Exam 4

A mother is concerned because her 13-year-old daughter comes home happy one day and sad the next. The girl also argues with her younger sister more than she did in the past, and does not like participating in family activities anymore. The best initial response from the nurse is

"Adolescence is a time of many changes. These changes can be stressful as teenagers struggle to come to terms with who they are. What other types of behaviors has she been displaying?"

The mother of a 13-year-old girl is concerned because her daughter has not started menstruating yet. The girl developed breast buds and started her height spurt at 12 years of age. Knowing this information, the nurse should tell the mother:

"Based on when the breast buds first appeared, she should starting menstruating around the age of 14."

A teenager is interested in getting a tattoo. She asks her nurse for advice. The nurse should respond by saying

"Tattoos are popular; however, they can lead to infection and/or bleeding."

A mother is concerned because her daughter has been taking a nap every day afterschool. The nurse's best response is to say:

"Tell me about your daughter's schedule

A teenager has been using acne medications for the last 14 days. Her acne is no better, and in fact, it is a little worse. What advice should the nurse offer this girl?

"The medications can make acne appear worse at first; try to give it a few more weeks."

After offering a teenager the HPV vaccine, the teenager responds by saying, "I can't have the vaccine because I have already been sexually active." The nurse should respond by saying:

"You can still benefit from the vaccine, but there is a chance it will not be as effective."

A mother is concerned because her son plays football and another boy on the team was recently treated for CA-MRSA. The mother asks the nurse for her recommendation. The nurse should respond by saying:

"Your son should always take precautions to avoid such infections by showering with soap and hot water after each game and practice."

3. A 4-year-old had an episode of enuresis. The parents should: a. Have him change h DIF: Cognitive Level: Application REF: 492 4. A 5-year-old is prescribed a medication that is renally excreted. As a result, the dose should be: a. Lower than the recommended dose b. At the recommended dose c. Higher than the recommended dose d. Avoided ANS: B The dose should be at the recommended dose. Kidneys reach full maturity by the end of infancy and early toddler years. As a result, medications that are renally excreted can by given at the recommended doses. DIF: Cognitive Level: Synthesis REF: 479 5. A 2-year-old has hives. Of the following items ingested, which is most likely to have caused the allergic reaction? a. Apple juice b. Oatmeal raisin cookies c. Jelly sandwich d. Banana ANS: B Oatmeal raisin cookies are most likely to have caused the allergic reaction. Nuts are a food that is likely to cause allergic reactions, and oatmeal raisin cookies often contain nut products. DIF: Cognitive Level: Application REF: 483 6. Which of the following is a test for visual acuity? a. Snellen Screening test b. Denver Eye Screening test c. Ishihara's test d. Cover test ANS: A The Snellen Screening test is a reliable estimate of actual visual acuity. The Snellen Screening test is performed with the Snellen E chart. DIF: Cognitive Level: Knowledge REF: 487 7. A 4-year-old asks her mother for a second cup of yogurt. The extra helping is likely for: a. The child herself b. The child's brother c. The child's dog d. The child's imaginary friend ANS: D The extra helping is likely for the child's imaginary friend. Preschoolers may have one or more imaginary companions. They are usually another child. Preschoolers eat, play, and sleep with their imaginary companions. DIF: Cognitive Level: Synthesis REF: 484 | 487 8. Calculate the approximate number of daily calories required by an 18-kg preschooler. a. 1360 calories b. 1540 calories c. 1620 calories d. 1800 calories ANS: C The approximate number of calories required by an 18-kg preschooler is 1620. Preschoolers need approximately 90 kcal/kg of body weight per day for health maintenance, activity, and growth. DIF: Cognitive Level: Application REF: 482 9. A 4-year-old tells his father that he invented a new song. The father's best response is to: a. Congratulate his son on a job well done b. Tell his son that he is too young to invent anything c. Tell his son nicely that it does not sound like a song d. Tell his son to come back later because he is busy ANS: A The father's best response is to congratulate his son on a job well done. When children perceive their value, they experience good feelings about themselves. They develop initiative through active imagination. According to Erickson, this is the most important developmental task in the development of self-concept. Reinforcement of behaviors and praising are methods that help develop self-concept. DIF: Cognitive Level: Application REF: 491-492 10. Which recommendation is most useful at preventing burns in a preschooler? a. Do not read to the child while sitting on the sofa in front of the fireplace. b. Do not cook on a gas grill until the child is a teenager. c. Do not leave cigarettes and matches on the kitchen counter. d. Do not cook with the child in the kitchen. ANS: C Advising a parent to not leave cigarettes and matches on the kitchen counter is the most useful recommendation for preventing burns in a preschooler. Preschoolers like to imitate and act older than they are. Having cigarettes and matches on the kitchen counter makes them available for use by the preschooler and can lead to burns. Preschoolers should also be taught the dangers of matches and fire. DIF: Cognitive Level: Synthesis REF: 491-492 | 497 11. Appropriate outdoor play for a 5-year-old includes: a. Riding his bike around the neighborhood with a friend b. Playing hopscotch in the driveway c. Swimming in the family pool d. Playing in the park while being supervised by his parent ANS: D Appropriate outdoor play for a 5-year-old includes playing in the park while being supervised by his parent. At the age of 5, the child is still not proficient at controlling a bike in the streets. Additionally, children of this age have less fear of strangers. DIF: Cognitive Level: Application REF: 482 | 497 12. A child should not sit in the front seat of a car until the age of: a. 10 b. 11 c. 12 d. 13 ANS: D The age is 13. Federal investigations concluded that children under the age of 13 should ride in the back seat of a car because of the potential for injury or death from the air bag. DIF: Cognitive Level: Knowledge REF: 491 | 497 13. The hallmark of Piaget's preconceptual substage is: a. Using language to function symbolically b. Using concrete thought processes c. Using mental abstracting d. Using transductive reasoning ANS: A The hallmark of Piaget's preconceptual substage is using language to function symbolically. DIF: Cognitive Level: Knowledge REF: 486 14. A mother thinks her 2-year-old drank Drano®. The first thing she should do is: a. Call the pediatrician on call b. Give ipecac syrup c. Call the Poison Control Center d. Wait to see if the child will vomit ANS: C The first thing the mother should do is call the Poison Control Center. Parents should have the number for the poison control center handy. Ipecac syrup should also be in the home; however, you do not want to induce vomiting of acidic substances. DIF: Cognitive Level: Synthesis REF: 499 15. A preschooler and her school-age brother both received the same swimming tube as a gift. The brother accidentally took his sister's swimming tube. The sister protested that she needed her swimming tube to go swimming. This behavior is indicative of: a. Abstract thinking b. Concrete thinking c. Jealousy d. A temper tantrum ANS: B The behavior is indicative of concrete thinking. Egocentrism exemplifies the concept of concrete thinking. Children can only concentrate on their own perspective. The preschooler is not able to consider more than one factor at a time when solving problems. DIF: Cognitive Level: Synthesis REF: 484 | 486 16. A common reason for nighttime awakening in the preschooler is: a. Nightmares b. Night terrors c. Enuresis d. Hunger ANS: A Nightmares are a common reason for nighttime awakenings. Nightmares fully waken the child and give them a feeling of fearfulness and helplessness. DIF: Cognitive Level: Knowledge REF: 485 17. The nurse suspects a 5-year-old has asthma. Which fact from the past medical history is a risk factor? a. The child was breast-fed b. The child had RSV as an infant c. The child was born via a C-section d. The child had PE tubes as an infant ANS: B Having respiratory infections (such as RSV) as an infant is a risk factor for asthma. DIF: Cognitive Level: Knowledge REF: 501 18. Which is the most common intraocular tumor in young children? a. Neuroblastoma b. Wilms tumor c. Retinoblastoma d. Leukemia ANS: C Retinoblastoma is the most common intraocular tumor in young children. DIF: Cognitive Level: Knowledge REF: 500 19. The best way for parents to teach their child good hygiene is to: a. Have him learn it at school b. Model the behavior at home c. Lecture him about hygiene d. Punish him when he forgets to brush his teeth ANS: B The best way for a parent to teach their child good hygiene is to model the behavior at home. Reinforcement of health-promotion activities helps to instill behaviors. Additionally, preschoolers like to imitate adults. DIF: Cognitive Level: Application REF: 491-492 20. The nurse makes a home asthma visit. Which environmental finding has the potential to trigger an asthma exacerbation? a. Radiator heating system b. Air conditioner c. Hardwood flooring d. Leaky roof ANS: D A leaky roof has the potential to trigger an asthma exacerbation because water or moisture can lead to mold growth, and mold is an allergen that can trigger asthma. DIF: Cognitive Level: Application REF: 501 21. Which behavior best indicates that the preschooler is socially ready to attend school? a. He gives his brother the ball when he is tired of playing with it. b. He never engages in any activity until his mother tells him to. c. He plays well with a group of neighborhood children. d. He moves from one activity to another. ANS: C Playing well with a group of neighborhood children best indicates the preschooler is ready to attend school. Social interaction prepares preschoolers for school. The child acquires readiness to interact in group situations, follow directions, and take turns by interacting with others. DIF: Cognitive Level: Application REF: 492 22. The best way for the nurse to approach a 3-year-old during a physical exam is to: a. Let him listen to your heart with the stethoscope b. Tell him to sit quietly while you examine him c. Ask his parents to leave the room to minimize distractions d. Ask another nurse to hold him while you examine him ANS: A The best way for the nurse to approach a 3-year-old during a physical exam is to let him listen to the nurse's heart with the stethoscope. Preschoolers like to imitate adults and like to play with medical devices. DIF: Cognitive Level: Application REF: 492 | 502 23. Which is a primary prevention method for avoiding child abuse? a. Educating the public about violence and the potential for abuse b. Removing a child who has been abused from the home c. Reporting a case of child abuse d. Referring a parent who abused their child to counseling ANS: A Educating the public about violence and the potential for abuse is a form of primary prevention. Nurses provide primary prevention for violence by promoting awareness and providing anticipatory guidance. Primary prevention is used before violence actually occurs. DIF: Cognitive Level: Synthesis REF: 493 | 503 (Box 19-6) 24. A child who recently learned how to throw a ball overhand is likely how old? a. 3 years old b. 4 years old c. 5 years old d. 6 years old ANS: B At the age of 4, most children have mastered throwing a ball overhand. DIF: Cognitive Level: Knowledge REF: 481 (Table 19-1) 25. A preschooler with a receptive vocabulary of up to 5600 words is likely how old? a. 42 months old b. 48 months old c. 54 months old d. 60 months old ANS: B By 48 months of age, most preschoolers have receptive languages skills of up to 5600 words. DIF: Cognitive Level: Knowledge REF: 489 (Table 19-2) 26. One way to address a Healthy People 2010 health promotion and disease prevention objective for preschoolers is to: a. Eliminate the school requirement for the MMR vaccine b. Eliminate computers from the home c. Regulate the paint allowed for use with toys d. Eliminate WIC programs ANS: C One way to address a Healthy People 2010 health promotion and disease prevention objective for preschoolers is to regulate the paint that is allowed for use in toys. Paints can contain lead, and lead poisoning can lead to disabilities. A Healthy People 2010 objective is to eliminate elevated blood-lead levels in children. DIF: Cognitive Level: Application REF: 499 27. Which sleep ritual is age-appropriate for a preschooler? a. Asking for every light in the home to be turned on at bedtime b. Saying good night to all 20 stuffed animals in the room before going to sleep c. Going right to sleep d. Asking the parent to read all books on the bookshelf before going to bed ANS: B An age-appropriate sleep ritual for a preschooler is to say good night to all 20 stuffed animals in the room before going to sleep. Preschoolers have longer, more rigid bedtime rituals than toddlers. They prolong bedtime routines, which for them generally last about 30 minutes. Reasonable rituals should be honored. DIF: Cognitive Level: Application REF: 485 | 494 MULTIPLE RESPONSE 1. A mother tells the nurse her 3-year-old has not been himself lately. The nurse examines the child. Which of the following physical findings would be cause for concern? Select all that apply. a. Bruises b. Pale skin c. Enlarged lymph nodes d. Red spots ANS: A, B, C, D Bruises, pale skin, enlarged lymph nodes, and red spots are all signs of cancer. DIF: Cognitive Level: Knowledge REF: 500

...

What percentage of adolescent females suffer from an eating disorder in the United States?

10%

Which stage of female breast development is characterized by enlargement of the areolar diameter along with a small area of elevation around the papillae?

2

Females usually begin puberty

2 years before males

Which stage of male genital development is characterized by initial enlargement of the penis, mainly in length along with further growth of the testes and scrotum?

3

1. In feeding children, adults are responsible for determining a. children's likes and dislikes. b. the amount of food consumed. c. the quantity and quality of foods prepared. d. the amount of time taken to consume foods. ANS: C Parents and caregivers are responsible for providing nutritious foods for children. It is up to the children to decide whether, how much, and how quickly they eat. Children determine their own food likes and dislikes. DIF: Cognitive Level: Comprehension REF: Page 251 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 2. Children should be fed a. three times per day only. b. only when they request food. c. at about the same times each day. d. three meals and three snacks each day. ANS: C Parents and caregivers should provide meals and snacks at about the same times each day. Regular meals and snacks help support successful learning and growth and help children feel secure. Most children need more than three meals a day; the specific number of meals and snacks varies for each family and each child. If children are only fed when they request food, the family will not eat meals together and the social aspect of eating will be lost. DIF: Cognitive Level: Comprehension REF: Page 251 TOP: Nursing Process: Planning MSC: Client Needs: Health promotion and maintenance 3. The best way to encourage children to consume adequate nutrients with less than 30% of kcals from fat is to a. avoid fast food and fried foods. b. follow a vegan eating pattern. c. use low-fat foods and take a vitamin/mineral supplement. d. include plenty of fruits, vegetables, and whole grains. ANS: D Children should be provided with a diet that includes plenty of fruits, vegetables, and whole grains to help them consume adequate nutrients with less than 30% of kcals from fat. It is not necessary to completely avoid fat food and fried foods, although they should be eaten in moderation. A vegan eating pattern may not provide adequate amounts of iron, zinc, vitamin B12, and other important nutrients found in lean meats and low-fat dairy products. Low-fat processed food products can help limit fat intake, but a vitamin/mineral supplement does not compensate for omitting fruits, vegetables, and whole grains. DIF: Cognitive Level: Application REF: Page 251 TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance 4. Children ages 1 to 3 years have an increasing sense of a. privacy. b. isolation. c. dependence. d. independence. ANS: D Toddlers are dealing with issues of autonomy and like to assert their newly discovered independence. They are not usually concerned with privacy or isolation. They are still very dependent on their parents, but less so than in infancy. DIF: Cognitive Level: Knowledge REF: Page 252 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 5. If a 2-year-old is drinking 4 cups of milk daily, they are probably drinking a. too little milk to provide sufficient calcium for their growing skeleton. b. about the right amount of milk to meet their nutrient needs. c. about the right amount of milk provided they are at a healthy weight. d. too much milk, which may displace other important foods from their diet. ANS: D Children ages 1 to 3 years should drink 2 to 3 8-oz cups of milk per day. Therefore, 4 cups of milk is probably too much, and may displace other important foods from their diet. DIF: Cognitive Level: Application REF: Page 253 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity 6. Excessive juice intake may be a problem for young children because a. high potassium intakes may be harmful. b. it may displace more nutrient-dense foods. c. excessive fluid intake may cause kidney damage. d. fruit juice contains substances that may be addictive. ANS: B Excessive juice intake may displace more nutrient-dense foods from the diet because it provides kcals with few nutrients. The high potassium and fluid intakes are not harmful and juice does not contain addictive substances. DIF: Cognitive Level: Comprehension REF: Page 253 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity 7. Children ages 4 to 6 years are more likely to eat steamed green beans if they are presented a. as green bean casserole. b. highly seasoned. c. alone as a snack between meals. d. separated from other foods on the plate. ANS: D Children ages 4 to 6 tend to accept foods more easily if they are served separately from other foods on the plate, rather than mixed with other foods in a casserole. Children do not usually favor highly seasoned foods. Green beans alone would not provide sufficient kcals for a between-meal snack for children. DIF: Cognitive Level: Knowledge REF: Page 253 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 8. If a child does not like a food when they try it for the first time a. their preference should be respected and they should not be encouraged to try it again. b. they should be offered a reward if they eat a reasonable amount of the food. c. they should be encouraged to eat at least five bites to see if their taste buds adjust. d. they should be offered the food at least 8 to 10 times before deciding whether they like it. ANS: D Children often need to be exposed to new food 8 to 10 times before they will accept them. Rewarding children for eating foods and forcing them to eat specific amounts do not usually encourage acceptance. They should be offered the food again because one time is not sufficient to determine food preferences. DIF: Cognitive Level: Application REF: Pages 253-254 TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance 9. It is important for parents to teach children to a. recognize internal hunger cues. b. recognize external hunger cues. c. eat the same amount of food each day. d. monitor their weight on a regular basis. ANS: A Parents can help children develop healthy eating patterns by teaching them to recognize and respond to internal hunger cues, to eat when they are hungry and stop when they are satisfied. External cues are not really hunger, but are more environmental influences that may cause overeating if the child is not responsive to internal hunger cues. Children's food intake may vary greatly from day to day because variations in appetite are common. Children should not monitor their weight regularly; instead they should focus on healthy eating and exercise habits and trust their bodies to maintain a healthy weight. DIF: Cognitive Level: Comprehension REF: Pages 250, 252-254 TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance 10. The best way for a parent to encourage their toddler to eat a variety of foods is to a. offer rewards for trying new foods. b. make new foods look like favorite foods. c. allow free access to foods at all times. d. eat a variety of foods themselves. ANS: D Parents can encourage their toddlers to eat a variety of foods by modeling this behavior and eating a variety of foods themselves. It is not helpful to offer rewards for trying new foods; parents want children to learn that eating well is its own reward. Parents should not allow free access to foods at all times but should serve regular meals and snacks at about the same time eat day. Disguising foods to look like favorite foods simply creates suspicion and negative feelings toward new foods. DIF: Cognitive Level: Application REF: Page 253 TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance 11. The child most likely to develop type 2 diabetes is the one who a. is obese. b. is malnourished. c. has multiple food allergies. d. lives in a low-income household. ANS: A Type 2 diabetes is strongly associated with obesity. Malnutrition, food allergies, and poverty do not generally contribute to type 2 diabetes. DIF: Cognitive Level: Application REF: Pages 260, 262 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 12. The National School Lunch Program provides a. free lunches for all schoolchildren. b. reduced-price lunches for all schoolchildren. c. lunches only for children from low-income families. d. lunches at varying costs depending on family income. ANS: D The National School Lunch Program provides lunches free, at reduced cost, or at full cost, depending on family income. Meals are available to all schoolchildren, but the cost depends on family income. DIF: Cognitive Level: Comprehension REF: Page 257 TOP: Nursing Process: Assessment MSC: Client Needs: Health promotion and maintenance 13. An example of a breakfast that would meet the School Breakfast Program requirements would be a. scrambled egg, bacon, toast, and orange juice. b. cold breakfast cereal with milk, toast with honey. c. toast with peanut butter, banana, and milk. d. turkey sausage, hash browns, ketchup, and milk. ANS: C School Breakfast Program requirements indicate that a breakfast must include a serving of milk, a serving of fruit, and two servings of meat and/or bread and cereal. Toast (bread serving), peanut butter (meat serving), banana (fruit serving), and milk (milk serving) meets this requirement. Scrambled egg (meat serving), bacon (meat serving), toast (bread serving), and orange juice (fruit serving) is missing milk. Cold breakfast cereal (bread serving ), milk (milk serving), and toast with honey (bread serving) is missing fruit. Turkey sausage (meat serving), hash browns with ketchup (vegetable serving), and milk (milk serving) is missing a serving of meat or bread. DIF: Cognitive Level: Application REF: Page 257 TOP: Nursing Process: Planning, Evaluation MSC: Client Needs: Health promotion and maintenance 14. To promote good eating habits in adolescents, adults should a. discuss the reasons for good food choices with adolescents. b. design daily menus and provide only the specific foods on the menu. c. create guidelines for dietary patterns and provide appropriate food choices. d. model good food behaviors and allow adolescents to make their own choices. ANS: C Adults can help promote good eating habits in adolescents by creating guidelines for dietary patterns and providing appropriate food choices. Simply discussing reasons for good food choices provides education without tools. Designing menus and providing only these foods does not teach adolescents to make good choices on their own. Modeling good food behaviors and allowing adolescents to make their own choices does not provide sufficient guidance. DIF: Cognitive Level: Comprehension REF: Page 258 TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Psychosocial integrity 15. Adolescent boys generally require more protein than adolescent girls because a. boys become taller than girls during adolescence. b. lean body mass increases more in boys than in girls during adolescence. c. hormonal differences allow adolescent girls to use protein more efficiently than adolescent boys. d. foods high in protein are also high in minerals, and boys have higher mineral needs than girls during adolescence. ANS: B Adolescent boys generally need more protein than adolescent girls because they are developing more lean body mass. Height does not affect protein needs as much as development of lean body mass, and adolescent boys are not necessarily taller than girls. Adolescent girls' hormones do not cause them to use protein more efficiently than boys. Boys do need more of some minerals than girls because of their increased body size, but this is not the reason for their increased protein needs. DIF: Cognitive Level: Comprehension REF: Page 259 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity

;-0

16. It is especially important to make sure that teenage girls obtain adequate calcium because a. calcium is lost from the body during menstruation. b. adolescent girls require more calcium than adolescent boys. c. lactose intolerance is especially common in adolescent girls. d. adolescent girls often have inadequate intakes of calcium-rich foods. ANS: D Calcium intake is a concern for teenage girls because they often have inadequate intakes of calcium-rich foods. Iron, not calcium, is lost from the body during menstruation. Adolescent girls and boys have the same calcium needs. Lactose intolerance is not especially common in adolescent girls. DIF: Cognitive Level: Knowledge REF: Page 259 TOP: Nursing Process: Assessment, Planning MSC: Client Needs: Physiological integrity 17. The best way to reduce the risk of asphyxiation (choking) in toddlers is to make sure that they a. drink plenty of fluids with meals. b. avoid conversation during meals. c. sit down while eating and chew foods well. d. eat using utensils rather than with their fingers. ANS: C Toddlers may choke if they are too active while they are eating or if they do not chew foods properly. Therefore, sitting down while eating and chewing foods well can help prevent choking. Drinking plenty of fluids with meals will not necessarily prevent choking. Conversation should be encouraged during meals to help create a relaxed family atmosphere and to slow the pace of eating. Eating with utensils rather than fingers is not related to a risk of choking. DIF: Cognitive Level: Comprehension REF: Pages 259-260 TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance 18. Lead poisoning may be diagnosed at the same time as a. food allergies. b. anorexia nervosa. c. iron deficiency anemia. d. vitamin D and calcium deficiencies. ANS: C Lead poisoning is associated with iron-deficiency anemia and may be diagnosed at the same time. Lead poisoning is not related to food allergies, anorexia nervosa, and vitamin D deficiencies. Lead poisoning may be related to calcium deficiency, but this is less obvious than iron deficiency. DIF: Cognitive Level: Comprehension REF: Pages 260, 262 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 19. Children become overweight because of a. sedentary lifestyles. b. excessive portion sizes. c. consumption of high-fat foods. d. a combination of several factors. ANS: D Many factors contribute to overweight in children. These factors include sedentary lifestyles, excessive portion sizes, and consumption of high-fat foods, as well as eating more snacks, eating more food away from home, spending large amounts of time watching television or playing computer games, genetics, and lack of adult supervision after school. DIF: Cognitive Level: Comprehension REF: Page 260 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity | Client Needs: Physiological integrity 20. Interventions for obese children should focus on a. gradual weight loss. b. low-fat food choices. c. healthy lifestyle behaviors. d. increased physical activity. ANS: C Interventions for obese children should focus on healthy lifestyle behaviors including eating habits and activity patterns. These may include low-fat food choices and increasing physical activity, but need to evaluate and address factors contributing to obesity for the specific child. Gradual weight loss is not the goal. As lifestyle habits improve, a child may lose weight or maintain a fairly constant weight as their height increases until they reach a healthy weight for their height. DIF: Cognitive Level: Application REF: Page 260 TOP: Nursing Process: Planning MSC: Client Needs: Physiological integrity | Client Needs: Health promotion and maintenance 21. An example of a child who is at high risk for iron-deficiency anemia is one a. who has allergies to milk and nuts. b. living in an African American low-income family. c. whose parents both work full time. d. who eats most of their food away from home. ANS: B Iron-deficiency anemia is associated with poverty and malnutrition and is most common in African American, Hispanic American, and Native American families. A child with allergies to milk and nuts may have low intakes of calcium, but would probably not have low intakes of iron. Working parents and eating food away from home are not known to be related to iron-deficiency anemia. DIF: Cognitive Level: Application REF: Pages 262-263 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity | Client Needs: Psychosocial integrity 22. In children, the most common food allergens include a. wheat, barley, oats, and milk. b. peanuts, milk, eggs, and wheat. c. fish, shellfish, tree nuts, and peanuts. d. eggs, strawberries, oranges, and tree nuts. ANS: B The most common food allergens in children are peanuts, milk, eggs, and wheat. Seafood allergies are common in older children and adults. Allergies to barley, oats, tree nuts, strawberries, and oranges occur less commonly. DIF: Cognitive Level: Knowledge REF: Page 263 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 23. The most serious, potentially life-threatening reaction to a food allergen is a. dermatitis. b. anaphylaxis. c. syncope (fainting). d. gastrointestinal bleeding. ANS: B The most serious, potentially life-threatening reaction to a food allergen is anaphylaxis, in which the airway becomes swollen and blocked, causing unconsciousness. Dermatitis, syncope, and gastrointestinal bleeding may be problematic, but are not life threatening. DIF: Cognitive Level: Knowledge REF: Page 263 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 24. A true food allergy involves the _____ system. a. immune b. digestive c. respiratory d. cardiovascular ANS: A In a true food allergy, the immune system reacts to a substance in food as if it needed to protect the body from a foreign substance. Food allergies may cause reactions in the digestive or respiratory systems, but these are secondary effects, not primary responses. The cardiovascular system is not usually involved in food allergy. DIF: Cognitive Level: Comprehension REF: Page 263 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological integrity 25. Food allergies are treated by a. use of antihistamine medications. b. avoiding all sources of the offending food. c. taking supplemental digestive enzymes to break down the offending protein. d. gradual desensitization to the offending protein under medical supervision. ANS: B The only way to treat food allergies is to avoid all sources of the offending food. Use of antihistamine medications may blunt the allergenic response, but should not be relied upon because of the risk of anaphylaxis. Supplemental digestive enzymes cannot reliably digest the offending protein before it makes contact with the digestive system. With allergies, sensitivity to the offending protein tends to increase, rather than decrease, with repeated exposure. DIF: Cognitive Level: Comprehension REF: Pages 263-265 TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance 26. A food that includes "sodium caseinate" and "lactalbumin" in the list of ingredients should be avoided by individuals with a(n) _____ allergy. a. egg b. milk c. wheat d. peanut ANS: B Caseinate and lactalbumin are made from proteins found in milk and should be avoided by individuals with a milk allergy. Individuals with allergies to egg, wheat, and peanut would not be affected by these ingredients. DIF: Cognitive Level: Application REF: Page 265 TOP: Nursing Process: Planning, Implementation MSC: Client Needs: Health promotion and maintenance 27. Eating disorders are generally caused by a. unresolved emotional conflicts. b. a desire to achieve a healthy weight. c. dietary restrictions imposed by families. d. a desire to achieve a high level of fitness. ANS: A Eating disorders are generally caused by unresolved emotional conflicts. Even though the presenting behaviors are food-related and may be connected to a desire to achieve a certain weight or fitness level, the underlying problem is emotional and psychological, not nutritional. Dietary restrictions imposed by families may contribute to disordered eating, but are not the root cause. DIF: Cognitive Level: Comprehension REF: Page 265 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 28. If a parent often finds empty food wrapper's in their teenage daughter's bedroom, if she spends several minutes in the bathroom right after every meal, and if she exercises for more than an hour every day, the parent may suspect a. bulimia nervosa. b. anorexia nervosa. c. binge-eating disorder. d. chronic dieting syndrome. ANS: A Bulimia nervosa is characterized by episodes of binge eating (food wrappers may be evidence of this), and compensatory behaviors including purging (time spent in the bathroom after meals may signal vomiting), and excessive exercise. Anorexia nervosa is characterized by refusal to maintain weight above a certain low value and fear of gaining weight; this would be demonstrated by restricted food intake and/or excessive exercise. Binge-eating disorder is characterized by episodes of binge eating (the food wrappers may suggest this), but without compensatory behaviors. Chronic dieting may be associated with several eating disorders, but is not a defined syndrome. DIF: Cognitive Level: Application REF: Pages 267-268 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 29. For individuals with binge eating disorder, episodes of binge eating may be triggered by a. stressful events. b. nutrient deficiencies. c. periods of relaxation. d. unintended weight loss. ANS: A Episodes of binge eating may be triggered by stressful events because of poor coping skills and loss of self-control. Binge eating is not triggered by nutrient deficiencies and is less likely to occur during periods of relaxation or after unintended weight loss. DIF: Cognitive Level: Comprehension REF: Page 268 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial integrity 30. An important part of nutrition intervention for clients with eating disorders includes a. eating all foods with other people present. b. separating food behaviors from emotional issues. c. limiting exercise to no more than 30 minutes daily. d. keeping a record of food and exercise habits. ANS: B Nutrition intervention for clients with eating disorders includes separating food and weight-related behaviors from emotional and psychological issues. It may be helpful for these clients to eat with other people present to help them normalize their eating patterns, those who exercise excessively may need to limit their exercise, and a record of food and exercise habits may be helpful (especially if combined with a record of emotions experienced). However, these are not necessarily included in treatment. DIF: Cognitive Level: Application REF: Pages 268-269

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Which teenager is at increased risk for acquiring a sexually transmitted disease and should be provided with anticipatory guidance?

A teenager who feels her friends and family do not care about her

Which behavior is cause for concern and requires further evaluation

A teenager who is agitated and has trouble sleeping

Which is an indication that a teenager is at risk for not meeting his developmental task?

A teenager who is arrested for petty theft

Which teenage behavior is cause for concern?

A teenager who takes frequent naps and states it is because he is bored

During a physical exam, a teenager asks the nurse if she can have a stronger medication for her constipation because the laxatives she has been taking are not helping. During the physical exam, the nurse notices striae and mild to moderate erosion of the tooth enamel. These findings should alert the nurse to the possibility of:

Bulimia nervosa

A good way to initiate a discussion about drinking during a physical exam with a teenager is to say:

Do any of your friends drink?"

A teenager has a family history of Type 2 Diabetes Mellitus. He asks the nurse what he can do to try to prevent developing it himself. Which advice should the nurse give this client?

Encourage activity and a balanced diet

Parents recently discovered that their teenage daughter has been drinking on a regular basis. They ask the nurse for advice on how to best help their daughter. The nurse should tell these parents to:

Enroll their daughter in a peer support group focused on teenage drinking

A disorder where males have an extra chromosome and typically are tall and initially thin, and do not develop secondary sex characteristics is known as:

Klinefelter syndrome

To help their teenager meet his developmental task, parents should

Maintain an ongoing dialogue about important issues and upcoming challenges

Maintain an ongoing dialogue about important issues and upcoming challenges

May 23rd

Which behavior is most reflective of a teenager's behavior?

Riding an ATV without a helmet

The third leading cause of death in adolescents between 15 and 19 years of age is which of the following?

Suicide

The best way to prevent an adolescent pregnancy is to:

Talk to teenagers about sex, including abstinence, contraception, and sexually transmitted diseases

A 14-year-old female is in for a physical exam. Which finding requires further investigation?

The lack of breast buds

A female disorder in which only one X chromosome is present instead of two is known as:

Turner syndrome

1. A 5-year-old has a daily caloric intake of 1800 calories. Approximately what portion of the diet should be comprised of carbohydrates 4. A 5-year-old is prescribed a medication that is renally excreted. As a result, the dose should be: a. Lower than the recommended dose b. At the recommended dose c. Higher than the recommended dose d. Avoided ANS: B The dose should be at the recommended dose. Kidneys reach full maturity by the end of infancy and early toddler years. As a result, medications that are renally excreted can by given at the recommended doses. DIF: Cognitive Level: Synthesis REF: 479 5. A 2-year-old has hives. Of the following items ingested, which is most likely to have caused the allergic reaction? a. Apple juice b. Oatmeal raisin cookies c. Jelly sandwich d. Banana ANS: B Oatmeal raisin cookies are most likely to have caused the allergic reaction. Nuts are a food that is likely to cause allergic reactions, and oatmeal raisin cookies often contain nut products. DIF: Cognitive Level: Application REF: 483 11 Calculate the approximate number of daily calories required by an 18-kg preschooler. a. 1360 calories b. 1540 calories c. 1620 calories d. 1800 calories ANS: C The approximate number of calories required by an 18-kg preschooler is 1620. Preschoolers need approximately 90 kcal/kg of body weight per day for health maintenance, activity, and growth. DIF: Cognitive Level: Application REF: 482 9. A 4-year-old tells his father that he invented a new song. The father's best response is to: a. Congratulate his son on a job well done b. Tell his son that he is too young to invent anything c. Tell his son nicely that it does not sound like a song d. Tell his son to come back later because he is busy ANS: A The father's best response is to congratulate his son on a job well done. When children perceive their value, they experience good feelings about themselves. They develop initiative through active imagination. According to Erickson, this is the most important developmental task in the development of self-concept. Reinforcement of behaviors and praising are methods that help develop self-concept. DIF: Cognitive Level: Application REF: 491-492 10. Which recommendation is most useful at preventing burns in a preschooler? a. Do not read to the child while sitting on the sofa in front of the fireplace. b. Do not cook on a gas grill until the child is a teenager. c. Do not leave cigarettes and matches on the kitchen counter. d. Do not cook with the child in the kitchen. ANS: C Advising a parent to not leave cigarettes and matches on the kitchen counter is the most useful recommendation for preventing burns in a preschooler. Preschoolers like to imitate and act older than they are. Having cigarettes and matches on the kitchen counter makes them available for use by the preschooler and can lead to burns. Preschoolers should also be taught the dangers of matches and fire. DIF: Cognitive Level: Synthesis REF: 491-492 | 497 11. Appropriate outdoor play for a 5-year-old includes: a. Riding his bike around the neighborhood with a friend b. Playing hopscotch in the driveway c. Swimming in the family pool d. Playing in the park while being supervised by his parent ANS: D Appropriate outdoor play for a 5-year-old includes playing in the park while being supervised by his parent. At the age of 5, the child is still not proficient at controlling a bike in the streets. Additionally, children of this age have less fear of strangers. DIF: Cognitive Level: Application REF: 482 | 497 12. A child should not sit in the front seat of a car until the age of: a. 10 b. 11 c. 12 d. 13 ANS: D The age is 13. Federal investigations concluded that children under the age of 13 should ride in the back seat of a car because of the potential for injury or death from the air bag. DIF: Cognitive Level: Knowledge REF: 491 | 497 13. The hallmark of Piaget's preconceptual substage is: a. Using language to function symbolically b. Using concrete thought processes c. Using mental abstracting d. Using transductive reasoning ANS: A The hallmark of Piaget's preconceptual substage is using language to function symbolically. DIF: Cognitive Level: Knowledge REF: 486 14. A mother thinks her 2-year-old drank Drano®. The first thing she should do is: a. Call the pediatrician on call b. Give ipecac syrup c. Call the Poison Control Center d. Wait to see if the child will vomit ANS: C The first thing the mother should do is call the Poison Control Center. Parents should have the number for the poison control center handy. Ipecac syrup should also be in the home; however, you do not want to induce vomiting of acidic substances. DIF: Cognitive Level: Synthesis REF: 499 15. A preschooler and her school-age brother both received the same swimming tube as a gift. The brother accidentally took his sister's swimming tube. The sister protested that she needed her swimming tube to go swimming. This behavior is indicative of: a. Abstract thinking b. Concrete thinking c. Jealousy d. A temper tantrum ANS: B The behavior is indicative of concrete thinking. Egocentrism exemplifies the concept of concrete thinking. Children can only concentrate on their own perspective. The preschooler is not able to consider more than one factor at a time when solving problems. DIF: Cognitive Level: Synthesis REF: 484 | 486 16. A common reason for nighttime awakening in the preschooler is: a. Nightmares b. Night terrors c. Enuresis d. Hunger ANS: A Nightmares are a common reason for nighttime awakenings. Nightmares fully waken the child and give them a feeling of fearfulness and helplessness. DIF: Cognitive Level: Knowledge REF: 485 17. The nurse suspects a 5-year-old has asthma. Which fact from the past medical history is a risk factor? a. The child was breast-fed b. The child had RSV as an infant c. The child was born via a C-section d. The child had PE tubes as an infant ANS: B Having respiratory infections (such as RSV) as an infant is a risk factor for asthma. DIF: Cognitive Level: Knowledge REF: 501 18. Which is the most common intraocular tumor in young children? a. Neuroblastoma b. Wilms tumor c. Retinoblastoma d. Leukemia ANS: C Retinoblastoma is the most common intraocular tumor in young children. DIF: Cognitive Level: Knowledge REF: 500 19. The best way for parents to teach their child good hygiene is to: a. Have him learn it at school b. Model the behavior at home c. Lecture him about hygiene d. Punish him when he forgets to brush his teeth ANS: B The best way for a parent to teach their child good hygiene is to model the behavior at home. Reinforcement of health-promotion activities helps to instill behaviors. Additionally, preschoolers like to imitate adults. DIF: Cognitive Level: Application REF: 491-492 20. The nurse makes a home asthma visit. Which environmental finding has the potential to trigger an asthma exacerbation? a. Radiator heating system b. Air conditioner c. Hardwood flooring d. Leaky roof ANS: D A leaky roof has the potential to trigger an asthma exacerbation because water or moisture can lead to mold growth, and mold is an allergen that can trigger asthma. DIF: Cognitive Level: Application REF: 501 21. Which behavior best indicates that the preschooler is socially ready to attend school? a. He gives his brother the ball when he is tired of playing with it. b. He never engages in any activity until his mother tells him to. c. He plays well with a group of neighborhood children. d. He moves from one activity to another. ANS: C Playing well with a group of neighborhood children best indicates the preschooler is ready to attend school. Social interaction prepares preschoolers for school. The child acquires readiness to interact in group situations, follow directions, and take turns by interacting with others. DIF: Cognitive Level: Application REF: 492 24. A child who recently learned how to throw a ball overhand is likely how old? a. 3 years old b. 4 years old c. 5 years old d. 6 years old ANS: B At the age of 4, most children have mastered throwing a ball overhand. DIF: Cognitive Level: Knowledge REF: 481 (Table 19-1) 25. A preschooler with a receptive vocabulary of up to 5600 words is likely how old? a. 42 months old b. 48 months old c. 54 months old d. 60 months old ANS: B By 48 months of age, most preschoolers have receptive languages skills of up to 5600 words. DIF: Cognitive Level: Knowledge REF: 489 (Table 19-2) 26. One way to address a Healthy People 2010 health promotion and disease prevention objective for preschoolers is to: a. Eliminate the school requirement for the MMR vaccine b. Eliminate computers from the home c. Regulate the paint allowed for use with toys d. Eliminate WIC programs ANS: C One way to address a Healthy People 2010 health promotion and disease prevention objective for preschoolers is to regulate the paint that is allowed for use in toys. Paints can contain lead, and lead poisoning can lead to disabilities. A Healthy People 2010 objective is to eliminate elevated blood-lead levels in children. DIF: Cognitive Level: Application REF: 499 27. Which sleep ritual is age-appropriate for a preschooler? a. Asking for every light in the home to be turned on at bedtime b. Saying good night to all 20 stuffed animals in the room before going to sleep c. Going right to sleep d. Asking the parent to read all books on the bookshelf before going to bed ANS: B An age-appropriate sleep ritual for a preschooler is to say good night to all 20 stuffed animals in the room before going to sleep. Preschoolers have longer, more rigid bedtime rituals than toddlers. They prolong bedtime routines, which for them generally last about 30 minutes. Reasonable rituals should be honored. DIF: Cognitive Level: Application REF: 485 | 494 MULTIPLE RESPONSE 1. A mother tells the nurse her 3-year-old has not been himself lately. The nurse examines the child. Which of the following physical findings would be cause for concern? Select all that apply. a. Bruises b. Pale skin c. Enlarged lymph nodes d. Red spots ANS: A, B, C, D Bruises, pale skin, enlarged lymph nodes, and red spots are all signs of cancer. DIF: Cognitive Level: Knowledge REF: 500

a. 300 calories b. 600 calories c. 900 calories d. 1200 calories ANS: C Nine hundred calories of the 1800 calorie diet should be comprised of carbohydrates. Preschoolers should consume approximately half of their diet in carbohydrates.

A 5-year-old has a daily caloric intake of 1800 calories. Approximately what portion of the diet should be comprised of carbohydrates?

a. 300 calories b. 600 calories c. 900 calories d. 1200 calories ANS: C Nine hundred calories of the 1800 calorie diet should be comprised of carbohydrates. Preschoolers should consume approximately half of their diet in carbohydrates.

3. A 4-year-old had an episode of enuresis. The parents should:

a. Have him change his own pajamas before going to bed b. Take away one video game c. Tell his 6-year-old sister about the incident d. Make him wear his diaper to bed ANS: A The parents should have the child change his own pajamas before going to bed. Preschoolers should not be ridiculed or punished. They should be responsible for changing their own clothes and encouraged to avoid problems in the future.

2. Which of the following will a 5-year-old need help eating?

a. Pudding b. Ziti c. Chicken d. Jelly sandwich ANS: C The preschooler will need help with the chicken. In the later preschool years, most children need help cutting meats.

Which of the following will a 5-year-old need help eating?

a. Pudding b. Ziti c. Chicken d. Jelly sandwich ANS: C The preschooler will need help with the chicken. In the later preschool years, most children need help cutting meats.