McKinney Maternal Test Bank Chap 1-30

4. Which activity does the nurse recommend to help develop fine motor skills in the school-age child? a. Drawing b. Singing c. Soccer d. Swimming

A Activities such as drawing, building models, and playing a musical instrument increase the school-age child's fine motor skills. Activities such as soccer or swimming help develop gross motor skills. Singing does not increase motor skills. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 133 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

1. A nurse assessing a 2-month-old infant notes that the child can briefly hold the head erect when held against the shoulder. What action by the nurse is best? a. Document the findings in the child's chart. b. Notify the provider immediately. c. Conduct a lead-exposure assessment. d. Prepare the parents for genetic testing.

A A 2-month-old infant is able to briefly hold the head erect. If a parent were holding the infant against the parent's shoulder, the infant would be able to lift his or her head briefly. Since this is normal behavior, all that is required of the nurse is documentation. There is no need to notify the provider immediately, conduct a lead-exposure assessment, or prepare the parents for genetic testing. PTS: 1 DIF: Cognitive Level: Application/Applying REF: Table 6.1 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

3. The nurse is assessing an infant's growth and development. The parents want education on how to stimulate this process. What action suggested by the nurse is inconsistent with knowledge of this topic? a. Have the family draw a three-generation family pedigree. b. Show the family how to coo and babble with their child. c. Encourage the parents to buy interactive toys for the child. d. Involve the child in activities that are outside the home.

A A family pedigree can help show relationships and health care problems but will not stimulate growth and development. Activities that are stimulating for a child include the consistent use of language by the parents, allowing play time with interactive toys (toys that make noises or do something in response to the baby's actions), and exposing the child to new sights and sounds. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 66 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

5. The nurse advises the mother of a 3-month-old exclusively breastfed infant to a. start giving the infant a vitamin D supplement. b. start using an infant feeder and add rice cereal to the formula. c. start feeding the infant rice cereal with a spoon at the evening feeding. d. continue breastfeeding without any supplements.

A Breast milk does not provide an adequate amount of dietary vitamin D. Infants who are exclusively breastfed need vitamin D supplements to prevent rickets. An infant feeder is an inappropriate method of providing the infant with caloric intake. Solid foods are not recommended for a 3-month-old infant. Rice cereal and other solid foods are contraindicated in a 3-month-old infant. Solid feedings do not typically begin before 4 to 6 months of age. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 93 | Table 6.1 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

3. The ability to mentally understand that 1 + 3 = 4 and 4 - 1 = 3 occurs in which stage of cognitive development? a. Concrete operations b. Formal operations c. Intuitive thought d. Preoperations

A By 7 to 8 years of age, the child is able to retrace a process (reversibility) and has the skills necessary for solving mathematical problems. This stage is called concrete operations. The formal operations stage deals with abstract reasoning and does not occur until adolescence. Thinking in the intuitive stage is based on immediate perceptions. A child in this stage often solves problems by random guessing. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 133 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

5. A nurse determines that a child consistently displays predictable behavior and is regular in performing daily habits. Which temperament is the child displaying? a. Easy b. Slow-to-warm-up c. Difficult d. Shy

A Children with an easy temperament are even tempered, predictable, and regular in their habits. They react positively to new stimuli. The slow-to-warm-up temperament type prefers to be inactive and moody. A high activity level and adapting slowly to new stimuli are characteristics of a difficult temperament. Shyness is a personality type and not a characteristic of temperament. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 43 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

1. Which statement best describes development in infants and children? a. Development, a predictable and orderly process, occurs at varying rates within normal limits. b. Development is primarily related to the growth in the number and size of cells. c. Development occurs in a proximodistal direction with fine muscle development occurring first. d. Development is more easily and accurately measured than growth.

A Development, a continuous and orderly process, provides the basis for increases in the child's function and complexity of behavior. The increases in rate of function and complexity can vary normally within limits for each child. An increase in the number and size of cells is a definition for growth. Development proceeds in a proximodistal direction with fine muscle organization occurring as a result of large muscle organization. Development is a more complex process that is affected by many factors; therefore, it is less easily and accurately measured. Growth is a predictable process with standard measurement methods. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 62 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

5. A school nurse is teaching a health class for 5th grade children. The nurse plans to include which statement to best describe growth in the early school-age period? a. Boys grow faster than girls. b. Puberty occurs earlier in boys than in girls. c. Puberty occurs at the same age for all races and ethnicities. d. It is a period of rapid physical growth.

A During the school-age developmental period, boys are approximately 1 inch taller and 2 pounds heavier than girls. Puberty occurs 1 1/2 to 2 years later in boys, which is developmentally later than puberty in girls (not unusual in 9- or 10-year-old girls). Puberty occurs approximately 1 year earlier in African-American girls than in white girls. Physical growth is slow and steady during the school-age years. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 130 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

5. The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is a. Erikson. b. Freud. c. Kohlberg. d. Piaget.

A Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled. Sigmund Freud proposed a psychosexual theory of development. He proposed that certain parts of the body assume psychological significance as foci of sexual energy. The foci shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of development. Lawrence Kohlberg described moral development as having three levels (preconventional, conventional, and postconventional). His theory closely parallels Piaget's. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 69 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

4. Which response by the nurse to the woman's statement, "I'm afraid to have a cesarean birth," would be the most therapeutic? a. "What concerns you most about a cesarean birth?" b. "Everything will be OK." c. "Don't worry about it. It will be over soon." d. "The doctor will be in later, and you can talk to him."

A Focusing on what the woman is saying and asking for clarification are the most therapeutic responses. Stating that "everything will be ok" or "don't worry about it" belittles the woman's feelings and might be providing false hope. Telling the patient to talk to the doctor does not allow the woman to verbalize her feelings when she desires. PTS: 1 DIF: Cognitive Level: Application/Applying REF: Box 2.2 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Psychosocial Integrity

9. A nurse wants to work to increase the number of immunized children. What action by the nurse would best meet this goal? a. Present a workshop to the local home-schooling parent support group. b. Volunteer for a mass "back to school" immunization clinic. c. Prepare welcome and information packets to college freshmen. d. Work with the health department to bring immunizations to day cares.

A Home-schooled children are often overlooked when it comes to immunizations, because they are not in immunization-friendly systems such as day care, schools, and colleges where immunizations are required. The best way for the nurse to help increase the number of immunized children is to reach out to the home-schooled group. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 75 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 10. The parents of a preschool-aged child are in the clinic and report the child is seen playing with the genitals frequently. What response by the nurse is best? a. Reassure parents this is normal at this age. b. Teach parents about behavior modification. c. Refer parents and child to a psychologist. d. Ask the provider to speak to the parents. ANS: A Preschool children are in the Phallic or Oedipal/Electra Stage of Freud's theory during which the genitals become the focus of curiosity and interest. The nurse should explain that this behavior is normal at this stage. Teaching about disciplinary techniques and referrals to psychotherapy are inappropriate. The nurse may well want the provider to speak to the parents, but the nurse is responsible for patient/parent teaching and should provide education him- or herself. PTS: 1 DIF: Cognitive Level: Application/Applying REF: Table 5.2 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 11. A nurse is teaching parents to avoid environmental injury to their 2-year-old child. What information does the nurse include in teaching? a. Avoiding sun exposure, secondhand smoke, and lead b. Living in a middle-class neighborhood c. Avoiding smoking and alcohol intake during pregnancy d. Limiting breastfeeding to avoid toxins being passed through breast milk ANS: A Lead can be present in the home and in toys made overseas. Environmental injury can also be the result of mercury, pesticides (flea and tick collars), radon, and exposure to the sun and secondhand smoke. It is important for the nurse to provide health teaching related to these factors. The nurse is unable to influence socioeconomic status, and the family may not want or be able to move. It is too late for the nurse to instruct the mother regarding smoking or alcohol intake during pregnancy. This should have been included in prenatal teaching. It is unlikely that a 2-year-old child will still be breastfeeding. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 65 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 12. Which immunizations should be used with caution in children with an allergy to eggs? a. HepB b. DTaP c. Hib d. MMR ANS: D Live measles vaccine is produced by using chick embryo cell culture, so there is a remote possibility of anaphylactic hypersensitivity in children with egg allergies. Most reactions are actually the result of other components in the vaccine. The other vaccines are safe for children with an egg allergy. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 77 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 13. When counseling parents and children about the importance of increased physical activity, the nurse will emphasize which of the following? a. Anaerobic exercise should comprise a major component of the child's daily exercise. b. All children should be physically active for at least 2 hours per day. c. It is not necessary to participate in physical education classes at school if a student is taking part in other activities. d. Make exercise a fun and habitual activity. ANS: D It is important to make exercise a fun and habitual activity. Encourage parents to investigate their community's different activity programs. This includes recreation centers, parks, and the YMCA. Aerobic exercise should comprise a major component of children's daily exercise; however, physical activity should also include muscle- and bone-strengthening activities. Children and adolescents should be physically active for at least 1 hour daily. Encourage all students to participate fully in any physical education classes. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 80 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 14. A student nurse is preparing to administer an Hib vaccination to an infant. What action by the student requires the registered nurse to intervene? a. Gives the vaccine information statement prior to administering the vaccine b. Wipes the dorsal gluteal area with alcohol prior to injection c. Obtains written informed consent before giving the vaccine d. Assesses the family's beliefs and values about vaccinations ANS: B The anterolateral thigh is the preferred site for intramuscular administration of vaccines for infants. When the student prepares the wrong site, the registered nurse should intervene. Federal law requires parents be given vaccine information statements and sign informed consent prior to the nurse's administering vaccinations. The nurse should also assess the family's beliefs and values related to vaccination, which can help dispel myths and guide teaching. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 76 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment 15. A nurse is planning to teach about injury prevention to a group of parents. What action by the nurse would best ensure a successful event? a. Have handouts listing community resources. b. Provide free safety gear like bike helmets. c. Group parents by child's developmental stage. d. Present the material in an interactive way. ANS: C When providing anticipatory guidance to prevent injury, the most important thing for the nurse to know and understand is developmental levels of the children involved. Grouping parents by their child's developmental level allows the nurse to know this information about the group and to provide teaching specific to the group. The other options will help but are not as important as tailoring teaching to the specific needs of the children. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 80 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 16. A nurse is assessing a 1-year-old's food intake over the past 3 days. What information from the parent leads the nurse to provide education on nutrition? a. Child drinks 2 cups of 1% milk each day. b. Child loves to snack on fruit throughout the day. c. Child gets one 4-ounce cup of juice with breakfast. d. Parent allows child to regulate own portions at meals. ANS: A A child this age should not be drinking low-fat milk. Snacking on fruit, 4 ounces of juice, and not forcing the child to eat everything on the plate are appropriate activity and do not require education. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Box 5.6 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE

1. The nurse teaches parents that the formula used to guide time-out as a disciplinary method is a. 1 minute per each year of the child's age. b. to relate the length of the time-out to the severity of the behavior. c. never to use time-out for a child younger than 4 years. d. to follow the time-out with a treat.

A It is important to structure time-out in a time frame that allows the child to understand why he or she has been removed from the environment. The current guideline is 1 minute per age in years. Relating time to a behavior is subjective and is inappropriate when the child is very young. Time-out can be used with the toddler. Negative behavior should not be reinforced with a positive action. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 44 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

1. Which principle of teaching should the nurse use to ensure learning in a family situation? a. Motivate the family with praise and positive reinforcement. b. Present complex subject material first, while the family is alert and ready to learn. c. Families should be taught using medical jargon so they will be able to understand the technical language used by physicians. d. Learning is best accomplished using the lecture format.

A Praise and positive reinforcement are particularly important when a family is trying to master a frustrating task, such as breastfeeding. Learning is enhanced when the teaching is structured to present the simple tasks before the complex material. Even though a family may understand English fairly well, they may not understand the medical terminology or slang terms. A lively discussion stimulates more learning than a straight lecture, which tends to inhibit questions. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 25 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

8. The nurse is assessing a preschool aged child during a well-child checkup. This child has gained 2 pounds in 1 year. What action by the nurse is best? a. Ask the parent to provide a 3-day diet diary. b. Assess the child's teeth and gums. c. Plot the weight gain on the growth chart. d. Instruct the parent on today's needed vaccinations.

A Preschool children gain an average of 5 pounds a year. A gain of only 2 pounds is less than half of the expected weight gain and should be investigated. The other actions are part of a well-child checkup but are not related to the lack of weight gain. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 126 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

2. Which toy is the most developmentally appropriate for an 18- to 24-month-old child? a. A push-and-pull toy b. Nesting blocks c. A bicycle with training wheels d. A computer

A Push-and-pull toys encourage large muscle activity and are appropriate for toddlers. Nesting blocks are more appropriate for a 12- to 15-month-old child. This child is too young for bicycles or computers. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Box 7.1 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. The nurse is performing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as a(n) a. normal finding—nurse should document finding in chart. b. questionable finding—infant should be rechecked in 1 month. c. abnormal finding—indicates need for immediate referral to practitioner. d. abnormal finding—indicates need for developmental assessment.

A This is a normal finding. The anterior fontanel closes between ages 12 and 18 months. The posterior fontanel closes between 2 and 3 months of age. There is no need for a recheck, a referral, or a developmental assessment. PTS: 1 DIF: Cognitive Level: Analysis/Analyzing REF: p. 93 | Table 6.1 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

8. The fastest growing group of homeless people is a. men and women preparing for retirement. b. migrant workers. c. single women and their children. d. intravenous (IV) substance abusers.

C Pregnancy and birth, especially for a teenager, are important contributing factors for becoming homeless. People preparing for retirement, migrant workers, and IV substance abusers are not among the fastest growing groups of homeless people. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 14 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

3. A nurse wishes to incorporate the American Nurses Association Code of Ethics for Nurses in daily practice. Which of the following actions best demonstrates successful integration of the code into daily routines? a. Strives to treat all patients equally and with caring kindness b. Calls the provider when the patient's pain is not controlled with prescribed medications c. Reads current literature related to practice area and brings ideas to unit management d. Routinely stays overtime in order to visit and bond with new families e. Decides to "play nicely" and not get involved in disputes about patient care

A, B, C The ANAs Code of Ethics includes statements about practicing with compassion and respect for the inherent dignity, worth, and unique attributes of every person, advocating for the patient, and advancing the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. Staying overtime may contribute to burn out and does not advance the Code of Ethics. Nurses are responsible for making decisions and taking action consistent with the obligation to promote health and to provide optimal care; not getting involved in patient care disputes does not uphold this standard. PTS: 1 DIF: Cognitive Level: Analysis/Analyzing REF: Box 2.1 OBJ: Integrated Process: Caring MSC: Client Needs: Safe and Effective Care Environment Chapter 03: The Childbearing and Child-Rearing Family McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE

9. A nurse wishes to work to reduce infant mortality in the United States. Which activity would this nurse most likely participate in? a. Creating pamphlets in several different languages using an interpreter. b. Assisting women to enroll in Medicaid by their third trimester. c. Volunteering to provide prenatal care at community centers. d. Working as an intake counselor at a women's shelter.

C Prenatal care is vital to reducing infant mortality and medical costs. This nurse would most likely participate in community service providing prenatal care outreach activities in community centers, particularly in low-income areas. Pamphlets in other languages, enrolling in Medicaid, and working at a women's shelter all might impact infant mortality, but the greatest effect would be from assisting women to get consistent prenatal care. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 14 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 10. The intrapartum woman sees no need for a routine admission fetal monitoring strip. If she continues to refuse, what is the first action the nurse should take? a. Consult the family of the woman. b. Notify the provider of the situation. c. Document the woman's refusal in the nurse's notes. d. Make a referral to the hospital ethics committee. ANS: B Patients must be allowed to make choices voluntarily without undue influence or coercion from others. The physician, especially if unaware of the patient's decision, should be notified immediately. Both professionals can work to ensure the mother understands the rationale for the action and the possible consequences of refusal. The woman herself is the decision maker, unless incapacitated. Documentation should occur but is not the first action. This situation does not rise to the level of an ethical issue so there is no reason to call the ethics committee. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 18 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment 11. Which statement is true regarding the "quality assurance" or "incident" report? a. The report assures the legal department that no problem exists. b. Reports are a permanent part of the patient's chart. c. The nurse's notes should contain, "Incident report filed, and copy placed in chart." d. This report is a form of documentation of an event that may result in legal action. ANS: D An incident report is used when something occurs that might result in legal action, such as a patient fall or medication error. It warns the legal department that there may be a problem in a particular patient's care. Incident reports are not part of the patient's chart; thus the nurses' notes should not contain any reference to them. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 18 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Safe and Effective Care Environment 12. Elective abortion is considered an ethical issue because a. abortion law is unclear about a woman's constitutional rights. b. the Supreme Court ruled that life begins at conception. c. a conflict exists between the rights of the woman and the rights of the fetus. d. it requires third-party consent. ANS: C Elective abortion is an ethical dilemma because two opposing courses of action are available. The belief that induced abortion is a private choice is in conflict with the belief that elective pregnancy termination is taking a life. Abortion laws are clear concerning a woman's constitutional rights. The Supreme Court has not ruled on when life begins. Abortion does not require third-party consent. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 11 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Safe and Effective Care Environment 13. Which woman would be most likely to seek prenatal care? a. A 15-year-old who tells her friends, "I don't believe I'm pregnant." b. A 20-year-old who is in her first pregnancy and has access to a free prenatal clinic. c. A 28-year-old who is in her second pregnancy and abuses drugs and alcohol. d. A 30-year-old who is in her fifth pregnancy and delivered her last infant at home. ANS: B The patient who acknowledges the pregnancy early, has access to health care, and has no reason to avoid health care is most likely to seek prenatal care. Being in denial about the pregnancy increases the risk of not seeking care. This patient is also 15, and other social factors may discourage her from seeking care as well. Women who abuse substances are less likely to receive prenatal care. Some women see pregnancy and delivery as a natural occurrence and do not seek health care. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 14 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 14. A woman who delivered her baby 6 hours ago complains of headache and dizziness. The nurse administers an analgesic but does not perform any assessments. The woman then has a tonic-clonic seizure, falls out of bed, and fractures her femur. How would the actions of the nurse be interpreted in relation to standards of care? a. Negligent: the nurse failed to assess the woman for possible complications b. Negligent: because the nurse medicated the woman c. Not negligent: the woman had signed a waiver concerning the use of side rails d. Not negligent: the woman did not inform the nurse of her symptoms as soon as they occurred ANS: A There are four elements to malpractice, which is negligence in the performance of professional duties: duty, breach of duty, damage, and proximate cause. The nurse was negligent because she or he did not perform any assessments, which is the first step of the nursing process and is a standard of care. By not assessing the patient, the nurse did not meet established standards of care, and thus is guilty of professional negligence, or malpractice. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 16 OBJ: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment 15. Which patient situation fails to meet the first requirement of informed consent? a. The patient does not understand the physician's explanations. b. The physician gives the patient only a partial list of possible side effects and complications. c. The patient is confused and disoriented. d. The patient signs a consent form because her husband tells her to. ANS: C The first requirement of informed consent is that the patient must be competent to make decisions about health care. Full disclosure of information is an important element of the consent, but first the patient has to be competent to sign. Understanding is an important element of the consent, but first the patient has to be competent to sign. Voluntary consent is an important element of the consent, but first the patient has to be competent to sign. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 17 OBJ: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment 16. Which situation reflects a potential ethical dilemma for the nurse? a. A nurse administers analgesics to a patient with cancer as often as the provider's order allows. b. A neonatal nurse provides nourishment and care to a newborn who has a defect that is incompatible with life. c. A labor nurse, whose religion opposes abortion, is asked to assist with an elective abortion. d. A postpartum nurse provides information about adoption to a new mother who feels she cannot adequately care for her infant. ANS: C A dilemma exists in this situation because the nurse is being asked to assist with a procedure that she or he believes is morally wrong. The other situations do not contain elements of conflict for the nurse. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 11 OBJ: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment 17. When planning a parenting class, the nurse should explain that the leading cause of death in children 1 to 4 years of age in the United States is a. premature birth. b. congenital anomalies. c. accidental death. d. respiratory tract illness. ANS: C Although the rates have dropped, unintentional injury (accidents) are still the leading cause of death for children aged 1 to 19. The other options contribute to morbidity and mortality in children but are not the leading cause. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 10 | Table 1.3 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Safe and Effective Care Environment 18. A nurse is floated to a different unit. The nurse does not know how to perform a treatment that has been prescribed for one of his or her assigned patients. What should the nurse's first action be? a. Delay the treatment until another nurse can do it. b. Make the child's parents aware of the situation. c. Inform the nursing supervisor of the problem. d. Arrange to have the child transferred to another unit. ANS: C Nurses who work outside their usual areas of expertise must assess their own skills and avoid performing tasks or taking on responsibilities in areas in which they are not competent. This nurse should inform the supervisor of the situation. The nurse could endanger the child by delaying the intervention until another nurse is available. Telling the child's parents would most likely increase their anxiety and will not resolve the difficulty. Transfer to another unit delays needed treatment and would create unnecessary disruption for the child and family. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 19 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment 19. The mother of a 5-year-old female inpatient on the pediatric unit asks the nurse if she could provide information regarding the recommended amount of television viewing time for her daughter. The nurse responds that the appropriate amount of time a child should be watching television is a. 1 to 2 hours per day. b. 2 to 3 hours per day. c. 3 to 4 hours per day. d. 4 hours or more. ANS: A The American Academy of Pediatrics (2013) encourages parents to monitor their children's media exposure and limit their children's screen time (TV, computer, video games) to no more than 1 to 2 hours per day. The other options all contain more screen time than is recommended. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 15 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 20. Family-centered care (FCC) describes safe, quality care that recognizes and adapts to both the physical and psychosocial needs of the family. Which nursing practice coincides with the principles of FCC? a. The newborn is returned to the nursery at night so that the mother can receive adequate rest before discharge. b. The father is encouraged to go home after the baby is delivered. c. All patients are routinely placed on the fetal monitor. d. The nurse's assignment includes both mom and baby and increases the nurse's responsibility for education. ANS: D Family-centered care increases the responsibilities of nurses. In addition to the physical care provided, nurses assume a major role in teaching, counseling, and supporting families. The other options do not provide family-centered care because they increase family separation or use technology routinely, which may not be needed. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 2 OBJ: Integrated Process: Caring MSC: Client Needs: Health Promotion and Maintenance 21. Which statement related to nursing care of the child at home is most correct? a. The technology-dependent infant can safely be cared for at home. b. Home care increases readmissions to the hospital for a child with chronic conditions. c. There is increased stress for the family when a sick child is being cared for at home. d. The family of the child with a chronic condition is likely to be separated from their support system if the child is cared for at home. ANS: A Greater numbers of technology-dependent infants and children are now cared for at home. The numbers include those needing ventilator assistance, total parenteral nutrition, IV medications, apnea monitoring, and other device-assisted nursing care. Optimal home care can reduce the rate of readmission to the hospital for children with chronic conditions. Consumers often prefer home care because of the decreased stress on the family when the patient is able to remain at home. When the child is cared for at home the family is less likely to be separated from their support system because of the need for hospitalization. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 7 OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment 22. Maternity nursing care that is based on knowledge gained through research is known as a. nurse-sensitive indicators. b. evidence-based practice. c. case management. d. outcomes management. ANS: B Evidence-based practice is based on knowledge gained from research and clinical trials. Nurse-sensitive indicators are patient care outcomes particularly dependent on the quality and quantity of nursing care provided. Case management is a practice model that uses a systematic approach to identify specific patients, determine eligibility for care, and arrange access to services. The determination to lower health care costs while maintaining the quality of care has led to a clinical practice model known as outcomes management. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 6 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Safe and Effective Care Environment 23. The level of practice a reasonably prudent nurse provides is called a. the standard of care. b. risk management. c. a sentinel event. d. failure to rescue. ANS: A Guidelines for standards of care are published by various professional nursing organizations. The standard of care for neonatal nurses is set by the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN). The Society of Pediatric Nurses is the primary specialty organization that sets standards for the pediatric nurse. Risk management identifies risks and establishes preventive practices, but it does not define the standard of care. Sentinel events and failure to rescue can be caused by not practicing up to standards of care, but they do not define it. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 16 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment MULTIPLE RESPONSE

4. A 2-month-old child has not had any immunizations. Which ones should the nurse prepare to give? (Select all that apply.) a. Hib b. HepB c. MCV d. Varicella e. HPV

A, B, C, D Hib, HepB, MCV, and varicella are all appropriate vaccinations for this child. HPV is for adolescents. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 75 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance Chapter 06: Health Promotion for the Infant McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE

1. Today's nurse often assumes the role of teacher or educator. Which strategies would be best to use for a nurse working with a new mother? (Select all that apply.) a. Computer-based learning b. Videos c. Printed material d. Group discussion e. Lecture

A, B, C, D To be effective as a teacher, the nurse must tailor teaching to specific needs and characteristics of the patient. Computer-based learning, videos, printed material, and group discussions have all be shown to be effective teaching strategies. Lecture is probably the least effective method as it does not allow for participation. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 24 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

3. Traditional ethnocultural beliefs related to the maintenance of health are likely to include which of the following? (Select all that apply.) a. Avoidance of natural events such as a solar eclipse b. Practicing silence, meditation, and prayer c. Protection of the soul by avoiding envy or jealousy d. Understanding that a hex, spell, or the evil eye may cause illness or injury e. Turning to Western medicine first before trying traditional practices

A, B, C, D Traditional ethnocultural beliefs related to health care can include avoiding some natural events; practicing silence, meditation, and prayer; protecting oneself against envy or jealousy on the part of others; and avoiding hexes, spells, and the evil eye. Usually people with these beliefs turn to their traditional practices prior to seeking Western medical care. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 42 OBJ: Integrated Process: Culture and Spirituality MSC: Client Needs: Psychosocial Integrity

1. Which play patterns does a 3-year-old child typically display? (Select all that apply.) a. Imaginary play b. Parallel play c. Cooperative play d. Structured play e. Associative play

A, B, C, E Children between ages 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Structured play is typical of school-age children. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 122 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

3. While developing a care plan for a school-age child with a visual impairment, the nurse knows that which of the following actions are important in working with this special needs child? (Select all that apply.) a. Obtain a thorough assessment of the child's self-care abilities. b. Orient the child to various sounds in the environment. c. Tell the child's parents to stay continuously with their child during hospitalization. d. Allow the child to handle equipment as procedures are explained. e. Encourage the child to use a dry erase board to write his needs.

A, B, D Conducting a thorough assessment of the child's self-care abilities, orienting the child to various sounds in the environment, and allowing the child to handle equipment are all ways to enhance communication with a visually impaired child. Mandating that the child's parents stay continuously with their child may not be possible and is not usually necessary if the school-age child is at the expected level of growth and development. Encouraging a child to write his needs on a dry erase board would be an appropriate intervention for a child who is hearing impaired, not for a child with a visual deficit. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 59 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Psychosocial Integrity

6. A nurse is assessing a child for toilet training readiness during a home visit. Which behaviors by the child are positive signs? (Select all that apply.) a. Removes own clothing b. Walks into bathroom on own c. Has been walking for 6 months d. Will give up toy when asked to e. Scratches as legs periodically

A, B, D Signs of readiness for toilet training include being able to remove own clothing, being willing to let go of a toy when asked, is able to sit, squat, and walk well, has been walking for 1 year, noticing if diaper is wet, pulls on diaper or exhibits other behavior indicating diaper needs to be changed, communicating the need to go to the bathroom or goes there by self and wanting to please parent by staying dry. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Box 7.4 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance Chapter 08: Health Promotion for the School-Age Child McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE

1. When counseling the newly pregnant woman regarding the option of using a free-standing birth center for care, the nurse should be aware that this type of care setting includes which advantages? (Select all that apply.) a. Less expensive than acute-care hospitals b. Access to follow-up care for 6 weeks postpartum c. Equipped for obstetric emergencies d. Safe, home-like births in a familiar setting e. Staffing by lay midwives

A, B, D Women who are at low risk and desire a safe, home-like birth are very satisfied with this type of care setting. The new mother may return to the birth center for postpartum follow-up care, breastfeeding assistance, and family planning information for 6 weeks postpartum. Because birth centers do not incorporate advanced technologies into their services, costs are significantly less than those for a hospital setting. The major disadvantage of this care setting is that these facilities are not equipped to handle obstetric emergencies. Should unforeseen difficulties occur, the woman must be transported by ambulance to the nearest hospital. Birth centers are usually staffed by certified nurse-midwives (CNMs); however, in some states lay midwives may provide this service. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 3 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Safe and Effective Care Environment

2. A school nurse is working with unlicensed assistive personnel (UAPs). What aspects of delegation should the nurse incorporate into his or her practice in this setting? a. The registered nurse is always responsible for assessment. b. Uncomplicated medication administration can be performed by the UAP. c. The nurse does not need to supervise UAPs in this setting. d. The nurse must work within school district policies when delegating. e. Understanding the complexity of the child's needs is a consideration when delegating.

A, B, D, E Delegation to UAPs is very common in all health care settings, including schools. When delegating to a UAP in the school setting, factors for the nurse to consider include that the RN is always responsible for assessment, supervision is necessary, the complexity of the child's needs must be considered, and policies must be followed. Medication administration by the UAP may be allowed. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 19 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

3. The nurse is assessing parental knowledge of temper tantrums. Which are true statements about temper tantrums? (Select all that apply.) a. Temper tantrums are a common response to anger and frustration in toddlers. b. Temper tantrums often include screaming, kicking, throwing things, and head banging. c. Parents can effectively manage temper tantrums by giving in to the child's demands. d. Children having temper tantrums should be safely isolated and ignored. e. Parents can learn to anticipate times when tantrums are more likely to occur.

A, B, D, E Temper tantrums are a common response to anger and frustration in toddlers. They occur more often when toddlers are tired, hungry, bored, or excessively stimulated. A nap before fatigue or a snack if mealtime is delayed will be helpful in alleviating the times when tantrums are most likely to occur. Tantrums may include screaming, kicking, throwing things, biting themselves, or banging their head. Effective management of tantrums includes safely isolating and ignoring the child. The child should learn that nothing is gained by having a temper tantrum. Giving in to the child's demands only increases the behavior. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: pp. 119-120 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

1. The nurse preparing to administer the Denver Developmental Screening Test II (DDST-II) should understand that it assesses which functional areas? (Select all that apply.) a. Personal-functional b. Fine motor c. Intelligence d. Language e. Gross motor

A, B, D, E The four functional areas assessed by this tool are personal-functional, fine motor, language, and gross motor. It is not an intelligence test. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 72 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

2. The nurse understands that risk factors for hearing loss include (Select all that apply.) a. structural abnormalities of the ear. b. family history of hearing loss. c. alcohol or drug use by the mother during pregnancy. d. gestational diabetes. e. trauma.

A, B, E Structural abnormalities of the ear, a family history of hearing loss, and trauma are risk factors for hearing loss. Other risk factors include persistent otitis media and developmental delay. The American Academy of Pediatrics suggests that infants who demonstrate hearing loss be eligible for early intervention and specialized hearing and language services. Prenatal alcohol or drug intake and gestational diabetes are not risk factors for hearing loss in the infant. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 88 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

2. The nurse is caring for a child from a Middle Eastern family. Which interventions should the nurse include in planning care? (Select all that apply.) a. Include the father in the decision making. b. Ask for a dietary consult to maintain religious dietary practices. c. Plan for a male nurse to care for a female patient. d. Ask the housekeeping staff to interpret if needed. e. Allow time for prayer.

A, B, E The man is typically the head of the household in Muslim families. So the father should be included in all decision making. Muslims do not eat pork and do not use alcohol. Many are vegetarians. The dietitian should be consulted for dietary preferences. Compulsory prayer is practiced several times throughout the day. The family should not be interrupted during prayer, and treatments should not be scheduled during this time. Muslim women often prefer a female health care provider because of laws of modesty; therefore, the female patient should not be assigned a male nurse. A housekeeping staff member should not be asked to interpret. When interpreters are used, they should be of the same country and religion, if possible, because of regional differences and hostilities. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Table 3.1 OBJ: Integrated Process: Culture and Spirituality MSC: Client Needs: Psychosocial Integrity

2. Which behaviors by the nurse may indicate professional separation or underinvolvement? (Select all that apply.) a. Avoiding the child or his or her family b. Revealing personal information c. Calling in sick d. Spending less time with a particular child e. Asking to trade assignments

A, C, D, E Whether nurses become too emotionally involved or find themselves at the other end of the spectrum—being underinvolved—they lose effectiveness as objective professional resources. These are all indications of the nurse who is underinvolved in a child's care. Revealing personal information to a patient or his or her family is an indication of overinvolvement. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Box 4.3 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Safe and Effective Care Environment

1. A nurse has completed a teaching session for parents about "baby-proofing" the home. Which statements made by the parents indicate an understanding of the teaching? (Select all that apply.) a. "We will put plastic fillers in all electrical plugs." b. "We will place poisonous substances in a high cupboard." c. "We will place a gate at the top and bottom of stairways." d. "We will keep our household hot water heater at 130 degrees." e. "We will remove front knobs from the stove."

A, C, E By the time babies reach 6 months of age, they begin to become much more active, curious, and mobile. Putting plastic fillers on all electrical plugs can prevent an electrical shock. Putting gates at the top and bottom of stairways will prevent falls. Removing front knobs from the stove can prevent burns. Poisonous substances should be stored in a locked cabinet not in a cabinet that children can reach when they begin to climb. The household hot water heater should be turned down to 120 degrees or less. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 97 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

2. The nurse plans a teaching session with a toddler's parents on car safety. Which will the nurse teach? (Select all that apply.) a. Secure in a rear-facing, upright car safety seat. b. Place the car safety seat in the rear seat, behind the driver's seat. c. Harness safety straps should fit snugly. d. Place the car safety seat in the front passenger seat equipped with an airbag. e. After the age of 2 years, toddlers can be placed in a forward-facing car seat.

A, C, E Toddlers should be secured in a rear-facing, upright, approved car safety seat. Harness straps should be adjusted to provide a snug fit. After age 2, the child can sit in a forward-facing car seat. The car safety seat should be placed in the middle of the rear seat. Children younger than 13 years should not ride in a front passenger seat that is equipped with an airbag. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 115 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

4. A preschool-age child is being admitted for some diagnostic tests and possible surgery. The nurse planning care should use which phrases when explaining procedures to the child? (Select all that apply.) a. Fluids will be given through tubing connected to a tiny tube inserted into your arm. b. After surgery we will be doing dressing changes. c. You will get a shot before surgery. d. The doctor will give you medicine that will help you go into a deep sleep. e. We will take you to surgery on a bed on wheels.

A, D, E A preschool child needs simple concrete explanations that cannot be misinterpreted. An IV should be explained as fluids going into a tube connected to a small tube in your hand; anesthesia can be explained as a medicine that will help you go into a deep sleep (put to sleep should be avoided); and a stretcher can be described as riding on a bed with wheels. The term "dressing changes" is ambiguous and will not be understood by a preschooler. The term "get a shot" should not be used. A preschooler or young child is likely to misinterpret this information. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Table 4.4 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Psychosocial Integrity Chapter 05: Health Promotion for the Developing Child McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE

3. The nurse is teaching a community group about preventing sudden infant death syndrome (SIDS). What information does the nurse provide? (Select all that apply.) a. Placing the baby supine to sleep b. Covering the baby warmly with blankets c. Have the baby sleep upright in the infant carrier d. Provide "tummy time" while awake e. Do not allow smoking in the house

A, D, E Recommendations to prevent SIDS include placing the baby supine in a crib with a well-fitting bottom sheet without covers or toys, providing tummy time during play, and avoiding exposure to environmental hazards such as smoke. The child should not be put to sleep in an infant carrier or covered warmly with blankets. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 96 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Safe and Effective Care Environment Chapter 07: Health Promotion During Early Childhood McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE

9. What is an appropriate preoperative teaching plan for a school-age child? a. Begin preoperative teaching the morning of surgery. b. Schedule a tour of the hospital a few weeks before surgery. c. Show the child books and pictures 4 days before surgery. d. Limit teaching to 5 minutes and use simple terminology.

C Preparatory material can be introduced to the school-age child several days (1 to 5) in advance of the event. Books, pictures, charts, and videos are appropriate. Preoperative teaching a few hours before surgery is more appropriate for the preschool child. Preoperative materials should be introduced 1 to 5 days in advance for school-age children. Preparation too far in advance of the procedure can be forgotten or cause undue anxiety for an extended period of time. A very short, simple explanation of the surgery is appropriate for a younger child such as a toddler. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Table 4.3 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 10. When a child broke her favorite doll during a hospitalization, her primary nurse bought the child a new doll and gave it to her the next day. What is the best interpretation of the nurse's behavior? a. The nurse is displaying signs of overinvolvement. b. The nurse is a kind and generous person. c. The nurse feels a special closeness to the child. d. The nurse wants to make the child happy. ANS: A Buying gifts for individual children is a warning sign of overinvolvement. Nurses are kind and generous people, but buying gifts for individual children is unprofessional. Nurses may feel closer to some patients and families. This does not make giving gifts to children or families acceptable from a professional standpoint. Replacing lost items is not the nurse's responsibility. Becoming overly involved with a child can inhibit a healthy relationship. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Box 4.2 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 11. When meeting a toddler for the first time, the nurse initiates contact by a. calling the toddler by name and picking the toddler up. b. asking the toddler for his or her first name. c. kneeling in front of the toddler and speaking softly to the child. d. telling the toddler that you are his or her nurse today. ANS: C More positive interactions occur when the toddler perceives the meeting in a nonthreatening way. Placing yourself at the toddler's level and speaking softly can be less threatening for the child. Picking a toddler up at an initial meeting is a threatening action and will more likely result in a negative response from the child. Toddlers are unlikely to respond to direct questions at a first meeting. Telling the toddler you are the nurse is not likely to facilitate or encourage cooperation. The toddler perceives you as a stranger and will find the action threatening. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 48 OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 12. An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to a. ask why the child wants to know. b. determine why the child is so anxious. c. explain in simple terms how it works. d. tell the child he or she will see how it works as it is used. ANS: C School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. The nurse should respond positively for requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. The child is not exhibiting anxiety, just requesting clarification of what will be occurring. The nurse must explain how the blood pressure cuff works so that the child can then observe during the procedure. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Table 4.3 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 13. A positive, supportive communication technique that is effective from birth throughout adulthood is a. listening. b. physical proximity. c. environment. d. touch. ANS: D Touch can convey warmth, comfort, reassurance, security, caring, and support. In infancy, messages of security and comfort are conveyed when they are being held. Toddlers and preschoolers find it soothing and comforting to be held and rocked. School-aged children and adolescents appreciate receiving a hug or pat on the back (with permission). Listening is an essential component of the communication process. By practicing active listening skills, nurses can be effective listeners. Listening is a component of verbal communication. Individuals have different comfort zones for physical distance. The nurse should be aware of these differences and move cautiously when meeting new children and families. It is important to create a supportive and friendly environment for children including the use of child-sized furniture, posters, developmentally appropriate toys, and art displayed at a child's eye level. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 48 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance 14. A nurse is caring for a child who does not speak English. The parents are able to understand and speak only limited English. What action by the nurse is best? a. Allow the patient's 12-year-old sister to interpret. b. See if there is another family member who can interpret. c. Use a professionally trained interpreter for this family. d. Use the Internet to translate written information in the native language. ANS: C A professional interpreter is the best option in this situation. They are trained in medical interpreting and do not allow cultural influences into their work. A child should never be asked to interpret; the child may be too young to understand sophisticated concepts involved in the discussion and the information from the patient may be misconstrued and disturbing to the child. An adult family member may have to do temporarily in an emergency, but the best option is a professional interpreter. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 53 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE

3. An effective technique for communicating with toddlers is to a. have the toddler make up a story from a picture. b. involve the toddler in dramatic play with dress-up clothing. c. use picture books. d. ask the toddler to draw pictures of his fears.

C Activities and procedures should be described as they are about to be done. Use picture books and play for demonstration. Toddlers experience the world through their senses. Most toddlers do not have the vocabulary to make up stories. Dramatic play is associated with older children. Toddlers probably are not capable of drawing or verbally articulating their fears. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Table 4.3 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

7. Which child is most likely to be frightened by hospitalization? a. A 4-month-old infant admitted with a diagnosis of bronchiolitis b. A 2-year-old toddler admitted for cystic fibrosis c. A 9-year-old child hospitalized with a fractured femur d. A 15-year-old adolescent admitted for abdominal pain

B All children can be frightened by hospitalization. However, toddlers are most likely to be frightened by hospitalization because their thought processes are egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange environments. Young infants are not as likely to be as frightened as toddlers by hospitalization because they are not as aware of the environment. The 9-year-old child's cognitive ability is sufficient for the child to understand the reason for hospitalization. The 15-year-old adolescent has the cognitive ability to interpret the reason for hospitalization. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Table 5.2 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

2. Approximately how much would a newborn who weighed 7 pounds 6 ounces at birth weigh at 1 year of age? a. 14 3/4 lb b. 22 1/8 lb c. 29 1/2 lb d. Unable to estimate weigh at 1 year

B An infant triples birth weight by 1 year of age. The other calculations are incorrect. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 83 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

6. A nurse has been teaching a parent of a toddler about effective discipline. Which statement by the parent indicates that goals for teaching have been met? a. "I always include explanations and morals when I am disciplining my toddler." b. "I always try to be immediate and consistent when disciplining the children." c. "I believe that discipline should be done by only one family member." d. "My rule of thumb is no more than one spanking a day."

B Consistent and immediate discipline for toddlers is the most effective approach. Unless disciplined immediately, the toddler will have difficulty connecting the discipline with the behavior. The toddler's cognitive level of development precludes the use of explanations and morals as a part of discipline. Discipline for the toddler should be immediate; therefore the family member caring for the child should provide discipline to the toddler when it is necessary. Discipline is required for unacceptable behavior, and the one-spanking-a-day rule contradicts the concept of a consistent response to inappropriate behavior. In addition, spanking is an inappropriate method of disciplining a child. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 119 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

3. Which statement made by a mother is consistent with a developmental delay? a. "I notice my 9-month-old infant responds consistently to his name." b. "My 12-month-old child does not get herself to a sitting position or pull to stand." c. "I am so happy when my 1 1/2-month-old infant smiles at me." d. "My 5-month-old infant is not rolling over in both directions yet."

B Critical developmental milestones for gross motor development in a 12-month-old include standing briefly without support, getting to a sitting position, and pulling to stand. If a 12-month-old child does not perform these activities, it may be indicative of a developmental delay. An infant who responds to his name at 9 months of age is demonstrating abilities to both hear and interpret sound. A social smile is present by 2 months of age. Rolling over in both directions is not a critical milestone for gross motor development until the child reaches 6 months of age. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Table 6.1 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

8. A nurse uses Erikson's theory to guide nursing practice. What action by a hospitalized 4-year-old child would the nurse evaluate as developmentally appropriate? a. Dressed and fed by the parents b. Independently ask for play materials or other personal needs c. Verbalizes an understanding of the reason for the hospitalization d. Asks for a parent stay in the room at all times

B Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrates developmental appropriateness. Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. A 4-year-old child cannot be expected to cognitively understand the reason for hospitalization. Expecting the child to verbalize an understanding for hospitalization is an inappropriate outcome. Parents staying with the child throughout a hospitalization is not a developmental outcome. Although children benefit from parental involvement, parents may not have the support structure to stay in the room with the child at all times. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: Table 5.2 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

1. Which information should the nurse include when preparing a 5-year-old child for a cardiac catheterization? a. A detailed explanation of the procedure b. A description of what the child will feel and see during procedure c. An explanation about the dye that will go directly into his vein d. An assurance to the child that he and the nurse can talk about the procedure when it is over

B For a preschooler, the provision of sensory information about what to expect during the procedure will enhance the child's ability to cope with the events of the procedure and will decrease anxiety. Explaining the procedure in detail is probably more than the 5-year-old child can comprehend, and it will likely produce anxiety. Using the word "dye" with a preschooler can be frightening for the child. The child needs information before the procedure. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Table 4.3 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

7. What characteristic would most likely be found in a Mexican-American family? a. Stoicism b. Close extended family c. Considering docile children weak d. Very interested in health-promoting lifestyles

B Most Mexican-American families are very close, and it is not unusual for children to be surrounded by parents, siblings, grandparents, and godparents. It is important to respect this cultural characteristic and to see it as a strength, not a weakness. Although stoicism may be present in any family, Mexican-American families tend to be more expressive. Considering docile children weak is a characteristic of Native Americans. Although everyone tends now to embrace more health-promoting lifestyles, they are more prominent in Anglo-Americans. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 41 OBJ: Integrated Process: Culture and Spirituality MSC: Client Needs: Psychosocial Integrity

3. Which nursing intervention is an independent (nurse-driven) function of the nurse? a. Administering oral analgesics b. Teaching the woman perineal care c. Requesting diagnostic studies d. Providing wound care to a surgical incision

B Nurses are responsible for various independent functions, including teaching, counseling, and intervening in nonmedical problems. Interventions initiated by the physician and carried out by the nurse are called dependent functions. Administering oral analgesics is a dependent function; it is initiated by a physician or other provider and carried out by the nurse. Requesting diagnostic studies is a dependent function. Providing wound care is a dependent function; it is usually initiated by the physician or other provider through direct orders or protocol. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Box 2.3 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

4. Which family will most likely have the most difficulty coping with a seriously ill child? a. A single-parent mother who has the support of her parents and siblings b. Parents who have just moved to the area and have not yet found health care providers c. The family of a child who has had multiple hospitalizations related to asthma and has adequate relationships with the nursing staff d. A family in which there is a young child and four older married children who live in the area

B Parents in a new environment will have increased stress related to their lack of a support system. They have no previous experiences in the setting from which to draw confidence. Not only does this family not have friends or relatives to help them, they must find a provider when their child is seriously ill. Although only one parent is available, she has the support of her extended family, which will assist her in adjusting to the crisis. Because this family has had positive experiences in the past, family members can draw from those experiences and feel confident about the setting. This family has an extensive support system that will assist the parents in adjusting to the crisis. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 38 | Box 3.1 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

1. The parent of a 14-month-old child is concerned because the child's appetite has decreased. The best response for the nurse to make to the parent is, a. "It is important for your toddler to eat three meals a day and no snacks." b. "It is not unusual for toddlers to eat less due to slower growth." c. "Be sure to increase your child's milk consumption, which will improve nutrition." d. "Give your child a multivitamin daily to increase your toddler's nutrition."

B Physiologically, growth slows and appetite decreases during the toddler period. So the nurse should assure the parent that this is normal behavior. Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age-group. Milk consumption should not exceed 16 to 24 oz daily. Juice should be limited to 4 to 6 oz per day. Increasing the amount of milk will only further decrease solid food intake. Supplemental vitamins are important for all children, but they do not increase appetite. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 116 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

6. A nurse wants to assess a chronically ill child's feelings regarding a lengthy hospitalization and treatments. What action by the nurse is best? a. Ask direct questions of the child as to feelings. b. Watch the child play on several occasions. c. Discuss the situation with the parents. d. Refer the child to the child life specialist for assessment.

B Play for all children is an activity woven with meaning and purpose. For chronically ill children, play can indicate their state of wellness and response to treatment. It is a way to express joy, fear, anxiety, and disappointments. The nurse can best decipher the child's emotional state by observing this activity. Children often are threatened by direct questions, especially if the questioner is not well known to the child. The nurse may want to discuss the situation with the parents or enlist the help of the child life specialist, but these will not give the nurse the rich data that can be obtained through watching the child play. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 73 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

8. The step of the nursing process in which the nurse determines the appropriate interventions for the identified nursing diagnosis is called a. assessment. b. planning. c. intervention. d. evaluation.

B The third step in the nursing process involves planning care for problems that were identified during assessment. The first step of the nursing process is assessment, during which data are collected. The intervention phase is when the plan of care is carried out. The evaluation phase is determining whether the goals have been met. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: pp. 30-31 OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment

5. The nurse is assessing a toddler's growth and development. Which statement does the nurse understand about language development in a toddler? a. Language development skills slow during the toddler period. b. The toddler understands more than he or she can express. c. Most of the toddler's speech is not easily understood. d. The toddler's vocabulary contains approximately 600 words.

B The toddler's ability to understand language (receptive language) exceeds the child's ability to speak it (expressive language). Although language development varies in relationship to physical activity, language skills are rapidly accelerating by 15 to 24 months of age. By 2 years of age, 60% to 70% of the toddler's speech is understandable. The toddler's vocabulary contains approximately 300 or more words. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 112 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

8. What is the most appropriate response for the nurse to make to the parent of a 3-year-old child found in a bed with the side rails down? a. "You must never leave the child in the room alone with the side rails down." b. "I am very concerned about your child's safety when you leave the side rails down." c. "It is hospital policy that side rails need to be up if the child is in bed." d. "When parents leave side rails down, they might be considered as uncaring."

B To express concern and then choose words that convey a policy without appearing to cast blame on improper behavior is appropriate. Framing the communication in the negative does not facilitate effective communication. Stating a policy to parents conveys the attitude that the hospital has authority over parents in matters concerning their children and may be perceived negatively. It also does not give information as to why the side rails need to be up. This statement conveys blame and judgment to the parent. PTS: 1 DIF: Cognitive Level: Application/Applying REF: Table 4.2 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Psychosocial Integrity

2. An important consideration for the nurse who is communicating with a 5-year-old child is to a. speak loudly, clearly, and directly. b. use picture or story books, or puppets. c. disguise own feelings, attitudes, and anxiety. d. initiate contact with child when parent is not present.

B Using objects such as a puppet or doll allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This will facilitate communication with a child of this age. Speaking in this manner will tend to increase anxiety in very young children as they may interpret this as being yelled at. The nurse must be honest with the child. Attempts at deception will lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Table 4.3 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Psychosocial Integrity

9. A nurse is caring for a child who is a Christian Scientist. What intervention should the nurse include in the care plan for this child? a. Offer iced tea to the child who is experiencing deficient fluid volume. b. Offer to inform a Christian Science practitioner of the child's admission. c. Allow parents to sign a form opting out of routine immunizations. d. Ask parents whether the child has been baptized.

B When a Christian Science believer is hospitalized, a parent or patient may request that a Christian Science practitioner be notified as opposed to the hospital-assigned clergy. Coffee and tea are declined as a drink. Christian Science believers seek exemption from immunizations but obey legal requirements. Baptism is not a ceremony for the Christian Science religion. PTS: 1 DIF: Cognitive Level: Application/Applying REF: Table 3.1 OBJ: Integrated Process: Culture and Spirituality MSC: Client Needs: Psychosocial Integrity 10. To resolve family conflict, it is necessary to have open communication, accurate perception of the problem, and a(n) a. intact family structure. b. arbitrator. c. willingness to consider the view of others. d. balance in personality types. ANS: C Without constructive efforts to resolve the conflict, such as the willingness of the members of a group to consider the views of others, conflict resolution cannot take place. The structure of a family may affect family dynamics, but it is still possible to resolve conflict without an intact family structure if all of the ingredients of conflict resolution are present. Conflicts can be resolved without the assistance of an arbitrator. Most families have diverse personality types among their members. This diversity may make conflict resolution more difficult but should not impede it as long as the ingredients of conflict resolution are present. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 37 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 11. Which statement is true about the characteristics of a healthy family? a. The parents and children have rigid assignments for all the family tasks. b. Young families assume the total responsibility for the parenting tasks, refusing any assistance. c. The family is overwhelmed by the significant changes that occur as a result of childbirth. d. Adults agree on the majority of basic parenting principles. ANS: D Adults in a healthy family communicate with each other so that minimal discord occurs in parenting principles, such as discipline and sleep schedules. Healthy families remain flexible in their role assignments. Members of a healthy family accept assistance without feeling guilty. Healthy families can adapt to the significant changes that are common during the months after childbirth. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 37 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 12. A nurse observes that parents discuss rules with their children when the children do not agree with the rules. Which style of parenting is being displayed? a. Autocratic b. Authoritative c. Permissive d. Disciplinarian ANS: B A parent who discusses the rules with which children do not agree is using an authoritative parenting style. A parent who expects children to follow rules without questioning is using an authoritarian parenting style. A parent who does not consistently enforce rules and allows the child to decide whether he or she wishes to follow rules is using a permissive parenting style. A disciplinarian style would be similar to the authoritarian style. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 43 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 13. What should the nurse expect to be problematic for a family whose religious affiliation is Jehovah's Witness? a. Birth control b. Autopsy c. Plasma expanders d. Blood transfusion ANS: D Jehovah's Witnesses do not accept blood transfusions but may accept alternatives such as plasma expanders. Birth control and autopsy are also allowed. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Table 3.1 OBJ: Integrated Process: Culture and Spirituality MSC: Client Needs: Psychosocial Integrity 14. A traditional family structure in which married male and female partners and their children live as an independent unit is known as a(n) _____ family. a. extended b. binuclear c. nuclear d. blended ANS: C A nuclear family is one in which two opposite-sex parents and their children live together. This is also known as a traditional family. Extended or multigenerational families include other blood relatives in addition to the parents. Binuclear is not a listed family type according to U.S. Census Bureau data but would include two nuclear families living together. A blended family is reconstructed after divorce and involves the merger of two families. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 34 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 15. A pictorial tool that can assist the nurse in assessing aspects of family life related to health care is the a. genogram. b. ecomap. c. life cycle model. d. human development wheel. ANS: A A genogram (also known as a pedigree) is a diagram that depicts the relationships and health issues of family members over generations, usually three. An ecomap is a pictorial representation of the family structures and their relationships with the external environment. The life cycle model in no way illustrates a family genogram. This model focuses on stages that a person reaches throughout his or her life. The human development wheel describes various stages of growth and development rather than a family's relationships to each other. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 45 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 16. According to Friedman's classifications, providing such physical necessities as food, clothing, and shelter is the __________ family function. a. economic b. socialization c. reproductive d. health care ANS: D Physical necessities such as food, clothing, and shelter are considered part of health care. The economic function provides resources but is not concerned with health care and other basic necessities. The socialization function teaches the child cultural values. The reproductive function is concerned with ensuring family continuity. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 45 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 17. The nurse is in a unique position to assess children for symptoms of neglect. Which high-risk family situation places the child at the greatest risk for being neglected? a. Marital conflict and divorce b. Adolescent parenting c. Substance abuse d. A child with special needs ANS: C Parents who abuse drugs or alcohol may neglect their children because obtaining and using the substance(s) may have a stronger pull on the parents than the care of their children. Although divorce is traumatic to children, research has shown that living in a home filled with conflict is also detrimental. In this situation conflict may arise and young children may be unable to verbalize their distress; however, the child is not likely to be neglected. Teenage parenting often has a negative effect on the health and social outcomes of the entire family. Adolescent girls are at risk for a number of pregnancy complications, are unlikely to attain a high level of education, and are more likely to be poor. But this does not equate with a higher risk of neglect. When a child is born with a birth defect or has an illness that requires special care, the family is under additional stress. These families often suffer financial hardship as health insurance benefits quickly reach their maximum. But again, this does not lead to neglect as a frequent problem. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 37 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 18. A nurse is caring for the seriously ill child of a single parent. The parent reports being overwhelmed with the situation and not being able to make decisions. What action by the nurse is best? a. Refer the patient to the hospital's social work department. b. Call the chaplain service and ask for a chaplain visit. c. Ask the parent if any other family member can come and assist. d. Have the parent describe coping methods used for past crises. ANS: D Helping the patient to marshal internal and external resources is vital to promoting coping. The nurse should ask about previous coping methods used and help the parent adapt them to the current situation. Referring the parent to social work does not allow the nurse to be of assistance and the parent may not want to have a visit from a clergy member. Both of those options are dismissive. Other family members may or may not be able to come to assist, but this closed-ended question will not elicit much information. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 38 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 19. The nurse is caring for a patient from a different culture and is frustrated by what appears to be a lack of cooperation on the patient's part. A colleague states that the patient is "in America and should do what everyone else does." This is an example of what trait? a. Ethnocentrism b. Cultural congruency c. Rudeness d. Ignorance ANS: A Ethnocentrism is the belief that one's culture is superior to any others. The nurse stating that all patients should follow common American behaviors is demonstrating this behavior. This does not demonstrate cultural congruency. Although the colleague may be rude or ignorant, the more specific description of this behavior is ethnocentrism. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 38 OBJ: Integrated Process: Culture and Spirituality MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE

3. A preschool aged child is in the clinic for a well-child checkup. Which statement identifies an appropriate level of language development in this child? (Select all that apply.) a. Vocabulary of 300 words b. Relates elaborate tales c. Uses correct grammar in sentences d. Able to pronounce consonants clearly e. Expresses abstract thought

B, C The 4-year-old child is able to use correct grammar in sentence structure and can tell elaborate tales and stories. A vocabulary of 300 words is appropriate for a 2-year-old. The 4-year-old child typically has difficulty in pronouncing consonants. The use of language to express abstract thought is developmentally appropriate for the adolescent. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 62 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

1. When providing anticipatory guidance to parents regarding disciplining children, the nurse teaches that behavioral consequences fall into which categories? (Select all that apply.) a. Corporal b. Natural c. Logical d. Unrelated e. Behavioral

B, C, D Natural consequences are those that occur spontaneously. For example, a child leaves a toy outside and it is lost. Logical consequences are those that are directly related to the misbehavior. If two children are fighting over a toy, the toy is removed and neither child has it. Unrelated consequences are purposely imposed; for example, the child is late for dinner so he or she is not allowed to watch television. Corporal punishment is not part of this behavioral approach and usually takes the approach of spanking the child. Corporal punishment is highly controversial and is strongly discouraged by the American Academy of Pediatrics. Behavior modification is another disciplinary technique that rewards positive behavior and ignores negative behavior. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 45 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

4. A nurse is planning care for a hospitalized toddler in the preoperational thinking stage. Which characteristics should the nurse expect in this stage? (Select all that apply.) a. Concrete thinking b. Egocentrism c. Animism d. Magical thought e. Ability to reason

B, C, D The characteristics of preoperational thinking that occur for the toddler include egocentrism (views everything in relation to self), animism (believes that inert objects are alive), and magical thought (believes that thinking something causes that event). Concrete thinking is seen in school-age children, and ability to reason is seen with adolescents. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: pp. 124-125 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

5. The increase in the number of overweight children in this country is addressed in Healthy People 2020. Strategies designed to approach this issue include (Select all that apply.) a. decreased calcium and iron intake. b. increased fiber and whole grain intake. c. decreased use of sugar and sodium. d. increase fruit and vegetable intake. e. decrease the use of solid fats.

B, C, D, E Along with these recommendations, children at risk for being overweight should be screened beginning at age 2 years. Children with a family history of dyslipidemia or early cardiovascular disease development, children whose body mass index percentile exceeds the definition for overweight, and children who have high blood pressure should have a fasting lipid screen. The nurse should instruct parents that calcium and iron intake should be increased as part of this strategy. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 117 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

4. A nurse is teaching a parenting group about behavior modification. What information does this nurse include in teaching? (Select all that apply.) a. Food rewards are highly motivating and as such are encouraged. b. Negative behavior from the child should be ignored by parents. c. Undesirable behavior may initially get worse if it is ignored. d. 1 minute per age is the suggested time limit for discipline. e. For younger kids, a behavior chart is a good visual cue.

B, C, E In behavior modification parents ignore "bad" behavior by the child, which initially may get worse as the child tries to recapture the attention it once brought. Younger children respond positively to charts with stickers that show good behavior. Food rewards should not be used as food is an essential necessity plus extra food may contribute to obesity. The time limit refers to the time-out method of discipline. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 45 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance Chapter 04: Communicating with Children and Families McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE

1. In planning care for a preschool-age child, the nurse knows that which open body postures encourage positive communication? (Select all that apply.) a. Leaning away from the preschooler b. Frequent eye contact c. Hands on hips d. Conversing at eye level e. Asking the parents to stay in the room

B, D Frequent eye contact and conversing at eye level are both open body postures that encourage positive communication. Leaning away from the child and placing your hands on your hips are both closed body postures that do not facilitate effective communication. Asking the parents to stay in the room while the nurse is talking to the child is helpful but is not an open body posture. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Table 4.1 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Psychosocial Integrity

2. The nurse who uses critical thinking understands that the steps of critical thinking include (Select all that apply.) a. therapeutic communication. b. examining biases. c. setting priorities. d. managing data. e. evaluating other factors.

B, D, E The five steps of critical thinking include recognizing assumptions, examining biases, analyzing the need for closure, managing data, and evaluating other factors such as emotions and environmental factors. Therapeutic communication is a skill that nurses must have to carry out the many roles expected in the profession; however, it is not one of the steps of critical thinking. Setting priorities is part of the planning phase of the nursing process. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 27 OBJ: Nursing Process: Planning |Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

7. The parents of a newborn infant state, "We will probably not have our baby immunized because we are concerned about the risks." What is the nurse's best response? a. "It is your decision to immunize your child or not." b. "You should probably think about this decision." c. "It is far riskier to not immunize your baby." d. "This has to be reported to the health department."

C Although immunizations have been documented to have a negative effect in a small number of cases, an unimmunized infant is at greater risk for development of complications from childhood diseases than from the vaccines. Plus children who get ill from communicable diseases are a threat to those who are immunocompromised. Telling parents they should think about a decision does not give them any information to consider. Of course the parents have the final decision, but the nurse needs to educate them on the risks of that decision. The parents will not be reported to the health department. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 90 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

2. Family-centered maternity care developed in response to a. demands by physicians for family involvement in childbirth. b. the Sheppard-Towner Act of 1921. c. parental requests that infants be allowed to remain with them rather than in a nursery. d. changes in pharmacologic management of labor.

C As research began to identify the benefits of early extended parent-infant contact, parents began to insist that the infant remain with them. This gradually developed into the practice of rooming-in and finally to family-centered maternity care. Family-centered care was a request by parents, not physicians. The Sheppard-Towner Act of 1921 provided funds for state-managed programs for mothers and children. The changes in pharmacologic management of labor were not a factor in family-centered maternity care. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 2 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Psychosocial Integrity

6. At what age is an infant first expected to locate an object hidden from view? a. 4 months of age b. 6 months of age c. 9 months of age d. 20 months of age

C By 9 months of age, an infant will actively search for an object that is out of sight. Four-month-old infants are not cognitively capable of searching out objects hidden from their view. Infants at this developmental level do not pursue hidden objects. Six-month-old infants have not developed the ability to perceive objects as permanent and do not search out objects hidden from their view. Twenty-month-old infants actively pursue objects not in their view and are capable of recalling the location of an object not in their view. They first look for hidden objects around age 9 months. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 87 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

7. Which is the most appropriate question to ask when interviewing an adolescent to encourage conversation? a. "Are you in school?" b. "Are you doing well in school?" c. "How is school going for you?" d. "How do your parents feel about your grades?"

C Open-ended questions encourage communication. Questions with "yes" or "no" answers do not encourage conversation. Questions that can be interpreted as judgmental do not enhance communication. Asking adolescents about their parents' feelings may block communication. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Table 4.3 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Psychosocial Integrity

7. Which comments indicate that the mother of a toddler needs further teaching about dental care? a. "We use well water so I give my toddler fluoride supplements." b. "My toddler brushes his teeth with my help." c. "My child will not need a dental checkup until his permanent teeth come in." d. "I use a small nylon bristle brush for my toddler's teeth."

C Children should first see the dentist 6 months after the first primary tooth erupts and no later than age 30 months. Toddlers need fluoride supplements when they use a water supply that is not fluoridated. Toddlers need supervision with dental care. The parent should finish brushing areas not reached by the child. A small nylon bristle brush works best for cleaning toddlers' teeth. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 117 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

7. The maternity nurse should have a clear understanding of the correct use of a clinical pathway. One characteristic of clinical pathways is that they a. are developed and implemented by nurses. b. are used primarily in the pediatric setting. c. set specific time lines for sequencing interventions. d. are part of the nursing process.

C Clinical pathways are standardized, interdisciplinary plans of care devised for patients with a particular health problem. They are used to identify patient outcomes, specify time lines to achieve those outcomes, direct appropriate interventions and sequencing of interventions, include interventions from a variety of disciplines, promote collaboration, and involve a comprehensive approach to care. They are developed by multiple health care professionals and reflect interdisciplinary care. They can be used in multiple settings and for patients throughout the life span. They are not part of the nursing process but can be used in conjunction with the nursing process to provide care to patients. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 7 OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment

4. According to Piaget's theory, the period of cognitive development in which the child is able to distinguish between concepts related to fact and fantasy, such as human beings are incapable of flying like birds, is the __________ period of cognitive development. a. sensorimotor b. formal operations c. concrete operations d. preoperational

C Concrete operations is the period of cognitive development in which children's thinking is shifted from egocentric to being able to see another's point of view. They develop the ability to distinguish fact from fantasy. The sensorimotor stage occurs in infancy and is a period of reflexive behavior. During this period, the infant's world becomes more permanent and organized. The stage ends with the infant demonstrating some evidence of reasoning. Formal operations is a period in development in which new ideas are created through previous thoughts. Analytic reason and abstract thought emerge in this period. The preoperational stage is a period of egocentrism in which the child's judgments are illogical and dominated by magical thinking and animism. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 68 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

2. Frequent developmental assessments are important for which reason? a. Stable developmental periods during infancy provide an opportunity to identify any delays or deficits. b. Infants need stimulation specific to the stage of development. c. Critical periods of development occur during childhood. d. Child development is unpredictable and needs monitoring.

C Critical periods are blocks of time during which children are ready to master specific developmental tasks. The earlier those delays in development are discovered and intervention initiated, the less dramatic their effect will be. Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage. Normal growth and development is orderly and proceeds in a predictable pattern based on each individual's abilities and potentials. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 64 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. The nurse teaches the parents that which of the following is the primary purpose of a transitional object? a. It helps the parents with the guilt they feel when they leave the child. b. It keeps the child quiet at bedtime. c. It is effective in decreasing anxiety in the toddler. d. It decreases negativism and tantrums in the toddler.

C Decreasing anxiety, particularly separation anxiety, is the function of a transitional object; it provides comfort to the toddler in stressful situations and helps make the transition from dependence to autonomy. Decreased parental guilt (distress) is an indirect benefit of a transitional object. A transitional object may be part of a bedtime ritual, but it may not keep the child quiet at bedtime. A transitional object does not significantly affect negativity and tantrums, but it can comfort a child after tantrums. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 128 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

3. Families who deal effectively with stress exhibit which behavior pattern? a. Focus on family problems b. Feel weakened by stress c. Expect that some stress is normal d. Feel guilty when stress exists

C Healthy families recognize that some stress is normal in all families. Healthy families focus on family strengths rather than on the problems and know that stress is temporary and may be positive. If families are dealing effectively with stress, then weakening of the family unit should not occur. Because some stress is normal in all families, feeling guilty is not reasonable. Guilt only immobilizes the family and does not lead to resolution of the stress. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 38 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

3. Which setting for childbirth allows the least amount of parent-infant contact? a. Labor/delivery/recovery/postpartum room b. Birth center c. Traditional hospital birth d. Home birth

C In the traditional hospital setting, the mother may see the infant for only short feeding periods, and the infant is cared for in a separate nursery. The labor/delivery/recovery/postpartum room setting allows increased parent-infant contact. Birth centers are set up to allow an increase in parent-infant contact. Home births allow an increase in parent-infant contact. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 2 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

7. What is the primary role of practicing nurses in the research process? a. Designing research studies b. Collecting data for other researchers c. Identifying researchable problems d. Seeking funding to support research studies

C Nursing generates and answers its own questions based on evidence within its unique subject area. Nurses of all educational levels are in a position to find researchable questions based on problems seen in their practice area. Designing research studies is generally left to nurses with advanced degrees. Collecting data may be part of a nurse's daily activity, but not all nurses will have this opportunity. Seeking funding goes along with designing and implementing research studies. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 25 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Safe and Effective Care Environment

4. As a result of changes in health care delivery and funding, a current trend seen in the pediatric setting is a. increased hospitalization of children. b. decreased number of children living in poverty. c. an increase in ambulatory care. d. decreased use of managed care.

C One effect of managed care has been that pediatric health care delivery has shifted dramatically from the acute care setting to the ambulatory setting in order to provide more cost-efficient care. The number of hospital beds being used has decreased as more care is given in outpatient settings and in the home. The number of children living in poverty has increased over the past decade. One of the biggest changes in health care has been the growth of managed care. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 5 OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment

8. Which statement is the most accurate about moral development in the 9-year-old school-age child? a. Right and wrong are based on physical consequences of behavior. b. The child obeys parents because of fear of punishment. c. The school-age child conforms to rules to please others. d. Parents are the determiners of right and wrong for the school-age child.

C The 7- to 12-year-old child bases right and wrong on a good-boy or good-girl orientation in which the child conforms to rules to please others and avoid disapproval. Children 4 to 7 years of age base right and wrong on consequences. Consequences are the most important consideration for the child between 4 and 7 years of age. Parents determine right and wrong for the child younger than 4 years of age. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 135 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

2. When addressing the questions of a newly pregnant woman, the nurse can explain that the certified nurse-midwife is qualified to perform a. regional anesthesia. b. cesarean deliveries. c. vaginal deliveries. d. internal versions.

C The nurse-midwife is qualified to deliver infants vaginally in uncomplicated pregnancies. The other procedures must be performed by a physician or other medical provider. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 26 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Safe and Effective Care Environment

6. Which strategy is most likely to encourage a child to express feelings about the hospital experience? a. Avoiding periods of silence b. Asking yes/no questions c. Sharing personal experiences d. Using open-ended questions

D Open-ended questions encourage conversation. Periods of silence can serve to facilitate communication, but this is not the most effective means of getting the child to communicate. Yes/no questions are closed ended and do not encourage conversation. Talking about yourself shifts the focus of the conversation away from the child. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 50 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Psychosocial Integrity

5. To evaluate the woman's learning about performing infant care, the nurse should a. demonstrate infant care procedures. b. allow the woman to verbalize the procedure. c. observe the woman as she performs the procedure. d. routinely assess the infant for cleanliness.

C The woman's ability to perform the procedure correctly under the nurse's supervision is the best method of evaluation. Demonstration is an excellent teaching method but not an evaluation method. During verbalization of the procedure, the nurse may not pick up on techniques that are incorrect. It is not the best tool for evaluation. Observing the infant for cleanliness does not ensure the proper procedure is carried out. The nurse may miss seeing unsafe techniques being used. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 31 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

6. The parent of a child who has had numerous hospitalizations asks the nurse for advice because the child has been having behavior problems at home and in school. In discussing effective discipline, what is an essential component? a. All children display some degree of acting out, and this behavior is normal. b. The child is manipulative and should have firmer limits set on her behavior. c. Positive reinforcement and encouragement should be used to promote cooperation and the desired behaviors. d. Underlying reasons for rules should be given, and the child should be allowed to decide which rules should be followed.

C Using positive reinforcement and encouragement to promote cooperation and desired behaviors is one of the three essential components of effective discipline. Behavior problems should not be disregarded as normal. It would be incorrect to assume the child is being manipulative and should have firmer limits set on her behaviors. Providing the underlying reasons for rules and giving the child a choice concerning which rules to follow constitute a component of permissive parenting and are not considered an essential component of effective discipline. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 44 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Psychosocial Integrity

8. While reviewing the dietary-intake documentation of a 7-year-old Asian patient with a fractured femur, the nurse notes that the patient consistently refuses to eat the food on his tray. What assumption is most likely accurate? a. The child is a picky eater. b. The child needs less food because of bed rest. c. The child may have culturally related food preferences. d. The child is probably eating between meals and spoiling his appetite.

C When cultural differences are noted, food preferences should always be obtained. A child will often refuse to eat unfamiliar foods. Although the child may be a picky eater, the key point is that there are cultural differences that need to be considered. The foods he is being served may seem strange to a child. Nutrition plays an important role in healing. Although the energy the child expends has decreased while on bed rest, he or she has increased needs for good nutrition. Although the nurse should determine whether the child is eating food the family has brought from home, the more important point is to determine whether there are culturally related food preferences. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 38 OBJ: Integrated Process: Culture and Spirituality MSC: Client Needs: Psychosocial Integrity

3. A student nurse has been studying Healthy People 2020. What information about this initiative does the student understand? (Select all that apply.) a. It is a new agenda for health care and research priorities. b. None of the priorities in this document pertains to pregnant women or children. c. Objectives are aimed at keeping people healthy with a good quality of life. d. Ensuring that 77.9% of women receive prenatal care in the first trimester is one goal. e. Increasing to 100% the proportion of people with health insurance.

C, D, E The Healthy People 2020 initiative is an update of previous versions and is the nation's blueprint for health care and research priorities. Many of its objectives pertain to pregnant women and children. The objectives include improving health and quality of life, ensuring that 77.9% of pregnant women receive prenatal care in the first trimester, and increasing the number of people with health insurance to 100%. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 5 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance Chapter 02: The Nurse's Role in Maternity, Women's Health, and Pediatric Nursing McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition MULTIPLE CHOICE

6. In most states, adolescents who are not emancipated minors must have the permission of their parents before a. treatment for drug abuse. b. treatment for sexually transmitted diseases (STDs). c. accessing birth control. d. surgery.

D Minors are not considered capable of giving informed consent, so a surgical procedure would require consent of the parent or guardian. Exceptions exist for obtaining treatment for drug abuse or STDs or for getting birth control in most states. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 17 OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment

9. Which goal is most appropriate for demonstrating effective parenting? a. The parents will demonstrate correct bathing by discharge. b. The mother will make an appointment with the lactation specialist prior to discharge. c. The parents will place the baby in the proper position for sleeping and napping by 2300 on postpartum day 1. d. The parents will demonstrate effective parenting by discharge.

D Outcomes and goals are not the same. Goals are broad and not measurable and so must be linked to more measurable outcome criteria. Demonstrating effective parenting is one such goal. The other options are measurable outcome indicators that help determine if the goal has been met. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 31 OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment 10. Which nursing intervention is correctly written? a. Encourage turning, coughing, and deep breathing. b. Force fluids as necessary. c. Assist to ambulate for 10 minutes at 8 AM, 2 PM, and 6 PM. d. Observe interaction with infant. ANS: C This intervention is the most specific and details what should be done, for how long, and when. The other interventions are too vague. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 31 OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment 11. What part of the nursing process includes the collection of data on vital signs, allergies, sleep patterns, and feeding behaviors? a. Assessment b. Planning c. Intervention d. Evaluation ANS: A Assessment includes gathering baseline data. Planning is based on baseline data and physical assessment. Implementation is the initiation and completion of nursing interventions. Evaluation is the last step in the nursing process and involves determining whether the goals were met. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 29 OBJ: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment 12. The nurse who coordinates and manages a patient's care with other members of the health care team is functioning in which role? a. Teacher b. Collaborator c. Researcher d. Advocate ANS: B The nurse collaborates with other members of the health care team, often coordinating and managing the patient's care. Care is improved by this interdisciplinary approach as nurses work together with dietitians, social workers, physicians, and others. Education is an essential role of today's nurse. The nurse functions as a teacher during prenatal care, during maternity care, and when teaching parents of children regarding normal growth and development. Nurses contribute to their profession's knowledge base by systematically investigating theoretic for practice issues and nursing. A nursing advocate is one who speaks on behalf of another. As the health professional who is closest to the patient, the nurse is in an ideal position to humanize care and to intercede on the patient's behalf. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 25 OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment 13. Which statement about alternative and complementary therapies is true? a. Replace conventional Western modalities of treatment b. Are used by only a small number of American adults c. Allow for more patient autonomy but also may carry risks d. Focus primarily on the disease an individual is experiencing ANS: C Being able to choose alternative and complementary health products and practices does allow for patient autonomy, but the major concern is risk as patients may not disclose their use or substances may interact with other medications the patient is taking. Alternative and complementary therapies are part of an integrative approach to health care for most people, although some may choose only these types of therapies. An increasing number of American adults are seeking alternative and complementary health care options. Alternative healing modalities offer a holistic approach to health, focusing on the whole person and not just the disease. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 31 OBJ: Integrated Process: Culture and Spirituality MSC: Client Needs: Physiologic Integrity 14. Which step in the nursing process identifies the basis or cause of the patient's problem? a. Intervention b. Expected outcome c. Nursing diagnosis d. Evaluation ANS: C A nursing diagnosis states the problem and its cause ("related to"). Interventions are actions taken to meet the problem. Expected outcome is a statement of how the goal will be measured. Evaluation determines whether the goal has been met. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: pp. 30-31 OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment MULTIPLE RESPONSE

3. The nurse is planning to teach parents of a 15-month-old child. Which is the priority concern the nurse should address? a. Toilet training guidelines b. Guidelines for weaning children from bottles c. Instructions on preschool readiness d. Instructions on a home safety assessment

D Accidents are the major cause of death in children, including deaths caused by ingestion of poisonous materials. Home and environmental safety assessments are priorities in this age-group because of toddlers' increased motor skills and independence, which puts them at greater risk in an unsafe environment. Although it is appropriate to give parents of a 15-month-old child toilet training guidelines, the child is not usually ready for toilet training, so it is not the priority teaching intervention. Parents of a 15-month-old child should have been advised to begin weaning from the breast or bottle at 6 to 12 months of age. Educating a parent about preschool readiness is important and can occur later in the parents' educational process. The priority teaching intervention for the parents of a 15-month-old child is the importance of a safe environment. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 119 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

8. The mother of a 9-month-old infant is concerned because the infant cries when approached by an unknown shopper at the grocery store. What is the best response for the nurse to make to the mother? a. "You could consider leaving the infant with other people so he can adjust." b. "You might consider taking her to the doctor because she may be ill." c. "Have you noticed whether the baby is teething?" d. "This is a sign of stranger anxiety and demonstrates healthy attachment."

D An infant who manifests stranger anxiety is showing a normal sign of healthy attachment. This behavior peaks at 7 to 9 months and is developmentally appropriate. The mother leaving the child more often will not change this developmental response to new strangers. The child does not need to see a doctor, and teething is unrelated. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: Table 6.1 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

5. Which behavior is most likely to encourage open communication? a. Avoiding eye contact b. Folding arms across chest c. Standing with head bowed d. Soft stance with arms loose at the side

D An open body stance and positioning such as loose arms at the side invite communication and interaction. Avoiding eye contact, folding the arms across the chest, and standing with the head bowed, are closed body postures and do not facilitate communication. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Table 4.1 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Psychosocial Integrity

9. Which statement concerning physiologic factors is true? a. The infant has a slower metabolic rate than an adult. b. An infant has an inability to digest protein and lactase. c. Infants have a slower circulatory response than adults do. d. The infant's kidneys are less efficient in concentrating urine than an adult's kidneys.

D The infant's kidneys are not as effective at concentrating urine compared with an adult's because of immaturity of the renal system and slower glomerular filtration rates. This puts the infant at greater risk for fluid and electrolyte imbalance. Infants do not have slower metabolic rates, inabilities to digest protein and lactase, or a slower circulatory response compared to adults. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 86 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity 10. Which is a priority in counseling parents of a 6-month-old infant? a. Increasing food intake for secondary growth spurt b. Encouraging the infant to smile c. Securing a developmentally safe environment for the infant d. Teaching strategies to teach infants to sit up ANS: C Safety is a primary concern as an infant becomes increasingly mobile. The infant's appetite and growth velocity decrease in the second half of infancy. Although a social smile should be present by 6 months of age, encouraging this is not of higher priority than ensuring environmental safety. Unless the infant has a neuromuscular deficit, strategies for teaching a normally developing infant to sit up are not necessary. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 96 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 11. A mother of a 2-month-old infant tells the nurse, "My child doesn't sleep as much as his older brother did at the same age." What is the best response for the nurse? a. "Have you tried to feed the baby more often or play more before bedtime?" b. "Infant sleep patterns vary widely, some infants sleep only 2 to 3 hours at a time." c. "Keep a record of your baby's eating, waking, sleeping, and elimination patterns and to come back to discuss them." d. "This infant is difficult. It is important for you to identify what is bothering the baby." ANS: B Newborn infants may sleep as much as 17 to 20 hours per day. Sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time. Infants typically do not need more caloric intake to improve sleep behaviors. Stimulating activities before bedtime may keep the baby awake. There is no need for the mother to keep behavior records. Just because an infant may not sleep as much as a sibling did does not justify labeling the child as being difficult. Identifying an infant as difficult without identifying helpful actions is not a therapeutic response for a parent concerned about sleep. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 96 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 12. The mother of a 10-month-old infant tells the nurse that her infant "really likes cow's milk." What is the nurse's best response to this mother? a. "Milk is a nutritious choice at this time." b. "Children should not get cow's milk until 1 year of age." c. "Limit cow's milk to one bedtime bottle." d. "Mix cereal with cow's milk and feed it in a bottle." ANS: B It is best to wait until the infant is at least 1 year old before giving him cow's milk because of the risk of allergies and intestinal problems. Cow's milk protein intolerance is the most common food allergy during infancy. Although milk is a good source of calcium and protein for children after the first year of life, it is not the best source of nutrients for children younger than 1 year old. Bedtime bottles of formula or milk are contraindicated because of their high sugar content, which leads to dental decay in primary teeth. Food and milk or formula should not be mixed in a bottle. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 90 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity 13. The mother of a 10-month-old infant asks the nurse about weaning her child. What assessment by the nurse indicates the child is not ready to be weaned? a. Frequently throwing the bottle down b. Takes very little formula from bottle c. Constantly chewing on the bottle nipple d. Appears to be sucking consistently when given a bottle ANS: D Consistent sucking is a sign that the child is not ready to be weaned. Throwing the bottle down, taking more fluids from a cup than the bottle, and chewing on the nipple all indicate readiness for weaning. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 91 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 14. A nurse is modeling play time with a 6-month-old infant. Which activity is appropriate? a. Pat-a-cake, peek-a-boo b. Ball rolling, hide-and-seek game c. Bright rattles and tactile toys d. Push-and-pull toys ANS: A Six-month-old children enjoy playing pat-a-cake and peek-a-boo. Nine-month-old infants enjoy rolling a ball and playing hide-and-seek games. Four-month-old infants enjoy bright rattles and tactile toys. Twelve-month-old infants enjoy playing with push-and-pull toys. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 99 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 15. Parents tell the nurse their 5-month-old has started sitting up without support. What teaching does the nurse plan to provide the parents? a. Providing solid foods safely b. Encouraging cruising and walking c. Providing cow's milk d. Proper sock and shoe selection ANS: A Sitting up is a sign the child is ready to begin solid foods. The nurse should teach the parents how to provide them safely and how to introduce them. The other topics are not related to sitting up. PTS: 1 DIF: Cognitive Level: Application/Applying REF: Box 6.3 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 16. A nurse is teaching a parent group about dental hygiene for their babies. What information does the nurse provide? a. Babies don't need dental care until they are three. b. Start brushing teeth when all of them have come in. c. Children are ready for dental care when they can hold a toothbrush. d. Start with the first tooth using a cotton swab and water to wipe the teeth. ANS: D An infant's teeth need to be cleaned as soon as they erupt. Cleaning the teeth with cotton swabs or a face cloth is appropriate. Waiting until all the baby teeth are in is inappropriate and prolongs cleaning until 2 years of age. Being able to hold a toothbrush is not necessary as the parents should clean the teeth. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 93 | Table 6.1 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity 17. A nurse observes that a 3-month-old infant will hold a rattle if it is put in the hands, but the baby will not voluntarily grasp it. What action by the nurse is most appropriate? a. Provide anticipatory guidance. b. Document the findings in the chart. c. Refer the family to a neurologist. d. Perform a developmental screening. ANS: B This child is displaying normal age-appropriate behavior. The nurse should document the findings, but no other action is necessary. The nurse should always provide appropriate anticipatory guidance, but this answer is too vague to be the best response. PTS: 1 DIF: Cognitive Level: Application/Applying REF: Table 6.1 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 18. In terms of fine motor development, what should the 7-month-old infant be able to do? a. Transfer objects from one hand to the other. b. Use thumb and index finger in crude pincer grasp. c. Hold crayon and make a mark on paper. d. Release cubes into a cup. ANS: A By age 7 months, infants can transfer objects from one hand to the other, crossing the midline. The crude pincer grasp is apparent at approximately age 9 months. The child can scribble spontaneously at age 15 months. At age 12 months, the child can release cubes into a cup. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: Table 6.1 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 19. In terms of gross motor development, what would the nurse expect a 5-month-old infant to do? a. Roll from abdomen to back. b. Roll from back to abdomen. c. Sit erect without support. d. Move from prone to sitting position. ANS: A Rolling from abdomen to back is developmentally appropriate for a 5-month-old infant. The ability to roll from back to abdomen usually occurs at 6 months old. Sitting erect without support is a developmental milestone usually achieved by 8 months. The 10-month-old infant can usually move from a prone to a sitting position. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 93 | Table 6.1 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 20. According to Piaget, the 6-month-old infant is in what stage of the sensorimotor phase? a. Use of reflexes b. Primary circular reactions c. Secondary circular reactions d. Coordination of secondary schemata ANS: C Infants are usually in the secondary circular reaction stage from age 4 months to 8 months. This stage is characterized by a continuation of the primary circular reaction because of the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking. The use of reflexes is primarily during the first month of life. Primary circular reaction stage marks the replacement of reflexes with voluntary acts. The infant is in this stage from age 1 month to 4 months. The fourth sensorimotor stage is coordination of secondary schemata. This is a transitional stage in which increasing motor skills enable greater exploration of the environment. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 87 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 21. A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. What response by the nurse is best? a. "That's OK. formula is just as good for a 5-month-old." b. "Be sure to use an iron-fortified formula instead." c. "The baby will need immunizations earlier now." d. "Be sure to monitor how many diapers the baby wets." ANS: B For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should be used. There is no need to provide immunizations on a different schedule or specific reason for monitoring wet diapers. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 90 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 22. The parent of a 2-week-old infant asks the nurse whether the baby needs fluoride supplements, since mom is exclusively breastfeeding the baby. What response by the nurse is best? a. "Yes, the baby needs to begin taking them now." b. "Is your water fluoridated?" c. "She may need to begin taking them at age 6 months." d. "You can use infant cereal mixed with fluoridated water instead." ANS: C Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 6 months if the child is not drinking adequate amounts of fluoridated water. Asking if the water is fluoridated and advising to mix water and cereal are not the best responses since the child is only 2 months old. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 94 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 23. A nurse is making a home visit on a new mother with an infant. What action by the mother requires the nurse to intervene? a. Cooks while holding and cuddling infant to provide comfort b. Keeps hand on infant while reaching for supplies on changing table c. Shows the nurse the water heater setting that is on 110° F (43.3° C) d. Places baby to sleep in crib with no blankets, toys, or other objects ANS: A Burns are a leading cause of injury in children. The mother should not be holding the baby while cooking, so the nurse must intervene at this point. The other actions all provide safety. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 97 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment MULTIPLE RESPONSE

2. The nurse observes that when an 8-year-old enters the playroom, the child often causes disruption by taking toys from other children. The nurse's best approach for this behavior is to a. ban the child from the playroom until the child learns to control behavior. b. explain to the children in the playroom that this child is very ill and should be allowed to have the toys. c. approach the child in his or her room and ask, "Would you like it if the other children took your toys from you?" d. approach the child in his room and state, "I am concerned that you are taking the other children's toys. It upsets them and me."

D By the nurse's using "I" rather than the "you" message, the child can focus on the behavior. The child and the nurse can begin to explore why the behavior occurs. Banning the child from the playroom will not solve the problem. The problem is his behavior, not the place where he exhibits it. Illness is not a reason for a child to be undisciplined. When the child recovers, the parents will have to deal with a child who is undisciplined and unruly. Children should not be made to feel guilty and to have their self-esteem attacked. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 44 OBJ: Integrated Process: Communication and Documentation MSC: Client Needs: Health Promotion and Maintenance

7. A school nurse is conducting a class on safety for a group of school-age children. Which statement indicates that the children may need further teaching? a. "My sister and I know two different ways to get out of the house." b. "I can dial 911 if there is a fire or a burglar in the house." c. "If we have a fire, we have to meet at the neighbor's house." d. "If there is a fire I will go back for my cat Fluffy because she will be scared."

D Fire safety is important at any age, but for this age group children should know two different ways out of the house, how to call 911, and where the family will meet outside the house. Children should be taught never to return to a burning house, not even for a pet. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 140 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

6. The nurse is talking to a 7-year-old boy during a well-child clinic visit. The boy states "I am a Power Ranger, so don't make me angry!" What action by the nurse is best? a. Ask the child about other friends he might play with. b. Find out why the child thinks he is a Power Ranger. c. Ask the parents if he has any opposite sex friends. d. Conduct further developmental screening on the child.

D Magical thinking is developmentally appropriate for the preschooler not a 7-year-old. The nurse should assess this child's development further. Asking about other friends or special powers will not provide information related to development. A 7-year-old does not typically have opposite sex playmates. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 134 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

9. In providing anticipatory guidance to parents, which parental behavior does the nurse teach as most important in fostering moral development? a. Telling the child what is right and wrong b. Vigilantly monitoring the child and her peers c. Weekly family meetings to discuss behavior d. Living as the parents say they believe

D Parents living what they believe gives non-ambivalent messages and fosters the child's moral development and reasoning. Telling the child what is right and wrong is not effective unless the child has experienced what she hears. Parents need to live according to the values they are teaching to their children. Vigilant monitoring of the child and her peers is an inappropriate action for the parent to initiate. It does not foster moral development and reasoning in the child. Weekly family meetings to discuss behaviors may or may not be helpful in the development of moral reasoning. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 135 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 10. The nurse is providing anticipatory guidance for parents of a school-age child. Which behavior does the nurse suggest to best assist the child in negotiating the developmental task of industry? a. Identifying failures immediately and asking the child's peers for feedback b. Structuring the environment so that the child can master tasks c. Completing homework for children who are having difficulty with them d. Decreasing expectations to eliminate potential failures ANS: B The task of the caring teacher or parent is to identify areas in which a child is competent and to build on successful experiences to foster feelings of mastery and success. Structuring the environment to enhance self-confidence and to provide the opportunity to solve increasingly more complex problems will promote a sense of mastery. Asking peers for feedback reinforces the child's feelings of failure. When parents complete children's homework for them, it sends the message that they do not trust their child to do a good job. Providing assistance and suggestions and praising their best efforts are more appropriate. Decreasing expectations to eliminate failures will not promote a sense of achievement or mastery. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 141 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 11. A nurse is assessing an older school-age child recently admitted to the hospital. Which assessment does the nurse perform to determine if child is in an appropriate stage of cognitive development? a. Give the child a collection of similar objects, and ask him or her to organize them. b. Ask the child to perform a series of math problems using subtraction. c. Determine the child's vocabulary and reading comprehension. d. Find out what play activities the child enjoys engaging in. ANS: B The ability to classify things from simple to complex and the ability to identify differences and similarities are cognitive skills of the older school-age child; this demonstrates use of classification and logical thought processes. The emergency of this ability explains why children of this age enjoy collecting things. Subtraction and addition are appropriate cognitive activities for the young school-age child. Vocabulary is not as valid an assessment of cognitive ability as is the child's ability to classify. Play activity is not as valid an assessment of cognitive function as is the child's ability to classify. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 134 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 12. Which does the nurse teach as an appropriate disciplinary intervention for the school-age child? a. Time-out periods b. Consequences that are consistent with the behavior c. Physical punishment d. Lectures about inappropriate behavior ANS: B A consequence that is related to the inappropriate behavior is the recommended discipline. Responsibility can be developed in children through the use of natural and logical consequences related to actions. Time-out periods are more appropriate for younger children. Physical intervention is an inappropriate form of discipline. It does not connect the discipline with the child's inappropriate behavior. Lengthy discussions typically are not helpful. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 139 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 13. A parent of a chubby 8-year-old wants to know how to keep the child from gaining more weight. What response by the nurse is best? a. Do not allow your child to snack. b. Make a school lunch every day. c. Model the behaviors you'd like to see. d. Place your child on a restricted diet. ANS: C One good option for obesity prevention is to model the behaviors the parents want the child to emulate. The parents should set good examples with eating health and engaging in regular exercise. Snacks, if healthy, can be an important part of a nutritious day. Even if the parent makes a lunch for school each day, there is no guarantee the child will eat it. Children will likely rebel against a strict diet. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 144 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity 14. An 8-year-old girl tells the nurse that she has cancer because God is punishing her for "being bad." She shares her concern that if she dies, she will go to hell. What action by the nurse is most appropriate? a. Reassure the child that she is not being punished. b. Share concerns about development with the parents. c. Request a child-life specialist to intervene. d. Have the chaplain console the child. ANS: A Children at this age may view illness or injury as a punishment for a real or imagined transgression. The nurse should reassure the child that she is not being punished. Since this is a common belief at this age, there are no concerns to share with parents. A child-life specialist or chaplain visit may be appropriate, but the nurse needs to respond to this statement him- or herself. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 136 OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 15. A group of boys ages 9 and 10 years have formed a "boys-only" club that is open to neighborhood and school friends who have skateboards. This should be interpreted as a. behavior that encourages bullying and sexism. b. behavior that reinforces poor peer relationships. c. characteristic of social development of this age. d. characteristic of children who are at risk for membership in gangs. ANS: C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. A boys-only club does not have a direct correlation with later gang activity. PTS: 1 DIF: Cognitive Level: Application REF: p. 134 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 16. A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her schoolwork satisfactorily, but lately she has been somewhat aggressive and stubborn in the classroom. What action by the school nurse is most appropriate? a. Assess the child for unusual stress. b. Perform a detailed physical exam. c. Call the parents in for a conference. d. Screen the child for developmental delay. ANS: A Signs of stress include stomach pains or headache, sleep problems, bedwetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. The nurse should assess the child for stress. The other actions are not warranted although the nurse may want to have a conference with parents after screening the child. PTS: 1 DIF: Cognitive Level: Application/Applying REF: Box 8.2 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychological Integrity 17. The school nurse has been asked to begin teaching sex education in the 5th grade. The nurse should recognize that a. children in 5th grade are too young for sex education. b. children should be discouraged from asking too many questions. c. correct terminology should be reserved for children who are older. d. sex can be presented as a normal part of growth and development. ANS: D When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development. Fifth graders are usually 10 to 11 years old. This age is not too young to speak about physiologic changes in their bodies. The students should be encouraged to ask questions. Preadolescents need precise and concrete information. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 132 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 18. A nurse is interested in preventing injuries to children while they play. What action by the nurse would most likely lead to the biggest impact? a. Volunteering for an organization that gives away bicycle helmets. b. Providing education on the need for knee pads when skating. c. Teaching parents that children too big for child care seats should sit in the front seat. d. Encouraging children to play only on formal, constructed playgrounds. ANS: A Head injuries from bicycles are a large part of serious injury to children in this age group. They need to be taught to only ride a bike while wearing a helmet. The nurse's best option is to volunteer for an organization that gives away helmets. Knee pads when skating is also a good idea, but that won't have the impact of helmets. Once a child is too big for a child care seat and the seat belt fits appropriately, the child should sit in the back seat. Playing on constructed playgrounds only will not prevent injuries and is unrealistic. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 139 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 19. A parent reports getting annoyed with a 6-year-old child who seems to always get cranky and irritable when playing with friends. What suggestion by the nurse is best? a. Maybe he should not play with those friends anymore. b. The parents should monitor the children's play more closely. c. When the child gets cranky he should be told to rest. d. The parents should assess the child's diet for protein. ANS: C Children often do not recognize that they are becoming fatigued. Six-year-olds in particular are quite bad about this. Signs of fatigue include being cranky. The parent should have the child rest at this point. Forbidding the child's friends, monitoring play more closely, and assessing the diet for protein are not needed for this problem. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 133 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity 20. A school nurse reports to the parents that their child is complaining of frequent headaches. What suggestion does the nurse offer to the parents? a. A complete neurologic workup b. A vision screening exam c. Decreased amount of household stress d. Assessment for seasonal allergies ANS: B Children often manifest visual problems during the school-age period. These children may squint, move closer to the television or to the front of the class if possible, or complain of headaches. The parents should obtain a visual screening exam for their child. None of the other options is needed at this point. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 134 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 21. A school-age child got a hand-knitted sweater from a relative as a gift. The child refuses to wear it, and it is causing a great deal of conflict in the family as the relative wants to see the child in it. What information can the nurse provide the family about this issue? a. This is a time when strict discipline is needed and should be enforced. b. It's best to choose your battles carefully or you'll fight over everything. c. Teach the child a polite way of expressing dislike for the sweater. d. Children this age find it painful to be different from their peers. ANS: D Children at this age do find it very painful to be different in any way from their peers. The sweater may be very different from anything the peers are wearing, which makes the child reluctant to wear it. The nurse can provide this information to the family so they have information they can use in working out a solution to this problem. Strict discipline is not needed. Telling parents to choose their battles does not help them solve this situation. Children should be taught polite ways in which to express themselves, but this also does not help to solve the family conflict. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 136 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 22. A parent is worried that a child is not eating well. What does the nurse teach the parent to address this problem? a. Limit sports and team events that occur over the dinner hour. b. Pack a nutritious lunch to take to school every day. c. Teach about healthy snacks available at school. d. Ensure the child gets 2 cups of milk products a day. ANS: A Sports and team schedules often disrupt mealtime, especially dinner, and families often find themselves eating fast food on the way to practices and games. The family's best option is to limit activities that occur during this time. The child may not eat a packed lunch and may choose unhealthy foods from the schools' vending machines. Children in this age group need 3 cups of milk and dairy products per day. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 145 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE

6. What situation is most conducive to learning? a. A teacher who speaks very little Spanish is teaching a class of Latino students. b. A class is composed of students of various ages and educational backgrounds. c. An auditorium is being used as a classroom for 300 students. d. An Asian nurse provides nutritional information to a group of pregnant Asian women.

D Teaching is a vital function of the professional nurse. A patient's language and culture influence the learning process; thus a situation that is most conducive to learning is one in which the teacher has knowledge and understanding of the patient's language and cultural beliefs. The ability to understand the language in which teaching is done determines how much the patient learns. Patients for whom English is not their primary language may not understand idioms, nuances, slang terms, informal usage of words, or medical words. The teacher should be fluent in the language of the student. Developmental levels and educational levels influence how a person learns best. In order for the teacher to best present information, the class should be composed of the same levels. A large class is not conducive to learning. It does not allow for questions, and the teacher is not able to see the nonverbal cues from the students to ensure understanding. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 25 OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

1. Which statement made by a mother of a school-age boy indicates a need for further teaching? a. "My child is playing soccer on a team this year." b. "He is always active with his friends playing games." c. "I limit his television watching to about 2 hours a day." d. "I am glad his coach emphasizes winning and discipline in today's society."

D Team sports are important for the development of sportsmanship and teamwork and for exercise and refinement of motor skills. A coach who emphasizes winning and strict discipline is not appropriate for children in this age-group. Team sports such as soccer are appropriate for exercise and refinement of motor skills. Limiting television to 2 hours a day is an appropriate restriction. School-age children should be encouraged to participate in physical activities. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 133 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

1. Which factor significantly contributed to the shift from home births to hospital births in the early 20th century? a. Puerperal sepsis was identified as a risk factor in labor and delivery. b. Forceps were developed to facilitate difficult births. c. The importance of early parental-infant contact was identified. d. Technologic developments became available to physicians.

D Technologic developments were available to physicians, not lay midwives. So in-hospital births increased in order to take advantage of these advancements. Puerperal sepsis has been a known problem for generations. In the late 19th century, Semmelweis discovered how it could be prevented with improved hygienic practices. The development of forceps is an example of a technology advance made in the early 20th century but is not the only reason birthplaces moved. Unlike home births, early hospital births hindered bonding between parents and their infants. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Safe and Effective Care Environment

9. A 17-month-old child is expected to be in what stage according to Piaget? a. Trust b. Preoperations c. Secondary circular reaction d. Sensorimotor period

D The 17-month-old is in the fifth stage of the sensorimotor phase, tertiary circular reactions. Learning in this stage occurs mainly by trial and error. Trust is Erikson's first stage. Preoperation is the stage of cognitive development usually present in older toddlers and preschoolers. Secondary circular reactions last from approximately ages 4 to 8 months. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 109 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 10. 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 should be forced to sit on the toilet when first learning. ANS: B Voluntary control of the anal and urethral sphincters is achieved some time 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 himself 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. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 124 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 11. What should the nurse teach a parent who is concerned about preventing sleep problems in a 2-year-old child? a. Have the child always sleep in a quiet, darkened room. b. Provide high-carbohydrate snacks before bedtime. c. Have the child's daytime caretaker eliminate naps. d. Use a nightlight in the child's room. ANS: D The boundaries between reality and fantasy are not well defined for children of this age, so monsters and scary creatures that lurk in the preschooler's imagination become real to the child after the light is turned off. A nightlight may help ease the child's fears. A dark room may be scary to a preschooler. High-carbohydrate snacks increase energy and do not promote relaxation. Most 2-year-olds take one nap each day. Many give up the habit by age 3 years. Insufficient rest during the day can lead to irritability and difficulty sleeping at night. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 118 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 12. Which statement, made by a nursing student to the father of a 4-year-old child, warrants correction by the nurse? a. "Because the 'baby teeth' are not permanent, they are not important to the child." b. "Encourage your child to practice brushing his teeth after you have thoroughly cleaned them." c. "Your child's 'permanent teeth' will begin to come in around 6 years of age." d. "Fluoride supplements are needed if you do not have fluoridated water." ANS: A Deciduous teeth are important because they maintain spacing and play an important role in the growth and development of the jaws and face and in speech development. Toddlers and preschoolers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility. But encouraging the child to practice will aid in increasing his or her abilities. Secondary teeth erupt at approximately 6 years of age. If the family does not have fluoridated water, the child will need fluoride treatments. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 118 OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity 13. What do parents of preschool children need to understand about discipline? a. Both parents and the child should agree on the method of discipline. b. Discipline should involve some physical restriction. c. The method of discipline should be consistent with that of the child's peers. d. Discipline should include positive reinforcement of desired behaviors. ANS: D Effective discipline strategies should involve a comprehensive approach that includes consideration of the parent-child relationship, reinforcement of desired behaviors, and consequences for negative behaviors. Discipline does not need to be agreed on by the child. Preschoolers feel secure with limits and appropriate, consistent discipline. Both parents should be in agreement so that the discipline is consistently applied. Discipline does not necessarily need to include physical restriction. Discipline does not need to be consistent with that of the child's peers. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 119 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 14. In providing anticipatory guidance to parents whose child will soon be entering kindergarten, which is a critical factor to include in this teaching? a. The child needs to be able to sit still. b. The child should be able to count to 25. c. The parent should have interaction and be responsive to the child. d. The child should attend a preschool program first. ANS: C The earliest interactions between parent and infant lay the foundation for school readiness. Probably the most important factor in the development of academic competency is the relationship between parent and child. Sitting still and counting are important skills but are not as vital as parental involvement and responsiveness. Preschool is a helpful experience but not required to enter kindergarten. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 127 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 15. 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." The nurse's best action is to a. assess the older child for signs of child abuse. b. refer the family for psychological counseling. c. assist the family to deal with this response. d. encourage the family to give the toddler extra attention. ANS: C The arrival of a new infant represents a crisis for even the best prepared toddler. Toddlers have their entire schedule and routines disrupted because of the new family member. This is a normal response. The nurse should work with parents on ways to involve the toddler in the newborn's care and to help focus attention on the toddler. There is no need to assess for child abuse or to refer the family for counseling. Giving the toddler some extra attention and "special time" will probably help, but this is too narrow in scope to be the best answer. The nurse should help brainstorm several different strategies. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 125 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 16. A parent is very frustrated by the amount of time a toddle says "no" and asks the nurse about effective strategies to manage this negativism. The most appropriate recommendation is to a. punish the child for the behavior. b. provide more attention to the child. c. ask the child to not always say "no." d. reduce the opportunities for a "no" answer. ANS: D The nurse should suggest that the parent phrase questions or directives with restrictive 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 for this approach. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 113 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 17. A father tells the nurse that his toddler wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should suggest that the family do which of the following? a. Do not take the child to restaurants until this behavior has stopped. b. Take the child but do not give in to this demand. c. Explain to the child that restaurants have their own dishes. d. Suggest the family take the dishes and use them at the restaurant. ANS: D The child is exhibiting the ritualism that is characteristic at this age. Ritualism is the need to maintain the sameness and reliability. It provides a sense of 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. The family can take the dishes and serve the toddler's food and drink with them. Not taking the child out sometimes deprives him or her of a social experience. Not giving in sets the stage for temper tantrums. This child is too young to understand an explanation. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 113 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 18. Parents tell the nurse that their preschool-age child seems to have an imaginary friend named Bob. Whenever their child is scolded or disciplined, the child in turn scolds Bob. What response by the nurse is most appropriate? a. Ask the child to introduce Bob when the parents are not present. b. Inform the parents that this is normal behavior in this age group. c. Suggest the parents discuss the situation with the provider. d. Refer the child for hearing and vision screening. ANS: B In the early preschool years, boundaries between reality and fantasy blur. Children at the age may develop imaginary friends who can keep them company or take the blame when the child misbehaves. The nurse informs the parents that this is normal behavior. The child likely will not "introduce" Bob to a stranger. The nurse him- or herself needs to provide this anticipatory guidance and not just suggest the parents talk to the provider. There is no reason for sensory screening. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 115 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 19. The nursing student has planned teaching for a toddler parent group on poison prevention in the home. In reviewing the presentation with the nurse, what information requires the nurse to provide more instruction to the student? a. Lock all medications away securely. b. Place cleaning supplies in a top cabinet. c. Try not to let your child watch you take pills. d. Call Poison Control right away for an exposure. ANS: B Anything potentially poisonous including things like medication, cleaning supplies, or personal care items must be stored in places completely inaccessible to children. Toddlers view climbing as a challenge, so a top cabinet is not inaccessible. The other instructions are appropriate. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 109 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance 20. The nurse is presenting information on burn safety to a toddler and preschool parenting group at a local community center. To avoid the most common cause of fire death in children this age, what information does the nurse provide? a. Practice family fire drills often. b. Cover outlets with plastic covers. c. Turn the water heater temperature to 110° F (43.3° C). d. Keep children out of the kitchen when cooking. ANS: A Children younger than 5 years are at the greatest risk for burn deaths in a house fire. They often panic and hide in closets or under beds rather than escape safely. Parents need to practice fire drills with their children to teach them what to do in the event of a house fire. Covering outlets, turning the water heater down, and keeping children out of the kitchen when cooking are more appropriate for younger children. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 133 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE

4. What is the most important consideration for effectively communicating with a child? a. The child's chronologic age b. The parent-child interaction c. The child's receptiveness d. The child's developmental level

D The child's developmental level is the basis for selecting the terminology and structure of the message most likely to be understood by the child. The child's age may not correspond with the child's developmental level; therefore it is not the most important consideration for communicating with children. Parent-child interaction is useful in planning communication with children, but it is not the primary factor in establishing effective communication. The child's receptiveness is a consideration in evaluating the effectiveness of communication. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 54 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

2. A nurse is assessing an 8-year-old child. Which finding leads the nurse to conduct further assessment? a. Understands that his or her point of view is not the only one b. Enjoys telling riddles and silly jokes c. Demonstrates the principle of object conservation d. Engages in fantasy and magical thinking

D The preschool-age child engages in fantasy and magical thinking. The school-age child moves away from this type of thinking and becomes more skeptical and logical. Belief in Santa Claus or the Easter Bunny ends in this period of development. If the child demonstrated this type of thinking, the nurse would need to follow up with more developmental screening. School-age children enter the stage of concrete operations. They learn that their point of view is not the only one. The school-age child has a sense of humor. The child's increased language mastery and increased logic allow for appreciation of plays on words, jokes, and incongruities. The school-age child understands that properties of objects do not change when their order, form, or appearance does (object conservation). PTS: 1 DIF: Cognitive Level: Analysis/Analyzing REF: p. 134 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

5. The Women, Infants, and Children (WIC) program provides a. well-child examinations for infants and children living at the poverty level. b. immunizations for high-risk infants and children. c. screening for infants with developmental disorders. d. supplemental food supplies to low-income pregnant or breastfeeding women.

D WIC is a federal program that provides supplemental food supplies to low-income women who are pregnant or breastfeeding and to their children until age 5 years. Medicaid's Early and Periodic Screening, Diagnosis, and Treatment Program provides for well-child examinations and for treatment of any medical problems diagnosed during such checkups. Children in the WIC program are often referred for immunizations, but that is not the primary focus of the program. Public Law 99-457 is part of the Individuals with Disabilities Education Act that provides financial incentives to states to establish comprehensive early intervention services for infants and toddlers with, or at risk for, developmental disabilities. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 8 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

2. An immunocompromised child is in the clinic for immunizations. Which vaccine prescriptions should the nurse question? (Select all that apply.) a. DTaP b. HepA c. IPV d. Varicella e. MMR

D, E Children who are immunologically compromised should not receive live viral vaccines. Varicella is a live vaccine and should not be given except in special circumstances. MMR is a live vaccine and should not be given to immunologically compromised children. DTaP, HepA, and IPV can be given safely. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 77 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity