Wong's Pediatrics Ch 6

4. Because children younger than 5 years are egocentric, the nurse should do which of the following when communicating with them? a. Focus communication on the child. b. Use easy analogies when possible. c. Explain experiences of others to the child. d. Assure child that communication is private.

A (Because children of this age are able to see things only in terms of themselves, the best approach is to focus communication directly on them. Children should be provided with information about what they can do and how they will feel. With children who are egocentric, analogies, experiences, and assurances that communication is private will not be effective because the child is not capable of understanding. DIF: Cognitive Level: Comprehension REF: p. 123 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance)

7. The nurse must assess 10-month-old Chad. He is sitting on his father's lap and appears to be afraid of the nurse and of what might happen next. Which of the following initial actions by the nurse would be most appropriate? a. Initiate a game of peek-a-boo. b. Ask father to place Chad on the examination table. c. Talk softly to Chad while taking him from his father. d. Undress Chad while he is still sitting on his father's lap.

A (Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done with the child on the father's lap. The nurse should have the father undress the child as needed during the examination. DIF: Cognitive Level: Application REF: p. 126 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance)

1. The nurse is seeing an adolescent boy and his parents in the clinic for the first time. Which of the following should the nurse do first? a. Introduce self. b. Make family comfortable. c. Give assurance of privacy. d. Explain purpose of interview.

A (The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. Clarification of the purpose of the interview and the nurse's role is the second thing that should be done. During the initial part of the interview, the nurse should include general conversation to help make the family feel at ease. The interview also should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality. DIF: Cognitive Level: Application REF: p. 118 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance)

5. The nurse's approach when introducing hospital equipment to a preschooler who seems afraid should be based on which one of the following principles? a. The child may think the equipment is alive. b. Explaining the equipment will only increase the child's fear. c. One brief explanation will be enough to reduce the child's fear. d. The child is too young to understand what the equipment does.

A (Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. Simple, concrete explanations about what the equipment does and how it will feel will help alleviate the child's fear. The preschooler needs repeated explanations as reassurance. DIF: Cognitive Level: Analysis REF: p. 123 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance)

6. When the nurse interviews an adolescent, which of the following is especially important? a. Focus the discussion on the peer group. b. Allow an opportunity to express feelings. c. Use the same type of language as the adolescent. d. Emphasize that confidentiality will always be maintained.

B (Adolescents, like all children, need an opportunity to express their feelings. Often they interject feelings into their words. The nurse must be alert to the words and feelings expressed. The nurse should maintain a professional relationship with adolescents. To avoid misunderstanding or misinterpretation of words and phrases used, the nurse should clarify the terms used, what information will be shared with other members of the health care team, and any limits to confidentiality. Although the peer group is important to this age-group, the interview should focus on the adolescent. DIF: Cognitive Level: Comprehension REF: p. 124 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance)

9. The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique might be most helpful? a. Recommend that the child keep a diary. b. Provide supplies for the child to draw a picture. c. Suggest that the parent read fairy tales to the child. d. Ask the parent if the child is always uncommunicative.

B (Drawing is one of the most valuable forms of communication. Children's drawings tell a great deal about them because they are projections of the children's inner self. A diary would be difficult for a 6-year-old child, who is most likely learning to read. The parent reading fairy tales to the child is a passive activity involving the parent and child; it would not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not always uncommunicative. DIF: Cognitive Level: Application REF: p. 125 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance)

21. The nurse needs to take the blood pressure of a small child. Of the cuffs available, one is too large and one is too small. The best nursing action is which of the following? a. Use the small cuff. b. Use the large cuff. c. Use either cuff, using palpation method. d. Wait to take blood pressure until proper cuff can be located.

B (If blood pressure measurement is indicated and the appropriate size cuff is not available, the next larger size is used. The nurse recognizes that this may be a falsely low blood pressure. Using the small cuff will give an incorrectly high reading. The palpation method will not improve the inaccuracy inherent in the cuff. DIF: Cognitive Level: Comprehension REF: p. 150 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance)

19. Rectal temperatures are indicated in which of the following situations? a. In the newborn period b. Whenever accuracy is essential c. Rectal temperatures are never indicated d. When rapid temperature changes are occurring

B (Rectal temperatures are recommended when definitive measurements are necessary in infants over age 1 month. Rectal temperatures are not done in the newborn period to avoid trauma to the rectal mucosa. Rectal temperature is an intrusive procedure that should be avoided whenever possible. DIF: Cognitive Level: Comprehension REF: p. 145 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance)

20. What is the earliest age at which a satisfactory radial pulse can be taken in children? a. 1 year b. 2 years c. 3 years d. 6 years

B (Satisfactory radial pulses can be taken in children older than 2 years. In infants and young children the apical pulse is more reliable. DIF: Cognitive Level: Comprehension REF: p. 148 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance)

2. Which of the following is considered a block to effective communication? a. Using silence b. Using clichés c. Directing the focus d. Defining the problem

B (Using stereotyped comments or clichés can block effective communication. After the nurse uses such trite phrases, parents often do not respond. Silence can be an effective interviewing tool. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. To be effective, the nurse must be able to direct the focus of the interview while allowing maximum freedom of expression. By using open-ended questions and guiding questions, the nurse can obtain the necessary information and maintain a relationship with the family. The nurse and parent must collaborate and define the problem that will be the focus of the nursing intervention. DIF: Cognitive Level: Application REF: p. 121 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance)

33. When auscultating an infant's lungs, the nurse detects diminished breath sounds. The nurse should interpret this as which of the following? a. Suggestive of chronic pulmonary disease b. Suggestive of impending respiratory failure c. An abnormal finding warranting investigation d. A normal finding in infants less than 1 year of age

C (Absent or diminished breath sounds are always an abnormal finding. Fluid, air, or solid masses in the pleural space all interfere with the conduction of breath sounds. Further data are necessary for diagnosis of chronic pulmonary disease or impending respiratory failure. Diminished breath sounds in certain segments of the lungs can alert the nurse to pulmonary areas that may benefit from chest physiotherapy. Further evaluation is needed in all age-groups. DIF: Cognitive Level: Comprehension REF: p. 165 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance)

23. During a routine health assessment the nurse notes that the 8-month-old infant has a significant head lag. Which of the following is the most appropriate action? a. Recheck head control at next visit. b. Teach parents appropriate exercises. c. Schedule child for further evaluation. d. Refer child for further evaluation if anterior fontanel is still open.

C (Significant head lag after age 6 months strongly indicates cerebral injury and is referred for further evaluation. Head control is part of normal development. Exercises will not be effective. The lack of achievement of this developmental milestone must be evaluated. DIF: Cognitive Level: Comprehension REF: p. 154 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance)

3. What is the single most important factor to consider when communicating with children? a. Presence of the child's parent b. Child's physical condition c. Child's developmental level d. Child's nonverbal behaviors

C (The nurse must be aware of the child's developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Nonverbal behaviors vary in importance based on the child's developmental level and physical condition. Although the child's physical condition is a consideration, developmental level is much more important. The presence of parents is important when communicating with young children, but may be detrimental when speaking with adolescents. DIF: Cognitive Level: Comprehension REF: p. 177 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance)

28. The nurse is testing an infant's visual acuity. By what age should the infant be able to fix on and follow a target? a. 1 month b. 1 to 2 months c. 3 to 4 months d. 6 months

C (Visual fixation and ability to follow a target should be present by ages 3 to 4 months. One to 2 months is too young for this developmental milestone. If the infant is not able to fix and follow by 6 months, further ophthalmologic evaluation is needed. DIF: Cognitive Level: Comprehension REF: p. 157 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance)

32. When assessing a preschooler's chest, the nurse would expect: a. respiratory movements to be chiefly thoracic. b. anteroposterior diameter to be equal to the transverse diameter. c. retraction of the muscles between the ribs on respiratory movement. d. movement of the chest wall to be symmetric bilaterally and coordinated with breathing.

D (Movement of the chest wall should be symmetric bilaterally and coordinated with breathing. In children younger than 6 or 7 years, respiratory movement is principally abdominal or diaphragmatic. The anteroposterior diameter is equal to the transverse diameter during infancy. As the child grows, the chest increases in the transverse direction, so that the anteroposterior diameter is less than the lateral diameter. Retractions of the muscles between the ribs on respiratory movement are indicative of respiratory distress. DIF: Cognitive Level: Comprehension REF: p. 163 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance)