seen as toys by young children and should be kept out of reach. Older toddlers and preschool children are at risk of chewing on electrical cords and placing objects in outlets. Microwave-heated fluids and foods can become superheated, resulting in oral burns.

 

DIF:    Cognitive Level: Analyzing            REF:   p. 992            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is teaching a group of female adolescents about toxic shock syndrome and the use of tampons. What statement by a participant indicates a need for additional teaching?
a. “I can alternate using a tampon and a sanitary napkin.”
b. “I should wash my hands before inserting a tampon.”
c. “I can use a superabsorbent tampon for more than 6 hours.”
d. “I should call my health care provider if I suddenly develop a rash that looks like sunburn.”

 

 

ANS:  C

Teaching female adolescents about the association between toxic shock syndrome and the use of tampons is important. The teaching should include not using superabsorbent tampons; not leaving the tampon in for longer than 4 to 6 hours; alternating the use of tampons with sanitary napkins; washing hands before inserting a tampon to decrease the chance of introducing pathogens; and informing a health care provider if a sudden high fever, vomiting, muscle pain, dizziness, or a rash that looks like a sunburn appears.

 

DIF:    Cognitive Level: Applying              REF:   p. 958

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is caring for an 18-month-old child with rotavirus. What clinical manifestations should the nurse expect to observe?
a. Severe abdominal cramping and bloody diarrhea
b. Mild fever and vomiting followed by onset of watery stools
c. Colicky abdominal pain and vomiting
d. High fever, diarrhea, and lethargy

 

 

ANS:  B

Rotavirus is one of the most common pathogens that cause gastroenteritis in children younger than the age of 2 years. Clinical manifestations include mild to moderate fever and vomiting followed by the onset of watery stools. The fever and vomiting usually abate in 1 or 2 days, but the diarrhea persists for 5 to 7 days. Severe abdominal cramping and bloody diarrhea are seen with Escherichia coli infection; colicky abdominal pain and vomiting are seen with salmonella infection; and high fever, diarrhea, and lethargy are seen with infection by Salmonella typhi.

 

DIF:    Cognitive Level: Applying              REF:   p. 954

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

 

MULTIPLE RESPONSE

 

  1. The nurse is preparing a presentation on compensated, decompensated, and irreversible shock in children. What clinical manifestations related to decompensated shock should the nurse include? (Select all that apply.)
a. Tachypnea
b. Oliguria
c. Confusion
d. Pale extremities
e. Hypotension
f. Thready pulse

 

 

ANS:  A, B, C, D

As shock progresses, perfusion in the microcirculation becomes marginal despite compensatory adjustments, and the signs are more obvious. Signs include tachypnea, oliguria, confusion, and pale extremities, as well as decreased skin turgor and poor capillary filling. Hypotension and a thready pulse are clinical manifestations of irreversible shock.

 

DIF:    Cognitive Level: Applying              REF:   p. 960

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

 

  1. In what condition should the nurse be alert for altered fluid requirements in children? (Select all that apply.)
a. Oliguric renal failure
b. Increased intracranial pressure
c. Mechanical ventilation
d. Compensated hypotension
e. Tetralogy of Fallot
f. Type 1 diabetes mellitus

 

 

ANS:  A, B, C

The nurse should recognize that conditions such as oliguric renal failure, increased intracranial pressure, and mechanical ventilation can cause an increase or a decrease in fluid requirements. Conditions such as hypotension, tetralogy of Fallot, and diabetes mellitus (type 1) do not cause an alteration in fluid requirements.

 

DIF:    Cognitive Level: Applying              REF:   p. 946

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

 

  1. What clinical manifestations should be observed in a 2-year-old child with hypotonic dehydration? (Select all that apply.)
a. Thick, doughy feel to the skin
b. Slightly moist mucous membranes
c. Absent tears
d. Very rapid pulse
e. Hyperirritability

 

 

ANS:  B, C, D

Clinical manifestations of hypotonic dehydration include slightly moist mucous membranes, absent tears, and a very rapid pulse. A thick, doughy feel to the skin and hyperirritability are signs of hypertonic dehydration.

 

DIF:    Cognitive Level: Applying              REF:   p. 952

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

 

  1. The nurse is caring for a child with hypokalemia. The nurse evaluates the child for which signs and symptoms of hypokalemia? (Select all that apply.)
a. Twitching
b. Hypotension
c. Hyperreflexia
d. Muscle weakness
e. Cardiac arrhythmias

 

 

ANS:  B, D, E

Signs and symptoms of hypokalemia are hypotension, muscle weakness, and cardiac arrhythmias. Twitching and hyperreflexia are signs of hyperkalemia.

 

DIF:    Cognitive Level: Applying              REF:   p. 950            TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is caring for a child with hypercalcemia. The nurse evaluates the child for which signs and symptoms of hypercalcemia? (Select all that apply.)
a. Tetany
b. Anorexia
c. Constipation
d. Laryngospasm
e. Muscle hypotonicity

 

 

ANS:  B, C, E

Signs and symptoms of hypercalcemia are anorexia, constipation, and muscle hypotonicity. Tetany and laryngospasm are signs of hypocalcemia.

 

DIF:    Cognitive Level: Applying              REF:   p. 951            TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is caring for a child with hypernatremia. The nurse evaluates the child for which signs and symptoms of hypernatremia? (Select all that apply.)
a. Apathy
b. Lethargy
c. Oliguria
d. Intense thirst
e. Dry, sticky mucos

 

 

ANS:  B, C, E

Signs and symptoms of hypernatremia are nausea; oliguria; and dry, sticky mucos. Apathy and lethargy are signs of hyponatremia.

 

DIF:    Cognitive Level: Applying              REF:   p. 950            TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Physiological Integrity

 

COMPLETION

 

  1. A health care provider prescribes dopamine (Intropin), 5 mcg/kg/min in a continuous intravenous (IV) infusion for a child in shock. The child weighs 25 kg. The medication is available as dopamine 400 mg in 250 ml. The nurse prepares to calculate the rate. How many milliliters per hour will the nurse set the IV infusion pump to deliver 5 mcg/kg/min? Fill in the blank. Round to one decimal place.

________________

 

ANS:

4.7

 

Follow the formula for dosage calculation.

 

5 ´ kg ´ 60

_________________ = Pump rate ml/hr

 

Drug concentration

 

The patient weighs 10 kg, and the drug is available as 400 mg in 250 ml.

 

Calculate the drug concentration.

 

400 ´ 1000

___________ = 1600 mcg/ml

 

250

 

Then calculate the infusion rate.

 

5 ´ 25 ´ 60

_____________________ = 4.6875 ml/hr = rounded to 4.7 ml/hr

 

1600

 

DIF:    Cognitive Level: Applying              REF:   p. 962

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. A health care provider prescribes diphenhydramine (Benadryl), 1 mg/kg PO every 4 to 6 hours as needed for pruritus to a child with a mild cutaneous anaphylactic reaction. The child weighs 5 kg. The medication label states: “Diphenhydramine 12.5 mg/5 ml.” The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number.

________________

 

ANS:

2

 

Follow the formula for dosage calculation.

Multiply 1 mg ´ 5 kg to get the dose = 5 mg

 

Desired

———– ´ Volume = ml per dose

Available

 

5 mg

———– ´ 5 mL = 2 mL

12.5 mg

 

DIF:    Cognitive Level: Applying              REF:   p. 966

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. A health care provider prescribes nitroprusside (Nipride), 1 mcg/kg/min in a continuous intravenous (IV) infusion for a child in shock. The child weighs 20 kg. The medication is available as nitroprusside 50 mg in 250 ml. The nurse prepares to calculate the rate. How many milliliters per hour will the nurse set the IV infusion pump to deliver 1 mcg/kg/min? Fill in the blank. Record your answer in a whole number.

________________

 

ANS:

6

 

Follow the formula for dosage calculation.

 

1 ´ kg ´ 60

_________________ = Pump rate ml/hr

 

Drug concentration

 

The patient weighs 20 kg and the drug is available as 50 mg in 250 ml.

 

Calculate the drug concentration.

 

50 ´ 1000

___________ = 200 mcg/ml

 

250

 

Then calculate the infusion rate.

 

1 ´ 20 ´ 60

_____________________ = 6 ml/hr

 

200

 

DIF:    Cognitive Level: Applying              REF:   p. 964

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. A health care provider prescribes midazolam (Versed) syrup 0.5 mg/kg per mouth (PO) 30 minutes before a burn wound dressing change on a child. The medication label states: “Versed 2 mg/1 ml.” The child weighs 8 kg. The nurse prepares to administer the dose. How many milliliters will the nurse prepare to administer the dose? Fill in the blank. Record your answer in a whole number.

________________

 

ANS:

2

 

Follow the formula for dosage calculation.

Multiply 0.5 mg ´ 8 kg to get the dose = 4 mg

 

Desired

———– ´ Volume = ml per dose

Available

 

4 mg

———– ´ 1 ml = 2 ml

2 mg

 

DIF:    Cognitive Level: Applying              REF:   p. 980

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Safe and Effective Care Environment

 

MATCHING

 

Match the type of skin graft to its definition.

a. Allografts
b. Xenografts
c. Autografts
d. Isografts

 

 

  1. Tissue obtained from undamaged areas of the patient’s own body

 

  1. Histocompatible tissue obtained from genetically identical individuals

 

  1. Skin that is obtained from genetically different members of the same species who are free of disease

 

  1. Skin that is obtained from members of a different species, primarily pigskin

 

  1. ANS:  C                    DIF:    Cognitive Level: Understanding     REF:   p. 982

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

 

  1. ANS:  D                    DIF:    Cognitive Level: Understanding     REF:   p. 982

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

 

  1. ANS:  A                    DIF:    Cognitive Level: Understanding     REF:   p. 982

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

 

  1. ANS:  B                    DIF:    Cognitive Level: Understanding     REF:   p. 982

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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